A Comparison of Efficacy of Segmental Epidural Block versus Spinal Anaesthesia for Percutaneous Nephrolithotomy.

PubMed

Nandanwar, Avinash S; Patil, Yogita; Wagaskar, Vinayak G; Baheti, Vidyasagar H; Tanwar, Harshwardhan V; Patwardhan, Sujata K

2015-08-01

Percutaneous nephrolithotomy (PCNL) is done under general anaesthesia in most of the centres. Associated complications and cost are higher for general anaesthesia than for regional anaesthesia. Present study is designed to compare the efficacy of epidural block versus spinal anaesthesia with regards to intraoperative mean arterial pressure, heart rate, postoperative pain intensity, analgesic requirement, Postoperative complications and patient satisfaction in patients undergoing PCNL. After taking Ethical Committee clearance, patients were randomly allocated into 2 groups using table of randomization (n= 40 each) Group E- Epidural block, Group S- Spinal block. Various parameters like intraoperative mean arterial pressure, heart rate, postoperative pain intensity, analgesic requirement, postoperative complications and patient satisfaction were studied in these groups. Quantitative data was analysed using unpaired t-test and qualitative data was analysed using chi-square test. Twenty four times in Epidural as compared to fifteen times in spinal anaesthesia two or more attempts required. Mean time (min) required to achieve the block of anaesthesia in group E and group S was 15.45±2.8 and 8.52±2.62 min respectively. Mean arterial pressure (MAP) at 5 min, 10 min and 15 min were significantly lower in spinal group as compared to epidural group. After 30 minutes, differences were not significant but still MAP was lower in spinal group. After 30 minutes difference in heart rate between two groups was statistically significant and higher rate recorded in spinal group till the end of 3 hours. Postoperative VAS score was significantly higher in spinal group and 4 hours onwards difference was highly significant. Postoperative Nausea Vomiting (PONV) Score was significantly higher in spinal group as compared to epidural group. For PCNL, segmental epidural block is better than spinal anaesthesia in terms of haemodynamic stability, postoperative analgesia, patient satisfaction and reduced incidence of PONV. Epidural anaesthesia is difficult to execute and takes longer time to act as compared to spinal block which limits its use.

Correlations of circulating peptide YY and ghrelin with body weight, rate of weight gain, and time required to achieve the recommended daily intake in preterm infants.

PubMed

Chen, XiaFang; Du, XueLiang; Zhu, JianXing; Xie, LiJuan; Zhang, YongJun; He, ZhenJuan

2012-07-01

The objective was to elucidate the relationships between serum concentrations of the gut hormone peptide YY (PYY) and ghrelin and growth development in infants for potential application to the clinical observation index. Serum concentrations of PYY and ghrelin were measured using radioimmunoassay from samples collected at the clinic. For each patient, gestational age, birth weight, time required to return to birth weight, rate of weight gain, time required to achieve recommended daily intake (RDI) standards, time required for full-gastric feeding, duration of hospitalization, and time of administration of total parenteral nutrition were recorded. Serum PYY and ghrelin concentrations were significantly higher in the preterm group (N = 20) than in the full-term group (N = 20; P < 0.01). Within the preterm infant group, the serum concentrations of PYY and ghrelin on postnatal day (PND) 7 (ghrelin = 1485.38 ± 409.24; PYY = 812.37 ± 153.77 ng/L) were significantly higher than on PND 1 (ghrelin = 956.85 ± 223.09; PYY = 545.27 ± 204.51 ng/L) or PND 3 (ghrelin = 1108.44 ± 351.36; PYY = 628.96 ± 235.63 ng/L; P < 0.01). Both serum PYY and ghrelin concentrations were negatively correlated with body weight, and the degree of correlation varied with age. Serum ghrelin concentration correlated negatively with birth weight and positively with the time required to achieve RDI (P < 0.05). In conclusion, serum PYY and ghrelin concentrations reflect a negative energy balance, predict postnatal growth, and enable compensation. Further studies are required to elucidate the precise concentration and roles of PYY and ghrelin in newborns and to determine the usefulness of measuring these hormones in clinical practice.

Correlations of circulating peptide YY and ghrelin with body weight, rate of weight gain, and time required to achieve the recommended daily intake in preterm infants

PubMed Central

Chen, XiaFang; Du, Xueliang; Zhu, JianXing; Xie, LiJuan; Zhang, YongJun; He, ZhenJuan

2012-01-01

The objective was to elucidate the relationships between serum concentrations of the gut hormone peptide YY (PYY) and ghrelin and growth development in infants for potential application to the clinical observation index. Serum concentrations of PYY and ghrelin were measured using radioimmunoassay from samples collected at the clinic. For each patient, gestational age, birth weight, time required to return to birth weight, rate of weight gain, time required to achieve recommended daily intake (RDI) standards, time required for full-gastric feeding, duration of hospitalization, and time of administration of total parenteral nutrition were recorded. Serum PYY and ghrelin concentrations were significantly higher in the preterm group (N = 20) than in the full-term group (N = 20; P < 0.01). Within the preterm infant group, the serum concentrations of PYY and ghrelin on postnatal day (PND) 7 (ghrelin = 1485.38 ± 409.24; PYY = 812.37 ± 153.77 ng/L) were significantly higher than on PND 1 (ghrelin = 956.85 ± 223.09; PYY = 545.27 ± 204.51 ng/L) or PND 3 (ghrelin = 1108.44 ± 351.36; PYY = 628.96 ± 235.63 ng/L; P < 0.01). Both serum PYY and ghrelin concentrations were negatively correlated with body weight, and the degree of correlation varied with age. Serum ghrelin concentration correlated negatively with birth weight and positively with the time required to achieve RDI (P < 0.05). In conclusion, serum PYY and ghrelin concentrations reflect a negative energy balance, predict postnatal growth, and enable compensation. Further studies are required to elucidate the precise concentration and roles of PYY and ghrelin in newborns and to determine the usefulness of measuring these hormones in clinical practice. PMID:22527125

Next Steps in Network Time Synchronization For Navy Shipboard Applications

DTIC Science & Technology

2008-12-01

40th Annual Precise Time and Time Interval (PTTI) Meeting NEXT STEPS IN NETWORK TIME SYNCHRONIZATION FOR NAVY SHIPBOARD APPLICATIONS...dynamic manner than in previous designs. This new paradigm creates significant network time synchronization challenges. The Navy has been...deploying the Network Time Protocol (NTP) in shipboard computing infrastructures to meet the current network time synchronization requirements

Does the use of automated fetal biometry improve clinical work flow efficiency?

PubMed

Espinoza, Jimmy; Good, Sara; Russell, Evie; Lee, Wesley

2013-05-01

This study was designed to compare the work flow efficiency of manual measurements of 5 fetal parameters with a novel technique that automatically measures these parameters from 2-dimensional sonograms. This prospective study included 200 singleton pregnancies between 15 and 40 weeks' gestation. Patients were randomly allocated to either manual (n = 100) or automatic (n = 100) fetal biometry. The automatic measurement was performed using a commercially available software application. A digital video recorder captured all on-screen activity associated with the sonographic examination. The examination time and number of steps required to obtain fetal measurements were compared between manual and automatic methods. The mean time required to obtain the biometric measurements was significantly shorter using the automated technique than the manual approach (P < .001 for all comparisons). Similarly, the mean number of steps required to perform these measurements was significantly fewer with automatic measurements compared to the manual technique (P < .001). In summary, automated biometry reduced the examination time required for standard fetal measurements. This approach may improve work flow efficiency in busy obstetric sonography practices.

Variable Structure PID Control to Prevent Integrator Windup

NASA Technical Reports Server (NTRS)

Hall, C. E.; Hodel, A. S.; Hung, J. Y.

1999-01-01

PID controllers are frequently used to control systems requiring zero steady-state error while maintaining requirements for settling time and robustness (gain/phase margins). PID controllers suffer significant loss of performance due to short-term integrator wind-up when used in systems with actuator saturation. We examine several existing and proposed methods for the prevention of integrator wind-up in both continuous and discrete time implementations.

Orbital transfer vehicle launch operations study. Volume 2: Detailed summary

NASA Technical Reports Server (NTRS)

1986-01-01

A series of Operational Design Drivers were identified. Several of these could have significant impact(s) on program costs. These recommendations, for example, include such items as: complete factory assembly and checkout prior to shipment to the ground launch site to make significant reductions in time required at the launch site as well as overall manpower required to do this work; minimize use of nonstandard equipment when orbiter provided equipment is available; and require commonality (or interchangeability) of subsystem equipment elements that are common to the space station, Orbit Maneuvering Vehicles, and/or Orbit Transfer Vehicles. Several additional items were identified that will require a significant amount of management attention (and direction) to resolve. Key elements of the space based processing plans are discussed.

Parallel processing architecture for computing inverse differential kinematic equations of the PUMA arm

NASA Technical Reports Server (NTRS)

Hsia, T. C.; Lu, G. Z.; Han, W. H.

1987-01-01

In advanced robot control problems, on-line computation of inverse Jacobian solution is frequently required. Parallel processing architecture is an effective way to reduce computation time. A parallel processing architecture is developed for the inverse Jacobian (inverse differential kinematic equation) of the PUMA arm. The proposed pipeline/parallel algorithm can be inplemented on an IC chip using systolic linear arrays. This implementation requires 27 processing cells and 25 time units. Computation time is thus significantly reduced.

Structures and materials technology issues for reusable launch vehicles

NASA Technical Reports Server (NTRS)

Dixon, S. C.; Tenney, D. R.; Rummler, D. R.; Wieting, A. R.; Bader, R. M.

1985-01-01

Projected space missions for both civil and defense needs require significant improvements in structures and materials technology for reusable launch vehicles: reductions in structural weight compared to the Space Shuttle Orbiter of up to 25% or more, a possible factor of 5 or more increase in mission life, increases in maximum use temperature of the external surface, reusable containment of cryogenic hydrogen and oxygen, significant reductions in operational costs, and possibly less lead time between technology readiness and initial operational capability. In addition, there is increasing interest in hypersonic airbreathing propulsion for launch and transmospheric vehicles, and such systems require regeneratively cooled structure. The technology issues are addressed, giving brief assessments of the state-of-the-art and proposed activities to meet the technology requirements in a timely manner.

The Postcard Initiative: Personal Communication From Students Can Increase Timely Compliance With Health Requirements.

PubMed

Maurer, Michelle; Warren, Kerry E; Pohl, Carla

2016-05-01

Immunizations and physical exams ensure the health and safety of school children. Failure to comply with state regulations can lead to exclusion from school activities. Students in fifth and eighth grades personalized postcards that contained health requirements for entry into sixth (junior high) and ninth (high school). The postcards were mailed three times over the school year. The junior high had a decline in first-day exclusions that did not reach significance. The high school decreased first-day exclusions from 6.4% to 1.6%. Both schools had significantly more physicals turned in before August 1 when compared with the previous year. Communicating health requirements by personalized postcards provides information in a manner that is better understood by parents/guardians. © 2016 The Author(s).

Evaluation of the advantageous anesthetic properties of dexmedetomidine used as hypotensive agent compared with nitroglycerin in orthognathic surgery.

PubMed

Rummasak, Duangdee; Apipan, Benjamas

2014-12-01

To evaluate the advantageous anesthetic properties, such as the decrease of intraoperative analgesic requirement, time to extubation and recovery, and early postoperative pain, of dexmedetomidine used as hypotensive agent compared with nitroglycerin in orthognathic surgery. The authors implemented a prospective, single-blinded, randomized clinical trial. The sample was composed of healthy patients who were admitted for bimaxillary osteotomies and were assigned to 1 of 2 groups by a computer-generated random number and blinded to the group. Dexmedetomidine or nitroglycerin was used as the hypotensive drug for each group. All patients underwent hypotensive anesthesia and surgery according to standard protocol. Intraoperative amount of fentanyl, time to eye opening, time to follow basic verbal commands, time to extubation, early postoperative pain scores, and analgesics were recorded. Compared means were analyzed using the unpaired Student t test. A 2-sided statistical test was used. A P value less than .05 was considered significant. The sample was composed of 40 participants. The intraoperative fentanyl requirement was significantly lower in the dexmedetomidine group than in the nitroglycerin group (168.75±56.29 and 222.50±96.12 μg, respectively; P=.037). Times to eye opening and following commands were considerably longer in the dexmedetomidine group, but the time to extubation showed no meaningful difference. Early postoperative pain after 30 and 60 minutes and the requirement for meperidine were not meaningfully different between the 2 groups. Dexmedetomidine, used as a hypotensive drug, has anesthetic benefits compared with nitroglycerin. Dexmedetomidine decreases the intraoperative fentanyl requirement and does not meaningfully change the time to extubation, early postoperative pain, and analgesic drug requirement. Copyright © 2014 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Experimental investigation of drying characteristics of cornelian cherry fruits ( Cornus mas L.)

NASA Astrophysics Data System (ADS)

Ozgen, Filiz

2015-03-01

Major target of present paper is to investigate the drying kinetics of cornelian cherry fruits ( Cornus mas L.) in a convective dryer, by varying the temperature and the velocity of drying air. Freshly harvested fruits are dried at drying air temperature of 35, 45 and 55 °C. The considered drying air velocities are V air = 1 and 1.5 m/s for each temperature. The required drying time is determined by taking into consideration the moisture ratio measurements. When the moisture ratio reaches up to 10 % at the selected drying air temperature, then the time is determined ( t = 40-67 h). The moisture ratio, fruit temperature and energy requirement are presented as the functions of drying time. The lowest drying time (40 h) is obtained when the air temperature is 55 °C and air velocity is 1.5 m/s. The highest drying time (67 h) is found under the conditions of 35 °C temperature and 1 m/s velocity. Both the drying air temperature and the air velocity significantly affect the required energy for drying system. The minimum amount of required energy is found as 51.12 kWh, at 55 °C and 1 m/s, whilst the maximum energy requirement is 106.7 kWh, at 35 °C and 1.5 m/s. It is also found that, air temperature significantly influences the total drying time. Moreover, the energy consumption is decreasing with increasing air temperature. The effects of three parameters (air temperature, air velocity and drying time) on drying characteristics have also been analysed by means of analysis of variance method to show the effecting levels. The experimental results have a good agreement with the predicted ones.

Web-based oil immersion whole slide imaging increases efficiency and clinical team satisfaction in hematopathology tumor board

PubMed Central

Chen, Zhongchuan Will; Kohan, Jessica; Perkins, Sherrie L.; Hussong, Jerry W.; Salama, Mohamed E.

2014-01-01

Background: Whole slide imaging (WSI) is widely used for education and research, but is increasingly being used to streamline clinical workflow. We present our experience with regard to satisfaction and time utilization using oil immersion WSI for presentation of blood/marrow aspirate smears, core biopsies, and tissue sections in hematology/oncology tumor board/treatment planning conferences (TPC). Methods: Lymph nodes and bone marrow core biopsies were scanned at ×20 magnification and blood/marrow smears at 83X under oil immersion and uploaded to an online library with areas of interest to be displayed annotated digitally via web browser. Pathologist time required to prepare slides for scanning was compared to that required to prepare for microscope projection (MP). Time required to present cases during TPC was also compared. A 10-point evaluation survey was used to assess clinician satisfaction with each presentation method. Results: There was no significant difference in hematopathologist preparation time between WSI and MP. However, presentation time was significantly less for WSI compared to MP as selection and annotation of slides was done prior to TPC with WSI, enabling more efficient use of TPC presentation time. Survey results showed a significant increase in satisfaction by clinical attendees with regard to image quality, efficiency of presentation of pertinent findings, aid in clinical decision-making, and overall satisfaction regarding pathology presentation. A majority of respondents also noted decreased motion sickness with WSI. Conclusions: Whole slide imaging, particularly with the ability to use oil scanning, provides higher quality images compared to MP and significantly increases clinician satisfaction. WSI streamlines preparation for TPC by permitting prior slide selection, resulting in greater efficiency during TPC presentation. PMID:25379347

Improved Short-Term Clock Prediction Method for Real-Time Positioning.

PubMed

Lv, Yifei; Dai, Zhiqiang; Zhao, Qile; Yang, Sheng; Zhou, Jinning; Liu, Jingnan

2017-06-06

The application of real-time precise point positioning (PPP) requires real-time precise orbit and clock products that should be predicted within a short time to compensate for the communication delay or data gap. Unlike orbit correction, clock correction is difficult to model and predict. The widely used linear model hardly fits long periodic trends with a small data set and exhibits significant accuracy degradation in real-time prediction when a large data set is used. This study proposes a new prediction model for maintaining short-term satellite clocks to meet the high-precision requirements of real-time clocks and provide clock extrapolation without interrupting the real-time data stream. Fast Fourier transform (FFT) is used to analyze the linear prediction residuals of real-time clocks. The periodic terms obtained through FFT are adopted in the sliding window prediction to achieve a significant improvement in short-term prediction accuracy. This study also analyzes and compares the accuracy of short-term forecasts (less than 3 h) by using different length observations. Experimental results obtained from International GNSS Service (IGS) final products and our own real-time clocks show that the 3-h prediction accuracy is better than 0.85 ns. The new model can replace IGS ultra-rapid products in the application of real-time PPP. It is also found that there is a positive correlation between the prediction accuracy and the short-term stability of on-board clocks. Compared with the accuracy of the traditional linear model, the accuracy of the static PPP using the new model of the 2-h prediction clock in N, E, and U directions is improved by about 50%. Furthermore, the static PPP accuracy of 2-h clock products is better than 0.1 m. When an interruption occurs in the real-time model, the accuracy of the kinematic PPP solution using 1-h clock prediction product is better than 0.2 m, without significant accuracy degradation. This model is of practical significance because it solves the problems of interruption and delay in data broadcast in real-time clock estimation and can meet the requirements of real-time PPP.

20 CFR 655.1114 - Element IV-What are the timely and significant steps an H-1C employer must take to recruit and...

Code of Federal Regulations, 2010 CFR

2010-04-01

... significant steps an H-1C employer must take to recruit and retain U.S. nurses? 655.1114 Section 655.1114... Workers as Registered Nurses? § 655.1114 Element IV—What are the timely and significant steps an H-1C employer must take to recruit and retain U.S. nurses? (a) The fourth attestation element requires that the...

I-15 reconstruction long-term embankment monitoring study : final report.

DOT National Transportation Integrated Search

2012-05-01

The I-15 Reconstruction Project in Salt Lake City, Utah required rapid embankment construction in an urban environment atop soft lacustrine soils. These soils are thick, highly compressible, have low shear strength and require significant time to com...

Rapid prototyping and AI programming environments applied to payload modeling

NASA Technical Reports Server (NTRS)

Carnahan, Richard S., Jr.; Mendler, Andrew P.

1987-01-01

This effort focused on using artificial intelligence (AI) programming environments and rapid prototyping to aid in both space flight manned and unmanned payload simulation and training. Significant problems addressed are the large amount of development time required to design and implement just one of these payload simulations and the relative inflexibility of the resulting model to accepting future modification. Results of this effort have suggested that both rapid prototyping and AI programming environments can significantly reduce development time and cost when applied to the domain of payload modeling for crew training. The techniques employed are applicable to a variety of domains where models or simulations are required.

A GIS TECHNIQUE FOR ESTIMATING NATURAL ATTENUATION RATES AND MASS BALANCES

EPA Science Inventory

ABSTRACT: Regulatory approval of monitored natural attenuation (MNA) as a component for site remediation often requires a demonstration that contaminant mass has decreased significantly over time. Successful approval of MNA also typically requires an estimate of past and future n...

Timing of intra-aortic balloon pump support and 1-year survival.

PubMed

Ramnarine, Ian R; Grayson, Antony D; Dihmis, Walid C; Mediratta, Neeraj K; Fabri, Brian M; Chalmers, John A C

2005-05-01

The relationship between the timing of intra-aortic balloon pump (IABP) support and surgical outcome remains a subject of debate. Peri-operative mechanical circulatory support is commenced either prophylactically or after increasing inotropic support has proved inadequate. This study evaluates the effect timing of IABP support on the 1-year survival of patients undergoing cardiac surgery. From April 1997 to September 2002, 7698 consecutive cardiac surgical procedures were performed. This included 5678 isolated coronary artery bypasses (CABGs), 1245 isolated valve procedures and 775 simultaneous CABG and valve procedures. IABP support was required in 237 patients (3.1%). Twenty-seven patients (0.35%) were classed as high-risk and received preoperative IABP support, 25 patients (0.32%) were haemodynamically compromised and required preoperative IABP support, 120 patients (1.56%) required intra-operative IABP support, and 65 patients (0.84%) required post-operative IABP support. Multiple variables were offered to a Cox proportional hazards model and significant predictors of 1-year survival were identified. These were used to risk adjust Kaplan-Meier survival curves. 1-year follow-up was complete and 450 deaths (5.8%) were recorded. The significant independent predictors of increased mortality at 1-year (P<0.05, HR=hazard ratio) were post-operative renal failure (HR=3.5), increasing EuroSCORE (HR=1.2), post-operative myocardial infarction (HR=3.7), post-operative IABP (HR=4.1) intra-operative IABP (HR=2.8), post-operative stroke (HR=2.5), increasing number of valves (HR=1.6), ejection fraction <30% (HR=1.3) and triple-vessel disease (HR=1.3). After risk-adjustment, 1-year survival for patients who required intra-operative IABP support was significantly greater than for those patients who required IABP support in the post-operative period. Patients who warrant IABP support in the post-operative setting have a significantly increased mortality at 1-year when compared to any other group. Therefore, earlier IABP support as part of surgical strategy may help to improve the outcome.

The Impact of Alerting Designs on Air Traffic Controller's Eye Movement Patterns and Situation Awareness.

PubMed

Kearney, Peter; Li, Wen-Chin; Yu, Chung-San; Braithwaite, Graham

2018-06-26

This research investigated controller' situation awareness by comparing COOPANS's acoustic alerts with newly designed semantic alerts. The results demonstrate that ATCOs' visual scan patterns had significant differences between acoustic and semantic designs. ATCOs established different eye movement patterns on fixations number, fixation duration and saccade velocity. Effective decision support systems require human-centred design with effective stimuli to direct ATCO's attention to critical events. It is necessary to provide ATCOs with specific alerting information to reflect the nature of of the critical situation in order to minimize the side-effects of startle and inattentional deafness. Consequently, the design of a semantic alert can significantly reduce ATCOs' response time, therefore providing valuable extra time in a time-limited situation to formulate and execute resolution strategies in critical air safety events. The findings of this research indicate that the context-specified design of semantic alerts could improve ATCO's situational awareness and significantly reduce response time in the event of Short Term Conflict Alert activation which alerts to two aircraft having less than the required lateral or vertical separation.

40 CFR 25.4 - Information, notification, and consultation responsibilities.

Code of Federal Regulations, 2013 CFR

2013-07-01

..., consistent with applicable statutory requirements, the social, economic, and environmental consequences of... complex technical materials that relate to significant decisions should be summarized for public and media... media in advance of times at which major decisions not covered by notice requirements for public...

40 CFR 25.4 - Information, notification, and consultation responsibilities.

Code of Federal Regulations, 2011 CFR

2011-07-01

..., consistent with applicable statutory requirements, the social, economic, and environmental consequences of... complex technical materials that relate to significant decisions should be summarized for public and media... media in advance of times at which major decisions not covered by notice requirements for public...

40 CFR 25.4 - Information, notification, and consultation responsibilities.

Code of Federal Regulations, 2012 CFR

2012-07-01

..., consistent with applicable statutory requirements, the social, economic, and environmental consequences of... complex technical materials that relate to significant decisions should be summarized for public and media... media in advance of times at which major decisions not covered by notice requirements for public...

40 CFR 25.4 - Information, notification, and consultation responsibilities.

Code of Federal Regulations, 2014 CFR

2014-07-01

..., consistent with applicable statutory requirements, the social, economic, and environmental consequences of... complex technical materials that relate to significant decisions should be summarized for public and media... media in advance of times at which major decisions not covered by notice requirements for public...

40 CFR 25.4 - Information, notification, and consultation responsibilities.

Code of Federal Regulations, 2010 CFR

2010-07-01

..., consistent with applicable statutory requirements, the social, economic, and environmental consequences of... complex technical materials that relate to significant decisions should be summarized for public and media... media in advance of times at which major decisions not covered by notice requirements for public...

Management patterns of medicare patients undergoing treatment for upper urinary tract calculi.

PubMed

Matlaga, Brian R; Meckley, Lisa M; Kim, Micheline; Byrne, Thomas W

2014-06-01

We conducted this study to identify differences in the re-treatment rates and ancillary procedures for the two most commonly utilized stone treatment procedures in the Medicare population: ureteroscopy (URS) and shock wave lithotripsy (SWL). A retrospective claims analysis of the Medicare standard analytical file 5% sample was conducted to identify patients with a new diagnosis of urolithiasis undergoing treatment with URS or SWL from 2009-2010. Outcomes evaluated: (1) repeat stone removal procedures within 120 days post index procedure, (2) stent placement procedures on the index date, 30 days prior to and 120 days post index date, and (3) use of general anesthesia. We identified 3885 eligible patients, of which 2165 (56%) underwent SWL and 1720 (44%) underwent URS. Overall, SWL patients were 1.73 times more likely to undergo at least one repeat procedure than URS patients, and twice as likely to require multiple re-treatments compared to URS. Among those with ureteral stones, SWL patients were 2.27 times more likely to undergo repeat procedures. The difference was not statistically significant in renal stone patients. Overall, SWL patients were 1.41 times more likely than URS patients to have a stent placed prior to index procedure, and 1.33 times more likely to have a stent placed subsequent to the index procedure. The majority of URS patients (77.8%) had a stent placed at the time of index procedure. There was no significant difference in anesthetic approaches between SWL and URS. Patients undergoing SWL are significantly more likely to require re-treatments than URS patients. SWL patients are also significantly more likely to require ureteral stent placement as a separate event. SWL and URS patients have similar rates of general anesthesia.

A Comparison of Efficacy of Segmental Epidural Block versus Spinal Anaesthesia for Percutaneous Nephrolithotomy

PubMed Central

Nandanwar, Avinash S; Patil, Yogita; Baheti, Vidyasagar H.; Tanwar, Harshwardhan V.; Patwardhan, Sujata K.

2015-01-01

Introduction Percutaneous nephrolithotomy (PCNL) is done under general anaesthesia in most of the centres. Associated complications and cost are higher for general anaesthesia than for regional anaesthesia. Present study is designed to compare the efficacy of epidural block versus spinal anaesthesia with regards to intraoperative mean arterial pressure, heart rate, postoperative pain intensity, analgesic requirement, Postoperative complications and patient satisfaction in patients undergoing PCNL. Materials and Methods After taking Ethical Committee clearance, patients were randomly allocated into 2 groups using table of randomization (n= 40 each) Group E- Epidural block, Group S- Spinal block. Various parameters like intraoperative mean arterial pressure, heart rate, postoperative pain intensity, analgesic requirement, postoperative complications and patient satisfaction were studied in these groups. Statistical Analysis Quantitative data was analysed using unpaired t-test and qualitative data was analysed using chi-square test. Results Twenty four times in Epidural as compared to fifteen times in spinal anaesthesia two or more attempts required. Mean time (min) required to achieve the block of anaesthesia in group E and group S was 15.45±2.8 and 8.52±2.62 min respectively. Mean arterial pressure (MAP) at 5 min, 10 min and 15 min were significantly lower in spinal group as compared to epidural group. After 30 minutes, differences were not significant but still MAP was lower in spinal group. After 30 minutes difference in heart rate between two groups was statistically significant and higher rate recorded in spinal group till the end of 3 hours. Postoperative VAS score was significantly higher in spinal group and 4 hours onwards difference was highly significant. Postoperative Nausea Vomiting (PONV) Score was significantly higher in spinal group as compared to epidural group. Conclusion For PCNL, segmental epidural block is better than spinal anaesthesia in terms of haemodynamic stability, postoperative analgesia, patient satisfaction and reduced incidence of PONV. Epidural anaesthesia is difficult to execute and takes longer time to act as compared to spinal block which limits its use. PMID:26436021

Crystal Growth Furnace (CGF)

NASA Technical Reports Server (NTRS)

Billingsley, Charles E.; Frederick, Larry

1993-01-01

The contract baseline, contract requirements review, contract modifications, contract problem areas and conclusions are addressed. Contract baseline was established 11 June 1987 and updated 1 December 1989. Significant changes were introduced into the 1989 baseline as compared to the original baseline. Contract modifications were made to add requirements as the program matured and as definition of requirements were completed. Problems were solved in real time through the contractor/customer team involvement and relationship to assure a timely and successful mission. The conclusion is that the CGF performed as designed and the experiments performed during the USML-1 Mission supports the conclusion.

30 CFR 250.803 - Additional production system requirements.

Code of Federal Regulations, 2014 CFR

2014-07-01

... pressure vessels at any time when there is a change in operating pressures that requires new settings for... significant change in operating pressures. The most recent pressure-recorder charts used to determine... subfreezing climates, the lessee shall furnish evidence to the District Manager that the firefighting system...

30 CFR 250.803 - Additional production system requirements.

Code of Federal Regulations, 2012 CFR

2012-07-01

... pressure vessels at any time when there is a change in operating pressures that requires new settings for... significant change in operating pressures. The most recent pressure-recorder charts used to determine... subfreezing climates, the lessee shall furnish evidence to the District Manager that the firefighting system...

30 CFR 250.803 - Additional production system requirements.

Code of Federal Regulations, 2013 CFR

2013-07-01

... pressure vessels at any time when there is a change in operating pressures that requires new settings for... significant change in operating pressures. The most recent pressure-recorder charts used to determine... subfreezing climates, the lessee shall furnish evidence to the District Manager that the firefighting system...

Efficacy of protaper next and protaper universal retreatment systems in removing gutta-percha in curved root canals during root canal retreatment.

PubMed

Ozyurek, Taha; Ozsezer-Demiryurek, Ebru

2017-01-01

The aim of this study was to compare the cleanliness of root canal walls after retreatment using ProTaper Next (PTN), ProTaper Universal Retreatment (PTR) nickel-titanium (NiTi) systems and Hedström hand files in curved mesial canals of mandibular molar teeth and the time required for gutta-percha and sealer removal. Ninety mandibular molar teeth with curved mesial roots were instrumented up to #35.04 with Mtwo NiTi rotary instruments and obturated using the continuous wave of condensation technique. Removal of gutta-percha and sealer was performed using one of the following: PTN and PTR NiTi systems and Hedström hand files. Samples were placed on the VistaScan phosphor plates in the mesio-distal direction and the radiographs were taken. The digital radiographs were analyzed using AutoCAD software. Also, the total time required for gutta-percha removal was calculated by a chronometer. The total retreatment time was significantly shorter in the PTN and PTR groups compared with the manual group (p<0.05). There was a significant difference between the groups according to the total residual gutta-percha and sealer (p<0.05). The PTN and PTR groups left significantly less gutta-percha and sealer remnant than the manual group (p<0.001). Within the limitations of this study, the PTN and PTR groups showed less residual gutta-percha and sealer than the manual group. The NiTi rotary systems were significantly faster than the manual group in the time required for gutta-percha and sealer removal.

The effect of kidney morcellation on operative time, incision complications, and postoperative analgesia after laparoscopic nephrectomy.

PubMed

Camargo, Affonso H; Rubenstein, Jonathan N; Ershoff, Brent D; Meng, Maxwell V; Kane, Christopher J; Stoller, Marshall L

2006-01-01

Compare the outcomes between kidney morcellation and two types of open specimen extraction incisions, several covariates need to be taken into consideration that have not yet been studied. We retrospectively reviewed 153 consecutive patients who underwent laparoscopic nephrectomy at our institution, 107 who underwent specimen morcellation and 46 with intact specimen removal, either those with connected port sites with a muscle-cutting incision and those with a remote, muscle-splitting incision. Operative time, postoperative analgesia requirements, and incisional complications were evaluated using univariate and multivariate analysis, comparing variables such as patient age, gender, body mass index (BMI), laterality, benign versus cancerous renal conditions, estimated blood loss, specimen weight, overall complications, and length of stay. There was no significant difference for operative time between the 2 treatment groups (p = 0.65). Incision related complications occurred in 2 patients (4.4%) from the intact specimen group but none in the morcellation group (p = 0.03). Overall narcotic requirement was lower in patients with morcellated (41 mg) compared to intact specimen retrieval (66 mg) on univariate (p = 0.03) and multivariate analysis (p = 0.049). Upon further stratification, however, there was no significant difference in mean narcotic requirement between the morcellation and muscle-splitting incision subgroup (p = 0.14). Morcellation does not extend operative time, and is associated with significantly less postoperative pain compared to intact specimen retrieval overall, although this is not statistically significant if a remote, muscle-splitting incision is made. Morcellation markedly reduces the risk of incisional-related complications.

Combining GPS and VLBI earth-rotation data for improved universal time

NASA Technical Reports Server (NTRS)

Freedman, A. P.

1991-01-01

The Deep Space Network (DSN) routinely measures Earth orientation in support of spacecraft tracking and navigation using very long-baseline interferometry (VLBI) with the deep-space tracking antennas. The variability of the most unpredictable Earth-orientation component, Universal Time 1 (UT1), is a major factor in determining the frequency with which the DSN measurements must be made. The installation of advanced Global Positioning System (GPS) receivers at the DSN sites and elsewhere may soon permit routine measurements of UT1 variation with significantly less dependence on the deep-space tracking antennas than is currently required. GPS and VLBI data from the DSN may be combined to generate a precise UT1 series, while simultaneously reducing the time and effort the DSN must spend on platform-parameter calibrations. This combination is not straightforward, however, and a strategy for the optimal combination of these data is presented and evaluated. It appears that, with the aid of GPS, the frequency of required VLBI measurements of Earth orientation could drop from twice weekly to once per month. More stringent real-time Earth orientation requirements possible in the future would demand significant improvements in both VLBI and GPS capabilities, however.

Comparative assessment of laparoscopic single-site surgery instruments to conventional laparoscopic in laboratory setting.

PubMed

Stolzenburg, Jens-Uwe; Kallidonis, Panagiotis; Oh, Min-A; Ghulam, Nabi; Do, Minh; Haefner, Tim; Dietel, Anja; Till, Holger; Sakellaropoulos, George; Liatsikos, Evangelos N

2010-02-01

Laparoendoscopic single-site surgery (LESS) represents the latest innovation in laparoscopic surgery. We compare in dry and animal laboratory the efficacy of recently introduced pre-bent instruments with conventional laparoscopic and flexible instruments in terms of time requirement, maneuverability, and ease of handling. Participants of varying laparoscopic experience were included in the study and divided in groups according to their experience. The participants performed predetermined tasks in dry laboratory using all sets of instruments. An experienced laparoscopic surgeon performed 24 nephrectomies in 12 pigs using all sets of instruments. Single port was used for all instrument sets except for the conventional instruments, which were inserted through three ports. The time required for the performance of dry laboratory tasks and the porcine nephrectomies was recorded. Errors in the performance of dry laboratory tasks of each instrument type were also recorded. Pre-bent instruments had a significant advantage over flexible instruments in terms of time requirement to accomplish tasks and procedures as well as maneuverability. Flexible instruments were more time consuming in comparison to the conventional laparoscopic instruments during the performance of the tasks. There were no significant differences in the time required for the accomplishment of dry laboratory tasks or steps of nephrectomy using conventional instruments through appropriate number of ports in comparison to pre-bent instruments through single port. Pre-bent instruments were less time consuming and with better maneuverability in comparison to flexible instruments in experimental single-port access surgery. Further clinical investigations would elucidate the efficacy of pre-bent instruments.

Effect of abdominopelvic abscess drain size on drainage time and probability of occlusion

PubMed Central

Rotman, Jessica A.; Getrajdman, George I.; Maybody, Majid; Erinjeri, Joseph P.; Yarmohammadi, Hooman; Sofocleous, Constantinos T.; Solomon, Stephen B.; Boas, F. Edward

2016-01-01

Background The purpose of this study is to determine whether larger abdominopelvic abscess drains reduce the time required for abscess resolution, or the probability of tube occlusion. Methods 144 consecutive patients who underwent abscess drainage at a single institution were reviewed retrospectively. Results: Larger initial drain size did not reduce drainage time, drain occlusion, or drain exchanges (p>0.05). Subgroup analysis did not find any type of collection that benefitted from larger drains. A multivariate model predicting drainage time showed that large collections (>200 ml) required 16 days longer drainage time than small collections (<50 ml). Collections with a fistula to bowel required 17 days longer drainage time than collections without a fistula. Initial drain size and the viscosity of the fluid in the collection had no significant effect on drainage time in the multivariate model. Conclusions 8 F drains are adequate for initial drainage of most serous and serosanguineous collections. 10 F drains are adequate for initial drainage of most purulent or bloody collections. PMID:27634422

Age and measurement time-of-day effects on speech recognition in noise.

PubMed

Veneman, Carrie E; Gordon-Salant, Sandra; Matthews, Lois J; Dubno, Judy R

2013-01-01

The purpose of this study was to determine the effect of measurement time of day on speech recognition in noise and the extent to which time-of-day effects differ with age. Older adults tend to have more difficulty understanding speech in noise than younger adults, even when hearing is normal. Two possible contributors to this age difference in speech recognition may be measurement time of day and inhibition. Most younger adults are "evening-type," showing peak circadian arousal in the evening, whereas most older adults are "morning-type," with circadian arousal peaking in the morning. Tasks that require inhibition of irrelevant information have been shown to be affected by measurement time of day, with maximum performance attained at one's peak time of day. The authors hypothesized that a change in inhibition will be associated with measurement time of day and therefore affect speech recognition in noise, with better performance in the morning for older adults and in the evening for younger adults. Fifteen younger evening-type adults (20-28 years) and 15 older morning-type adults with normal hearing (66-78 years) listened to the Hearing in Noise Test (HINT) and the Quick Speech in Noise (QuickSIN) test in the morning and evening (peak and off-peak times). Time of day preference was assessed using the Morningness-Eveningness Questionnaire. Sentences and noise were presented binaurally through insert earphones. During morning and evening sessions, participants solved word-association problems within the visual-distraction task (VDT), which was used as an estimate of inhibition. After each session, participants rated perceived mental demand of the tasks using a revised version of the NASA Task Load Index. Younger adults performed significantly better on the speech-in-noise tasks and rated themselves as requiring significantly less mental demand when tested at their peak (evening) than off-peak (morning) time of day. In contrast, time-of-day effects were not observed for the older adults on the speech recognition or rating tasks. Although older adults required significantly more advantageous signal-to-noise ratios than younger adults for equivalent speech-recognition performance, a significantly larger younger versus older age difference in speech recognition was observed in the evening than in the morning. Older adults performed significantly poorer than younger adults on the VDT, but performance was not affected by measurement time of day. VDT performance for misleading distracter items was significantly correlated with HINT and QuickSIN test performance at the peak measurement time of day. Although all participants had normal hearing, speech recognition in noise was significantly poorer for older than younger adults, with larger age-related differences in the evening (an off-peak time for older adults) than in the morning. The significant effect of measurement time of day suggests that this factor may impact the clinical assessment of speech recognition in noise for all individuals. It appears that inhibition, as estimated by a visual distraction task for misleading visual items, is a cognitive mechanism that is related to speech-recognition performance in noise, at least at a listener's peak time of day.

Extracellular space preservation aids the connectomic analysis of neural circuits.

PubMed

Pallotto, Marta; Watkins, Paul V; Fubara, Boma; Singer, Joshua H; Briggman, Kevin L

2015-12-09

Dense connectomic mapping of neuronal circuits is limited by the time and effort required to analyze 3D electron microscopy (EM) datasets. Algorithms designed to automate image segmentation suffer from substantial error rates and require significant manual error correction. Any improvement in segmentation error rates would therefore directly reduce the time required to analyze 3D EM data. We explored preserving extracellular space (ECS) during chemical tissue fixation to improve the ability to segment neurites and to identify synaptic contacts. ECS preserved tissue is easier to segment using machine learning algorithms, leading to significantly reduced error rates. In addition, we observed that electrical synapses are readily identified in ECS preserved tissue. Finally, we determined that antibodies penetrate deep into ECS preserved tissue with only minimal permeabilization, thereby enabling correlated light microscopy (LM) and EM studies. We conclude that preservation of ECS benefits multiple aspects of the connectomic analysis of neural circuits.

Achieving reutilization of scheduling software through abstraction and generalization

NASA Technical Reports Server (NTRS)

Wilkinson, George J.; Monteleone, Richard A.; Weinstein, Stuart M.; Mohler, Michael G.; Zoch, David R.; Tong, G. Michael

1995-01-01

Reutilization of software is a difficult goal to achieve particularly in complex environments that require advanced software systems. The Request-Oriented Scheduling Engine (ROSE) was developed to create a reusable scheduling system for the diverse scheduling needs of the National Aeronautics and Space Administration (NASA). ROSE is a data-driven scheduler that accepts inputs such as user activities, available resources, timing contraints, and user-defined events, and then produces a conflict-free schedule. To support reutilization, ROSE is designed to be flexible, extensible, and portable. With these design features, applying ROSE to a new scheduling application does not require changing the core scheduling engine, even if the new application requires significantly larger or smaller data sets, customized scheduling algorithms, or software portability. This paper includes a ROSE scheduling system description emphasizing its general-purpose features, reutilization techniques, and tasks for which ROSE reuse provided a low-risk solution with significant cost savings and reduced software development time.

Should prenatal hydronephrosis that resolves before birth be followed postnatally? Analysis and comparison to persistent prenatal hydronephrosis.

PubMed

Scarborough, Patrick L; Ferrara, Elizabeth; Storm, Douglas W

2015-09-01

Prenatal ultrasonography has greatly enhanced detection of congenital genitourinary abnormalities. However, although persistent prenatal hydronephrosis (PPH) is typically imaged and followed postnatally, it remains unclear if prenatal hydronephrosis that resolves in utero (RPH) should be similarly managed. We determined postnatal abnormalities associated with RPH and compared these to those associated with PPH. We performed a retrospective review of all consecutive patients evaluated for prenatal hydronephrosis over 24 months. Patients were followed prenatally with serial ultrasounds and postnatally with ultrasonography and a voiding cystourethrogram. Of the consecutive 165 patients enrolled in the study, 72 had RPH. The average prenatal anterior-posterior renal pelvis length was significantly longer in patients with PPH (5.5 mm) than in those with RPH (4.9 mm) (p = 0.01). Recurrent postnatal hydronephrosis occurred in 44% of patients with RPH, with eventual resolution in 34% of those affected. In comparison, 29% of PPH cases resolved postnatally. Mean time to resolution was statistically shorter for PPH (116 days) than for RPH (175 days) (p = 0.01). Seven PPH patients required surgery, while no RPH patients needed intervention (difference was statistically significant). A significant number of RPH children had postnatal hydronephrosis. Despite a slower resolution time, no children with RPH required intervention. Although RPH may recur postnatally, the significantly lower chance of intervention being required suggests that these children may not require postnatal imaging.

Usability of Optical Mark Reader Sheet as an Answering Tool in Testing.

PubMed

Booka, Masayuki; Oku, Hidehisa; Scheller, Andreas; Yamaoka, Shintaro

2017-01-01

The research result on usability of Optical Mark Reader Sheet (OMRS) being used as the standard answering tool is reported. The use of OMRS significantly requires more answer time than the answer time without OMRS, and the use of assistive devices for OMRS has the possibility to reduce the answer time.

Increased Learning Time under Stimulus-Funded School Improvement Grants: High Hopes, Varied Implementation

ERIC Educational Resources Information Center

McMurrer, Jennifer

2012-01-01

Research has long suggested that significantly increasing quality time in school for teaching and learning can have a positive impact on student achievement. Recognizing this connection, federal guidance requires low-performing schools to increase student learning time if they are implementing two popular reform models using school improvement…

42 CFR 102.21 - Smallpox (Vaccinia) Vaccine Injury Table.

Code of Federal Regulations, 2010 CFR

2010-10-01

...) vaccine in recipients (R); or (2) exposure to vaccinia in contacts (C). Please note that these time... contact requires sufficient evidence in the medical records of the occurrence of a significant local skin... recipient or contact requires sufficient evidence in the medical records of the occurrence of SJS. The SJS...

75 FR 20627 - Biweekly Notice: Applications and Amendments to Facility Operating Licenses Involving No...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-20

... designed, on an RAS. Basis for proposed no significant hazards consideration determination: As required by...], Time Response Design Criteria for Safety- Related Operator Actions, 1984 guidance. Although the change... changes to the RAS Allowable Values and RWT minimum required level on the RWT structural design...

30 CFR 250.803 - Additional production system requirements.

Code of Federal Regulations, 2010 CFR

2010-07-01

... ranges of pressure vessels at any time when there is a change in operating pressures that requires new... significant change in operating pressures. The most recent pressure-recorder charts used to determine... prominent place on the facility or structure. (v) For operations in subfreezing climates, the lessee shall...

Responding to and Supporting Students with Disabilities: Risk Management Considerations

ERIC Educational Resources Information Center

Lundquist, Anne; Shackelford, Allan

2011-01-01

Making the "right" risk management decisions involving students with significant psychological disabilities requires a clear and comprehensive understanding of the legal obligations and duties at issue. It also requires taking into consideration the best interests of these individual students. At the same time, decision makers must focus…

Influence of computer work under time pressure on cardiac activity.

PubMed

Shi, Ping; Hu, Sijung; Yu, Hongliu

2015-03-01

Computer users are often under stress when required to complete computer work within a required time. Work stress has repeatedly been associated with an increased risk for cardiovascular disease. The present study examined the effects of time pressure workload during computer tasks on cardiac activity in 20 healthy subjects. Heart rate, time domain and frequency domain indices of heart rate variability (HRV) and Poincaré plot parameters were compared among five computer tasks and two rest periods. Faster heart rate and decreased standard deviation of R-R interval were noted in response to computer tasks under time pressure. The Poincaré plot parameters showed significant differences between different levels of time pressure workload during computer tasks, and between computer tasks and the rest periods. In contrast, no significant differences were identified for the frequency domain indices of HRV. The results suggest that the quantitative Poincaré plot analysis used in this study was able to reveal the intrinsic nonlinear nature of the autonomically regulated cardiac rhythm. Specifically, heightened vagal tone occurred during the relaxation computer tasks without time pressure. In contrast, the stressful computer tasks with added time pressure stimulated cardiac sympathetic activity. Copyright © 2015 Elsevier Ltd. All rights reserved.

A STUDY ON TEMPORAL DISTRIBUTION OF FREIGHT TRANSPORTATION IN CONSIDERATION OF DAILY WORK-LIFE CYCLE

NASA Astrophysics Data System (ADS)

Kitaoka, Daiki; Hara, Hidetaka; Oeda, Yoshinao; Sumi, Tomonori

As advanced freight service is demanded, the time related requirements fo r freight transportation becomes more and more significant. This study, focusing on temporal distribution of freight transportation responding to the travel time, developed a shipment departure time decision model for each item, aiming at quantitatively grasping social requirement in the time domain. The model takes account of the daily work cycle of both work cy cles of shippers and carriers along with the travel time. The proposed model has a similar structure as that derived from the previous studies taking account of the daily living cycle of individuals. This model properly reproduced temporal distribution of shipment departure time that changes depending on the length of necessary lead time for each item.

Comparison between open and laparoscopic repair of perforated peptic ulcer disease.

PubMed

Bhogal, Ricky H; Athwal, Ruvinder; Durkin, Damien; Deakin, Mark; Cheruvu, Chandra N V

2008-11-01

The place of laparoscopic repair of perforated peptic ulcer followed by peritoneal toilet has been established, although it is not routinely practiced. This prospective study compared laparoscopic and open repair of perforated peptic ulcer disease. We evaluated whether the early results from laparoscopic repair resulted in improved patient outcome compared with conventional open repair. All patients who underwent repair of perforated peptic ulcer disease during a 12-month period in our unit were included in the study. The primary end points that were evaluated were total operative time, nasogastric tube utilisation, intravenous fluid requirement, total time of urinary catheter and abdominal drainage usage, time taken to return to normal diet, intravenous/intramuscular opiate use, time to full mobilization, and total in-patient hospital stay. Thirty-three patients underwent surgical repair of perforated peptic ulcer disease (19 laparoscopic repairs and 14 open repairs; mean age, 54.2 (range, 32-82) years). There was no increase in total operative time in patients who had undergone laparoscopic repair (mean: 61 minutes laparoscopic versus 57 minutes open). There was significantly less requirement for intravenous/intramuscular opiate analgesia in patients who had undergone laparoscopic repair (mean time to oral analgesia: 1.2 days laparoscopic versus 3.8 days open). In addition there was a significant decrease in the time that the nasogastric tube (mean: 2.1 days laparoscopic versus 3.1 days open), urinary catheter (mean: 2.3 days laparoscopic versus 3.7 days open) and abdominal drain (mean: 2.2 days laparoscopic versus 3.8 days open) were required during the postoperative period. Patients who had undergone laparoscopic repair required less intravenous fluids (mean: 1.4 days laparoscopic versus 3.1 days open) and returned to normal diet (mean: 2.3 days laparoscopic versus 4.8 days open) and full mobilization significantly earlier than those who had undergone open repair (mean: 2.3 days laparoscopic versus 3.3 days open). In addition, patients who had undergone laparoscopic repair required a shorter in-patient hospital stay (mean: 3.1 days laparoscopic versus 4.3 days open). Laparoscopic repair is a viable and safe surgical option for patients with perforated peptic ulcer disease and should be considered for all patients, providing that the necessary expertise is available.

[CMACPAR an modified parallel neuro-controller for control processes].

PubMed

Ramos, E; Surós, R

1999-01-01

CMACPAR is a Parallel Neurocontroller oriented to real time systems as for example Control Processes. Its characteristics are mainly a fast learning algorithm, a reduced number of calculations, great generalization capacity, local learning and intrinsic parallelism. This type of neurocontroller is used in real time applications required by refineries, hydroelectric centers, factories, etc. In this work we present the analysis and the parallel implementation of a modified scheme of the Cerebellar Model CMAC for the n-dimensional space projection using a mean granularity parallel neurocontroller. The proposed memory management allows for a significant memory reduction in training time and required memory size.

Efficacy of tranexamic acid in reducing allogeneic blood products in adolescent idiopathic scoliosis surgery.

PubMed

Sui, Wen-yuan; Ye, Fang; Yang, Jun-lin

2016-04-27

Adolescent idiopathic scoliosis (AIS) surgery usually require prolonged operative times with extensive soft tissue dissection and significant perioperative blood loss, and allogeneic blood products are frequently needed. Methods to reduce the requirement for transfusion would have a beneficial effect on these patients. Although many previous studies have revealed the efficacy of tranexamic acid (TXA) in spinal surgery, there is still a lack of agreement concerning the reduction of both blood loss and transfusion requirements of large dose tranexamic acid (TXA) in surgery for adolescent idiopathic scoliosis (AIS). The objective of this study was to elevate the efficacy and safety of a large dose tranexamic acid (TXA) in reducing transfusion requirements of allogeneic blood products in adolescent idiopathic scoliosis (AIS) surgery using a retrospective study designed with historical control group. One hundred thirty seven consecutive AIS patients who underwent surgery treatment with posterior spinal pedicle systems from August 2011 to March 2015 in our scoliosis center were retrospectively reviewed. Patients were divided into two groups, the TXA group and the historical recruited no TXA group (NTXA). Preoperative demographics, radiographic parameters, operative parameters, estimated blood loss (EBL), total irrigation fluid, number of patients requiring blood transfusion, mean drop of Hb (Pre-op Hb-Post-op Hb), haematocrit pre and post-surgery, mean volume of blood transfusion, hospitalization time, and adverse effect were recorded and compared. All the patients were successfully treated with satisfied clinical and radiographic outcomes. There were 71 patients in the TXA group and 66 patients in the NTXA group. The preoperative demographics were homogeneity between two groups (P > 0.05). There were no significant difference in average operative time between two groups (209 min vs 215 min, p >0.05). Number of patients in the TXA group showed a significant decrease in transfusion requirements with an associated reduced intraoperative blood loss of nearly 45% compared with those in NTXA group (8 vs 37, 619 ml vs 1125 ml, P < 0.05). There were no significant difference in total irrigation fluid between two groups (540 vs 550, p >0.05). Additional, patients in NTXA group showed significant decrease of Hb compared with patients in TXA group (5.2 g/dL vs 3.3 g/dL, P < 0.05), No significant difference were found in hospitalization time between two groups (6.3 vs 7.2 days, P > 0.05). No minor adverse effects associated with use of TXA were noted. Use of large dose tranexamic acid routinely seems to be effective and safe in reducing allogenic blood transfusion and blood loss in adolescent idiopathic scoliosis surgery.

Climate impacts of oil extraction increase significantly with oilfield age

NASA Astrophysics Data System (ADS)

Masnadi, Mohammad S.; Brandt, Adam R.

2017-08-01

Record-breaking temperatures have induced governments to implement targets for reducing future greenhouse gas (GHG) emissions. Use of oil products contributes ~35% of global GHG emissions, and the oil industry itself consumes 3-4% of global primary energy. Because oil resources are becoming increasingly heterogeneous, requiring different extraction and processing methods, GHG studies should evaluate oil sources using detailed project-specific data. Unfortunately, prior oil-sector GHG analysis has largely neglected the fact that the energy intensity of producing oil can change significantly over the life of a particular oil project. Here we use decades-long time-series data from twenty-five globally significant oil fields (>1 billion barrels ultimate recovery) to model GHG emissions from oil production as a function of time. We find that volumetric oil production declines with depletion, but this depletion is accompanied by significant growth--in some cases over tenfold--in per-MJ GHG emissions. Depletion requires increased energy expenditures in drilling, oil recovery, and oil processing. Using probabilistic simulation, we derive a relationship for estimating GHG increases over time, showing an expected doubling in average emissions over 25 years. These trends have implications for long-term emissions and climate modelling, as well as for climate policy.

Undergraduate Time Use and Academic Outcomes: Results from the University of California Undergraduate Experiences Survey 2006

ERIC Educational Resources Information Center

Brint, Steven; Cantwell, Allison M.

2010-01-01

Background/Context: Previous research has established the significance of academic study time on undergraduate students' academic performance. The effects of other uses of time are, however, in dispute. Some researchers have argued that students involved in activities that require initiative and effort also perform better in class, while students…

[Daily living activities and oral condition among care facility residents with severe intellectual disabilities. Comparative analyses between residents receiving tooth-brushing assistance and those not receiving tooth-brushing assistance].

PubMed

Chiwata, Kaoru; Takeda, Fumi

2007-06-01

To clarify 1) differences in daily living activities and oral condition among care facility residents with severe intellectual disabilities and 2) chronological changes in daily living activities and oral condition for residents receiving tooth-brushing assistance and those never receiving tooth-brushing assistance. Subjects were 44 residents at a care facility for individuals with severe intellectual disabilities, who underwent dental screening in July 1994 and October 2003. At each time point, daily living activities, behavior during oral health guidance, behavior during dental health screening and oral condition were compared between residents receiving tooth-brushing assistance (assistance group) and those not receiving tooth-brushing assistance (independent group). Furthermore, chronological changes were analyzed for residents requiring assistance at both screenings, those requiring assistance only at the second screening, and those not requiring assistance at either screening. 1) In the assistance group, 100% and 36.4% of residents were unable to brush their teeth independently in 1994 and 2003, respectively. Significant differences between the assistance and independent groups were observed in all items of behavior during dental health screening in 1994, but not in 2003. No significant intergroup differences in oral condition were observed in 1994, but differences were seen in 2003; when compared to the assistance group, the number of lost teeth was significantly higher in the independent group, while the number of remaining teeth was lower. 2) Regarding changes over the nine-year period, a significantly greater proportion of residents not requiring assistance at either screening and those requiring assistance only at the second screening finally required assistance in bathing. As for oral condition, no significant changes in healthy teeth were observed in residents requiring assistance at both screening time points, while significant increases in dental caries and filled teeth and a significant decrease in the number of healthy teeth were observed in residents requiring assistance only at the second screening and those not requiring assistance at either screening. Over the nine-year period, the subjects of tooth-brushing assistance changed, and assistance was given to those able to brush their teeth independently in addition to those unable to brush their teeth independently. The number of healthy teeth did not change in residents receiving tooth-brushing assistance during this period, but in residents never receiving tooth-brushing assistance, decrease was noted. Therefore, even for individuals able to brush their teeth independently, some form of tooth-brushing assistance is needed to sufficiently prevent oral diseases.

Correlates and perceived outcomes of four types of employee development activity.

PubMed

Birdi, K; Allan, C; Warr, P

1997-12-01

Participation in 4 different types of development activity was studied in a sample of manufacturing employees (N = 1,798). It was found that similar sets of variables were linked to greater participation in 3 activities: required training courses in work time, work-based development activity in work time, and career planning activity in work time or an individual's own time. Three kinds of reported benefits were studied, and the occurrence of these benefits was found to vary between different types of development activity. Overall job satisfaction and organizational commitment were significantly associated with prior participation in required training courses and work-based development activity. However, voluntary learning in one's own time was completely unrelated to these work attitudes.

Removal of Gross Air Embolization from Cardiopulmonary Bypass Circuits with Integrated Arterial Line Filters: A Comparison of Circuit Designs.

PubMed

Reagor, James A; Holt, David W

2016-03-01

Advances in technology, the desire to minimize blood product transfusions, and concerns relating to inflammatory mediators have lead many practitioners and manufacturers to minimize cardiopulmonary bypass (CBP) circuit designs. The oxygenator and arterial line filter (ALF) have been integrated into one device as a method of attaining a reduction in prime volume and surface area. The instructions for use of a currently available oxygenator with integrated ALF recommends incorporating a recirculation line distal to the oxygenator. However, according to an unscientific survey, 70% of respondents utilize CPB circuits incorporating integrated ALFs without a path of recirculation distal to the oxygenator outlet. Considering this circuit design, the ability to quickly remove a gross air bolus in the blood path distal to the oxygenator may be compromised. This in vitro study was designed to determine if the time required to remove a gross air bolus from a CPB circuit without a path of recirculation distal to the oxygenator will be significantly longer than that of a circuit with a path of recirculation distal to the oxygenator. A significant difference was found in the mean time required to remove a gross air bolus between the circuit designs (p = .0003). Additionally, There was found to be a statistically significant difference in the mean time required to remove a gross air bolus between Trial 1 and Trials 4 (p = .015) and 5 (p =.014) irrespective of the circuit design. Under the parameters of this study, a recirculation line distal to an oxygenator with an integrated ALF significantly decreases the time it takes to remove an air bolus from the CPB circuit and may be safer for clinical use than the same circuit without a recirculation line.

Comparing fixation used for calcaneal displacement osteotomies: a look at removal rates and cost.

PubMed

Lucas, Douglas E; Simpson, G Alex; Philbin, Terrence M

2015-02-01

The calcaneal displacement osteotomy is a procedure frequently used by foot and ankle surgeons for hindfoot angular deformity. Traditional techniques use compression screw fixation that can result in prominent hardware. While the results of the procedure are generally good, a common concern is the development of plantar heel pain related to prominent hardware. The primary purpose of this study is to retrospectively compare clinical outcomes of 2 fixation methods for the osteotomy. Secondarily a cost analysis will compare implant costs to hardware removal costs. Records were reviewed for patients who had undergone a calcaneal displacement osteotomy fixated with either lag screw or a locked lateral compression plate (LLCP). Neuropathy, previous ipsilateral calcaneus surgery, heel pad trauma, or incomplete radiographic follow-up were exclusionary. Thirty-two patients (19.4%) required hardware removal from the screw fixation group compared to 1 (1.6%) of the LLCP group, which is significant (P < .05). Time to radiographic healing was not significantly different (P = .87). The screw fixation group required more follow-up visits over a longer period of time (P < .05). Implant cost was remarkably different with screw fixation costing on average $247.12, compared to the LLCP costing $1175.59. Although the LLCP cost was significantly higher, cost savings were identified when the cost of removal and removal rates were included. This study demonstrates that this device provides adequate stabilization for healing in equivalent time to screw fixation. The LLCP required decreased rates of hardware removal with fewer postoperative visits over a shorter period of time. Significant savings were demonstrated in the LLCP group despite the higher implant cost. Therapeutic, Level III, Retrospective Comparative Study. © 2014 The Author(s).

The SmartOR: a distributed sensor network to improve operating room efficiency.

PubMed

Huang, Albert Y; Joerger, Guillaume; Fikfak, Vid; Salmon, Remi; Dunkin, Brian J; Bass, Barbara L; Garbey, Marc

2017-09-01

Despite the significant expense of OR time, best practice achieves only 70% efficiency. Compounding this problem is a lack of real-time data. Most current OR utilization programs require manual data entry. Automated systems require installation and maintenance of expensive tracking hardware throughout the institution. This study developed an inexpensive, automated OR utilization system and analyzed data from multiple operating rooms. OR activity was deconstructed into four room states. A sensor network was then developed to automatically capture these states using only three sensors, a local wireless network, and a data capture computer. Two systems were then installed into two ORs, recordings captured 24/7. The SmartOR recorded the following events: any room activity, patient entry/exit time, anesthesia time, laparoscopy time, room turnover time, and time of preoperative patient identification by the surgeon. From November 2014 to December 2015, data on 1003 cases were collected. The mean turnover time was 36 min, and 38% of cases met the institutional goal of ≤30 min. Data analysis also identified outlier cases (>1 SD from mean) in the domains of time from patient entry into the OR to intubation (11% of cases) and time from extubation to patient exiting the OR (11% of cases). Time from surgeon identification of patient to scheduled procedure start time was 11 min (institution bylaws require 20 min before scheduled start time), yet OR teams required 22 min on average to bring a patient into the room after surgeon identification. The SmartOR automatically and reliably captures data on OR room state and, in real time, identifies outlier cases that may be examined closer to improve efficiency. As no manual entry is required, the data are indisputable and allow OR teams to maintain a patient-centric focus.

Does the valve regulated release of urine from the bladder decrease encrustation and blockage of indwelling catheters by crystalline proteus mirabilis biofilms?

PubMed

Sabbuba, N A; Stickler, D J; Long, M J; Dong, Z; Short, T D; Feneley, R J C

2005-01-01

We tested whether valve regulated, intermittent flow of urine from catheterized bladders decreases catheter encrustation. Laboratory models of the catheterized bladder were infected with Proteus mirabilis. Urine was allowed to drain continuously through the catheters or regulated by valves to drain intermittently at predetermined intervals. The time that catheters required to become blocked was recorded and encrustation was visualized by scanning electron microscopy. When a manual valve was used to drain urine from the bladder at 2-hour intervals 4 times during the day, catheters required significantly longer to become blocked than those on continuous drainage (mean 62.6 vs 35.9 hours, p = 0.039). A similar 1.7-fold increase occurred when urine was drained at 4-hour intervals 3 times daily. Experiments with an automatic valve in which urine was released at 2 or 4-hour intervals through the day and night also showed a significant increase in mean time to blockage compared with continuous drainage (p = 0.001). Scanning electron microscopy confirmed that crystalline biofilm was less extensive on valve regulated catheters. Valve regulated, intermittent flow of urine through catheters increases the time that catheters require to become blocked with crystalline biofilm. The most beneficial effect was recorded when urine was released from the bladder at 4-hour intervals throughout the day and night by an automatic valve.

Environmental Compliance Issue Coordination

EPA Pesticide Factsheets

An order to establish the Department of Energy (DOE) requirements for coordination of significant environmental compliance issues to ensure timely development and consistent application of Departmental environmental policy and guidance

Effect of abdominopelvic abscess drain size on drainage time and probability of occlusion.

PubMed

Rotman, Jessica A; Getrajdman, George I; Maybody, Majid; Erinjeri, Joseph P; Yarmohammadi, Hooman; Sofocleous, Constantinos T; Solomon, Stephen B; Boas, F Edward

2017-04-01

The purpose of this study is to determine whether larger abdominopelvic abscess drains reduce the time required for abscess resolution or the probability of tube occlusion. 144 consecutive patients who underwent abscess drainage at a single institution were reviewed retrospectively. Larger initial drain size did not reduce drainage time, drain occlusion, or drain exchanges (P > .05). Subgroup analysis did not find any type of collection that benefitted from larger drains. A multivariate model predicting drainage time showed that large collections (>200 mL) required 16 days longer drainage time than small collections (<50 mL). Collections with a fistula to bowel required 17 days longer drainage time than collections without a fistula. Initial drain size and the viscosity of the fluid in the collection had no significant effect on drainage time in the multivariate model. 8 F drains are adequate for initial drainage of most serous and serosanguineous collections. 10 F drains are adequate for initial drainage of most purulent or bloody collections. Copyright © 2016 Elsevier Inc. All rights reserved.

Time management in radiation oncology: evaluation of time, attendance of medical staff, and resources during radiotherapy for prostate cancer: the DEGRO-QUIRO trial.

PubMed

Keilholz, L; Willner, J; Thiel, H-J; Zamboglou, N; Sack, H; Popp, W

2014-01-01

In order to evaluate resource requirements, the German Society of Radiation Oncology (DEGRO) recorded the times needed for core procedures in the radio-oncological treatment of various cancer types within the scope of its QUIRO trial. The present study investigated the personnel and infrastructural resources required in radiotherapy of prostate cancer. The investigation was carried out in the setting of definitive radiotherapy of prostate cancer patients between July and October 2008 at two radiotherapy centers, both with well-trained staff and modern technical facilities at their disposal. Personnel attendance times and room occupancy times required for core procedures (modules) were each measured prospectively by two independently trained observers using time measurements differentiated on the basis of professional group (physician, physicist, and technician), 3D conformal (3D-cRT), and intensity-modulated radiotherapy (IMRT). Total time requirements of 983 min for 3D-cRT and 1485 min for step-and-shoot IMRT were measured for the technician (in terms of professional group) in all modules recorded and over the entire course of radiotherapy for prostate cancer (72-76 Gy). Times needed for the medical specialist/physician were 255 min (3D-cRT) and 271 min (IMRT), times of the physicist were 181 min (3D-cRT) and 213 min (IMRT). The difference in time was significant, although variations in time spans occurred primarily as a result of various problems during patient treatment. This investigation has permitted, for the first time, a realistic estimation of average personnel and infrastructural requirements for core procedures in quality-assured definitive radiotherapy of prostate cancer. The increased time needed for IMRT applies to the step-and-shoot procedure with verification measurements for each irradiation planning.

Heroic Reliability Improvement in Manned Space Systems

NASA Technical Reports Server (NTRS)

Jones, Harry W.

2017-01-01

System reliability can be significantly improved by a strong continued effort to identify and remove all the causes of actual failures. Newly designed systems often have unexpected high failure rates which can be reduced by successive design improvements until the final operational system has an acceptable failure rate. There are many causes of failures and many ways to remove them. New systems may have poor specifications, design errors, or mistaken operations concepts. Correcting unexpected problems as they occur can produce large early gains in reliability. Improved technology in materials, components, and design approaches can increase reliability. The reliability growth is achieved by repeatedly operating the system until it fails, identifying the failure cause, and fixing the problem. The failure rate reduction that can be obtained depends on the number and the failure rates of the correctable failures. Under the strong assumption that the failure causes can be removed, the decline in overall failure rate can be predicted. If a failure occurs at the rate of lambda per unit time, the expected time before the failure occurs and can be corrected is 1/lambda, the Mean Time Before Failure (MTBF). Finding and fixing a less frequent failure with the rate of lambda/2 per unit time requires twice as long, time of 1/(2 lambda). Cutting the failure rate in half requires doubling the test and redesign time and finding and eliminating the failure causes.Reducing the failure rate significantly requires a heroic reliability improvement effort.

Effects of Above Real Time Training (ARTT) On Individual Skills and Contributions to Crew/Team Performance

NASA Technical Reports Server (NTRS)

Ali, Syed Firasat; Khan, M. Javed; Rossi, Marcia J.; Crane, Peter; Guckenberger, Dutch; Bageon, Kellye

2001-01-01

Above Real Time Training (ARTT) is the training acquired on a real time simulator when it is modified to present events at a faster pace than normal. The experiments on training of pilots performed by NASA engineers and others have indicated that real time training (RTT) reinforced with ARTT would offer an effective training strategy for such tasks which require significant effort at time and workload management. A study was conducted to find how ARTT and RTT complement each other for training of novice pilot-navigator teams to fly on a required route. In the experiment, each of the participating pilot-navigator teams was required to conduct simulator flights on a prescribed two-legged ground track while maintaining required air speed and altitude. At any instant in a flight, the distance between the actual spatial point location of the airplane and the required spatial point was used as a measure of deviation from the required route. A smaller deviation represented better performance. Over a segment of flight or over complete flight, an average value of the deviation represented consolidated performance. The deviations were computed from the information on latitude, longitude, and altitude. In the combined ARTT and RTT program, ARTT at intermediate training intervals was beneficial in improving the real time performance of the trainees. It was observed that the team interaction between pilot and navigator resulted in maintaining high motivation and active participation throughout the training program.

Development of a semi-automated model identification and calibration tool for conceptual modelling of sewer systems.

PubMed

Wolfs, Vincent; Villazon, Mauricio Florencio; Willems, Patrick

2013-01-01

Applications such as real-time control, uncertainty analysis and optimization require an extensive number of model iterations. Full hydrodynamic sewer models are not sufficient for these applications due to the excessive computation time. Simplifications are consequently required. A lumped conceptual modelling approach results in a much faster calculation. The process of identifying and calibrating the conceptual model structure could, however, be time-consuming. Moreover, many conceptual models lack accuracy, or do not account for backwater effects. To overcome these problems, a modelling methodology was developed which is suited for semi-automatic calibration. The methodology is tested for the sewer system of the city of Geel in the Grote Nete river basin in Belgium, using both synthetic design storm events and long time series of rainfall input. A MATLAB/Simulink(®) tool was developed to guide the modeller through the step-wise model construction, reducing significantly the time required for the conceptual modelling process.

Frequency of Testing to Detect Visual Field Progression Derived Using a Longitudinal Cohort of Glaucoma Patients.

PubMed

Wu, Zhichao; Saunders, Luke J; Daga, Fábio B; Diniz-Filho, Alberto; Medeiros, Felipe A

2017-06-01

To determine the time required to detect statistically significant progression for different rates of visual field loss using standard automated perimetry (SAP) when considering different frequencies of testing using a follow-up scheme that resembles clinical practice. Observational cohort study. One thousand seventy-two eyes of 665 patients with glaucoma followed up over an average of 4.3±0.9 years. Participants with 5 or more visual field tests over a 2- to 5-year period were included to derive the longitudinal measurement variability of SAP mean deviation (MD) using linear regressions. Estimates of variability then were used to reconstruct real-world visual field data by computer simulation to evaluate the time required to detect progression for various rates of visual field loss and different frequencies of testing. The evaluation was performed using a follow-up scheme that resembled clinical practice by requiring a set of 2 baseline tests and a confirmatory test to identify progression. Time (in years) required to detect progression. The time required to detect a statistically significant negative MD slope decreased as the frequency of testing increased, albeit not proportionally. For example, 80% of eyes with an MD loss of -2 dB/year would be detected after 3.3, 2.4, and 2.1 years when testing is performed once, twice, and thrice per year, respectively. For eyes with an MD loss of -0.5 dB/year, progression can be detected with 80% power after 7.3, 5.7, and 5.0 years, respectively. This study provides information on the time required to detect progression using MD trend analysis in glaucoma eyes when different testing frequencies are used. The smaller gains in the time to detect progression when testing is increased from twice to thrice per year suggests that obtaining 2 reliable tests at baseline followed by semiannual testing and confirmation of progression through repeat testing in the initial years of follow-up may provide a good compromise for detecting progression, while minimizing the burden on health care resources in clinical practice. Copyright © 2017 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

Accurate Radiometry from Space: An Essential Tool for Climate Studies

NASA Technical Reports Server (NTRS)

Fox, Nigel; Kaiser-Weiss, Andrea; Schmutz, Werner; Thome, Kurtis; Young, Dave; Wielicki, Bruce; Winkler, Rainer; Woolliams, Emma

2011-01-01

The Earth s climate is undoubtedly changing; however, the time scale, consequences and causal attribution remain the subject of significant debate and uncertainty. Detection of subtle indicators from a background of natural variability requires measurements over a time base of decades. This places severe demands on the instrumentation used, requiring measurements of sufficient accuracy and sensitivity that can allow reliable judgements to be made decades apart. The International System of Units (SI) and the network of National Metrology Institutes were developed to address such requirements. However, ensuring and maintaining SI traceability of sufficient accuracy in instruments orbiting the Earth presents a significant new challenge to the metrology community. This paper highlights some key measurands and applications driving the uncertainty demand of the climate community in the solar reflective domain, e.g. solar irradiances and reflectances/radiances of the Earth. It discusses how meeting these uncertainties facilitate significant improvement in the forecasting abilities of climate models. After discussing the current state of the art, it describes a new satellite mission, called TRUTHS, which enables, for the first time, high-accuracy SI traceability to be established in orbit. The direct use of a primary standard and replication of the terrestrial traceability chain extends the SI into space, in effect realizing a metrology laboratory in space . Keywords: climate change; Earth observation; satellites; radiometry; solar irradiance

40 CFR 35.937-9 - Required solicitation and subagreement provisions.

Code of Federal Regulations, 2010 CFR

2010-07-01

...; (2) The time for performance and completion of the contract work, including where appropriate, dates for completion of significant project tasks; (3) Personnel and facilities necessary to accomplish the... for later tasks or steps at the time of contract execution, the contract should not include the...

Relationship between chlorophyll density and SPAD chlorophyll meter reading for Jerusalem artichoke (Helianthus tuberosus L.)

USDA-ARS?s Scientific Manuscript database

Chlorophyll is an indicator of crop health and productivity. Measuring chlorophyll is usually done directly and requires significant time and resources. Indirect measurement of chlorophyll density using a handheld portable chlorophyll meter can reduce time. However, this information is very limit...

Robotic partial nephrectomy shortens warm ischemia time, reducing suturing time kinetics even for an experienced laparoscopic surgeon: a comparative analysis.

PubMed

Faria, Eliney F; Caputo, Peter A; Wood, Christopher G; Karam, Jose A; Nogueras-González, Graciela M; Matin, Surena F

2014-02-01

Laparoscopic and robotic partial nephrectomy (LPN and RPN) are strongly related to influence of tumor complexity and learning curve. We analyzed a consecutive experience between RPN and LPN to discern if warm ischemia time (WIT) is in fact improved while accounting for these two confounding variables and if so by which particular aspect of WIT. This is a retrospective analysis of consecutive procedures performed by a single surgeon between 2002-2008 (LPN) and 2008-2012 (RPN). Specifically, individual steps, including tumor excision, suturing of intrarenal defect, and parenchyma, were recorded at the time of surgery. Multivariate and univariate analyzes were used to evaluate influence of learning curve, tumor complexity, and time kinetics of individual steps during WIT, to determine their influence in WIT. Additionally, we considered the effect of RPN on the learning curve. A total of 146 LPNs and 137 RPNs were included. Considering renal function, WIT, suturing time, renorrhaphy time were found statistically significant differences in favor of RPN (p < 0.05). In the univariate analysis, surgical procedure, learning curve, clinical tumor size, and RENAL nephrometry score were statistically significant predictors for WIT (p < 0.05). RPN decreased the WIT on average by approximately 7 min compared to LPN even when adjusting for learning curve, tumor complexity, and both together (p < 0.001). We found RPN was associated with a shorter WIT when controlling for influence of the learning curve and tumor complexity. The time required for tumor excision was not shortened but the time required for suturing steps was significantly shortened.

Economic analysis of blood product transfusions according to the treatment of acute myeloid leukemia in the elderly.

PubMed

Cannas, G; Fattoum, J; Boukhit, M; Thomas, X

2015-01-01

Blood transfusion requirement represents one of the most significant cost driver associated with acute myeloid leukemia (AML). Low-intensity treatments (low-dose cytarabine, hypomethylating agents) have the potential to reduce transfusion dependence, and improve health-related quality of life. We assessed the cost-effectiveness of treatment types regarding blood product transfusions in a cohort of 214 AML patients aged ≥ 70 years. Analyzes did not indicate any significant overall survival (OS) advantage of intensive chemotherapy comparatively to low-intensity treatment. The difference was significant when compared to best supportive care (BSC) (P<0.0001). Blood products transfusion cost per patient was 1.3 times lower with low-intensity therapy and 2.7 times lower with BSC than with intensive chemotherapy. Mean transfusion cost per patient according to OS varied from 2.4 to 1.3 times less with low-intensity treatment comparatively to intensive chemotherapy for patients having OS ≤ 13.3 months. Costs varied from 3.5 to 2.6 times less with BSC comparatively to intensive chemotherapy. In contrast, mean transfusion costs were comparable among treatments for patients with OS>13.3 months. Low-intensity treatments represent a cost-effective alternative to BSC and require a reduced number of transfused blood products comparatively to intensive chemotherapy, while OS was not significantly different. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

Comparison of nitrile gloves and nitrile over Nomex gloves.

PubMed

Vorih, Deirdre Cronin; Bolton, Lauri D; Marcelynas, James; Nowicki, Thomas A; Jacobs, Lenworth; Robinson, Kenneth J

2009-01-01

Aeromedical flight crews must perform many tasks in flight requiring manual dexterity and fine precision. A common perception is that safety-enhancing fire-retardant gloves compromise patient care if worn during such tasks by providing added bulk and barrier to the hand. This study is a quantitative and qualitative analysis of this possible compromise to patient care. Sixteen practicing flight nurses and respiratory therapists were asked to perform 10 different standard patient care tasks while wearing either nitrile gloves or a nitrile-Nomex glove pair. Tasks were timed, rated as completed successfully or not, and were subsequently judged subjectively by the participants. Whereas the time required to insert an intravenous catheter and to insert a central line while wearing only nitrile gloves was significantly faster than when wearing both gloves, the time to perform all other tasks was not significantly different. In subjective ratings, the nitrile glove alone was scored significantly better than the two-glove combination by the study participants. Comfort, dexterity, tactile discrimination, and ease of use were all adversely affected by wearing a Nomex glove under a nitrile glove. Although the differences in times for most tasks may not be clinically significant, the difference in the subjective parameters may be great enough to cause helicopter emergency medical services (HEMS) practitioners to not wear Nomex gloves under nitrile gloves while performing procedures.

Role of preemptive tapentadol in reduction of postoperative analgesic requirements after laparoscopic cholecystectomy

PubMed Central

Yadav, Ghanshyam; Jain, Gaurav; Samprathi, Abhishek; Baghel, Annavi; Singh, Dinesh Kumar

2016-01-01

Background and Aims: Poorly managed acute postoperative pain may result in prolonged morbidity. Various pharmacotherapies have targeted this, but research on an ideal preemptive analgesic continues, taking into account drug-related side effects. Considering the better tolerability profile of tapentadol, we assessed its role as a preemptive analgesic in the reduction of postoperative analgesic requirements, after laparoscopic cholecystectomy. Material and Methods: In a prospective-double-blinded fashion, sixty patients posted for above surgery, were randomized to receive tablet tapentadol 75 mg (Group A) or starch tablets (Group B) orally, an hour before induction of general anesthesia. Perioperative analgesic requirement, time to first analgesia, pain, and sedation score were compared for first 24 h during the postoperative period and analyzed by one-way analysis of variance test. A P < 0.05 was considered significant. Results: Sixty patients were analyzed. The perioperative analgesic requirement was significantly lower in Group A. Verbal numerical score was significantly lower in Group A at the time point, immediately after shifting the patient to the postanesthesia care unit. Ramsay sedation scores were similar between the groups. No major side effects were observed except for nausea and vomiting in 26 cases (10 in Group A, 16 in Group B). Conclusion: Single preemptive oral dose of tapentadol (75 mg) is effective in reducing perioperative analgesic requirements and acute postoperative pain, without added side effects. It could be an appropriate preemptive analgesic, subjected to future trials concentrating upon its dose-response effects. PMID:28096581

Contracted time and expanded space: The impact of circumnavigation on judgements of space and time.

PubMed

Brunec, Iva K; Javadi, Amir-Homayoun; Zisch, Fiona E L; Spiers, Hugo J

2017-09-01

The ability to estimate distance and time to spatial goals is fundamental for survival. In cases where a region of space must be navigated around to reach a location (circumnavigation), the distance along the path is greater than the straight-line Euclidean distance. To explore how such circumnavigation impacts on estimates of distance and time, we tested participants on their ability to estimate travel time and Euclidean distance to learned destinations in a virtual town. Estimates for approximately linear routes were compared with estimates for routes requiring circumnavigation. For all routes, travel times were significantly underestimated, and Euclidean distances overestimated. For routes requiring circumnavigation, travel time was further underestimated and the Euclidean distance further overestimated. Thus, circumnavigation appears to enhance existing biases in representations of travel time and distance. Copyright © 2017 The Author(s). Published by Elsevier B.V. All rights reserved.

Determinants of holmium:yttrium-aluminum-garnet laser time and energy during ureteroscopic laser lithotripsy.

PubMed

Molina, Wilson R; Marchini, Giovanni S; Pompeo, Alexandre; Sehrt, David; Kim, Fernando J; Monga, Manoj

2014-04-01

To evaluate the association of preoperative noncontrast computed tomography stone characteristics, laser settings, and stone composition with cumulative holmium:yttrium-aluminum-garnet (Ho:YAG) laser time/energy. We retrospectively reviewed patients who underwent semirigid/flexible ureteroscopy and Ho:YAG laser lithotripsy (200 or 365 μm laser fiber; 0.8-1.0 J energy; and 8-10 Hz rate) at 2 tertiary care centers (April 2010-May 2012). Studied parameters were as follows: patient's characteristics; stone characteristics (location, burden, hardness, and composition); total laser time and energy; and surgical outcomes. One hundred patients met our inclusion criteria. Mean stone size was 1.01 ± 0.42 cm and volume 0.33 ± 0.04 cm(3). Mean stone radiodensity was 990 ± 296 HU, and Hounsfield units density 13.8 ± 6.0 HU/mm. All patients were considered stone free. Stone size and volume had a significant positive correlation with laser energy (R = 0.516, P <.001; R = 0.621, P <.001) and laser time (R = 0.477, P <.001; R = 0.567, P <.001). When controlling for stone size, only the correlation between HU and laser time was significant (R = 0.262, P = .011). In the multivariate analysis, with exception of stone composition (P = .103), all parameters significantly increased laser energy (R(2) = 0.524). Multivariate analysis revealed a positive significant association of laser time with stone volume (P <.001) and Hounsfield units density (P <.001; R(2) = 0.512). In multivariate analysis for laser energy, only calcium phosphate stones required less energy to fragment compared with uric acid stones. No significant differences were found in the multivariate laser time model. Ho:YAG laser cumulative energy and total time are significantly affected by stone dimensions, hardness location, fiber size, and power. Kidney location, laser fiber size, and laser power have more influence on the final laser energy than on the total laser time. Calcium phosphate stones require less laser energy to fragment. Copyright © 2014 Elsevier Inc. All rights reserved.

Effective teaching of manual skills to physiotherapy students: a randomised clinical trial.

PubMed

Rossettini, Giacomo; Rondoni, Angie; Palese, Alvisa; Cecchetto, Simone; Vicentini, Marco; Bettale, Fernanda; Furri, Laura; Testa, Marco

2017-08-01

To date, despite the relevance of manual skills laboratories in physiotherapy education, evidence on the effectiveness of different teaching methods is limited. Peyton's four-step and the 'See one, do one' approaches were compared for their effectiveness in teaching manual skills. A cluster randomised controlled trial was performed among final-year, right-handed physiotherapy students, without prior experience in manual therapy or skills laboratories. The manual technique of C1-C2 passive right rotation was taught by different experienced physiotherapist using Peyton's four-step approach (intervention group) and the 'See one, do one' approach (control group). Participants, teachers and assessors were blinded to the aims of the study. Primary outcomes were quality of performance at the end of the skills laboratories, and after 1 week and 1 month. Secondary outcomes were time required to teach, time required to perform the procedure and student satisfaction. A total of 39 students were included in the study (21 in the intervention group and 18 in the control group). Their main characteristics were homogeneous at baseline. The intervention group showed better quality of performance in the short, medium and long terms (F 1,111  = 35.91, p < 0.001). Both groups demonstrated decreased quality of performance over time (F 2,111  = 12.91, p < 0.001). The intervention group reported significantly greater mean ± standard deviation satisfaction (4.31 ± 1.23) than the control group (4.03 ± 1.31) (p < 0.001). Although there was no significant difference between the two methods in the time required for teaching, the time required by the intervention group to perform the procedure was significantly lower immediately after the skills laboratories and over time (p < 0.001). Peyton's four-step approach is more effective than the 'See one, do one' approach in skills laboratories aimed at developing physiotherapy student competence in C1-C2 passive mobilisation. © 2017 John Wiley & Sons Ltd and The Association for the Study of Medical Education.

Extracellular space preservation aids the connectomic analysis of neural circuits

PubMed Central

Pallotto, Marta; Watkins, Paul V; Fubara, Boma; Singer, Joshua H; Briggman, Kevin L

2015-01-01

Dense connectomic mapping of neuronal circuits is limited by the time and effort required to analyze 3D electron microscopy (EM) datasets. Algorithms designed to automate image segmentation suffer from substantial error rates and require significant manual error correction. Any improvement in segmentation error rates would therefore directly reduce the time required to analyze 3D EM data. We explored preserving extracellular space (ECS) during chemical tissue fixation to improve the ability to segment neurites and to identify synaptic contacts. ECS preserved tissue is easier to segment using machine learning algorithms, leading to significantly reduced error rates. In addition, we observed that electrical synapses are readily identified in ECS preserved tissue. Finally, we determined that antibodies penetrate deep into ECS preserved tissue with only minimal permeabilization, thereby enabling correlated light microscopy (LM) and EM studies. We conclude that preservation of ECS benefits multiple aspects of the connectomic analysis of neural circuits. DOI: http://dx.doi.org/10.7554/eLife.08206.001 PMID:26650352

A generic template for automated bioanalytical ligand-binding assays using modular robotic scripts in support of discovery biotherapeutic programs.

PubMed

Duo, Jia; Dong, Huijin; DeSilva, Binodh; Zhang, Yan J

2013-07-01

Sample dilution and reagent pipetting are time-consuming steps in ligand-binding assays (LBAs). Traditional automation-assisted LBAs use assay-specific scripts that require labor-intensive script writing and user training. Five major script modules were developed on Tecan Freedom EVO liquid handling software to facilitate the automated sample preparation and LBA procedure: sample dilution, sample minimum required dilution, standard/QC minimum required dilution, standard/QC/sample addition, and reagent addition. The modular design of automation scripts allowed the users to assemble an automated assay with minimal script modification. The application of the template was demonstrated in three LBAs to support discovery biotherapeutic programs. The results demonstrated that the modular scripts provided the flexibility in adapting to various LBA formats and the significant time saving in script writing and scientist training. Data generated by the automated process were comparable to those by manual process while the bioanalytical productivity was significantly improved using the modular robotic scripts.

Midwives caring for asylum-seeking women: research findings.

PubMed

Bennett, Sarah; Scammell, Janet

2014-01-01

Over the past decade, the numbers of women seeking asylum in the United Kingdom (UK) and requiring midwifery care have increased significantly (Office for National Statistics (ONS) 2012). This article describes findings from a small study that explored the experiences of midwives caring for asylum seeking women. Time and communication emerged as significant factors impacting on quality of care and these are the focus of this article. Caring for these women was emotionally challenging and at times frustrating due to poor access to information and support. In conclusion, whilst considerable knowledge and skills were required to care for this vulnerable group, these appeared to be learned almost solely 'on the job': Implications for service delivery and education are explored and recommendations made to improve experiences for women and midwives.

Extraction of pacemaker and implantable cardioverter defibrillator leads: a single-centre study of electrosurgical and laser extraction.

PubMed

Scott, Paul A; Chow, Whitney; Ellis, Elizabeth; Morgan, John M; Roberts, Paul R

2009-11-01

Both electrosurgical dissection (EDS) and laser tools are effective in the extraction of chronic implanted endovascular leads. It is unclear which is superior. We undertook a retrospective single-centre study to assess this. In our institution from 2000 to 2004, all extractions requiring an ablative sheath were performed using the EDS system. In 2004, an excimer laser system was acquired, which became the first choice. Consecutive patients undergoing extraction requiring an ablative sheath (EDS or laser) were studied. From 2000 to 2007, 140 leads were extracted from 74 patients (EDS 31 and laser 43). Procedural success was non-significantly higher in the laser vs. the EDS group (95 vs. 87%). In the EDS group, one patient suffered tamponade requiring surgery; in the laser group, one patient suffered a significant pericardial effusion treated conservatively. There were no deaths. Procedure and fluoroscopy times were similar between groups. More patients were referred for primary surgical extraction in the EDS vs. the laser era (7 vs. 0, P = 0.003). Lead extraction using an ablative sheath is safe and effective. In our small study, there were no significant differences between EDS and laser sheaths in terms of success, time, or safety.

Real-Time Aerodynamic Flow and Data Visualization in an Interactive Virtual Environment

NASA Technical Reports Server (NTRS)

Schwartz, Richard J.; Fleming, Gary A.

2005-01-01

Significant advances have been made to non-intrusive flow field diagnostics in the past decade. Camera based techniques are now capable of determining physical qualities such as surface deformation, surface pressure and temperature, flow velocities, and molecular species concentration. In each case, extracting the pertinent information from the large volume of acquired data requires powerful and efficient data visualization tools. The additional requirement for real time visualization is fueled by an increased emphasis on minimizing test time in expensive facilities. This paper will address a capability titled LiveView3D, which is the first step in the development phase of an in depth, real time data visualization and analysis tool for use in aerospace testing facilities.

The Effect of Patella Eversion on Clinical Outcome Measures in Simultaneous Bilateral Total Knee Arthroplasty: A Prospective Randomized Controlled Trial.

PubMed

Zan, Pengfei; Wu, Zhong; Yu, Xiao; Fan, Lin; Xu, Tianyang; Li, Guodong

2016-03-01

During total knee arthroplasty (TKA), surgical exposure requires mobilization technique of the patella. With this trial, we intended to investigate the effect of patella eversion on clinical outcome measures in simultaneous bilateral TKA. We prospectively enrolled 44 patients (88 knees) from April 2008 to June 20l4.One knee was operated with patella eversion (group A) and the other with patella lateral retraction (group B) randomly. Follow-up results, including the operation time, complications, and the time of achieving straight leg raise (SLR) and 90° knee flexion, were recorded. The data of range of motion (ROM) and Visual Analogue Scale score were collected separately at 7 days, 3 months, 6 months, and 1 year postoperatively. The time of achieving SLR was 2.7 ± 0.8 days in group A and 2.1 ± 0.7 DAYS in group B, which were significantly different (P = .032). Significant difference was found on active and passive ROM during the follow-up times between groups A and B, except the passive ROM at 6 months postoperatively. No significant difference was found on operation time, complications, patella baja or tilt, time of achieving 90°knee flexion, and Visual Analogue Scale score during the follow-up times. Patellar eversion was adverse to the early knee function recovery after TKA; it would delay the time of achieving SLR and decrease the passive and active ROM. In addition, more carefully and scientifically designed randomized controlled trials are still required to further prove the claim. Copyright © 2016 Elsevier Inc. All rights reserved.

Automated Flight Dynamics Product Generation for the EOS AM-1 Spacecraft

NASA Technical Reports Server (NTRS)

Matusow, Carla

1999-01-01

As part of NASA's Earth Science Enterprise, the Earth Observing System (EOS) AM-1 spacecraft is designed to monitor long-term, global, environmental changes. Because of the complexity of the AM-1 spacecraft, the mission operations center requires more than 80 distinct flight dynamics products (reports). To create these products, the AM-1 Flight Dynamics Team (FDT) will use a combination of modified commercial software packages (e.g., Analytical Graphic's Satellite ToolKit) and NASA-developed software applications. While providing the most cost-effective solution to meeting the mission requirements, the integration of these software applications raises several operational concerns: (1) Routine product generation requires knowledge of multiple applications executing on variety of hardware platforms. (2) Generating products is a highly interactive process requiring a user to interact with each application multiple times to generate each product. (3) Routine product generation requires several hours to complete. (4) User interaction with each application introduces the potential for errors, since users are required to manually enter filenames and input parameters as well as run applications in the correct sequence. Generating products requires some level of flight dynamics expertise to determine the appropriate inputs and sequencing. To address these issues, the FDT developed an automation software tool called AutoProducts, which runs on a single hardware platform and provides all necessary coordination and communication among the various flight dynamics software applications. AutoProducts, autonomously retrieves necessary files, sequences and executes applications with correct input parameters, and deliver the final flight dynamics products to the appropriate customers. Although AutoProducts will normally generate pre-programmed sets of routine products, its graphical interface allows for easy configuration of customized and one-of-a-kind products. Additionally, AutoProducts has been designed as a mission-independent tool, and can be easily reconfigured to support other missions or incorporate new flight dynamics software packages. After the AM-1 launch, AutoProducts will run automatically at pre-determined time intervals . The AutoProducts tool reduces many of the concerns associated with the flight dynamics product generation. Although AutoProducts required a significant effort to develop because of the complexity of the interfaces involved, its use will provide significant cost savings through reduced operator time and maximum product reliability. In addition, user satisfaction is significantly improved and flight dynamics experts have more time to perform valuable analysis work. This paper will describe the evolution of the AutoProducts tool, highlighting the cost savings and customer satisfaction resulting from its development. It will also provide details about the tool including its graphical interface and operational capabilities.

A course-based research experience: how benefits change with increased investment in instructional time.

PubMed

Shaffer, Christopher D; Alvarez, Consuelo J; Bednarski, April E; Dunbar, David; Goodman, Anya L; Reinke, Catherine; Rosenwald, Anne G; Wolyniak, Michael J; Bailey, Cheryl; Barnard, Daron; Bazinet, Christopher; Beach, Dale L; Bedard, James E J; Bhalla, Satish; Braverman, John; Burg, Martin; Chandrasekaran, Vidya; Chung, Hui-Min; Clase, Kari; Dejong, Randall J; Diangelo, Justin R; Du, Chunguang; Eckdahl, Todd T; Eisler, Heather; Emerson, Julia A; Frary, Amy; Frohlich, Donald; Gosser, Yuying; Govind, Shubha; Haberman, Adam; Hark, Amy T; Hauser, Charles; Hoogewerf, Arlene; Hoopes, Laura L M; Howell, Carina E; Johnson, Diana; Jones, Christopher J; Kadlec, Lisa; Kaehler, Marian; Silver Key, S Catherine; Kleinschmit, Adam; Kokan, Nighat P; Kopp, Olga; Kuleck, Gary; Leatherman, Judith; Lopilato, Jane; Mackinnon, Christy; Martinez-Cruzado, Juan Carlos; McNeil, Gerard; Mel, Stephanie; Mistry, Hemlata; Nagengast, Alexis; Overvoorde, Paul; Paetkau, Don W; Parrish, Susan; Peterson, Celeste N; Preuss, Mary; Reed, Laura K; Revie, Dennis; Robic, Srebrenka; Roecklein-Canfield, Jennifer; Rubin, Michael R; Saville, Kenneth; Schroeder, Stephanie; Sharif, Karim; Shaw, Mary; Skuse, Gary; Smith, Christopher D; Smith, Mary A; Smith, Sheryl T; Spana, Eric; Spratt, Mary; Sreenivasan, Aparna; Stamm, Joyce; Szauter, Paul; Thompson, Jeffrey S; Wawersik, Matthew; Youngblom, James; Zhou, Leming; Mardis, Elaine R; Buhler, Jeremy; Leung, Wilson; Lopatto, David; Elgin, Sarah C R

2014-01-01

There is widespread agreement that science, technology, engineering, and mathematics programs should provide undergraduates with research experience. Practical issues and limited resources, however, make this a challenge. We have developed a bioinformatics project that provides a course-based research experience for students at a diverse group of schools and offers the opportunity to tailor this experience to local curriculum and institution-specific student needs. We assessed both attitude and knowledge gains, looking for insights into how students respond given this wide range of curricular and institutional variables. While different approaches all appear to result in learning gains, we find that a significant investment of course time is required to enable students to show gains commensurate to a summer research experience. An alumni survey revealed that time spent on a research project is also a significant factor in the value former students assign to the experience one or more years later. We conclude: 1) implementation of a bioinformatics project within the biology curriculum provides a mechanism for successfully engaging large numbers of students in undergraduate research; 2) benefits to students are achievable at a wide variety of academic institutions; and 3) successful implementation of course-based research experiences requires significant investment of instructional time for students to gain full benefit.

A Course-Based Research Experience: How Benefits Change with Increased Investment in Instructional Time

PubMed Central

Shaffer, Christopher D.; Alvarez, Consuelo J.; Bednarski, April E.; Dunbar, David; Goodman, Anya L.; Reinke, Catherine; Rosenwald, Anne G.; Wolyniak, Michael J.; Bailey, Cheryl; Barnard, Daron; Bazinet, Christopher; Beach, Dale L.; Bedard, James E. J.; Bhalla, Satish; Braverman, John; Burg, Martin; Chandrasekaran, Vidya; Chung, Hui-Min; Clase, Kari; DeJong, Randall J.; DiAngelo, Justin R.; Du, Chunguang; Eckdahl, Todd T.; Eisler, Heather; Emerson, Julia A.; Frary, Amy; Frohlich, Donald; Gosser, Yuying; Govind, Shubha; Haberman, Adam; Hark, Amy T.; Hauser, Charles; Hoogewerf, Arlene; Hoopes, Laura L. M.; Howell, Carina E.; Johnson, Diana; Jones, Christopher J.; Kadlec, Lisa; Kaehler, Marian; Silver Key, S. Catherine; Kleinschmit, Adam; Kokan, Nighat P.; Kopp, Olga; Kuleck, Gary; Leatherman, Judith; Lopilato, Jane; MacKinnon, Christy; Martinez-Cruzado, Juan Carlos; McNeil, Gerard; Mel, Stephanie; Mistry, Hemlata; Nagengast, Alexis; Overvoorde, Paul; Paetkau, Don W.; Parrish, Susan; Peterson, Celeste N.; Preuss, Mary; Reed, Laura K.; Revie, Dennis; Robic, Srebrenka; Roecklein-Canfield, Jennifer; Rubin, Michael R.; Saville, Kenneth; Schroeder, Stephanie; Sharif, Karim; Shaw, Mary; Skuse, Gary; Smith, Christopher D.; Smith, Mary A.; Smith, Sheryl T.; Spana, Eric; Spratt, Mary; Sreenivasan, Aparna; Stamm, Joyce; Szauter, Paul; Thompson, Jeffrey S.; Wawersik, Matthew; Youngblom, James; Zhou, Leming; Mardis, Elaine R.; Buhler, Jeremy; Leung, Wilson; Lopatto, David; Elgin, Sarah C. R.

2014-01-01

There is widespread agreement that science, technology, engineering, and mathematics programs should provide undergraduates with research experience. Practical issues and limited resources, however, make this a challenge. We have developed a bioinformatics project that provides a course-based research experience for students at a diverse group of schools and offers the opportunity to tailor this experience to local curriculum and institution-specific student needs. We assessed both attitude and knowledge gains, looking for insights into how students respond given this wide range of curricular and institutional variables. While different approaches all appear to result in learning gains, we find that a significant investment of course time is required to enable students to show gains commensurate to a summer research experience. An alumni survey revealed that time spent on a research project is also a significant factor in the value former students assign to the experience one or more years later. We conclude: 1) implementation of a bioinformatics project within the biology curriculum provides a mechanism for successfully engaging large numbers of students in undergraduate research; 2) benefits to students are achievable at a wide variety of academic institutions; and 3) successful implementation of course-based research experiences requires significant investment of instructional time for students to gain full benefit. PMID:24591510

Extending surgeon response times in tier 2 traumas does not adversely affect patient outcomes.

PubMed

Zimmerman, Steven Anthony; Reed, Christopher S; Reed, Alexander N; Jones, Ronald J; Chard, Annette; Reed, Donald N

2018-06-01

The presence of a trauma surgeon during patient resuscitations is required at most American College of Surgeons-verified trauma centers despite little evidence showing improved patient outcomes in the less-than-critically injured (Tier 2) trauma patients. This study was designed to identify the impact of extending required surgeon response times on outcomes in tier 2 trauma patients. An American College of Surgeons-verified level 2 trauma center extended the maximum allowed surgeon response time for tier 2 activations from 60 min to 120 min on November 1, 2011. Surgeon response time and patient outcomes of the retrospective control group (January 1, 2008-October 31, 2011) were then compared with the prospective test group (November 1, 2011-December 31, 2014). Primary outcomes included mortality and hospital length of stay (HLOS). Secondary outcomes were emergency department length of stay, and time from ED arrival to CT scan. A subset analysis of all patients evaluated by a surgeon within 60 min of arrival versus those evaluated by a surgeon after 60 min was also performed. The control and test groups were composed of 757 and 792 patients, and their mean injury severity score was 9.0 and 6.0, respectively. Emergency department length of stay showed a statistically significant increase of 12 min, whereas HLOS was unchanged throughout the study. Mortality was not significantly different between the groups. Subset analysis revealed a median surgeon arrival time of 15 min in the <60-min group and 85 min in the >60-min group, whereas the injury severity score, HLOS, and mortality were not significantly different between these subsets. No correlation existed between these outcomes and surgeon arrival time. Doubling required surgeon response time in tier 2 trauma patients does not produce negative outcomes in this patient group. Mandatory surgeon response times in similar patient groups can be re-evaluated to allow for greater flexibility of a limited surgeon workforce while still providing safe care. Copyright © 2018 Elsevier Inc. All rights reserved.

75 FR 41438 - Stainless Steel Bar from India: Extension of Time Limit for the Final Results of the 2008-2009...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-07-16

..., following the preliminary results, the Department received additional cost information from Venus, as... a comprehensive cost analysis, significantly delaying the briefing schedule. See Memorandum from..., the Department requires additional time to review and address the detail and complexity of the cost...

Modeling Pubertal Timing and Tempo and Examining Links to Behavior Problems

ERIC Educational Resources Information Center

Beltz, Adriene M.; Corley, Robin P.; Bricker, Josh B.; Wadsworth, Sally J.; Berenbaum, Sheri A.

2014-01-01

Research on the role of puberty in adolescent psychological development requires attention to the meaning and measurement of pubertal development. Particular questions concern the utility of self-report, the need for complex models to describe pubertal development, the psychological significance of pubertal timing vs. tempo, and sex differences in…

Analysis of Electrokinetic Mixing Using AC Electric Field and Patchwise Surface Heterogeneities

NASA Astrophysics Data System (ADS)

Luo, Win-Jet; Yarn, Kao-Feng; Hsu, Shou-Ping

2007-04-01

In this paper, the authors investigate the use of an applied AC electric field and microchannel surface heterogeneities to carry out the microfluidic mixing of two-dimensional, time-dependent electroosmotic flows. The time-dependent flow fields within the microchannel are simulated using the backwards-Euler time-stepping numerical method. The mixing efficiencies obtained in microchannels with two different patchwise surface heterogeneity patterns are investigated. In general, the results show that the application of an AC electric field significantly reduces the required mixing length compared with the use of a DC electric field. Furthermore, the presence of oppositely charged surface heterogeneities on the microchannel walls results in the formation of localized flow circulation regions within the bulk flow. These circulation regions grow and decay periodically in accordance with the periodic variation of the AC electric field intensity and provide an effective means of enhancing species mixing in the microchannel. Consequently, the use of an AC electric field together with patchwise surface heterogeneities permits a significant reduction in both the mixing channel length and the retention time required to attain a homogeneous solution.

76 FR 79141 - List of Rules To Be Reviewed Pursuant to the Regulatory Flexibility Act

Federal Register 2010, 2011, 2012, 2013, 2014

2011-12-21

... initial notice within a reasonable time after establishing a customer relationship in two additional..., requires an agency to review its rules that have a significant economic impact upon a substantial number of... be amended or rescinded * * * to minimize any significant economic impact of the rules upon a...

32 CFR 518.8 - Freedom of Information requirements.

Code of Federal Regulations, 2010 CFR

2010-07-01

... Activity, however, may compile a new record when so doing would result in a more useful response to the... significant expenditure of resources in both time and/or manpower that would cause a significant interference... resulted in the record being created or the date and circumstances surrounding the event the record covers...

32 CFR 518.8 - Freedom of Information requirements.

Code of Federal Regulations, 2013 CFR

2013-07-01

... Activity, however, may compile a new record when so doing would result in a more useful response to the... significant expenditure of resources in both time and/or manpower that would cause a significant interference... resulted in the record being created or the date and circumstances surrounding the event the record covers...

32 CFR 518.8 - Freedom of Information requirements.

Code of Federal Regulations, 2011 CFR

2011-07-01

... Activity, however, may compile a new record when so doing would result in a more useful response to the... significant expenditure of resources in both time and/or manpower that would cause a significant interference... resulted in the record being created or the date and circumstances surrounding the event the record covers...

32 CFR 518.8 - Freedom of Information requirements.

Code of Federal Regulations, 2014 CFR

2014-07-01

... Activity, however, may compile a new record when so doing would result in a more useful response to the... significant expenditure of resources in both time and/or manpower that would cause a significant interference... resulted in the record being created or the date and circumstances surrounding the event the record covers...

32 CFR 518.8 - Freedom of Information requirements.

Code of Federal Regulations, 2012 CFR

2012-07-01

... Activity, however, may compile a new record when so doing would result in a more useful response to the... significant expenditure of resources in both time and/or manpower that would cause a significant interference... resulted in the record being created or the date and circumstances surrounding the event the record covers...

Automation and integration of components for generalized semantic markup of electronic medical texts.

PubMed

Dugan, J M; Berrios, D C; Liu, X; Kim, D K; Kaizer, H; Fagan, L M

1999-01-01

Our group has built an information retrieval system based on a complex semantic markup of medical textbooks. We describe the construction of a set of web-based knowledge-acquisition tools that expedites the collection and maintenance of the concepts required for text markup and the search interface required for information retrieval from the marked text. In the text markup system, domain experts (DEs) identify sections of text that contain one or more elements from a finite set of concepts. End users can then query the text using a predefined set of questions, each of which identifies a subset of complementary concepts. The search process matches that subset of concepts to relevant points in the text. The current process requires that the DE invest significant time to generate the required concepts and questions. We propose a new system--called ACQUIRE (Acquisition of Concepts and Queries in an Integrated Retrieval Environment)--that assists a DE in two essential tasks in the text-markup process. First, it helps her to develop, edit, and maintain the concept model: the set of concepts with which she marks the text. Second, ACQUIRE helps her to develop a query model: the set of specific questions that end users can later use to search the marked text. The DE incorporates concepts from the concept model when she creates the questions in the query model. The major benefit of the ACQUIRE system is a reduction in the time and effort required for the text-markup process. We compared the process of concept- and query-model creation using ACQUIRE to the process used in previous work by rebuilding two existing models that we previously constructed manually. We observed a significant decrease in the time required to build and maintain the concept and query models.

Developing Software Requirements for a Knowledge Management System That Coordinates Training Programs with Business Processes and Policies in Large Organizations

ERIC Educational Resources Information Center

Kiper, J. Richard

2013-01-01

For large organizations, updating instructional programs presents a challenge to keep abreast of constantly changing business processes and policies. Each time a process or policy changes, significant resources are required to locate and modify the training materials that convey the new content. Moreover, without the ability to track learning…

How Long Should Routine EEG Be Recorded to Get Relevant Information?

PubMed

Doudoux, Hannah; Skaare, Kristina; Geay, Thomas; Kahane, Philippe; Bosson, Jean L; Sabourdy, Cécile; Vercueil, Laurent

2017-03-01

The optimal duration of routine EEG (rEEG) has not been determined on a clinical basis. This study aims to determine the time required to obtain relevant information during rEEG with respect to the clinical request. All rEEGs performed over 3 months in unselected patients older than 14 years in an academic hospital were analyzed retrospectively. The latency required to obtain relevant information was determined for each rEEG by 2 independent readers blinded to the clinical data. EEG final diagnoses and latencies were analyzed with respect to the main clinical requests: subacute cognitive impairment, spells, transient focal neurologic manifestation or patients referred by epileptologists. From 430 rEEGs performed in the targeted period, 364 were analyzed: 92% of the pathological rEEGs were provided within the first 10 minutes of recording. Slowing background activity was diagnosed from the beginning, whereas interictal epileptiform discharges were recorded over time. Moreover, the time elapsed to demonstrate a pattern differed significantly in the clinical groups: in patients with subacute cognitive impairment, EEG abnormalities appeared within the first 10 minutes, whereas in the other groups, data could be provided over time. Patients with subacute cognitive impairment differed from those in the other groups significantly in the elapsed time required to obtain relevant information during rEEG, suggesting that 10-minute EEG recordings could be sufficient, arguing in favor of individualized rEEG. However, this conclusion does not apply to intensive care unit patients.

The utility of a "trauma 1 OP" activation at a level 1 pediatric trauma center.

PubMed

Hunt, Madison M; Stevens, Austin M; Hansen, Kristine W; Fenton, Stephen J

2017-02-01

To expedite flow of injured children suspected to require operative intervention, a "trauma 1 OP" (T1OP) activation classification was created. The purpose of this study was to review this strategy at a level 1 pediatric trauma center. A retrospective review of T1OP activations between 2003 and 2015 was performed. Children suspected of requiring neurosurgical intervention were classified as trauma 1 OP neuro (T1OP(N)). Comparisons were made to trauma 1 (T1) patients who required emergent operative intervention, excluding orthopedic injuries. Overall, 461 T1OP activations occurred (72% T1OP(N)) compared to 129 T1 activations requiring emergent surgery. Demographics were not significantly different between groups, although T1OP patients were slightly younger and more often experienced falls or were victims of abuse. Compared to T1 activations, T1OP activations had a significantly higher mortality rate (21% vs. 7%, p<0.001). Repeat head imaging was more common in the T1OP(N) group compared to imaged children in the T1 group (20% vs. 37%, p=0.05). T1OP(N) patients more often went directly to the OR (45% vs. 33%, p=0.02) and did so in a significantly faster period of time (32min vs. 53min, p<0.001). Use of the T1OP activations appropriately triaged surgical patients, resulting in significantly faster transport times to the OR. II, prognosis study. Copyright © 2017 Elsevier Inc. All rights reserved.

Prospective, randomized comparison of 3 different hemoclips for the treatment of acute upper GI hemorrhage in an established experimental setting.

PubMed

Kato, Masayuki; Jung, Yunho; Gromski, Mark A; Chuttani, Ram; Matthes, Kai

2012-01-01

Recently, endoscopic clip application devices have undergone redesign and improvements to optimize their clinical use and effectiveness. Initially designed for the treatment of bleeding nonvariceal lesions, these devices are also increasingly used for the closure of perforations, fistulas, and anastomotic leaks. Several clinical studies, both randomized and nonrandomized, have used endoscopic hemoclips for hemostasis. However, no comparative studies have yet been reported in the literature comparing the latest endoscopic clip devices for usability and effectiveness for hemostasis of acute upper GI hemorrhage. We aimed to compare the usability and efficacy of 3 different types of endoscopic clip application devices in an established experimental setting by using a porcine ex-vivo simulator of upper GI hemorrhage. Randomized, controlled, ex-vivo study. Academic medical center. Spurting vessels were created within ex-vivo porcine stomachs as published in prior studies. The vessels were attached to a pressure transducer to record the pressure of the circulating blood replacement. Before the initiation of bleeding, each vessel was randomized to 1 of 3 endoscopic clipping devices: 2 different commonly used hemoclips deployed through the working channel and 1 novel clip deployed via an over-the-scope applications device. Two investigators treated 45 bleeding sites (15 bleeding sites for each device at various randomized locations in the stomach: fundus, body, and antrum). Usability was measured via the endpoints of procedure time and quantity of clips required to achieve hemostasis. Efficacy was measured via the endpoint of pressure increase (Δp) from baseline to after treatment. All of the 45 hemostasis treatments were carried out successfully. The mean procedure times were significantly different among the hemoclips, with the clip deployed in an over-the-scope fashion requiring significantly less time to attain hemostasis compared with the other 2 clips. For number of clips needed to attain hemostasis, the clip deployed in an over-the-scope fashion was significantly superior to the others. There were also significant differences among the changes in pressure (Δp ± SD) among the different hemoclips tested. Ex-vivo study. In this prospective, randomized ex-vivo study, we observed significant differences in the usability (time to achieve hemostasis and number of clips required) and the efficacy (change in pressure achieved by the hemoclips) among the 3 clips. The clip applied in the over-the-scope fashion was superior to the other 2 tested clips with regard to time to achieve hemostasis and number of clips required. Copyright © 2012 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.

Differential relationships between set-shifting abilities and dimensions of insight in schizophrenia.

PubMed

Diez-Martin, J; Moreno-Ortega, M; Bagney, A; Rodriguez-Jimenez, R; Padilla-Torres, D; Sanchez-Morla, E M; Santos, J L; Palomo, T; Jimenez-Arriero, M A

2014-01-01

To assess insight in a large sample of patients with schizophrenia and to study its relationship with set shifting as an executive function. The insight of a sample of 161 clinically stable, community-dwelling patients with schizophrenia was evaluated by means of the Scale to Assess Unawareness of Mental Disorder (SUMD). Set shifting was measured using the Trail-Making Test time required to complete part B minus the time required to complete part A (TMT B-A). Linear regression analyses were performed to investigate the relationships of TMT B-A with different dimensions of general insight. Regression analyses revealed a significant association between TMT B-A and two of the SUMD general components: 'awareness of mental disorder' and 'awareness of the efficacy of treatment'. The 'awareness of social consequences' component was not significantly associated with set shifting. Our results show a significant relation between set shifting and insight, but not in the same manner for the different components of the SUMD general score. Copyright © 2013 S. Karger AG, Basel.

Clinical Characteristics and Lesions Responsible for Swallowing Hesitation After Acute Cerebral Infarction.

PubMed

Saito, Tsukasa; Hayashi, Keisuke; Nakazawa, Hajime; Ota, Tetsuo

2016-08-01

Some stroke patients with a unilateral lesion demonstrate acute dysphagia characterized by a markedly prolonged swallowing time, making us think they are reluctant to swallow. In order to clarify the clinical characteristics and causative lesions of delayed swallowing, we conducted a retrospective analysis of 20 right-handed patients without a history of swallowing dysfunction who underwent videofluorography on suspicion of dysphagia after a first ischemic stroke. The oral processing time plus the postfaucial aggregation time required to swallow jelly for patients classified as having delayed swallowing was over 10 s. The time required for swallowing jelly was significantly longer than that without the hesitation (median value, 24.1 vs. 8.9 s, P < 0.001). The oral processing time plus the postfaucial aggregation time required for patients with delayed swallowing to swallow thickened water was largely over 5 s and significantly longer than that of patients without swallowing hesitation (median value, 10.2 vs. 3.3 s, P < 0.001). Swallowing hesitation caused by acute unilateral infarction could be separated into two different patterns. Because four of the five patients with a rippling tongue movement in the swallowing hesitation pattern had a lesion in the left primary motor cortex, which induces some kinds of apraxia, swallowing hesitation with a rippling tongue movement seems to be a representative characteristic of apraxia. The patients with swallowing hesitation with a temporary stasis of the tongue in this study tended to have broad lesions in the frontal lobe, especially in the middle frontal gyrus, which is thought to be involved in higher cognition.

Gastrografin may reduce time to oral diet in prolonged post-operative ileus: a pooled analysis of two randomized trials.

PubMed

Milne, Tony G E; Vather, Ryash; O'Grady, Gregory; Miquel, Jordi; Biondo, Sebastiano; Bissett, Ian

2018-03-06

Gastrografin has been suggested as a rescue therapy for prolonged post-operative ileus (PPOI) but trial data has been inconclusive. This study aimed to determine the benefit of gastrografin use in patients with PPOI by pooling the results of two recent randomized controlled trials assessing the efficacy of gastrografin compared to placebo given at time of PPOI diagnosis. Anonymized, individual patient data from patients undergoing elective bowel resection for any indication were included, stoma closure was excluded. The primary outcome was duration of PPOI. Secondary outcomes were time to tolerate oral diet, passage of flatus/stool, requirement and duration of nasogastric tube, length of post-operative stay and rate of post-operative complications. Individual patient data were pooled for analysis (53 gastrografin, 55 placebo). Gastrografin trended towards a reduction in PPOI duration compared to placebo, respectively, median 96 h (interquartile range, IQR, 78 h) versus median 120 h (IQR, 84 h), however, this result was non-significant (P = 0.11). In addition, no significant difference was detected between the two groups for time to passage of flatus/stool (P = 0.36) and overall length of stay (P = 0.35). Gastrografin conferred a significantly faster time to tolerate an oral diet compared to placebo (median 84 h versus median 107 h, P = 0.04). There was no difference in post-operative complications between the two interventions (P > 0.05). Gastrografin did not significantly reduce PPOI duration or length of stay after abdominal surgery, but did reduce time to tolerate a solid diet. Further studies are required to clarify the role of gastrografin in PPOI. © 2018 Royal Australasian College of Surgeons.

Separation of metadata and pixel data to speed DICOM tag morphing.

PubMed

Ismail, Mahmoud; Philbin, James

2013-01-01

The DICOM information model combines pixel data and metadata in single DICOM object. It is not possible to access the metadata separately from the pixel data. There are use cases where only metadata is accessed. The current DICOM object format increases the running time of those use cases. Tag morphing is one of those use cases. Tag morphing includes deletion, insertion or manipulation of one or more of the metadata attributes. It is typically used for order reconciliation on study acquisition or to localize the issuer of patient ID (IPID) and the patient ID attributes when data from one domain is transferred to a different domain. In this work, we propose using Multi-Series DICOM (MSD) objects, which separate metadata from pixel data and remove duplicate attributes, to reduce the time required for Tag Morphing. The time required to update a set of study attributes in each format is compared. The results show that the MSD format significantly reduces the time required for tag morphing.

Root canal shaping with manual stainless steel files and rotary Ni-Ti files performed by students.

PubMed

Sonntag, D; Guntermann, A; Kim, S K; Stachniss, V

2003-04-01

To investigate root canal shaping with manual stainless steel files and rotary Ni-Ti files by students. Two hundred and ten simulated root canals with the same geometrical shape and size in acrylic resin blocks were prepared by 21 undergraduate dental students with manual stainless steel files using a stepback technique or with rotary Ni-Ti files in crown-down technique. Preparation length, canal shape, incidence of fracture and preparation time were investigated. Zips and elbows occurred significantly (P < 0.001) less frequently with rotary than with manual preparation. The correct preparation length was achieved significantly (P < 0.05) more often with rotary Ni-Ti files than with manual stainless steel files. Fractures occurred significantly (P < 0.05) less frequently with hand instrumentation. The mean time required for manual preparation was significantly (P < 0.001) longer than that required for rotary preparation. Prior experience with a hand preparation technique was not reflected in an improved quality of the subsequent engine-driven preparation. Inexperienced operators achieved better canal preparations with rotary Ni-Ti instruments than with manual stainless steel files. However, rotary preparation was associated with significantly more fractures.

Fast Determination of Distribution-Connected PV Impacts Using a Variable Time-Step Quasi-Static Time-Series Approach: Preprint

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

Mather, Barry

The increasing deployment of distribution-connected photovoltaic (DPV) systems requires utilities to complete complex interconnection studies. Relatively simple interconnection study methods worked well for low penetrations of photovoltaic systems, but more complicated quasi-static time-series (QSTS) analysis is required to make better interconnection decisions as DPV penetration levels increase. Tools and methods must be developed to support this. This paper presents a variable-time-step solver for QSTS analysis that significantly shortens the computational time and effort to complete a detailed analysis of the operation of a distribution circuit with many DPV systems. Specifically, it demonstrates that the proposed variable-time-step solver can reduce themore » required computational time by as much as 84% without introducing any important errors to metrics, such as the highest and lowest voltage occurring on the feeder, number of voltage regulator tap operations, and total amount of losses realized in the distribution circuit during a 1-yr period. Further improvement in computational speed is possible with the introduction of only modest errors in these metrics, such as a 91 percent reduction with less than 5 percent error when predicting voltage regulator operations.« less

Traffic management simulation development.

DOT National Transportation Integrated Search

2011-01-03

Microscopic simulation can provide significant support to traffic management center (TMC) operations. However, traffic simulation applications require data that are expensive and time-consuming to collect. Data collected by TMCs can be used as a prim...

Optimization of Advanced ACTPol Transition Edge Sensor Bolometer Operation Using R(T,I) Transition Measurements

NASA Astrophysics Data System (ADS)

Salatino, Maria

2017-06-01

In the current submm and mm cosmology experiments the focal planes are populated by kilopixel transition edge sensors (TESes). Varying incoming power load requires frequent rebiasing of the TESes through standard current-voltage (IV) acquisition. The time required to perform IVs on such large arrays and the resulting transient heating of the bath reduces the sky observation time. We explore a bias step method that significantly reduces the time required for the rebiasing process. This exploits the detectors' responses to the injection of a small square wave signal on top of the dc bias current and knowledge of the shape of the detector transition R(T,I). This method has been tested on two detector arrays of the Atacama Cosmology Telescope (ACT). In this paper, we focus on the first step of the method, the estimate of the TES %Rn.

Effect of systematic local infiltration analgesia on postoperative pain in vaginal hysterectomy: a randomized, placebo-controlled trial.

PubMed

Hristovska, Ana-Marija; Kristensen, Billy B; Rasmussen, Marianne A; Rasmussen, Yvonne H; Elving, Lisbeth B; Nielsen, Christian V; Kehlet, Henrik

2014-03-01

To assess the effect of systematic local infiltration analgesia on postoperative pain in vaginal hysterectomy, and describe the technique in detail. A randomized, double-blind, placebo-controlled study following the CONSORT criteria. A university hospital. Thirty-seven patients undergoing vaginal hysterectomy. Patients received high-volume (50 mL) ropivacaine 0.50% (n = 20) or saline (n = 17) infiltration using a systematic technique ensuring uniform delivery to all tissues incised, handled or instrumented during the procedure. Pain, nausea, vomiting and opioid requirements were assessed for 32 h as well as time spent in the post-anesthesia care unit and time to first mobilization. Pain at rest was significantly reduced after one, four and eight hours in the ropivacaine group (p ≤ 0.001-0.01). Pain during coughing was significantly reduced after one and four hours (p ≤ 0.001 and p ≤ 0.003), and pain during movement was significantly reduced after four hours (p ≤ 0.02). Opioid requirements and time spent in the post-anesthesia care unit were significantly reduced in the ropivacaine group (p < 0.001 and p < 0.001, respectively), as well as the time to first mobilization (p < 0.001). Intra-operative systematic local infiltration analgesia reduces postoperative pain in patients undergoing vaginal hysterectomy, facilities mobilization and improves early recovery. © 2013 Nordic Federation of Societies of Obstetrics and Gynecology.

Current training: Where are we?

NASA Technical Reports Server (NTRS)

Golden, Gerald

1992-01-01

Petroleum Helicopters, Inc. maintains a staff of 750 helicopter pilots. The initial, transition, upgrade, and recurrent training for these pilots requires a significant financial outlay. Since a major portion of that training is done to satisfy the requirements of FAR 61.57, 'Recent Flight Experience, Pilot in Command' and 135.297, 'Pilot in Command: Instrument Proficiency Check Requirements', much could be accomplished using an approved simulator. However, it is imperative that credit be given for training time spent in the simulators and that the device be realistic, practical, and affordable.

Consolidation of lunar regolith: Microwave versus direct solar heating

NASA Technical Reports Server (NTRS)

Kunitzer, J.; Strenski, D. G.; Yankee, S. J.; Pletka, B. J.

1991-01-01

The production of construction materials on the lunar surface will require an appropriate fabrication technique. Two processing methods considered as being suitable for producing dense, consolidated products such as bricks are direct solar heating and microwave heating. An analysis was performed to compare the two processes in terms of the amount of power and time required to fabricate bricks of various size. The regolith was considered to be a mare basalt with an overall density of 60 pct. of theoretical. Densification was assumed to take place by vitrification since this process requires moderate amounts of energy and time while still producing dense products. Microwave heating was shown to be significantly faster compared to solar furnace heating for rapid production of realistic-size bricks.

The new Langley Research Center advanced real-time simulation (ARTS) system

NASA Technical Reports Server (NTRS)

Crawford, D. J.; Cleveland, J. I., II

1986-01-01

Based on a survey of current local area network technology with special attention paid to high bandwidth and very low transport delay requirements, NASA's Langley Research Center designed a new simulation subsystem using the computer automated measurement and control (CAMAC) network. This required significant modifications to the standard CAMAC system and development of a network switch, a clocking system, new conversion equipment, new consoles, supporting software, etc. This system is referred to as the advanced real-time simulation (ARTS) system. It is presently being built at LaRC. This paper provides a functional and physical description of the hardware and a functional description of the software. The requirements which drove the design are presented as well as present performance figures and status.

Timing of Tissue-specific Cell Division Requires a Differential Onset of Zygotic Transcription during Metazoan Embryogenesis*

PubMed Central

Wong, Ming-Kin; Guan, Daogang; Ng, Kaoru Hon Chun; Ho, Vincy Wing Sze; An, Xiaomeng; Li, Runsheng; Ren, Xiaoliang

2016-01-01

Metazoan development demands not only precise cell fate differentiation but also accurate timing of cell division to ensure proper development. How cell divisions are temporally coordinated during development is poorly understood. Caenorhabditis elegans embryogenesis provides an excellent opportunity to study this coordination due to its invariant development and widespread division asynchronies. One of the most pronounced asynchronies is a significant delay of cell division in two endoderm progenitor cells, Ea and Ep, hereafter referred to as E2, relative to its cousins that mainly develop into mesoderm organs and tissues. To unravel the genetic control over the endoderm-specific E2 division timing, a total of 822 essential and conserved genes were knocked down using RNAi followed by quantification of cell cycle lengths using in toto imaging of C. elegans embryogenesis and automated lineage. Intriguingly, knockdown of numerous genes encoding the components of general transcription pathway or its regulatory factors leads to a significant reduction in the E2 cell cycle length but an increase in cell cycle length of the remaining cells, indicating a differential requirement of transcription for division timing between the two. Analysis of lineage-specific RNA-seq data demonstrates an earlier onset of transcription in endoderm than in other germ layers, the timing of which coincides with the birth of E2, supporting the notion that the endoderm-specific delay in E2 division timing demands robust zygotic transcription. The reduction in E2 cell cycle length is frequently associated with cell migration defect and gastrulation failure. The results suggest that a tissue-specific transcriptional activation is required to coordinate fate differentiation, division timing, and cell migration to ensure proper development. PMID:27056332

Digital gate pulse generator for cycloconverter control

DOEpatents

Klein, Frederick F.; Mutone, Gioacchino A.

1989-01-01

The present invention provides a digital gate pulse generator which controls the output of a cycloconverter used for electrical power conversion applications by determining the timing and delivery of the firing pulses to the switching devices in the cycloconverter. Previous gate pulse generators have been built with largely analog or discrete digital circuitry which require many precision components and periodic adjustment. The gate pulse generator of the present invention utilizes digital techniques and a predetermined series of values to develop the necessary timing signals for firing the switching device. Each timing signal is compared with a reference signal to determine the exact firing time. The present invention is significantly more compact than previous gate pulse generators, responds quickly to changes in the output demand and requires only one precision component and no adjustments.

Factors influencing nursing time spent on administration of medication in an Australian residential aged care home.

PubMed

Qian, Siyu; Yu, Ping; Hailey, David M; Wang, Ning

2016-04-01

To examine nursing time spent on administration of medications in a residential aged care (RAC) home, and to determine factors that influence the time to medicate a resident. Information on nursing time spent on medication administration is useful for planning and implementation of nursing resources. Nurses were observed over 12 morning medication rounds using a time-motion observational method and field notes, at two high-care units in an Australian RAC home. Nurses spent between 2.5 and 4.5 hours in a medication round. Administration of medication averaged 200 seconds per resident. Four factors had significant impact on medication time: number of types of medication, number of tablets taken by a resident, methods used by a nurse to prepare tablets and methods to provide tablets. Administration of medication consumed a substantial, though variable amount of time in the RAC home. Nursing managers need to consider the factors that influenced the nursing time required for the administration of medication in their estimation of nursing workload and required resources. To ensure safe medication administration for older people, managers should regularly assess the changes in the factors influencing nursing time on the administration of medication when estimating nursing workload and required resources. © 2015 John Wiley & Sons Ltd.

A novel recursive Fourier transform for nonuniform sampled signals: application to heart rate variability spectrum estimation.

PubMed

Holland, Alexander; Aboy, Mateo

2009-07-01

We present a novel method to iteratively calculate discrete Fourier transforms for discrete time signals with sample time intervals that may be widely nonuniform. The proposed recursive Fourier transform (RFT) does not require interpolation of the samples to uniform time intervals, and each iterative transform update of N frequencies has computational order N. Because of the inherent non-uniformity in the time between successive heart beats, an application particularly well suited for this transform is power spectral density (PSD) estimation for heart rate variability. We compare RFT based spectrum estimation with Lomb-Scargle Transform (LST) based estimation. PSD estimation based on the LST also does not require uniform time samples, but the LST has a computational order greater than Nlog(N). We conducted an assessment study involving the analysis of quasi-stationary signals with various levels of randomly missing heart beats. Our results indicate that the RFT leads to comparable estimation performance to the LST with significantly less computational overhead and complexity for applications requiring iterative spectrum estimations.

Effects of observation heights and atmospheric wave evolution in sunspot seismology: a study using HMI and AIA (1600 A and 1700 A) data

NASA Astrophysics Data System (ADS)

Rajaguru, S. P.; Couvidaa, S.

2011-10-01

In achieving a high cadence and whole Sun coverage required of them, Doppler imagers such as HMI/SDO and MDI/SOHO necessarily forgo certain intricacies associated with magnetic and velocity field interactions, which require high (spectral) resolution spectropolarimetry for their accurate measurements with straightforward derivation of physical quantities (or observables). Magnetic field modified wave evolution, due to much reduced acoustic cut-off frequencies, in inclined field regions is one such situation. We first show, using a high cadence imaging spectropolarimetric observations made with IBIS instrument at NSO/Sac Peak, that significant contributions to seismically measured travel times arise from the line formation layers. We then present a comparative study of time-distance helioseismic measurements made over three sunspot regions using HMI and AIA (1600 A and 1700 A) data, which provide oscillation signals from three different heights. We bring out clear signals of height dependent wave phases and hence height dependent travel times. We further show that such signatures, from their differing contributions in one way travel times (in- or out-going wave travel times), could explain a significant part of the discrepancies between time-distance and other local helioseismic measurements and inferences.

Deterministic Ethernet for Space Applications

NASA Astrophysics Data System (ADS)

Fidi, C.; Wolff, B.

2015-09-01

Typical spacecraft systems are distributed to be able to achieve the required reliability and availability targets of the mission. However the requirements on these systems are different for launchers, satellites, human space flight and exploration missions. Launchers require typically high reliability with very short mission times whereas satellites or space exploration missions require very high availability at very long mission times. Comparing a distributed system of launchers with satellites it shows very fast reaction times in launchers versus much slower once in satellite applications. Human space flight missions are maybe most challenging concerning reliability and availability since human lives are involved and the mission times can be very long e.g. ISS. Also the reaction times of these vehicles can get challenging during mission scenarios like landing or re-entry leading to very fast control loops. In these different applications more and more autonomous functions are required to fulfil the needs of current and future missions. This autonomously leads to new requirements with respect to increase performance, determinism, reliability and availability. On the other hand side the pressure on reducing costs of electronic components in space applications is increasing, leading to the use of more and more COTS components especially for launchers and LEO satellites. This requires a technology which is able to provide a cost competitive solution for both the high reliable and available deep-space as well as the low cost “new space” markets. Future spacecraft communication standards therefore have to be much more flexible, scalable and modular to be able to deal with these upcoming challenges. The only way to fulfill these requirements is, if they are based on open standards which are used cross industry leading to a reduction of the lifecycle costs and an increase in performance. The use of a communication network that fulfills these requirements will be essential for such spacecraft’s to allow the use in launcher, satellite, human space flight and exploration missions. Using one technology and the related infrastructure for these different applications will lead to a significant reduction of complexity and would moreover lead to significant savings in size weight and power while increasing the performance of the overall system. The paper focuses on the use of the TTEthernet technology for launchers, satellites and human spaceflight and will demonstrate the scalability of the technology for the different applications. The data used is derived from the ESA TRP 7594 on “Reliable High-Speed Data Bus/Network for Safety-Oriented Missions”.

A Single Center Study of 1,179 Heart Transplant Patients-Factors Affecting Pacemaker Implantation.

PubMed

Wellmann, Petra; Herrmann, Florian Ernst Martin; Hagl, Christian; Juchem, Gerd

2017-03-01

After around 10% of heart transplant patients require pacemaker implantation. The bradyarrhythmias causing pacemaker requirement include sinus node dysfunction (SND) and atrioventricular block (AVB). This study sought to define clinical predictors for pacemaker requirement as well as identify differences in the patient groups developing SND and AVB. Our operative database was used to collect retrospective recipient, donor, and operative data of all patients receiving orthotopic heart transplants between 1981 and 2016. In the 35-year period 1,179 transplants were performed (mean recipient age 45.5 ± 0.5 years, 20.4% female, 90.6% biatrial technique) with bradyarrhythmias requiring pacemaker implantation developing in 135 patients (11.5%). Independent risk factors were prolonged operative time 340 minutes versus 313 minutes (P = 0.027) and a biatrial anastomosis (P = 0.036). Ischemia time, cardiopulmonary bypass time, aortic cross clamp time, and reperfusion time all had no significant effect on pacemaker implantation rates. Similarly, whether the transplant was a reoperation, a retransplant, or performed after primary assist implantation had no effects on pacemaker implantation rates. There was no survival difference between the paced and nonpaced groups. The donor age was higher in the patients who developed AVB as the indication for pacemaker implantation (43 vs 34 years, P = 0.031). Patients with AVB had longer aortic cross clamp times and developed the arrhythmia later than those who developed SND. Use of the bicaval instead of the biatrial technique and shortened operative times should reduce pacemaker requirement after heart transplantation. Survival is not affected by this complication. © 2017 Wiley Periodicals, Inc.

An analysis of thermal response factors and how to reduce their computational time requirement

NASA Technical Reports Server (NTRS)

Wiese, M. R.

1982-01-01

Te RESFAC2 version of the Thermal Response Factor Program (RESFAC) is the result of numerous modifications and additions to the original RESFAC. These modifications and additions have significantly reduced the program's computational time requirement. As a result of this work, the program is more efficient and its code is both readable and understandable. This report describes what a thermal response factor is; analyzes the original matrix algebra calculations and root finding techniques; presents a new root finding technique and streamlined matrix algebra; supplies ten validation cases and their results.

Efficacy of Different Nickel-Titanium Instruments in Removing Gutta-percha during Root Canal Retreatment.

PubMed

Özyürek, Taha; Demiryürek, Ebru Özsezer

2016-04-01

The aim of this study was to compare the cleanliness of root canal walls after retreatment using ProTaper Next (PTN; Dentsply Maillefer, Ballaigues, Switzerland), Twisted File Adaptive (TFA; Axis/SybronEndo, Orange, CA), Reciproc (PRC; VDW, Munich, Germany), and ProTaper Universal retreatment (PTR, Dentsply Maillefer) nickel-titanium systems and the time required for gutta-percha and sealer removal. Eighty human maxillary central incisors with single and straight root canals were instrumented up to #40.02 with manual K-files (Dentsply Maillefer) and obturated using the continuous wave of condensation technique. Removal of the gutta-percha and sealer was performed using 1 of the following nickel-titanium systems: PTN, TFA, RPC, or PTR. The teeth were sectioned, and digital images were captured. The photographs were analyzed using AutoCAD software (Autodesk, San Rafael, CA). Also, the total time required for gutta-percha removal was calculated by a chronometer. The total retreatment time was significantly shorter in the PTR group compared with the other groups (P < .05). There was a significant difference between the groups according to the total residual gutta-percha and sealer (P < .05). The PTN and PTR groups left significantly less gutta-percha and sealer remnant than the TFA and RPC groups (P < .05). Within the limitations of this study, the PTN and the PTR groups showed less residual gutta-percha and sealer than the TFA and RPC groups. The time required for gutta-percha and sealer removal was similar for all the groups, except for the PTR group. Copyright © 2016 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Mechanical evaluation of articulating instruments and cross-handed manipulation in laparoendoscopic single-site surgery.

PubMed

Xu, An An; Zhu, Jiang Fan; Xie, Xiaofeng; Su, Yuantao

2014-08-01

Laparoendoscopic single-site surgery (LESS) is limited by loss of triangulation and internal instruments conflict. To overcome these difficulties, some concepts have been introduced, namely, articulating instruments and cross-handed manipulation, which causes the right hand to control the left instrument tip and vice versa. The aim of this study was to compare task performance with different approaches based on a mechanical evaluation platform. A LESS mechanical evaluation platform was set up to investigate the performance of 2 tasks (suture pass-through rings and clip-cut) with 3 different settings: uncrossed manipulation with straight instruments (group A, the control group), uncrossed manipulation with articulating instruments (group B), and cross-handed manipulation with articulating instruments (group C). The operation time and average load required for accomplishment of the standard tasks were measured. Group A presented significantly better time scores than group B, and group C consumed the longest time to accomplish the 2 tasks (P < .05). Comparing of average load required to perform the suture pass-through rings task, it differed significantly between dominant and nondominant hand in all groups (P < .01) and was less in group A and group B than group C in dominant hand (P < .01), while it was almost the same in all groups in the nondominant hand. In terms of average load requirement to accomplish clip-cut task, it was almost equal not only between group A and B but also between dominant and nondominant hand while the increase reached statistical significance when comparing group C with other groups (P < .05). Compared with conventional devices and maneuvering techniques, articulating instruments and cross-handed manipulation are associated with longer operation time and higher workload. Instruments with better maneuverability should be developed in the future for LESS. © The Author(s) 2013.

Pharmacokinetics of detomidine administered to horses at rest and after maximal exercise.

PubMed

Hubbell, J A E; Sams, R A; Schmall, L M; Robertson, J T; Hinchcliff, K W; Muir, W W

2009-05-01

Increased doses of detomidine are required to produce sedation in horses after maximal exercise compared to calm or resting horses. To determine if the pharmacokinetics of detomidine in Thoroughbred horses are different when the drug is given during recuperation from a brief period of maximal exercise compared to administration at rest. Six Thoroughbred horses were preconditioned by exercising them on a treadmill. Each horse ran a simulated race at a treadmill speed that caused it to exercise at 120% of its maximal oxygen consumption. One minute after the end of exercise, horses were treated with detomidine. Each horse was treated with the same dose of detomidine on a second occasion a minimum of 14 days later while standing in a stocks. Samples of heparinised blood were obtained at various time points on both occasions. Plasma detomidine concentrations were determined by liquid chromatography-mass spectrometry. The plasma concentration vs. time data were analysed by nonlinear regression analysis. Median back-extrapolated time zero plasma concentration was significantly lower and median plasma half-life and median mean residence time were significantly longer when detomidine was administered after exercise compared to administration at rest. Median volume of distribution was significantly higher after exercise but median plasma clearance was not different between the 2 administrations. Detomidine i.v. is more widely distributed when administered to horses immediately after exercise compared to administration at rest resulting in lower peak plasma concentrations and a slower rate of elimination. The dose requirement to produce an equivalent effect may be higher in horses after exercise than in resting horses and less frequent subsequent doses may be required to produce a sustained effect.

Adult male circumcision with a circular stapler versus conventional circumcision: A prospective randomized clinical trial

PubMed Central

Jin, X.D.; Lu, J.J.; Liu, W.H.; Zhou, J.; Yu, R.K.; Yu, B.; Zhang, X.J.; Shen, B.H.

2015-01-01

Male circumcision is the most frequently performed procedure by urologists. Safety and efficacy of the circumcision procedure requires continual improvement. In the present study, we investigated the safety and efficacy of a new male circumcision technique involving the use of a circular stapler. In total, 879 consecutive adult male patients were randomly divided into 2 groups: 441 underwent stapler circumcision, and 438 underwent conventional circumcision. The operative time, pain score, blood loss volume, healing time, treatment costs, and postoperative complications were compared between the two groups. The operative time and blood loss volume were significantly lower in the stapler group than in the conventional group (6.8 ± 3.1 vs 24.2 ± 3.2 min and 1.8 ± 1.8 vs 9.4 ± 1.5 mL, respectively; P<0.01 for both). The intraoperative and postoperative pain scores were significantly lower in the stapler group than in the conventional group (0.8 ± 0.5 vs 2.4 ± 0.8 and 4.0 ±0.9 vs 5.8 ± 1.0, respectively; P<0.01 for both). Additionally, the stapler group had significantly fewer complications than the conventional group (2.7% vs 7.8%, respectively; P<0.01). However, the treatment costs in the stapler group were much higher than those in the conventional group (US$356.60 ± 8.20 vs US$126.50 ± 7.00, respectively; P<0.01). Most patients (388/441, 88.0%) who underwent stapler circumcision required removal of residual staple nails. Overall, the present study has shown that stapler circumcision is a time-efficient and safe male circumcision technique, although it requires further improvement. PMID:25831203

Adult male circumcision with a circular stapler versus conventional circumcision: A prospective randomized clinical trial.

PubMed

Jin, X D; Lu, J J; Liu, W H; Zhou, J; Yu, R K; Yu, B; Zhang, X J; Shen, B H

2015-06-01

Male circumcision is the most frequently performed procedure by urologists. Safety and efficacy of the circumcision procedure requires continual improvement. In the present study, we investigated the safety and efficacy of a new male circumcision technique involving the use of a circular stapler. In total, 879 consecutive adult male patients were randomly divided into 2 groups: 441 underwent stapler circumcision, and 438 underwent conventional circumcision. The operative time, pain score, blood loss volume, healing time, treatment costs, and postoperative complications were compared between the two groups. The operative time and blood loss volume were significantly lower in the stapler group than in the conventional group (6.8 ± 3.1 vs 24.2 ± 3.2 min and 1.8 ± 1.8 vs 9.4 ± 1.5 mL, respectively; P<0.01 for both). The intraoperative and postoperative pain scores were significantly lower in the stapler group than in the conventional group (0.8 ± 0.5 vs 2.4 ± 0.8 and 4.0 ±0.9 vs 5.8 ± 1.0, respectively; P<0.01 for both). Additionally, the stapler group had significantly fewer complications than the conventional group (2.7% vs 7.8%, respectively; P<0.01). However, the treatment costs in the stapler group were much higher than those in the conventional group (US$356.60 ± 8.20 vs US$126.50 ± 7.00, respectively; P<0.01). Most patients (388/441, 88.0%) who underwent stapler circumcision required removal of residual staple nails. Overall, the present study has shown that stapler circumcision is a time-efficient and safe male circumcision technique, although it requires further improvement.

75 FR 81179 - Approval and Promulgation of Implementation Plans; Nebraska: Prevention of Significant...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-12-27

... Global Warming Potential (GWP) was developed to compare the heat- trapping capacity and atmospheric... CH 4 emissions would have 21 times as much impact on global warming over a 100-year time horizon as 1... emissions contribution to global warming based on a single metric. B. What are the general requirements of...

Mapping deforestation and forest degradation using Landsat time series: a case of Sumatra—Indonesia

Treesearch

Belinda Arunarwati Margono

2013-01-01

Indonesia experiences the second highest rate of deforestation among tropical countries (FAO 2005, 2010). Consequently, timely and accurate forest data are required to combat deforestation and forest degradation in support of climate change mitigation and biodiversity conservation policy initiatives. Remote sensing is considered as a significant data source for forest...

STEM Education on a Worldwide Voyage: Curriculum to College, Career, and Community Readiness

ERIC Educational Resources Information Center

Furuto, Linda H. L.

2015-01-01

This article addresses issues in equitable and quality STEM education, and comes at a significant time as students, educators, and policymakers strive to meet federal and state standards such as the Mathematics Common Core State Standards (CCSS) and Next Generation Science Standards (NGSS). CCSS and NGSS require significantly higher levels of…

FLC expression is down-regulated by cold treatment in Diplotaxis tenuifolia (wild rocket), but flowering time is unaffected.

PubMed

Taylor, Jemma L; Massiah, Andrea; Kennedy, Sue; Hong, Yiguo; Jackson, Stephen D

2017-07-01

Wild rocket (Diplotaxis tenuifolia) has become a very popular salad leaf due to its peppery taste. It is part of the Brassicaceae family and thus has a high level of homology at the DNA level to other Brassica species including Arabidopsis thaliana. The vernalization and photoperiodic requirements of wild rocket have not been reported to date. Photoperiodic experiments described here demonstrate that rocket is a facultative long day plant. To investigate the vernalization requirement, both seed and young plants were given vernalization treatments at 4°C for different lengths of time. A rocket homologue of FLOWERING LOCUS C (DtFLC) was isolated and shown to functionally complement the Arabidopsis FRI + flc3 null mutant. Whilst the expression of DtFLC was significantly reduced after just one week of cold treatment, cold treatments of two to eight weeks had no significant effect on bolting time of wild rocket indicating that rocket does not have a vernalization requirement. These findings illustrate that important fundamental differences can exist between model and crop plant species, such as in this case where down-regulation of DtFLC expression does not enable earlier flowering in wild rocket as it does in Arabidopsis and many other Brassica species. Copyright © 2017 Elsevier GmbH. All rights reserved.

Effects of proton irradiation on a gas phase in which condensation takes place. I Negative Mg-26 anomalies and Al-26. [applied to solar and meteoritic composition

NASA Technical Reports Server (NTRS)

Heymann, D.; Dziczkaniec, M.; Walker, A.; Huss, G.; Morgan, J. A.

1978-01-01

In the present paper, isotopic effects in magnesium generated in a proton-irradiated gas phase are examined, taking only (p,n), (p,d), and (p, alpha) reactions in magnesium, aluminum, and silicon into consideration. In the presence of proton radiation, the three elements are 'removed' from the gas phase by condensation. It is required that a value of Al-26/Al-27 greater than 6 times 10 to the -5th must be reached, consistent with the value deduced by Lee Papanastassiou, and Wasserburg (1976) from their studies of the Allende meteorite. The calculations show that fast aluminum condensation reduces the required proton fluence substantially, that a significant fraction of aluminum remains uncondensed when the above value of the Al-26/Al-27 ratio is reached, that a detectable MG-24 excess is very likely to occur, that detectable negative MG-28 anomalies can be generated, and that proton fluxes and irradiation times can be varied simultaneously, and over a wide range of values, without significant changes in the required proton fluence.

The effects of cuing in time-shared tasks. [for aircraft flight route-way-point information

NASA Technical Reports Server (NTRS)

Chechile, R. A.; Sadoski, D. M.

1983-01-01

The results of two divided-attention experiments involving the editing of route-way-point displays on an avionics computer unit are reported. Two side tasks were required of the subjects, and either no cue, verbal cues appearing on the CRT, or symbolic cues (lights on the keyboard adjacent to keys to be used) were given to facilitate the primary editing task. Forty female and 30 male undergraduates were trained in the separate and combined tasks and divided randomly into groups of 25 for the cuing tests. A second test with three 10-subject groups was conducted at least one month later to investigate the efficacy of cuing for infrequently used procedures. It is found that only symbolic cuing significantly improved primary-task performance, increasing editing accuracy in the repetitive tests and reducing editing time in the delayed tests. Verbal cuing, probably because it requires additional cognitive effort, has no significant beneficial effect. These results are considered important for designing instruments for work environments requiring the performance of concurrent tasks, and as aircraft cockpits.

A Coordinated Patient Transport System for ICU Patients Requiring Surgery: Impact on Operating Room Efficiency and ICU Workflow.

PubMed

Brown, Michael J; Kor, Daryl J; Curry, Timothy B; Marmor, Yariv; Rohleder, Thomas R

2015-01-01

Transfer of intensive care unit (ICU) patients to the operating room (OR) is a resource-intensive, time-consuming process that often results in patient throughput inefficiencies, deficiencies in information transfer, and suboptimal nurse to patient ratios. This study evaluates the implementation of a coordinated patient transport system (CPTS) designed to address these issues. Using data from 1,557 patient transfers covering the 2006-2010 period, interrupted time series and before and after designs were used to analyze the effect of implementing a CPTS at Mayo Clinic, Rochester. Using a segmented regression for the interrupted time series, on-time OR start time deviations were found to be significantly lower after the implementation of CPTS (p < .0001). The implementation resulted in a fourfold improvement in on-time OR starts (p < .01) while significantly reducing idle OR time (p < .01). A coordinated patient transfer process for moving patient from ICUs to ORs can significantly improve OR efficiency, reduce nonvalue added time, and ensure quality of care by preserving appropriate care provider to patient ratios.

Intervention time until discharge for newborns on transition from gavage to exclusive oral feeding.

PubMed

Medeiros, Andréa Monteiro Correia; Ramos, Blenda Karen Batista; Bomfim, Déborah Letticia Santana Santos; Alvelos, Conceição Lima; Silva, Talita Cardoso da; Barreto, Ikaro Daniel de Carvalho; Santos, Felipe Batista; Gurgel, Ricardo Queiroz

2018-01-01

Purpose Measure the intervention time required for transition from gavage to exclusive oral feeding, comparing newborns exposed exclusively to the mother's breast with those who, in addition to breastfeeding, received supplementation using a cup or baby bottle. Methods Analytical, longitudinal, cohort study conducted with 165 newborns (NB) divided into groups according to severity of medical complications (G1-with no complications; G2-with significant complications), and into subgroups according to feeding mechanism (A and B). All NBs were low birth weight, on Kangaroo Mother Care, and breast stimulated according to medical prescription and hospital routine. Regarding feeding pattern, subgroup A comprised NBs exclusively breastfed at hospital discharge, whereas subgroup B was composed of NBs fed through cup/bottle at some time during hospitalization. The number of days spent in each stage of transition was recorded for each NB. Results History of clinical complications significantly influenced total intervention time. Study participants in subgroups G1-A (10 days), G1-B (9 days), and G2-A (12 days) displayed greater chances of early discharge compared with those in subgroup G2-B (16 days). Conclusion NBs with no important history of clinical complications displayed greater chances of early hospital discharge. NBs with significant history of clinical complications that underwent gavage to exclusive breastfeeding transition presented smaller intervention time than those that required supplementation using cup/bottle. Feeding transition using the gavage-to-exclusive oral feeding technique is recommended for Speech-language Pathology practice in Neonatology.

Digestive efficiencies of ex situ and in situ West Indian manatees (Trichechus manatus latirostris).

PubMed

Worthy, Graham A J; Worthy, Tamara A M

2014-01-01

Digestive efficiencies (Dm) of ex situ and in situ manatees (Trichechus manatus latirostris) were, for the first time, assessed using manganese (Mn(2+)) as a naturally occurring marker. The Dm of ex situ manatees determined using [Mn(2+)] did not differ significantly from the Dm assessed using lignin, supporting the efficacy of the manganese approach. Gastrointestinal tract samples, obtained from recently dead animals, showed [Mn(2+)] concentrations were lowest in the stomach and remained low in the duodenum and small intestine but increased in the cecum, colon, and rectum, consistent with colonic digestion and absorption. In situ manatees consuming marine vegetation had significantly lower Dm (mean ± SE, 46.9% ± 1.8%; n=8) than did in situ manatees consuming freshwater vegetation (77.8% ± 2.6%; n=7), which in turn had significantly lower values than did ex situ manatees consuming lettuce (84.0% ± 0.7%; n=37). In situ manatees eating seagrasses had significantly higher Dm than did long-term ex situ animals consuming seagrass for short periods of time (46.9% ± 1.8% vs. 36.2% ± 1.2%, respectively), suggesting potential modification of gut flora over time. One significant ramification of our results is that manatees consuming seagrasses would require a greater standing biomass to support their needs than would be required if they were eating freshwater vegetation. This reinforces the critical need to implement habitat conservation and protection before considering downlisting or delisting manatees as an endangered species.

So much to do, so little time. To accomplish the mandatory initiatives of ARRA, healthcare organizations will require significant and thoughtful planning, prioritization and execution.

PubMed

Klein, Kimberly

2010-01-01

The American Recovery and Reinvestment Act of 2009 (ARRA) has set forth legislation for the healthcare community to achieve adoption of electronic health records (EHR), as well as form data standards, health information exchanges (HIE) and compliance with more stringent security and privacy controls under the HITECH Act. While the Office of the National Coordinator for Health Information Technology (ONCHIT) works on the definition of both "meaningful use" and "certification" of information technology systems, providers in particular must move forward with their IT initiatives to achieve the basic requirements for Medicare and Medicaid incentives starting in 2011, and avoid penalties that will reduce reimbursement beginning in 2015. In addition, providers, payors, government and non-government stakeholders will all have to balance the implementation of EHRs, working with HIEs, at the same time that they must upgrade their systems to be in compliance with ICD-10 and HIPAA 5010 code sets. Compliance deadlines for EHRs and HIEs begin in 2011, while ICD-10 diagnosis and procedure code sets compliance is required by October 2013 and HIPAA 5010 transaction sets, with one exception, is required by January 1, 2012. In order to accomplish these strategic and mandatory initiatives successfully and simultaneously, healthcare organizations will require significant and thoughtful planning, prioritization and execution.

Design of point-of-care (POC) microfluidic medical diagnostic devices

NASA Astrophysics Data System (ADS)

Leary, James F.

2018-02-01

Design of inexpensive and portable hand-held microfluidic flow/image cytometry devices for initial medical diagnostics at the point of initial patient contact by emergency medical personnel in the field requires careful design in terms of power/weight requirements to allow for realistic portability as a hand-held, point-of-care medical diagnostics device. True portability also requires small micro-pumps for high-throughput capability. Weight/power requirements dictate use of super-bright LEDs and very small silicon photodiodes or nanophotonic sensors that can be powered by batteries. Signal-to-noise characteristics can be greatly improved by appropriately pulsing the LED excitation sources and sampling and subtracting noise in between excitation pulses. The requirements for basic computing, imaging, GPS and basic telecommunications can be simultaneously met by use of smartphone technologies, which become part of the overall device. Software for a user-interface system, limited real-time computing, real-time imaging, and offline data analysis can be accomplished through multi-platform software development systems that are well-suited to a variety of currently available cellphone technologies which already contain all of these capabilities. Microfluidic cytometry requires judicious use of small sample volumes and appropriate statistical sampling by microfluidic cytometry or imaging for adequate statistical significance to permit real-time (typically < 15 minutes) medical decisions for patients at the physician's office or real-time decision making in the field. One or two drops of blood obtained by pin-prick should be able to provide statistically meaningful results for use in making real-time medical decisions without the need for blood fractionation, which is not realistic in the field.

Temporal characteristics of imagined and actual walking in frail older adults.

PubMed

Nakano, Hideki; Murata, Shin; Shiraiwa, Kayoko; Iwase, Hiroaki; Kodama, Takayuki

2018-05-09

Mental chronometry, commonly used to evaluate motor imagery ability, measures the imagined time required for movements. Previous studies investigating mental chronometry of walking have investigated healthy older adults. However, mental chronometry in frail older adults has not yet been clarified. To investigate temporal characteristics of imagined and actual walking in frail older adults. We investigated the time required for imagined and actual walking along three walkways of different widths [width(s): 50, 25, 15 cm × length: 5 m] in 29 frail older adults and 20 young adults. Imagined walking was measured with mental chronometry. We observed significantly longer imagined and actual walking times along walkways of 50, 25, and 15 cm width in frail older adults compared with young adults. Moreover, temporal differences (absolute error) between imagined and actual walking were significantly greater in frail older adults than in young adults along walkways with a width of 25 and 15 cm. Furthermore, we observed significant differences in temporal differences (constant error) between frail older adults and young adults for walkways with a width of 25 and 15 cm. Frail older adults tended to underestimate actual walking time in imagined walking trials. Our results suggest that walkways of different widths may be a useful tool to evaluate age-related changes in imagined and actual walking in frail older adults.

Evaluation of a novel algorithm for primary mass casualty triage by paramedics in a physician manned EMS system: a dummy based trial

PubMed Central

2014-01-01

Background The Amberg-Schwandorf Algorithm for Primary Triage (ASAV) is a novel primary triage concept specifically for physician manned emergency medical services (EMS) systems. In this study, we determined the diagnostic reliability and the time requirements of ASAV triage. Methods Seven hundred eighty triage runs performed by 76 trained EMS providers of varying professional qualification were included into the study. Patients were simulated using human dummies with written vital signs sheets. Triage results were compared to a standard solution, which was developed in a modified Delphi procedure. Test performance parameters (e.g. sensitivity, specificity, likelihood ratios (LR), under-triage, and over-triage) were calculated. Time measurements comprised the complete triage and tagging process and included the time span for walking to the subsequent patient. Results were compared to those published for mSTaRT. Additionally, a subgroup analysis was performed for employment status (career/volunteer), team qualification, and previous triage training. Results For red patients, ASAV sensitivity was 87%, specificity 91%, positive LR 9.7, negative LR 0.139, over-triage 6%, and under-triage 10%. There were no significant differences related to mSTaRT. Per patient, ASAV triage required a mean of 35.4 sec (75th percentile 46 sec, 90th percentile 58 sec). Volunteers needed slightly more time to perform triage than EMS professionals. Previous mSTaRT training of the provider reduced under-triage significantly. There were significant differences in time requirements for triage depending on the expected triage category. Conclusions The ASAV is a specific concept for primary triage in physician governed EMS systems. It may detect red patients reliably. The test performance criteria are comparable to that of mSTaRT, whereas ASAV triage might be accomplished slightly faster. From the data, there was no evidence for a clinically significant reliability difference between typical staffing of mobile intensive care units, patient transport ambulances, or disaster response volunteers. Up to now, there is no clinical validation of either triage concept. Therefore, reality based evaluation studies are needed. PMID:25214310

Sprint training shortens prolonged action potential duration in postinfarction rat myocyte: mechanisms.

PubMed

Zhang, X Q; Zhang, L Q; Palmer, B M; Ng, Y C; Musch, T I; Moore, R L; Cheung, J Y

2001-05-01

Two electrophysiological manifestations of myocardial infarction (MI)-induced myocyte hypertrophy are prolongation of action potential duration (APD) and reduction of transient outward current (I(to)) density. Because high-intensity sprint training (HIST) ameliorated myocyte hypertrophy and improved myocyte Ca(2+) homeostasis and contractility after MI, the present study evaluated whether 6-8 wk of HIST would shorten the prolonged APD and improve the depressed I(to) in post-MI myocytes. There were no differences in resting membrane potential and action potential amplitude (APA) measured in myocytes isolated from sham-sedentary (Sed), MI-Sed, and MI-HIST groups. Times required for repolarization to 50 and 90% APA were significantly (P < 0.001) prolonged in MI-Sed myocytes. HIST reduced times required for repolarization to 50 and 90% APA to values observed in Sham-Sed myocytes. The fast and slow components of I(to) were significantly (P < 0.0001) reduced in MI-Sed myocytes. HIST significantly (P < 0.001) enhanced the fast and slow components of I(to) in MI myocytes, although not to levels observed in Sham-Sed myocytes. There were no significant differences in steady-state I(to) inactivation and activation parameters among Sham-Sed, MI-Sed, and MI-HIST myocytes. Likewise, recovery from time-dependent inactivation was also similar among the three groups. We suggest that normalization of APD after MI by HIST may be mediated by restoration of I(to) toward normal levels.

Respiratory protection during simulated emergency pediatric life support: a randomized, controlled, crossover study.

PubMed

Schumacher, Jan; Gray, Stuart A; Michel, Sophie; Alcock, Roger; Brinker, Andrea

2013-02-01

Emergency pediatric life support (EPLS) of children infected with transmissible respiratory diseases requires adequate respiratory protection for medical first responders. Conventional air-purifying respirators (APR) and modern loose-fitting powered air-purifying respirator-hoods (PAPR-hood) may have a different impact during pediatric resuscitation and therefore require evaluation. This study investigated the influence of APRs and PAPR-hoods during simulated pediatric cardiopulmonary resuscitation. Study design was a randomized, controlled, crossover study. Sixteen paramedics carried out a standardized EPLS scenario inside an ambulance, either unprotected (control) or wearing a conventional APR or a PAPR-hood. Treatment times and wearer comfort were determined and compared. All paramedics completed the treatment objectives of the study arms without adverse events. Study subjects reported that communication, dexterity and mobility were significantly better in the APR group, whereas the heat-build-up was significantly less in the PAPR-hood group. Treatment times compared to the control group did not significantly differ for the APR group but did with the PAPR-hood group (261±12 seconds for the controls, 275±9 seconds for the conventional APR and 286±13 seconds for the PAPR-hood group, P < .05. APRs showed a trend to better treatment times compared to PAPR-hoods during simulated pediatric cardiopulmonary resuscitation. Study participants rated mobility, ease of communication and dexterity with the tight-fitting APR system significantly better compared to the loose-fitting PAPR-hood.

The use of three-dimensional ultrasound does not improve training in fetal biometric measurements.

PubMed

Chan, Lin W; Ting, Yuen H; Lao, Terence T; Chau, Macy M C; Fung, Tak Y; Leung, Tak Y; Sahota, Daljit S; Lau, Tze K

2011-09-01

To investigate whether three-dimensional (3D) technology offers any advantage over two-dimensional (2D) ultrasound in fetal biometric measurement training. Ten midwives with no hands-on experience in ultrasound were randomized to receive training on 2D or 3D ultrasound fetal biometry assessment. Midwives were taught how to obtain fetal biometric measurements (biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC), and femur length (FL)) by a trainer. Subsequently, each midwife measured the parameters on another 10 fetuses. The same set of measurements was repeated by the trainer. The percentage deviation between the midwives' and the trainer's measurements was determined and compared between training groups. Time required for completion was recorded. Frozen images were reviewed by another sonographer to assess the image quality using a standardized scoring system. The median time for the complete set of measurements was significantly shorter in the 2D than in 3D group (13.4 min versus 17.8 min, P = 0.03). The mean percentage deviations did not reach statistical significance between the two groups except for FL (3.83% in 2D group versus 2.23% in 3D group (P = 0.046)). There were no significant differences in the quality scores. This study showed that the only demonstrable advantage of 3D ultrasound was a slightly more accurate measurement of FL, at the expense of a significantly longer time required.

An Obstacle Alerting System for Agricultural Application

NASA Technical Reports Server (NTRS)

DeMaio, Joe

2003-01-01

Wire strikes are a significant cause of helicopter accidents. The aircraft most at risk are aerial applicators. The present study examines the effectiveness of a wire alert delivered by way of the lightbar, a GPS-based guidance system for aerial application. The alert lead-time needed to avoid an invisible wire is compared with that to avoid a visible wire. A flight simulator was configured to simulate an agricultural application helicopter. Two pilots flew simulated spray runs in fields with visible wires, invisible wires, and no wires. The wire alert was effective in reducing wire strikes. A lead-time of 3.5 sec was required for the alert to be effective. The lead- time required was the same whether the pilot could see the wire or not.

Does unilateral hip flexion increase the spinal anaesthetic level during combined spinal–epidural technique?

PubMed Central

Mohta, Medha; Agarwal, Deepti; Sethi, AK

2011-01-01

Needle-through-needle combined spinal–epidural (CSE) may cause significant delay in patient positioning resulting in settling down of spinal anaesthetic and unacceptably low block level. Bilateral hip flexion has been shown to extend the spinal block by flattening lumbar lordosis. However, patients with lower limb fractures cannot flex their injured limb. This study was conducted to find out if unilateral hip flexion could extend the level of spinal anaesthesia following a prolonged CSE technique. Fifty American Society of Anesthesiologists (ASA) I/II males with unilateral femur fracture were randomly allocated to Control or Flexion groups. Needle-through-needle CSE was performed in the sitting position at L2-3 interspace and 2.6 ml 0.5% hyperbaric bupivacaine injected intrathecally. Patients were made supine 4 min after the spinal injection or later if epidural placement took longer. The Control group patients (n=25) lay supine with legs straight, whereas the Flexion group patients (n=25) had their uninjured hip and knee flexed for 5 min. Levels of sensory and motor blocks and time to epidural drug requirement were recorded. There was no significant difference in sensory levels at different time-points; maximum sensory and motor blocks; times to achieve maximum blocks; and time to epidural drug requirement in two groups. However, four patients in the Control group in contrast to none in the Flexion group required epidural drug before start of surgery. Moreover, in the Control group four patients took longer than 30 min to achieve maximum sensory block. To conclude, unilateral hip flexion did not extend the spinal anaesthetic level; however, further studies are required to explore the potential benefits of this technique. PMID:21808396

Temporal binning of time-correlated single photon counting data improves exponential decay fits and imaging speed

PubMed Central

Walsh, Alex J.; Sharick, Joe T.; Skala, Melissa C.; Beier, Hope T.

2016-01-01

Time-correlated single photon counting (TCSPC) enables acquisition of fluorescence lifetime decays with high temporal resolution within the fluorescence decay. However, many thousands of photons per pixel are required for accurate lifetime decay curve representation, instrument response deconvolution, and lifetime estimation, particularly for two-component lifetimes. TCSPC imaging speed is inherently limited due to the single photon per laser pulse nature and low fluorescence event efficiencies (<10%) required to reduce bias towards short lifetimes. Here, simulated fluorescence lifetime decays are analyzed by SPCImage and SLIM Curve software to determine the limiting lifetime parameters and photon requirements of fluorescence lifetime decays that can be accurately fit. Data analysis techniques to improve fitting accuracy for low photon count data were evaluated. Temporal binning of the decays from 256 time bins to 42 time bins significantly (p<0.0001) improved fit accuracy in SPCImage and enabled accurate fits with low photon counts (as low as 700 photons/decay), a 6-fold reduction in required photons and therefore improvement in imaging speed. Additionally, reducing the number of free parameters in the fitting algorithm by fixing the lifetimes to known values significantly reduced the lifetime component error from 27.3% to 3.2% in SPCImage (p<0.0001) and from 50.6% to 4.2% in SLIM Curve (p<0.0001). Analysis of nicotinamide adenine dinucleotide–lactate dehydrogenase (NADH-LDH) solutions confirmed temporal binning of TCSPC data and a reduced number of free parameters improves exponential decay fit accuracy in SPCImage. Altogether, temporal binning (in SPCImage) and reduced free parameters are data analysis techniques that enable accurate lifetime estimation from low photon count data and enable TCSPC imaging speeds up to 6x and 300x faster, respectively, than traditional TCSPC analysis. PMID:27446663

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

Kristine Barrett; Shannon Bragg-Sitton

The Advanced Light Water Reactor (LWR) Nuclear Fuel Development Research and Development (R&D) Pathway encompasses strategic research focused on improving reactor core economics and safety margins through the development of an advanced fuel cladding system. To achieve significant operating improvements while remaining within safety boundaries, significant steps beyond incremental improvements in the current generation of nuclear fuel are required. Fundamental improvements are required in the areas of nuclear fuel composition, cladding integrity, and the fuel/cladding interaction to allow power uprates and increased fuel burn-up allowance while potentially improving safety margin through the adoption of an “accident tolerant” fuel system thatmore » would offer improved coping time under accident scenarios. With a development time of about 20 – 25 years, advanced fuel designs must be started today and proven in current reactors if future reactor designs are to be able to use them with confidence.« less

Accelerating the discovery of space-time patterns of infectious diseases using parallel computing.

PubMed

Hohl, Alexander; Delmelle, Eric; Tang, Wenwu; Casas, Irene

2016-11-01

Infectious diseases have complex transmission cycles, and effective public health responses require the ability to monitor outbreaks in a timely manner. Space-time statistics facilitate the discovery of disease dynamics including rate of spread and seasonal cyclic patterns, but are computationally demanding, especially for datasets of increasing size, diversity and availability. High-performance computing reduces the effort required to identify these patterns, however heterogeneity in the data must be accounted for. We develop an adaptive space-time domain decomposition approach for parallel computation of the space-time kernel density. We apply our methodology to individual reported dengue cases from 2010 to 2011 in the city of Cali, Colombia. The parallel implementation reaches significant speedup compared to sequential counterparts. Density values are visualized in an interactive 3D environment, which facilitates the identification and communication of uneven space-time distribution of disease events. Our framework has the potential to enhance the timely monitoring of infectious diseases. Copyright © 2016 Elsevier Ltd. All rights reserved.

Comparison of Maternal and Neonatal Effects of Combined Spinal Epidural Anaesthesia in Either the Sitting or Lateral Position During Elective Cesarean Section

PubMed Central

Tan, Ece Dumanlar; Günaydın, Berrin

2014-01-01

Objective Our goal was to demonstrate which position would be hemodynamically and technically better by comparing the effects of combined spinal epidural (CSE) in the sitting or lateral decubitus position for elective cesarean deliveries on maternal and neonatal parameters and ephedrine requirement. Methods Sixty parturients were randomly assigned into two groups to perform CSE in the sitting (Group I, n=30) or right lateral decubitus position (Group II, n=30) using hyperbaric 10 mg bupivacaine and 20 μg fentanyl. Mean arterial pressure (MAP), heart rate (HR), and characteristics of sensory and motor block were recorded from intrathecal drug administration until the end of surgery. Ephedrine and 1st analgesic requirement, number of attempts to perform CSE, incidence of paresthesia during spinal needle insertion, and Apgar scores were recorded. Results Ephedrine requirements and HR changes were similar in both groups. However, MAP values at 45 min in Group II were significantly less than in Group I. Maximum sensory block levels in Group II were significantly higher than in Group I. Despite similar motor block recovery times in both groups, regression times of sensory block and 1st analgesic requirement in Group II were significantly longer than in Group I. Incidence of paresthesia due to spinal needle (3.3% versus 20% in Groups I and II, respectively) and number of attempts to perform CSE (26.7% versus 60% in Groups I and II, respectively) were significantly higher in Group II. Apgar scores were similar in both groups. Conclusion Performing CSE in the sitting position would be safer and easier because higher and earlier onset of sensory block, and a greater number attempts at epidural insertion and paresthesia develop to spinal needle insertion in the right lateral position. PMID:27366384

A prospective comparison between auto-registration and manual registration of real-time ultrasound with MR images for percutaneous ablation or biopsy of hepatic lesions.

PubMed

Cha, Dong Ik; Lee, Min Woo; Song, Kyoung Doo; Oh, Young-Taek; Jeong, Ja-Yeon; Chang, Jung-Woo; Ryu, Jiwon; Lee, Kyong Joon; Kim, Jaeil; Bang, Won-Chul; Shin, Dong Kuk; Choi, Sung Jin; Koh, Dalkwon; Seo, Bong Koo; Kim, Kyunga

2017-06-01

To compare the accuracy and required time for image fusion of real-time ultrasound (US) with pre-procedural magnetic resonance (MR) images between positioning auto-registration and manual registration for percutaneous radiofrequency ablation or biopsy of hepatic lesions. This prospective study was approved by the institutional review board, and all patients gave written informed consent. Twenty-two patients (male/female, n = 18/n = 4; age, 61.0 ± 7.7 years) who were referred for planning US to assess the feasibility of radiofrequency ablation (n = 21) or biopsy (n = 1) for focal hepatic lesions were included. One experienced radiologist performed the two types of image fusion methods in each patient. The performance of auto-registration and manual registration was evaluated. The accuracy of the two methods, based on measuring registration error, and the time required for image fusion for both methods were recorded using in-house software and respectively compared using the Wilcoxon signed rank test. Image fusion was successful in all patients. The registration error was not significantly different between the two methods (auto-registration: median, 3.75 mm; range, 1.0-15.8 mm vs. manual registration: median, 2.95 mm; range, 1.2-12.5 mm, p = 0.242). The time required for image fusion was significantly shorter with auto-registration than with manual registration (median, 28.5 s; range, 18-47 s, vs. median, 36.5 s; range, 14-105 s, p = 0.026). Positioning auto-registration showed promising results compared with manual registration, with similar accuracy and even shorter registration time.

Comparison of ultrasonic shears and traditional suture ligature for vaginal hysterectomy: randomized controlled trial.

PubMed

Fitz-Gerald, Alison Louise; Tan, Jason; Chan, Kok-Weng; Polyakov, Alex; Edwards, Geoff N; Najjar, Haider; Tsaltas, Jim; Vollenhoven, Beverley

2013-01-01

To compare operating time, intraoperative blood loss, postoperative analgesia, and length of hospital stay using ultrasonic shears vs traditional suture ligature in vaginal hysterectomy. Randomized controlled trial (Canadian Task Force classification I). Gynecology units within a single health network, university hospital. Forty women requiring vaginal hysterectomy because of benign disease. Vaginal hysterectomy performed using either ultrasonically activated shears (USS) or traditional suture ligatures. Twenty-one patients were randomized to the USS arm, and 19 patients to the traditional suture ligature arm. Patient characteristics were comparable. Mean (SD) hysterectomy time and was similar in both the USS and traditional arms, 28.66 (4.0) minutes vs 32.37 (3.18) minutes (p = .47), as was total operating time, 97.38 (8.9) minutes vs 91.63 (7.69) minutes (p = .63). Operative blood loss was significantly decreased in the USS group: 62.63 (12.46) mL vs 136.05 (21.54) mL (p = .006). There was, however, no significant change in hemoglobin concentration between the 2 groups: 19.53 (1.79) g/L vs -16.72 (2.5) g/L. There was no significant difference in mean oxycodone use: 9.29 (2.66) mg vs 8.06 (3.19) mg (p = .77). Length of hospital stay was similar in both groups: 58.98 (3.27) hours vs 60.05 (6.48) hours (p = .88). There was no significant difference in overall complication rates between the groups. Although the Harmonic scalpel system, compared with the traditional suture ligation method, seems to be a safe alternative for securing the pedicles in vaginal hysterectomy, it offers no benefit insofar as operative time, reduction in clinically significant blood loss, and analgesic requirements. Copyright © 2013 AAGL. Published by Elsevier Inc. All rights reserved.

Automatic image fusion of real-time ultrasound with computed tomography images: a prospective comparison between two auto-registration methods.

PubMed

Cha, Dong Ik; Lee, Min Woo; Kim, Ah Yeong; Kang, Tae Wook; Oh, Young-Taek; Jeong, Ja-Yeon; Chang, Jung-Woo; Ryu, Jiwon; Lee, Kyong Joon; Kim, Jaeil; Bang, Won-Chul; Shin, Dong Kuk; Choi, Sung Jin; Koh, Dalkwon; Seo, Bong Koo; Kim, Kyunga

2017-11-01

Background A major drawback of conventional manual image fusion is that the process may be complex, especially for less-experienced operators. Recently, two automatic image fusion techniques called Positioning and Sweeping auto-registration have been developed. Purpose To compare the accuracy and required time for image fusion of real-time ultrasonography (US) and computed tomography (CT) images between Positioning and Sweeping auto-registration. Material and Methods Eighteen consecutive patients referred for planning US for radiofrequency ablation or biopsy for focal hepatic lesions were enrolled. Image fusion using both auto-registration methods was performed for each patient. Registration error, time required for image fusion, and number of point locks used were compared using the Wilcoxon signed rank test. Results Image fusion was successful in all patients. Positioning auto-registration was significantly faster than Sweeping auto-registration for both initial (median, 11 s [range, 3-16 s] vs. 32 s [range, 21-38 s]; P < 0.001] and complete (median, 34.0 s [range, 26-66 s] vs. 47.5 s [range, 32-90]; P = 0.001] image fusion. Registration error of Positioning auto-registration was significantly higher for initial image fusion (median, 38.8 mm [range, 16.0-84.6 mm] vs. 18.2 mm [6.7-73.4 mm]; P = 0.029), but not for complete image fusion (median, 4.75 mm [range, 1.7-9.9 mm] vs. 5.8 mm [range, 2.0-13.0 mm]; P = 0.338]. Number of point locks required to refine the initially fused images was significantly higher with Positioning auto-registration (median, 2 [range, 2-3] vs. 1 [range, 1-2]; P = 0.012]. Conclusion Positioning auto-registration offers faster image fusion between real-time US and pre-procedural CT images than Sweeping auto-registration. The final registration error is similar between the two methods.

Formulation of a dynamic analysis method for a generic family of hoop-mast antenna systems

NASA Technical Reports Server (NTRS)

Gabriele, A.; Loewy, R.

1981-01-01

Analytical studies of mast-cable-hoop-membrane type antennas were conducted using a transfer matrix numerical analysis approach. This method, by virtue of its specialization and the inherently easy compartmentalization of the formulation and numerical procedures, can be significantly more efficient in computer time required and in the time needed to review and interpret the results.

12 CFR 220.118 - Time of payment for mutual fund shares purchased in a special cash account.

Code of Federal Regulations, 2014 CFR

2014-01-01

... be delayed until after such date of issue, subject to other basic conditions for transactions in a..., the “payment date”. In any case, the time required for the mechanics of transfer and delivery of a... mechanics of their issuance and of the delivery of certificates are not significantly different from the...

12 CFR 220.118 - Time of payment for mutual fund shares purchased in a special cash account.

Code of Federal Regulations, 2012 CFR

2012-01-01

... be delayed until after such date of issue, subject to other basic conditions for transactions in a..., the “payment date”. In any case, the time required for the mechanics of transfer and delivery of a... mechanics of their issuance and of the delivery of certificates are not significantly different from the...

12 CFR 220.118 - Time of payment for mutual fund shares purchased in a special cash account.

Code of Federal Regulations, 2013 CFR

2013-01-01

... be delayed until after such date of issue, subject to other basic conditions for transactions in a..., the “payment date”. In any case, the time required for the mechanics of transfer and delivery of a... mechanics of their issuance and of the delivery of certificates are not significantly different from the...

Institutional management of core facilities during challenging financial times.

PubMed

Haley, Rand

2011-12-01

The economic downturn is likely to have lasting effects on institutions of higher education, prioritizing proactive institutional leadership and planning. Although by design, core research facilities are more efficient and effective than supporting individual pieces of research equipment, cores can have significant underlying financial requirements and challenges. This paper explores several possible institutional approaches to managing core facilities during challenging financial times.

Nuclear Hardness Evaluation Procedures for the Preliminary Assessment of the FLEETSATCOM Attitude and Velocity Control Subsystem.

DTIC Science & Technology

1979-12-01

processing holding register upset times. Therefore reaction wh these transient response times will not significantly affect pointing of SS7 -20 a error...change so that the requirements of SS7 -20 are not met. Command Logic and Power Switching I Transients whall not cause mode changes to occur in the CEA

The Impact of a Classroom-Based Guidance Program on Student Performance in Community College Math Classes

ERIC Educational Resources Information Center

Butcher, Kristin F.; Visher, Mary G.

2013-01-01

Passing through remedial and required math classes poses a significant barrier to success for many community college students. This study uses random assignment to investigate the impact of a "light-touch" intervention, where an individual visited math classes a few times during the semester, for a few minutes each time, to inform…

Radio-frequency tracking of respiratory equipment: rationale and early experience at the Cleveland Clinic.

PubMed

Stoller, James K; Roberts, Vincent; Matt, David; Chom, Leslie; Sasidhar, Madhu; Chatburn, Robert L

2013-12-01

When respiratory therapists (RTs) seek respiratory care equipment, finding it quickly is desirable, both to expedite patient care and to avert RTs wasting time. To optimize RTs' ability to quickly locate ventilators, we developed and implemented a radio-frequency identification (RFID) tagging system called eTrak. The Clinical Engineering and Information Technology groups at Cleveland Clinic collaboratively developed a Wi-Fi-based RFID program that used active RFID tags. Altogether, 218 ventilators, 82 noninvasive ventilators, and various non-respiratory equipment were tagged, beginning in March 2010. We calculated the difference in time required to locate equipment before versus after implementation. The eTrak system had a mean 145 log-ons per week over the first year of use, and was associated with a decreased time required for RTs to locate ventilators: median 18 min (range 1-45 min) versus 3 min (range 1-6 min) (P < .001). Surveys of RTs regarding whether equipment was hard to find before versus after implementing eTrak showed a non-significant trend toward improvement. An RFID tracking system for respiratory equipment shortened the time to locate ventilators and non-significantly improved RT satisfaction with finding equipment. RFID tagging of equipment warrants further investigation.

MyD88-dependent recruitment of monocytes and dendritic cells required for protection from pulmonary Burkholderia mallei infection.

PubMed

Goodyear, Andrew; Troyer, Ryan; Bielefeldt-Ohmann, Helle; Dow, Steven

2012-01-01

The Gram-negative bacterium Burkholderia mallei causes rapidly fatal illness in equines and humans when contracted by inhalation and also has the potential to be used as a bioweapon. However, little is known regarding the early innate immune responses and signaling mechanisms required to generate protection from pneumonic B. mallei infection. We showed previously that monocyte chemoattractant protein 1 (MCP-1) was a critical chemokine required for protection from pneumonic B. mallei infection. We have now extended those studies to identify key Toll-like receptor (TLR) signaling pathways, effector cells, and cytokines required for protection from respiratory B. mallei infection. We found that MyD88-/- mice were highly susceptible to pulmonary challenge with B. mallei and had significantly short survival times, increased bacterial burdens, and severe organ pathology compared to wild-type mice. Notably, MyD88-/- mice had significantly fewer monocytes and dendritic cells (DCs) in lung tissues and airways than infected wild-type mice despite markedly higher bacterial burdens. The MyD88-/- mice were also completely unable to produce gamma interferon (IFN-γ) at any time points following infection. In wild-type mice, NK cells were the primary cells producing IFN-γ in the lungs following B. mallei infection, while DCs and monocytes were the primary cellular sources of interleukin-12 (IL-12) production. Treatment with recombinant IFN-γ (rIFN-γ) was able to significantly restore protective immunity in MyD88-/- mice. Thus, we conclude that the MyD88-dependent recruitment of inflammatory monocytes and DCs to the lungs and the local production of IL-12, followed by NK cell production of IFN-γ, are the key initial cellular responses required for early protection from B. mallei infection.

The effect of the learner license Graduated Driver Licensing components on teen drivers' crashes.

PubMed

Ehsani, Johnathon Pouya; Bingham, C Raymond; Shope, Jean T

2013-10-01

Most studies evaluating the effectiveness of Graduated Driver Licensing (GDL) have focused on the overall system. Studies examining individual components have rarely accounted for the confounding of multiple, simultaneously implemented components. The purpose of this paper is to quantify the effects of a required learner license duration and required hours of supervised driving on teen driver fatal crashes. States that introduced a single GDL component independent of any other during the period 1990-2009 were identified. Monthly and quarterly fatal crash rates per 100,000 population of 16- and 17-year-old drivers were analyzed using single-state time series analysis, adjusting for adult crash rates and gasoline prices. Using the parameter estimates from each state's time series model, the pooled effect of each GDL component on 16- and 17-year-old drivers' fatal crashes was estimated using a random effects meta-analytic model to combine findings across states. In three states, a six-month minimum learner license duration was associated with a significant decline in combined 16- and 17-year-old drivers' fatal crash rates. The pooled effect of the minimum learner license duration across all states in the sample was associated with a significant change in combined 16- and 17-year-old driver fatal crash rates of -.07 (95% Confidence Interval [CI] -.11, -.03). Following the introduction of 30 h of required supervised driving in one state, novice drivers' fatal crash rates increased 35%. The pooled effect across all states in the study sample of having a supervised driving hour requirement was not significantly different from zero (.04, 95% CI -.15, .22). These findings suggest that a learner license duration of at least six-months may be necessary to achieve a significant decline in teen drivers' fatal crash rates. Evidence of the effect of required hours of supervised driving on teen drivers' fatal crash rates was mixed. Copyright © 2013 Elsevier Ltd. All rights reserved.

Effect of nabumetone and aspirin on colonic mucosal bleeding time.

PubMed

Basson, M D; Panzini, L; Palmer, R H

2001-04-01

The management of patients taking aspirin or non-steroidal anti-inflammatory drugs (NSAIDs) who require colonoscopy remains controversial because of concerns over bleeding after biopsy or polypectomy. To determine whether patients using the NSAID nabumetone, a non-acidic prodrug with mixed activity against cyclooxygenase-1 (COX-1) and COX-2, exhibited prolonged mucosal bleeding times and how this might compare with mucosal bleeding times in patients using aspirin. We assessed triplicate mucosal bleeding times in patients undergoing screening flexible sigmoidoscopy. We compared 90 patients who had taken no aspirin or NSAIDs within the previous 2 weeks, to 60 patients who had received nabumetone 1 g b.d. by mouth for the previous 2 weeks, and 30 patients who had taken 325 mg aspirin daily for the previous 2 weeks. In each case, the investigator performing the study was blinded to the patient's medication. Mucosal bleeding times did not differ significantly among control or nabumetone-using patients. However, the patients receiving aspirin exhibited significant prolongation. Mucosal bleeding time correlated statistically significantly, but weakly, with skin bleeding time. Nabumetone does not appear to prolong mucosal bleeding time after mucosal pinch biopsy, and skin bleeding time does not reliably screen for prolonged mucosal bleeding time.

Improving efficiency and decreasing scanning time of sonographic examination of the shoulder by using a poster illustrating proper shoulder positioning to the patient.

PubMed

Shah, Amit; Amin, Maslah; Srinivasan, Sriram; Botchu, Rajesh

2015-09-01

Patients often have difficulty performing the various movements required for ideal positioning to enable accurate sonographic (US) assessment of the shoulder; this may result from pain and or unclear oral instructions. We performed this study to ascertain whether the use of a poster depicting the positions required during the examination would decrease scanning time and hence improve the overall efficiency of shoulder US. We retrospectively compared results from 50 consecutive patients who underwent US examination without (group 1) and 50 with (group 2) the use of an illustrative poster produced by the European Society of Musculoskeletal Radiology. The difference in mean scanning time between the two groups was analyzed with Student's two-tailed t test. There was a statistically significant difference in scanning time between the two groups (group 1: 3 minutes and 5 seconds versus group 2: 2 minutes and 9 seconds; p < 0.0001). The patients in group 2, especially those who had hearing difficulty, found the poster useful. The use of a poster illustrating positioning of the shoulder during an US examination is an effective way to improve patient compliance and significantly decreases scanning time. © 2014 Wiley Periodicals, Inc.

Quantification of reaction time and time perception during Space Shuttle operations

NASA Technical Reports Server (NTRS)

Ratino, D. A.; Repperger, D. W.; Goodyear, C.; Potor, G.; Rodriguez, L. E.

1988-01-01

A microprocessor-based test battery containing simple reaction time, choice reaction time, and time perception tasks was flown aboard a 1985 Space Shuttle flight. Data were obtained from four crew members. Individual subject means indicate a correlation between change in reaction time during the flight and the presence of space motion sickness symptoms. The time perception task results indicate that the shortest duration task time (2 s) is progressively overestimated as the mission proceeds and is statistically significant when comparing preflight and postflight baselines. The tasks that required longer periods of time to estimate (8, 12, and 16 s) are less affected.

A web platform for integrated surface water - groundwater modeling and data management

NASA Astrophysics Data System (ADS)

Fatkhutdinov, Aybulat; Stefan, Catalin; Junghanns, Ralf

2016-04-01

Model-based decision support systems are considered to be reliable and time-efficient tools for resources management in various hydrology related fields. However, searching and acquisition of the required data, preparation of the data sets for simulations as well as post-processing, visualization and publishing of the simulations results often requires significantly more work and time than performing the modeling itself. The purpose of the developed software is to combine data storage facilities, data processing instruments and modeling tools in a single platform which potentially can reduce time required for performing simulations, hence decision making. The system is developed within the INOWAS (Innovative Web Based Decision Support System for Water Sustainability under a Changing Climate) project. The platform integrates spatially distributed catchment scale rainfall - runoff, infiltration and groundwater flow models with data storage, processing and visualization tools. The concept is implemented in a form of a web-GIS application and is build based on free and open source components, including the PostgreSQL database management system, Python programming language for modeling purposes, Mapserver for visualization and publishing the data, Openlayers for building the user interface and others. Configuration of the system allows performing data input, storage, pre- and post-processing and visualization in a single not disturbed workflow. In addition, realization of the decision support system in the form of a web service provides an opportunity to easily retrieve and share data sets as well as results of simulations over the internet, which gives significant advantages for collaborative work on the projects and is able to significantly increase usability of the decision support system.

Comparison of Accuracy and Speed of Information Identification by Nonpathologists in Synoptic Reports With Different Formats.

PubMed

Renshaw, Andrew A; Gould, Edwin W

2017-03-01

- The College of American Pathologists requires synoptic reports for specific types of pathology reports. - To compare the accuracy and speed of information retrieval in synoptic reports of different formats. - We assessed the performance of 28 nonpathologists from 4 different types of users (cancer registrars, MDs, medical non-MDs, and nonmedical) at identifying specific information in various formatted synoptic reports, using a computerized quiz that measured both accuracy and speed. - There was no significant difference in the accuracy of data identification for any user group or in any format. While there were significant differences in raw time between users, these were eliminated when normalized times were used. Compared with the standard format of a required data element (RDE) and response on 1 line, both a list of responses without an RDE (21%, P < .001) and a paired response with more concise text (33%, P < .001) were significantly faster. In contrast, both the 2-line format (RDE header on one line, response indented on the second line) (12%, P < .001) and a report with the RDE response pairs in a random order were significantly slower (16%, P < .001). - There are significant differences in ease of use by nonpathologists between different synoptic report formats. Such information may be useful in deciding between different format options.

On the Finite Element Implementation of the Generalized Method of Cells Micromechanics Constitutive Model

NASA Technical Reports Server (NTRS)

Wilt, T. E.

1995-01-01

The Generalized Method of Cells (GMC), a micromechanics based constitutive model, is implemented into the finite element code MARC using the user subroutine HYPELA. Comparisons in terms of transverse deformation response, micro stress and strain distributions, and required CPU time are presented for GMC and finite element models of fiber/matrix unit cell. GMC is shown to provide comparable predictions of the composite behavior and requires significantly less CPU time as compared to a finite element analysis of the unit cell. Details as to the organization of the HYPELA code are provided with the actual HYPELA code included in the appendix.

A randomised control study comparing the Infant Flow Driver with nasal continuous positive airway pressure in preterm infants.

PubMed

Mazzella, M; Bellini, C; Calevo, M G; Campone, F; Massocco, D; Mezzano, P; Zullino, E; Scopesi, F; Arioni, C; Bonacci, W; Serra, G

2001-09-01

To compare the effectiveness of the Infant Flow Driver (IFD) with single prong nasal continuous positive airway pressure (nCPAP) in preterm neonates affected by respiratory distress syndrome. Randomised controlled study. Between September 1997 and March 1999, 36 preterm infants who were eligible for CPAP treatment were randomly selected for either nCPAP or IFD and studied prospectively for changes in oxygen requirement and/or respiratory rate. The requirement for mechanical ventilation, complications of treatment, and effects on mid-term outcome were also evaluated. Use of the IFD had a significantly beneficial effect on both oxygen requirement and respiratory rate (p < 0.0001) when compared with nCPAP. Moreover, O(2) requirement and respiratory rate were significantly decreased by four hours (p < 0.001 and p < 0.03 respectively). The probability of remaining supplementary oxygen free over the first 48 hours of treatment was significantly higher in patients treated with the IFD than with nCPAP (p < 0.02). IFD treated patients had a higher success (weaning) rate (94% v 72 %) and shorter duration of treatment (49.3 (31) v 56 (29.7) hours respectively; mean (SD)), although the difference was not significant. IFD appears to be a feasible device for managing respiratory distress syndrome in preterm infants, and benefits may be had with regard to oxygen requirement and respiratory rate when compared with nCPAP. The trend towards reduced requirement for mechanical ventilation, shorter clinical recovery time, and shorter duration of treatment requires further evaluation in a multicentre randomised clinical trial.

Advances in Digital Calibration Techniques Enabling Real-Time Beamforming SweepSAR Architectures

NASA Technical Reports Server (NTRS)

Hoffman, James P.; Perkovic, Dragana; Ghaemi, Hirad; Horst, Stephen; Shaffer, Scott; Veilleux, Louise

2013-01-01

Real-time digital beamforming, combined with lightweight, large aperture reflectors, enable SweepSAR architectures, which promise significant increases in instrument capability for solid earth and biomass remote sensing. These new instrument concepts require new methods for calibrating the multiple channels, which are combined on-board, in real-time. The benefit of this effort is that it enables a new class of lightweight radar architecture, Digital Beamforming with SweepSAR, providing significantly larger swath coverage than conventional SAR architectures for reduced mass and cost. This paper will review the on-going development of the digital calibration architecture for digital beamforming radar instrument, such as the proposed Earth Radar Mission's DESDynI (Deformation, Ecosystem Structure, and Dynamics of Ice) instrument. This proposed instrument's baseline design employs SweepSAR digital beamforming and requires digital calibration. We will review the overall concepts and status of the system architecture, algorithm development, and the digital calibration testbed currently being developed. We will present results from a preliminary hardware demonstration. We will also discuss the challenges and opportunities specific to this novel architecture.

Interspecific competition between Solenopsis invicta and two native ant species, Pheidole fervens and Monomorium chinense.

PubMed

Chen, Yin-Cheng; Kafle, Lekhnath; Shih, Cheng-Jen

2011-04-01

This study was designed to understand the effects of the interspecific competition between red imported fire ant, Solenopsis invicta Buren and two native ant species, Pheidole fervens Smith and Monomorium chinense Santschi, by conducting colony interference and individual confrontation tests under laboratory conditions. The colony interference test showed that both native ant species, owing to their numerical advantage, killed the Solenopsis invicta virus-1 (SINV-1)-infected or healthy queens of S. invicta. Significantly less time was required for M. chinense to kill all SINV-1-infected S. invicta compared with the time required to kill the healthy S. invicta. Compared with healthy S. invicta, SINV-1-infected S. invicta spent a longer time eliminating the P. fervens colonies. In confrontation tests, M. chinense killed a significantly higher number of infected S. invicta minors than they did healthy minors, but the number of S. invicta majors (either infected or healthy) killed was substantially less. This study found that the viral infection weakened the competitive ability of S. invicta and made them prone to be eliminated by M. chinense but not by P. fervens.

Laparoendoscopic single-site surgery varicocelectomy versus conventional laparoscopic varicocele ligation: A meta-analysis

PubMed Central

Li, Mingchao; Wang, Zhengyun

2016-01-01

Objective To perform a meta-analysis of data from available published studies comparing laparoendoscopic single-site surgery varicocelectomy (LESSV) with conventional transperitoneal laparoscopic varicocele ligation. Methods A comprehensive data search was performed in PubMed and Embase to identify randomized controlled trials and comparative studies that compared the two surgical approaches for the treatment of varicoceles. Results Six studies were included in the meta-analysis. LESSV required a significantly longer operative time than conventional laparoscopic varicocelectomy but was associated with significantly less postoperative pain at 6 h and 24 h, a shorter recovery time and greater patient satisfaction with the cosmetic outcome. There was no difference between the two surgical approaches in terms of postoperative semen quality or the incidence of complications. Conclusion These data suggest that LESSV offers a well tolerated and efficient alternative to conventional laparoscopic varicocelectomy, with less pain, a shorter recovery time and better cosmetic satisfaction. Further well-designed studies are required to confirm these findings and update the results of this meta-analysis. PMID:27688686

System analysis for technology transfer readiness assessment of horticultural postharvest

NASA Astrophysics Data System (ADS)

Hayuningtyas, M.; Djatna, T.

2018-04-01

Availability of postharvest technology is becoming abundant, but only a few technologies are applicable and useful to a wider community purposes. Based on this problem it requires a significant readiness level of transfer technology approach. This system is reliable to access readiness a technology with level, from 1-9 and to minimize time of transfer technology in every level, time required technology from the selection process can be minimum. Problem was solved by using Relief method to determine ranking by weighting feasible criteria on postharvest technology in each level and PERT (Program Evaluation Review Technique) to schedule. The results from ranking process of post-harvest technology in the field of horticulture is able to pass level 7. That, technology can be developed to increase into pilot scale and minimize time required for technological readiness on PERT with optimistic time of 7,9 years. Readiness level 9 shows that technology has been tested on the actual conditions also tied with estimated production price compared to competitors. This system can be used to determine readiness of technology innovation that is derived from agricultural raw materials and passes certain stages.

Local sharpening and subspace wavefront correction with predictive dynamic digital holography

NASA Astrophysics Data System (ADS)

Sulaiman, Sennan; Gibson, Steve

2017-09-01

Digital holography holds several advantages over conventional imaging and wavefront sensing, chief among these being significantly fewer and simpler optical components and the retrieval of complex field. Consequently, many imaging and sensing applications including microscopy and optical tweezing have turned to using digital holography. A significant obstacle for digital holography in real-time applications, such as wavefront sensing for high energy laser systems and high speed imaging for target racking, is the fact that digital holography is computationally intensive; it requires iterative virtual wavefront propagation and hill-climbing to optimize some sharpness criteria. It has been shown recently that minimum-variance wavefront prediction can be integrated with digital holography and image sharpening to reduce significantly large number of costly sharpening iterations required to achieve near-optimal wavefront correction. This paper demonstrates further gains in computational efficiency with localized sharpening in conjunction with predictive dynamic digital holography for real-time applications. The method optimizes sharpness of local regions in a detector plane by parallel independent wavefront correction on reduced-dimension subspaces of the complex field in a spectral plane.

Development of a time sensitivity score for frequently occurring motor vehicle crash injuries.

PubMed

Schoell, Samantha L; Doud, Andrea N; Weaver, Ashley A; Talton, Jennifer W; Barnard, Ryan T; Martin, R Shayn; Meredith, J Wayne; Stitzel, Joel D

2015-03-01

Injury severity alone is a poor indicator of the time sensitivity of injuries. The purpose of the study was to quantify the urgency with which the most frequent motor vehicle crash injuries require treatment, according to expert physicians. The time sensitivity was quantified for the top 95% most frequently occurring Abbreviated Injury Scale (AIS) 2+ injuries in the National Automotive Sampling System-Crashworthiness Data System (NASS-CDS) 2000-2011. A Time Sensitivity Score was developed using expert physician survey data in which physicians were asked to determine whether a particular injury should go to a Level I/II trauma center and the urgency with which that injury required treatment. When stratifying by AIS severity, the mean Time Sensitivity Score increased with increasing AIS severity. The mean Time Sensitivity Scores by AIS severity were as follows: 0.50 (AIS 2); 0.78 (AIS 3); 0.92 (AIS 4); 0.97 (AIS 5); and 0.97 (AIS 6). When stratifying by anatomical region, the head, thorax, and abdomen were the most time sensitive. Appropriate triage depends on multiple factors, including the severity of an injury, the urgency with which it requires treatment, and the propensity of a significant injury to be missed. The Time Sensitivity Score did not correlate highly with the widely used AIS severity scores, which highlights the inability of AIS scores to capture all aspects of injury severity. The Time Sensitivity Score can be useful in Advanced Automatic Crash Notification systems for identifying highly time sensitive injuries in motor vehicle crashes requiring prompt treatment at a trauma center. Copyright © 2015 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Research Plan of the Department of Systems Engineering and the Operations Research Center for Academic Year 2007

DTIC Science & Technology

2006-10-01

high probability for success. Estimated Time to Complete: 31 May 2007. 4. Support and Upgrade of Armed Forces-CARES to integrate Chaplin ...Excellence (ORCEN) is to provide a small, full- time analytical capability to both the Academy and the United States Army and the Department of...complete significant research projects in this time as they usually require little train-up as they are exposed to many military and academic

A randomized trial comparing surgeon-administered intraoperative transversus abdominis plane block with anesthesiologist-administered transcutaneous block.

PubMed

Narasimhulu, D M; Scharfman, L; Minkoff, H; George, B; Homel, P; Tyagaraj, K

2018-04-27

Injection of local anesthetic into the transversus abdominis plane (TAP block) decreases systemic morphine requirements after abdominal surgery. We compared intraoperative surgeon-administered TAP block (surgical TAP) to anesthesiologist-administered transcutaneous ultrasound-guided TAP block (conventional TAP) for post-cesarean analgesia. We hypothesized that surgical TAP blocks would take less time to perform than conventional TAP blocks. We performed a randomized trial, recruiting 41 women undergoing cesarean delivery under neuraxial anesthesia, assigning them to either surgical TAP block (n=20) or conventional TAP block (n=21). Time taken to perform the block was the primary outcome, while postoperative pain scores and 24-hour opioid requirements were secondary outcomes. Student's t-test was used to compare block time and Kruskal-Wallis test opioid consumption and pain-scores. Time taken to perform the block (2.4 vs 12.1 min, P <0.001), and time spent in the operating room after delivery (55.3 vs 77.9 min, P <0.001) were significantly less for surgical TAP. The 24 h morphine consumption (P=0.17) and postoperative pain scores at 4, 8, 24 and 48 h were not significantly different between the groups. Surgical TAP blocks are feasible and less time consuming than conventional TAP blocks, while providing comparable analgesia after cesarean delivery. Copyright © 2018 Elsevier Ltd. All rights reserved.

Performance characteristics of a slagging gasifier for MHD combustor systems

NASA Technical Reports Server (NTRS)

Smith, K. O.

1979-01-01

The performance of a two stage, coal combustor concept for magnetohydrodynamic (MHD) systems was investigated analytically. The two stage MHD combustor is comprised of an entrained flow, slagging gasifier as the first stage, and a gas phase reactor as the second stage. The first stage was modeled by assuming instantaneous coal devolatilization, and volatiles combustion and char gasification by CO2 and H2O in plug flow. The second stage combustor was modeled assuming adiabatic instantaneous gas phase reactions. Of primary interest was the dependence of char gasification efficiency on first stage particle residence time. The influence of first stage stoichiometry, heat loss, coal moisture, coal size distribution, and degree of coal devolatilization on gasifier performance and second stage exhaust temperature was determined. Performance predictions indicate that particle residence times on the order of 500 msec would be required to achieve gasification efficiencies in the range of 90 to 95 percent. The use of a finer coal size distribution significantly reduces the required gasifier residence time for acceptable levels of fuel use efficiency. Residence time requirements are also decreased by increased levels of coal devolatilization. Combustor design efforts should maximize devolatilization by minimizing mixing times associated with coal injection.

Apollo 15 time and motion study

NASA Technical Reports Server (NTRS)

Kubis, J. F.; Elrod, J. T.; Rusnak, R.; Barnes, J. E.

1972-01-01

A time and motion study of Apollo 15 lunar surface activity led to examination of four distinct areas of crewmen activity. These areas are: an analysis of lunar mobility, a comparative analysis of tasks performed in 1-g training and lunar EVA, an analysis of the metabolic cost of two activities that are performed in several EVAs, and a fall/near-fall analysis. An analysis of mobility showed that the crewmen used three basic mobility patterns (modified walk, hop, side step) while on the lunar surface. These mobility patterns were utilized as adaptive modes to compensate for the uneven terrain and varied soil conditions that the crewmen encountered. A comparison of the time required to perform tasks at the final 1-g lunar EVA training sessions and the time required to perform the same task on the lunar surface indicates that, in almost all cases, it took significantly more time (on the order of 40%) to perform tasks on the moon. This increased time was observed even after extraneous factors (e.g., hardware difficulties) were factored out.

Totally laparoscopic aortic surgery: comparison of the apron and retrocolic techniques in a porcine model.

PubMed

Huynh, Hai; Elkouri, Stephane; Beaudoin, Nathalie; Bruneau, Luc; Guimond, Cathie; Daniel, Véronique; Blair, Jean-François

2007-01-01

This study evaluated the learning curve for a second-year general surgery resident and compared 2 totally laparoscopic aortic surgery techniques in 10 pigs: the transretroperitoneal apron approach and the transperitoneal retrocolic approach. Five end points were compared: success rate, percentage of conversion, time required, laparoscopic anastomosis quality, and learning curve. The first 3 interventions required an open conversion. The last 7 were done without complications. Mean dissection time was significantly higher with the apron approach compared with the retrocolic approach. The total times for operation, clamping, and arteriotomy time were similar. All laparoscopic anastomoses were patent and without stenosis. The initial learning curve for laparoscopic anastomosis was relatively short for a second-year surgery resident. Both techniques resulted in satisfactory exposure of the aorta and similar mean operative and clamping time. Training on an ex vivo laparoscopic box trainer and on an animal model seems to be complementary to decrease laparoscopic anastomosis completion time.

Rational reduction of periodic propagators for off-period observations.

PubMed

Blanton, Wyndham B; Logan, John W; Pines, Alexander

2004-02-01

Many common solid-state nuclear magnetic resonance problems take advantage of the periodicity of the underlying Hamiltonian to simplify the computation of an observation. Most of the time-domain methods used, however, require the time step between observations to be some integer or reciprocal-integer multiple of the period, thereby restricting the observation bandwidth. Calculations of off-period observations are usually reduced to brute force direct methods resulting in many demanding matrix multiplications. For large spin systems, the matrix multiplication becomes the limiting step. A simple method that can dramatically reduce the number of matrix multiplications required to calculate the time evolution when the observation time step is some rational fraction of the period of the Hamiltonian is presented. The algorithm implements two different optimization routines. One uses pattern matching and additional memory storage, while the other recursively generates the propagators via time shifting. The net result is a significant speed improvement for some types of time-domain calculations.

A double-blind, placebo-controlled randomized clinical trial to evaluate the efficacy of tranexamic acid in irrigant solution on blood loss during percutaneous nephrolithotomy: a pilot study from tertiary care center of North India.

PubMed

Bansal, Ankur; Arora, Aditi

2017-08-01

To evaluate the efficacy and safety of 0.1% tranexamic acid in irrigant fluid in reducing blood loss during PCNL. The study involved 400 patients who were planned for PCNL and were prospectively randomized into two equal groups. In tranexamic group, 0.1% tranexamic acid was given in irrigant fluid, while in placebo group, distilled water was added to irrigant fluid during surgery. Operative data were recorded which included fall in hemoglobin, total blood loss, operative time, irrigation fluid, length of stay in hospital, requirement of blood transfusion, complications related to PCNL and adverse events of tranexamic acid. Baseline parameters were comparable between two groups. The fall in hemoglobin and total blood loss in the tranexamic group was significantly lower than placebo group (1.71 vs. 2.67 gm/dL, 154.55 vs. 212.61 mL, respectively, p < 0.0001). Operative time, amount of irrigation fluid used and hospital stay of tranexamic group were significantly less compared to placebo (p < 0.05). Complete stone clearance rate was 88% in tranexamic group versus 82% in placebo (p = 0.12). The blood transfusion requirement was significantly lower in the tranexamic group versus placebo (5 vs. 12.5%, p = 0.012), as was the complication rate (19 vs. 28%, p = 0.044). The requirement of angioembolization in the tranexamic group was significantly less as compared to placebo (0.5 vs. 4%, p = 0.03). No adverse events related to administration of tranexamic acid were noted. 0.1% tranexamic acid in irrigant fluid is safe and significantly reduces perioperative blood loss and requirement of blood transfusion during percutaneous nephrolithotomy. It is associated with lower perioperative complication rates.

Use of randomised controlled trials for producing cost-effectiveness evidence: potential impact of design choices on sample size and study duration.

PubMed

Backhouse, Martin E

2002-01-01

A number of approaches to conducting economic evaluations could be adopted. However, some decision makers have a preference for wholly stochastic cost-effectiveness analyses, particularly if the sampled data are derived from randomised controlled trials (RCTs). Formal requirements for cost-effectiveness evidence have heightened concerns in the pharmaceutical industry that development costs and times might be increased if formal requirements increase the number, duration or costs of RCTs. Whether this proves to be the case or not will depend upon the timing, nature and extent of the cost-effectiveness evidence required. To illustrate how different requirements for wholly stochastic cost-effectiveness evidence could have a significant impact on two of the major determinants of new drug development costs and times, namely RCT sample size and study duration. Using data collected prospectively in a clinical evaluation, sample sizes were calculated for a number of hypothetical cost-effectiveness study design scenarios. The results were compared with a baseline clinical trial design. The sample sizes required for the cost-effectiveness study scenarios were mostly larger than those for the baseline clinical trial design. Circumstances can be such that a wholly stochastic cost-effectiveness analysis might not be a practical proposition even though its clinical counterpart is. In such situations, alternative research methodologies would be required. For wholly stochastic cost-effectiveness analyses, the importance of prior specification of the different components of study design is emphasised. However, it is doubtful whether all the information necessary for doing this will typically be available when product registration trials are being designed. Formal requirements for wholly stochastic cost-effectiveness evidence based on the standard frequentist paradigm have the potential to increase the size, duration and number of RCTs significantly and hence the costs and timelines associated with new product development. Moreover, it is possible to envisage situations where such an approach would be impossible to adopt. Clearly, further research is required into the issue of how to appraise the economic consequences of alternative economic evaluation research strategies.

Physiological Requirements to Perform the Glittre Activities of Daily Living Test by Subjects With Mild-to-Severe COPD.

PubMed

Souza, Gérson F; Moreira, Graciane L; Tufanin, Andréa; Gazzotti, Mariana R; Castro, Antonio A; Jardim, José R; Nascimento, Oliver A

2017-08-01

The Glittre activities of daily living (ADL) test is supposed to evaluate the functional capacity of COPD patients. The physiological requirements of the test and the time taken to perform it by COPD patients in different disease stages are not well known. The objective of this work was to compare the metabolic, ventilatory, and cardiac requirements and the time taken to carry out the Glittre ADL test by COPD subjects with mild, moderate, and severe disease. Spirometry, Medical Research Council questionnaire, cardiopulmonary exercise test, and 2 Glittre ADL tests were evaluated in 62 COPD subjects. Oxygen uptake (V̇ O 2 ), carbon dioxide production, pulmonary ventilation, breathing frequency, heart rate, S pO 2 , and dyspnea were analyzed before and at the end of the tests. Maximum voluntary ventilation, Glittre peak V̇ O 2 /cardiopulmonary exercise test (CPET) peak V̇ O 2 , Glittre V̇ E /maximum voluntary ventilation, and Glittre peak heart rate/CPET peak heart rate ratios were calculated to analyze their reserves. Subjects carried out the Glittre ADL test with similar absolute metabolic, ventilatory, and cardiac requirements. Ventilatory reserve decreased progressively from mild to severe COPD subjects ( P < .001 for Global Initiative for Chronic Obstructive Lung Disease [GOLD] 1 vs GOLD 2, P < .001 for GOLD 1 vs GOLD 3, and P < .001 for GOLD 2 vs GOLD 3). Severe subjects with COPD presented a significantly lower metabolic reserve than the mild and moderate subjects ( P = .006 and P = .043, respectively) and significantly lower Glittre peak heart rate/CPET peak heart rate than mild subjects ( P = .01). Time taken to carry out the Glittre ADL test was similar among the groups ( P = .82 for GOLD 1 vs GOLD 2, P = .19 for GOLD 1 vs GOLD 3, and P = .45 for GOLD 2 vs GOLD 3). As the degree of air-flow obstruction progresses, the COPD subjects present significant lower ventilatory reserve to perform the Glittre ADL test. In addition, metabolic and cardiac reserves may differentiate the severe subjects. These variables may be better measures to differentiate functional performance than Glittre ADL time. Copyright © 2017 by Daedalus Enterprises.

Automation and integration of components for generalized semantic markup of electronic medical texts.

PubMed Central

Dugan, J. M.; Berrios, D. C.; Liu, X.; Kim, D. K.; Kaizer, H.; Fagan, L. M.

1999-01-01

Our group has built an information retrieval system based on a complex semantic markup of medical textbooks. We describe the construction of a set of web-based knowledge-acquisition tools that expedites the collection and maintenance of the concepts required for text markup and the search interface required for information retrieval from the marked text. In the text markup system, domain experts (DEs) identify sections of text that contain one or more elements from a finite set of concepts. End users can then query the text using a predefined set of questions, each of which identifies a subset of complementary concepts. The search process matches that subset of concepts to relevant points in the text. The current process requires that the DE invest significant time to generate the required concepts and questions. We propose a new system--called ACQUIRE (Acquisition of Concepts and Queries in an Integrated Retrieval Environment)--that assists a DE in two essential tasks in the text-markup process. First, it helps her to develop, edit, and maintain the concept model: the set of concepts with which she marks the text. Second, ACQUIRE helps her to develop a query model: the set of specific questions that end users can later use to search the marked text. The DE incorporates concepts from the concept model when she creates the questions in the query model. The major benefit of the ACQUIRE system is a reduction in the time and effort required for the text-markup process. We compared the process of concept- and query-model creation using ACQUIRE to the process used in previous work by rebuilding two existing models that we previously constructed manually. We observed a significant decrease in the time required to build and maintain the concept and query models. Images Figure 1 Figure 2 Figure 4 Figure 5 PMID:10566457

Intravenous Tranexamic Acid Decreases Allogeneic Transfusion Requirements in Periacetabular Osteotomy.

PubMed

Bryan, Andrew J; Sanders, Thomas L; Trousdale, Robert T; Sierra, Rafael J

2016-01-01

Bernese (Ganz) periacetabular osteotomy is associated with significant blood loss and the need for perioperative transfusion. Tranexamic acid decreases blood loss and minimizes transfusion rates in total joint arthroplasty. However, no reports have described its use in patients undergoing Bernese periacetabular osteotomy. This study reports the use of intravenous tranexamic acid in these patients. The study included 137 patients (150 hips) who underwent isolated periacetabular osteotomy at a single institution between 2003 and 2014. Of these, 68 patients (75 hips) received intravenous tranexamic acid 1 g at the time of incision and 1 g at the time of closure. A group of 69 patients (75 hips) served as control subjects who underwent periacetabular osteotomy without administration of intravenous tranexamic acid. Thromboembolic disease was defined as deep venous thrombosis or pulmonary embolism occurring within 6 weeks of surgery. Outcomes measured included transfusion requirements, pre- and postoperative hemoglobin values, operative times, and thromboembolic disease rates. Aspirin was used as the thromboembolic prophylactic regimen in 95% of patients. The rate of allogeneic transfusion was 0 in the tranexamic acid group compared with 21% in the control group (P=.0001). No significant difference was found in the autologous cell salvage requirement (.96 vs 1.01; P=.43) or the thromboembolic disease rate between the tranexamic acid group and the control group (2.67% vs 1.33%; P=.31). The use of intravenous tranexamic acid led to a decreased transfusion requirement with no increased risk of thromboembolic disease in this contemporary cohort of patients undergoing periacetabular osteotomy. Copyright 2016, SLACK Incorporated.

The Effect of Hypobaria on Muscle Inflammation and Regeneration After Injury and Hemorrhagic Shock

DTIC Science & Technology

2017-08-01

including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and...significant bleeding. This situation may affect recovery following combat injuries, especially if wounded service members are traveling from Asia to... time from the battlefield to a medical care facility. While injury recovery in low oxygen environments requires further analysis, military operations

Quantifying nursing workflow in medication administration.

PubMed

Keohane, Carol A; Bane, Anne D; Featherstone, Erica; Hayes, Judy; Woolf, Seth; Hurley, Ann; Bates, David W; Gandhi, Tejal K; Poon, Eric G

2008-01-01

New medication administration systems are showing promise in improving patient safety at the point of care, but adoption of these systems requires significant changes in nursing workflow. To prepare for these changes, the authors report on a time-motion study that measured the proportion of time that nurses spend on various patient care activities, focusing on medication administration-related activities. Implications of their findings are discussed.

Analysis of the glow curve of SrB 4O 7:Dy compounds employing the GOT model

NASA Astrophysics Data System (ADS)

Ortega, F.; Molina, P.; Santiago, M.; Spano, F.; Lester, M.; Caselli, E.

2006-02-01

The glow curve of SrB 4O 7:Dy phosphors has been analysed with the general one trap model (GOT). To solve the differential equation describing the GOT model a novel algorithm has been employed, which reduces significantly the deconvolution time with respect to the time required by usual integration algorithms, such as the Runge-Kutta method.

Air Force Intelligence Officer Targeteers: A Discussion on Specialization

DTIC Science & Technology

2011-06-10

significant force management problems for several reasons ( Galway et al. 2005, 48). The first reason was attributed to having no dedicated career field...manager to coordinate joint command and major command (MAJCOM) personnel requirements ( Galway et al. 2005, 51). Lack of a full time career field...intelligence work was required ( Galway et al. 2005, 48). RAND also noted that a tenuous balance existed between acquiring breadth and depth as a company

40 CFR 600.310-12 - Fuel economy label format requirements-electric vehicles.

Code of Federal Regulations, 2014 CFR

2014-07-01

... significant cause of climate change and smog.” For a, b, c, and d, insert the appropriate values established... the time to charge the battery as specified in § 600.311. Change the specified voltage if appropriate...

40 CFR 600.310-12 - Fuel economy label format requirements-electric vehicles.

Code of Federal Regulations, 2013 CFR

2013-07-01

... significant cause of climate change and smog.” For a, b, c, and d, insert the appropriate values established... the time to charge the battery as specified in § 600.311. Change the specified voltage if appropriate...

From Chains for Mean Value Inequalities to Mitrinovic's Problem II

ERIC Educational Resources Information Center

Zhu, Ling

2005-01-01

In this note, an integrated form of some significant means with two variables is provided, and some chains for mean value inequalities are obtained. At the same time, a concise family of algebraic functions appears, which satisfy Mitrinovic's requirements.

Joint Contracture Orthosis (JCO)

NASA Technical Reports Server (NTRS)

Lunsford, Thomas R.; Parsons, Ken; Krouskop, Thomas; McGee, Kevin

1997-01-01

The purpose of this project was to develop an advanced orthosis which is effective in reducing upper and lower limb contractures in significantly less time than currently required with conventional methods. The team that developed the JCO consisted of an engineer, orthotist, therapist, and physician.

Lead Time Study,

DTIC Science & Technology

1982-05-01

1979, the number of titanium fabrications dropped from 16 to 4, primarily because of the sponge shortage and EPA and OSHA requirements. Non-military...East - Taiwan, Korea, Singapore, Malaysia and Hong Kong. In addition, a significant amount of ceramic parts, lead frames and high technology

Influence of operator experience on canal preparation time when using the rotary Ni-Ti ProFile system in simulated curved canals.

PubMed

Mesgouez, C; Rilliard, F; Matossian, L; Nassiri, K; Mandel, E

2003-03-01

The aim of this study was to determine the influence of operator experience on the time needed for canal preparation when using a rotary nickel-titanium (Ni-Ti) system. A total of 100 simulated curved canals in resin blocks were used. Four operators prepared a total of 25 canals each. The operators included practitioners with prior experience of the preparation technique, and practitioners with no experience. The working length for each instrument was precisely predetermined. All canals were instrumented with rotary Ni-Ti ProFile Variable Taper Series 29 engine-driven instruments using a high-torque handpiece (Maillefer, Ballaigues, Switzerland). The time taken to prepare each canal was recorded. Significant differences between the operators were analysed using the Student's t-test and the Kruskall-Wallis and Dunn nonparametric tests. Comparison of canal preparation times demonstrated a statistically significant difference between the four operators (P < 0.001). In the inexperienced group, a significant linear regression between canal number and preparation time occurred. Time required for canal preparation was inversely related to operator experience.

A randomized trial of vaginal misoprostol for cervical priming before hysteroscopy in postmenopausal women

PubMed Central

Kant, Anita; Divyakumar; Priyambada, Usha

2011-01-01

Objective: To perform hysteroscopy the cervix needs to be dilated and in nullipara and postmenopausal women this is sometimes difficult. Well-known, entry-related complications during hysteroscopy include cervical tear, creation of false tract, bleeding, uterine perforation, scarring, and subsequent anatomical stenosis. Materials and Methods: This study was done to investigate the priming effect of vaginal misoprostol on cervical dilatation in postmenopausal women, before hysteroscopy, to prevent such complications. Two hundred micrograms of misoprostol was inserted into the vagina at least 12 hours before the procedure and the control group did not receive any cervical priming agent. Pre-procedural dilatation, additional dilatation required, and time taken for dilatation was noted in each case. Observations: The study showed a significant difference between the study group (7.7 ± 1.7 mm) and the control group (4.5 ± 1.8 mm) in terms of pre-procedural cervical width and the number of women requiring a dditional dilatation (7 / 25 versus 22 / 25), and hence, the time required for dilatation (4.7 ± 8 seconds versus 20.6 ± 9.3 seconds). Conclusion: The pre-procedural cervical width was significantly more in the study group as compared to that in the control group. We found significant differences between the study and control groups with respect to the number of women who required cervical dilatation. To conclude, this study helps derive a conclusion that vaginal misoprostol as a cervical priming agent in postmenopausal women appears to be safe, effective, and inexpensive, with mild side effects. PMID:21897735

Insulin deficiency with and without glucagon: A comparative study between total pancreatectomy and type 1 diabetes.

PubMed

Niwano, Fumimaru; Hiromine, Yoshihisa; Noso, Shinsuke; Babaya, Naru; Ito, Hiroyuki; Yasutake, Sara; Matsumoto, Ippei; Takeyama, Yoshifumi; Kawabata, Yumiko; Ikegami, Hiroshi

2017-12-30

Patients with a total pancreatectomy and type 1 diabetes are similar in regard to absolute insulin deficiency, but different in regard to glucagon, providing a unique opportunity to study the contribution of glucagon to glucose metabolism in an insulin-dependent state. The aim of the present study was to investigate the contribution of glucagon to glucose homeostasis in complete insulin deficiency in vivo. A total of 38 individuals with a complete lack of endogenous insulin (fasting C-peptide <0.0066 nmol/L) and whose glycemic control was optimized with an insulin pump during hospitalization were retrospectively studied. The basal insulin requirement, time-to-time adjustment of the basal insulin infusion rate, prandial insulin requirement and fasting plasma glucagon were compared between patients with a total pancreatectomy (n = 10) and those with type 1 diabetes (n = 28) after achievement of optimal glycemic control. Total daily insulin (P = 0.03) and basal insulin (P = 0.000006), but not prandial insulin requirements, were significantly lower in total pancreatectomy patients than in type 1 diabetes patients. The basal percentage (basal insulin/total daily insulin) was also significantly lower in total pancreatectomy patients than in type 1 diabetes patients (15.8 ± 7.8 vs 32.9 ± 10.1%, P = 0.00003). An increase in the insulin infusion rate early in the morning was not necessary in most patients with a pancreatectomy. The fasting plasma glucagon concentration was significantly lower in total pancreatectomy patients than in type 1 diabetes patients (P = 0.00007), and was positively correlated with the basal insulin requirement (P = 0.038). The difference in insulin requirements between total pancreatectomy and type 1 diabetes patients suggests a contribution of glucagon to the basal insulin requirement and dawn phenomenon. © 2017 The Authors. Journal of Diabetes Investigation published by Asian Association for the Study of Diabetes (AASD) and John Wiley & Sons Australia, Ltd.

Decreasing the time to defibrillation: a comparative study of defibrillator electrode designs.

PubMed

Adams, Bruce D; Easty, David M; Stuffel, Elaine; Hartman, Irma

2005-08-01

Time to defibrillation (T(defib)) is the most important modifiable factor affecting survival from cardiac arrest. Mortality increases by approximately 7--10% for each minute of defibrillation delay. The purpose of this study was to determine whether defibrillator electrode design complexity affects T(defib). This was a randomized sequential design study utilizing a standardized ventricular fibrillation cardiac arrest model for CPR mannequins. We evaluated two common types of defibrillator electrode models: a single connector design and a double connector design that requires an adaptor. We compared the time required by cardiac arrest team leaders to apply the two types of defibrillator electrodes to a manikin, connect them to a defibrillator, and then deliver a first defibrillatory shock. The primary outcome was time to defibrillation. The secondary outcome was difficulty of application as perceived by the physician participants on a 10 cm visual analog scale. Thirty-two residents performed a sequential assessment of both electrodes. The average T(defib) for the double connector model was 42.9s longer than that of the single connector model (87.5s versus 44.6s, p<0.001). As evaluated by the study participants, the single connector model was significantly easier to apply then the double connector model (1.3 cm versus 4.4 cm, p<0.001). The single connector defibrillator electrode design was associated with a significantly shorter T(defib) than the double connector design. It also was judged to be easier to apply in this model. Ergonomic design of defibrillator electrodes can significantly impact time to defibrillation.

Do preoperative oral carbohydrates improve postoperative outcomesin patients undergoing coronary artery bypass grafts?

PubMed

Şavluk, Ömer Faruk; Kuşçu, Mehmet Ali; Güzelmeriç, Füsun; Gürcü, Mustafa Emre; Erkılınç, Atakan; Çevirme, Deniz; Oğuş, Halide; Koçak, Tuncer

2017-12-19

Background/aim: The aim of this prospective study was to determine whether the preoperative oral intake of carbohydrate-rich drinks by patients undergoing a coronary artery bypass graft attenuates postoperative insulin requirements, improves postoperative patient discomfort, provides inotropic support, shortens the length of the ICU stay, and shortens the duration of postoperative mechanical ventilation. Materials and methods: This randomized prospective clinical study included 152 patients with coronary artery disease who were divided into 4 groups. Carbohydrates were administered to 3 groups at different hours and doses before operation. The fourth group had an 8-h preoperative fasting period. The inotropic and vasopressor requirements, ventilation time, and ICU stay time were recorded for all of the groups. Patient wellbeing, mouth dryness, hunger, anxiety, and nausea were assessed using VAS scores of 1-10. Results: Mouth dryness and hunger were significantly higher in the control group (P = 0.03, P = 0.02). The increase in blood glucose level was significantly higher in the control group (P = 0.04). The exogenous insulin requirement was significantly higher in the control group than in the other groups (P = 0.04). Conclusion: The administration of carbohydrates before elective cardiac surgery reduced insulin resistance. Based on the VAS scores, the intake of carbohydrates reduced mouth dryness and hunger. Overall, preoperative oral carbohydrate treatments can improve the postoperative outcomes of coronary artery bypass graft surgeries.

Animated video vs pamphlet: comparing the success of educating parents about proper antibiotic use.

PubMed

Schnellinger, Mark; Finkelstein, Marsha; Thygeson, Megan V; Vander Velden, Heidi; Karpas, Anna; Madhok, Manu

2010-05-01

The objective was to create an animated video to teach parents about the appropriate use of antibiotics and to compare their knowledge to parents who were provided with the American Academy of Pediatrics pamphlet. We hypothesized that the video format would result in improved comprehension and retention. This prospective randomized, controlled trial was conducted in an urban pediatric emergency department. Parent subjects were randomly assigned to a control group, a pamphlet group, and a video group and completed a survey at 3 time points. Analysis included the nonparametric matched Friedman test, Kruskal-Wallis test, and the Mann-Whitney U test. A 2-sided P value of < .05 was required for significance, and a Bonferroni-corrected P value of < .017 was required for paired comparisons. Postintervention survey scores improved significantly in the pamphlet and video groups compared with baseline. The video group's follow-up scores were not significantly different from the postintervention-survey scores (P = .32). The pamphlet-group scores at follow-up were significantly lower than the postintervention-survey scores (P = .002). The control group's scores were similar at all 3 time periods. The pamphlet group had significantly better scores than the control group after the intervention (P < .001). The video-group scores exceeded the control-group scores at all 3 time periods. An animated video is highly effective for educating parents about the appropriate use of antibiotics in the emergency department setting and results in long-term knowledge retention. The results of this study provide a foundation to further evaluate the use of animated video in additional populations.

Is transcranial direct current stimulation a potential method for improving response inhibition?☆

PubMed Central

Kwon, Yong Hyun; Kwon, Jung Won

2013-01-01

Inhibitory control of movement in motor learning requires the ability to suppress an inappropriate action, a skill needed to stop a planned or ongoing motor response in response to changes in a variety of environments. This study used a stop-signal task to determine whether transcranial direct-current stimulation over the pre-supplementary motor area alters the reaction time in motor inhibition. Forty healthy subjects were recruited for this study and were randomly assigned to either the transcranial direct-current stimulation condition or a sham-transcranial direct-current stimulation condition. All subjects consecutively performed the stop-signal task before, during, and after the delivery of anodal transcranial direct-current stimulation over the pre-supplementary motor area (pre-transcranial direct-current stimulation phase, transcranial direct-current stimulation phase, and post-transcranial direct-current stimulation phase). Compared to the sham condition, there were significant reductions in the stop-signal processing times during and after transcranial direct-current stimulation, and change times were significantly greater in the transcranial direct-current stimulation condition. There was no significant change in go processing-times during or after transcranial direct-current stimulation in either condition. Anodal transcranial direct-current stimulation was feasibly coupled to an interactive improvement in inhibitory control. This coupling led to a decrease in the stop-signal process time required for the appropriate responses between motor execution and inhibition. However, there was no transcranial direct-current stimulation effect on the no-signal reaction time during the stop-signal task. Transcranial direct-current stimulation can adjust certain behaviors, and it could be a useful clinical intervention for patients who have difficulties with response inhibition. PMID:25206399

Novel strategy of endoscopic submucosal dissection using an insulation-tipped knife for early gastric cancer: near-side approach method

PubMed Central

Mori, Genki; Nonaka, Satoru; Oda, Ichiro; Abe, Seiichiro; Suzuki, Haruhisa; Yoshinaga, Shigetaka; Nakajima, Takeshi; Saito, Yutaka

2015-01-01

Background and study aims: Endoscopic submucosal dissection (ESD) using insulation-tipped knives (IT knives) to treat gastric lesions located on the greater curvature of the gastric body remains technically challenging because of the associated bleeding, control of which can be difficult and time consuming. To eliminate these difficulties, we developed a novel strategy which we have called the “near-side approach method” and assessed its utility. Patients and methods: We reviewed patients who underwent ESD for solitary early gastric cancer located on the greater curvature of the gastric body from January 2003 to September 2014. The technical results of ESD were compared between the group treated with the novel near-side approach method and the group treated with the conventional method. Results: This study included 238 patients with 238 lesions, 118 of which were removed using the near-side approach method and 120 of which were removed using the conventional method. The median procedure time was 92 minutes for the near-side approach method and 120 minutes for the conventional method. The procedure time was significantly shorter in the near-side approach method arm. Although, the procedure time required by an experienced endoscopist was not significantly different between the two groups (100 vs. 110 minutes), the near-side approach group showed significantly shorter procedure time for a less-experienced endoscopist (90 vs. 120 minutes). Conclusions: The near-side approach method appears to require less time to complete gastric ESD than the conventional method using IT knives for technically challenging lesions located on the greater curvature of the gastric body, especially if the procedure is performed by less-experienced endoscopists. PMID:26528496

Efficacy and Safety of Levosulpiride Versus Haloperidol Injection in Patients With Acute Psychosis: A Randomized Double-Blind Study.

PubMed

Lavania, Sagar; Praharaj, Samir Kumar; Bains, Hariender Singh; Sinha, Vishal; Kumar, Abhinav

2016-01-01

Injectable antipsychotics are frequently required for controlling agitation and aggression in acute psychosis. No study has examined the use of injectable levosulpiride for this indication. To compare the efficacy and safety of injectable levosulpiride and haloperidol in patients with acute psychosis. This was a randomized, double-blind, parallel-group study in which 60 drug-naive patients having acute psychosis were randomly assigned to receive either intramuscular haloperidol (10-20 mg/d) or levosulpiride (25-50 mg/d) for 5 days. All patients were rated on Brief Psychiatric Rating Scale (BPRS), Overt Agitation Severity Scale (OASS), Overt Aggression Scale-Modified (OAS-M) scores, Simpson Angus Scale (SAS), and Barnes Akathisia Rating Scale (BARS). Repeated-measures ANOVA for BPRS scores showed significant effect of time (P < 0.001) and a trend toward greater reduction in scores in haloperidol group as shown by group × time interaction (P = 0.076). Repeated-measures ANOVA for OASS showed significant effect of time (P < 0.001) but no group × time interaction. Repeated-measures ANOVA for OAS-M scores showed significant effect of time (P < 0.001) and greater reduction in scores in haloperidol group as shown by group × time interaction (P = 0.032). Lorazepam requirement was much lower in haloperidol group as compared with those receiving levosulpiride (P = 0.022). Higher rates of akathisia and extrapyramidal symptoms were noted in the haloperidol group. Haloperidol was more effective than levosulpiride injection for psychotic symptoms, aggression, and severity of agitation in acute psychosis, but extrapyramidal adverse effects were less frequent with levosulpiride as compared with those receiving haloperidol.

An economic analysis for optimal distributed computing resources for mask synthesis and tape-out in production environment

NASA Astrophysics Data System (ADS)

Cork, Chris; Lugg, Robert; Chacko, Manoj; Levi, Shimon

2005-06-01

With the exponential increase in output database size due to the aggressive optical proximity correction (OPC) and resolution enhancement technique (RET) required for deep sub-wavelength process nodes, the CPU time required for mask tape-out continues to increase significantly. For integrated device manufacturers (IDMs), this can impact the time-to-market for their products where even a few days delay could have a huge commercial impact and loss of market window opportunity. For foundries, a shorter turnaround time provides a competitive advantage in their demanding market, too slow could mean customers looking elsewhere for these services; while a fast turnaround may even command a higher price. With FAB turnaround of a mature, plain-vanilla CMOS process of around 20-30 days, a delay of several days in mask tapeout would contribute a significant fraction to the total time to deliver prototypes. Unlike silicon processing, masks tape-out time can be decreased by simply purchasing extra computing resources and software licenses. Mask tape-out groups are taking advantage of the ever-decreasing hardware cost and increasing power of commodity processors. The significant distributability inherent in some commercial Mask Synthesis software can be leveraged to address this critical business issue. Different implementations have different fractions of the code that cannot be parallelized and this affects the efficiency with which it scales, as is described by Amdahl"s law. Very few are efficient enough to allow the effective use of 1000"s of processors, enabling run times to drop from days to only minutes. What follows is a cost aware methodology to quantify the scalability of this class of software, and thus act as a guide to estimating the optimal investment in terms of hardware and software licenses.

Is transcranial direct current stimulation a potential method for improving response inhibition?

PubMed

Kwon, Yong Hyun; Kwon, Jung Won

2013-04-15

Inhibitory control of movement in motor learning requires the ability to suppress an inappropriate action, a skill needed to stop a planned or ongoing motor response in response to changes in a variety of environments. This study used a stop-signal task to determine whether transcranial direct-current stimulation over the pre-supplementary motor area alters the reaction time in motor inhibition. Forty healthy subjects were recruited for this study and were randomly assigned to either the transcranial direct-current stimulation condition or a sham-transcranial direct-current stimulation condition. All subjects consecutively performed the stop-signal task before, during, and after the delivery of anodal transcranial direct-current stimulation over the pre-supplementary motor area (pre-transcranial direct-current stimulation phase, transcranial direct-current stimulation phase, and post-transcranial direct-current stimulation phase). Compared to the sham condition, there were significant reductions in the stop-signal processing times during and after transcranial direct-current stimulation, and change times were significantly greater in the transcranial direct-current stimulation condition. There was no significant change in go processing-times during or after transcranial direct-current stimulation in either condition. Anodal transcranial direct-current stimulation was feasibly coupled to an interactive improvement in inhibitory control. This coupling led to a decrease in the stop-signal process time required for the appropriate responses between motor execution and inhibition. However, there was no transcranial direct-current stimulation effect on the no-signal reaction time during the stop-signal task. Transcranial direct-current stimulation can adjust certain behaviors, and it could be a useful clinical intervention for patients who have difficulties with response inhibition.

A prospective audit of preprocedural fasting practices on a transplant ward: when fasting becomes starving.

PubMed

Vidot, Helen; Teevan, Kate; Carey, Sharon; Strasser, Simone; Shackel, Nicholas

2016-03-01

To investigate the prevalence and duration of preprocedural medically ordered fasting during a period of hospitalisation in an Australian population of patients with hepatic cirrhosis or following liver transplantation and to identify potential solutions to reduce fasting times. Protein-energy malnutrition is a common finding in patients with hepatic cirrhosis and can impact significantly on survival and quality of life. Protein and energy requirements in patients with cirrhosis are higher than those of healthy individuals. A significant feature of cirrhosis is the induction of starvation metabolism following seven to eight hours of food deprivation. Many investigative and interventional procedures for patients with cirrhosis necessitate a period of fasting to comply with anaesthesia guidelines. An observational study of the fasting episodes for 34 hospitalised patients with hepatic cirrhosis or following liver transplantation. Nutritional status was estimated using subjective global assessment and handgrip strength. The prevalence and duration of fasting practices for diagnostic or investigational procedures were estimated using electronic records and patient notes. Thirty-three patients (97%) were malnourished. Twenty-two patients (65%) were fasted during the observation period. There were 43 occasions of fasting with a median fasting time of 13·5 hours. On 40 occasions fasting times exceeded the maximum six-hour guideline recommended prior to the administration of anaesthesia by the majority of Anaesthesiology Societies. The majority of procedures (77%) requiring fasting occurred after midday. Eating breakfast on the day of the procedure reduced fasting time by 45%. Medically ordered preprocedural fasting times almost always exceed existing guidelines in this nutritionally compromised group. Adherence to fasting guidelines and eating breakfast before the procedure can reduce fasting times significantly and avoid the potential induction of starvation metabolism in this nutritionally at risk group. © 2016 John Wiley & Sons Ltd.

Low-SWaP coincidence processing for Geiger-mode LIDAR video

NASA Astrophysics Data System (ADS)

Schultz, Steven E.; Cervino, Noel P.; Kurtz, Zachary D.; Brown, Myron Z.

2015-05-01

Photon-counting Geiger-mode lidar detector arrays provide a promising approach for producing three-dimensional (3D) video at full motion video (FMV) data rates, resolution, and image size from long ranges. However, coincidence processing required to filter raw photon counts is computationally expensive, generally requiring significant size, weight, and power (SWaP) and also time. In this paper, we describe a laboratory test-bed developed to assess the feasibility of low-SWaP, real-time processing for 3D FMV based on Geiger-mode lidar. First, we examine a design based on field programmable gate arrays (FPGA) and demonstrate proof-of-concept results. Then we examine a design based on a first-of-its-kind embedded graphical processing unit (GPU) and compare performance with the FPGA. Results indicate feasibility of real-time Geiger-mode lidar processing for 3D FMV and also suggest utility for real-time onboard processing for mapping lidar systems.

Delay to Reconstruction of the Adolescent Anterior Cruciate Ligament: The Socioeconomic Impact on Treatment.

PubMed

Newman, Justin T; Carry, Patrick M; Terhune, Elizabeth B; Spruiell, Murray; Heare, Austin; Mayo, Meredith; Vidal, Armando F

2014-08-01

A delay in pediatric and adolescent anterior cruciate ligament (ACL) reconstruction is associated with an increase in the number of concomitant meniscal and chondral injuries. Factors that contribute to this delay have not been well described. Socioeconomic and demographic factors are related to ACL surgery timing. Cohort study; Level of evidence, 3. All subjects who underwent primary ACL reconstruction at a single tertiary pediatric hospital between 2005 and 2012 were retrospectively reviewed. Variables included concomitant knee injuries (cartilage or meniscus injuries requiring additional operative treatment) and chronologic, demographic, and socioeconomic factors. Multivariable Cox proportional-hazards analyses were used to identify factors related to ACL surgery timing. The mean age of the 272 subjects was 15.2 ± 2.12 years. Time to surgery was significantly different among subjects who required multiple additional surgical procedures at time of ACL reconstruction (median, 3.3 months) compared with subjects with 1 (median, 2.0 months) or no additional injuries (median, 1.6 months). Subjects underwent ACL reconstruction significantly sooner if they were older at the time of injury (hazard ratio [HR], 1.2 per 1 year; 95% CI, 1.1-1.2; P < .0001) or were covered by a commercial insurance plan (HR, 2.0; 95% CI, 1.6-2.6; P < .0001). Median time to ACL surgery was 1.5 months (95% CI, 1.3-1.7) for subjects with commercial insurance plans compared with 3.0 months (95% CI, 2.3-3.3) for subjects with noncommercial insurance coverage. The risk of delayed ACL surgery was significantly higher among pediatric and adolescent subjects who were less affluent, who were covered by a noncommercial insurance plan, and who were younger. This study also confirms previous studies that have reported an association between a delay in ACL surgery and the presence of additional knee injuries requiring operative treatment, accentuating the importance of timely care. Access to care is a current area of research interest and health policy formation. Information in this arena drives 2 important aspects of health: most immediately, care provided to patients, and over a broader scope, the policy that directs health care. The orthopaedic surgeon should be aware of the association between socioeconomic and demographic factors and ACL surgery timing to optimize outcomes.

Factors Influencing Part-time Faculty Engagement With Online Nursing Programs.

PubMed

Reneau, Margaret; Wallace, Cara; Claywell, Lora; Price, Jill; Burdi, Melissa; Trybulski, Joanne

2018-03-28

This research investigated factors that influenced the engagement of part-time faculty teaching in online nursing programs with their institutions. Of the 257 part-time faculty surveyed, the most significant factor was being supported in decisions regarding student issues, followed by institutional commitment to quality online education. Compensation was moderately influential; a negative factor was requiring too frequent meetings. Understanding factors that influence the engagement of part-time faculty teaching in online nursing programs can help leaders of online programs attract and retain experienced, highly skilled faculty.

Autonomous Aerobraking: A Design, Development, and Feasibility Study

NASA Technical Reports Server (NTRS)

Prince, Jill L. H.; Powell, Richard W.; Murri, Dan

2011-01-01

Aerobraking has been used four times to decrease the apoapsis of a spacecraft in a captured orbit around a planetary body with a significant atmosphere utilizing atmospheric drag to decelerate the spacecraft. While aerobraking requires minimum fuel, the long time required for aerobraking requires both a large operations staff, and large Deep Space Network resources. A study to automate aerobraking has been sponsored by the NASA Engineering and Safety Center to determine initial feasibility of equipping a spacecraft with the onboard capability for autonomous aerobraking, thus saving millions of dollars incurred by a large aerobraking operations workforce and continuous DSN coverage. This paper describes the need for autonomous aerobraking, the development of the Autonomous Aerobraking Development Software that includes an ephemeris estimator, an atmospheric density estimator, and maneuver calculation, and the plan forward for continuation of this study.

DART system analysis.

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

Boggs, Paul T.; Althsuler, Alan; Larzelere, Alex R.

2005-08-01

The Design-through-Analysis Realization Team (DART) is chartered with reducing the time Sandia analysts require to complete the engineering analysis process. The DART system analysis team studied the engineering analysis processes employed by analysts in Centers 9100 and 8700 at Sandia to identify opportunities for reducing overall design-through-analysis process time. The team created and implemented a rigorous analysis methodology based on a generic process flow model parameterized by information obtained from analysts. They also collected data from analysis department managers to quantify the problem type and complexity distribution throughout Sandia's analyst community. They then used this information to develop a communitymore » model, which enables a simple characterization of processes that span the analyst community. The results indicate that equal opportunity for reducing analysis process time is available both by reducing the ''once-through'' time required to complete a process step and by reducing the probability of backward iteration. In addition, reducing the rework fraction (i.e., improving the engineering efficiency of subsequent iterations) offers approximately 40% to 80% of the benefit of reducing the ''once-through'' time or iteration probability, depending upon the process step being considered. Further, the results indicate that geometry manipulation and meshing is the largest portion of an analyst's effort, especially for structural problems, and offers significant opportunity for overall time reduction. Iteration loops initiated late in the process are more costly than others because they increase ''inner loop'' iterations. Identifying and correcting problems as early as possible in the process offers significant opportunity for time savings.« less

Reactivity, stability, and strength performance capacity in motor sports.

PubMed

Baur, H; Müller, S; Hirschmüller, A; Huber, G; Mayer, F

2006-11-01

Racing drivers require multifaceted cognitive and physical abilities in a multitasking situation. A knowledge of their physical capacities may help to improve fitness and performance. To compare reaction time, stability performance capacity, and strength performance capacity of élite racing drivers with those of age-matched, physically active controls. Eight élite racing drivers and 10 physically active controls matched for age and weight were tested in a reaction and determination test requiring upper and lower extremity responses to visual and audio cues. Further tests comprised evaluation of one-leg postural stability on a two-dimensional moveable platform, measures of maximum strength performance capacity of the extensors of the leg on a leg press, and a test of force capacity of the arms in a sitting position at a steering wheel. An additional arm endurance test consisted of isometric work at the steering wheel at +30 degrees and -30 degrees where an eccentric threshold load of 30 N.m was applied. Subjects had to hold the end positions above this threshold until exhaustion. Univariate one way analysis of variance (alpha = 0.05) including a Bonferroni adjustment was used to detect group differences between the drivers and controls. The reaction time of the racing drivers was significantly faster than the controls (p = 0.004). The following motor reaction time and reaction times in the multiple determination test did not differ between the groups. No significant differences (p>0.05) were found for postural stability, leg extensor strength, or arm strength and endurance. Racing drivers have faster reaction times than age-matched physically active controls. Further development of motor sport-specific test protocols is suggested. According to the requirements of motor racing, strength and sensorimotor performance capacity can potentially be improved.

Ketamine versus alfentanil combined with propofol for sedation in colonoscopy procedures: a randomized prospective study.

PubMed

Türk, Hacer Şebnem; Aydoğmuş, Meltem; Ünsal, Oya; Işıl, Canan Tülay; Citgez, Bülent; Oba, Sibel; Açık, Mehmet Eren

2014-12-01

Different drug combinations are used for sedation in colonoscopy procedures. A ketamine-propofol (ketofol) mixture provides effective sedation and has minimal adverse effects. Alfentanil also provides anesthesia for short surgical procedures by incremental injection as an adjunct. However, no study has investigated the use of ketofol compared with an opioid-propofol combination in colonoscopic procedures. A total of 70 patients, ASA physical status I-II, scheduled to undergo elective colonoscopy, were enrolled in this prospective randomized study and allocated to two groups. After premedication, sedation induction was performed with 0.5 mg/kg ketamine +1 mg/kg propofol in Group KP, and 10 mg/kg alfentanil +1 mg/kg propofol in Group AP. Propofol was added when required. Demographic data, colonoscopy duration, recovery time, discharge time, mean arterial pressure (MAP), heart rate (HR), peripheral oxygen saturation, Ramsey Sedation Scale values, colonoscopy patients' satisfaction scores, and complications were recorded. The need for additional propofol doses was significantly higher in Group AP than in Group KP. MAP at minute 1 and 5, Ramsey Sedation Scale at minute 5, and discharge time were significantly higher in Group KP than in Group AP. Additional propofol doses and total propofol dose were significantly lower in Group KP than in Group AP. Ketofol provided better hemodynamic stability and quality of sedation compared with alfentanil-propofol combination in elective colonoscopy, and required fewer additional propofol; however, it prolonged discharge time. Both combinations can safely be used in colonoscopy sedation.

A Prospective Comparison of Intraluminal and Extraluminal Placement of the 9-French Arndt Bronchial Blocker in Adult Thoracic Surgery Patients.

PubMed

Templeton, T Wesley; Morris, Benjamin N; Goenaga-Diaz, Eduardo J; Forest, Daniel J; Hadley, Rhett; Moore, Blake A; Bryan, Yvon F; Royster, Roger L

2017-08-01

To compare the standard intraluminal approach with the placement of the 9-French Arndt endobronchial blocker with an extraluminal approach by measuring the time to positioning and other relevant intraoperative and postoperative parameters. A prospective, randomized, controlled trial. University hospital. The study comprised 41 patients (20 intraluminal, 21 extraluminal) undergoing thoracic surgery. Placement of a 9-French Arndt bronchial blocker either intraluminally or extraluminally. Comparisons between the 2 groups included the following: (1) time for initial placement, (2) quality of isolation at 1-hour intervals during one-lung ventilation, (3) number of repositionings during one-lung ventilation, and (4) presence or absence of a sore throat on postoperative days 1 and 2 and, if present, its severity. Median time to placement (min:sec) in the extraluminal group was statistically faster at 2:42 compared with 6:24 in the intraluminal group (p < 0.05). Overall quality of isolation was similar between groups, even though a significant number of blockers in both groups required repositioning (extraluminal 47%, intraluminal 40%, p > 0.05), and 1 blocker ultimately had to be replaced intraoperatively. No differences in the incidence or severity of sore throat postoperatively were observed. A statistically significant reduction in time to placement using the extraluminal approach without any differences in the rate of postoperative sore throat was observed. Whether placed intraluminally or extraluminally, a significant percentage of Arndt endobronchial blockers required at least one intraoperative repositioning. Copyright © 2017 Elsevier Inc. All rights reserved.

A compliance assessment of midpoint formative assessments completed by APPE preceptors.

PubMed

Lea Bonner, C; Staton, April G; Naro, Patricia B; McCullough, Elizabeth; Lynn Stevenson, T; Williamson, Margaret; Sheffield, Melody C; Miller, Mindi; Fetterman, James W; Fan, Shirley; Momary, Kathryn M

Experiential pharmacy preceptors should provide formative and summative feedback during a learning experience. Preceptors are required to provide colleges and schools of pharmacy with assessments or evaluations of students' performance. Students and experiential programs value on-time completion of midpoint evaluations by preceptors. The objective of this study was to determine the number of on-time electronically documented formative midpoint evaluations completed by preceptors during advanced pharmacy practice experiences (APPEs). Compliance rates of on-time electronically documented formative midpoint evaluations were reviewed by the Office of Experiential Education of a five-member consortium during the two-year study period prior to the adoption of Standards 2016. Pearson chi-square test and generalized linear models were used to determine if statistically significant differences were present. Average midpoint compliance rates for the two-year research period were 40.7% and 41% respectively. No statistical significance was noted comparing compliance rates for year one versus year two. However, statistical significance was present when comparing compliance rates between schools during year two. Feedback from students and preceptors pointed to the need for brief formal midpoint evaluations that require minimal time to complete, user friendly experiential management software, and methods for documenting verbal feedback through student self-reflection. Additional education and training to both affiliate and faculty preceptors on the importance of written formative feedback at midpoint is critical to remaining in compliance with Standards 2016. Copyright © 2017 Elsevier Inc. All rights reserved.

Implementation of a timed, electronic, assessment-driven potassium-replacement protocol.

PubMed

Zielenski, Christopher; Crabtree, Adam; Le, Tien; Marlatt, Alyse; Ng, Dana; Tran, Alan

2017-06-15

The adherence to and effectiveness and safety of a timed, electronic, assessment-driven potassium-replacement protocol (TARP) were compared with an electronic nurse-driven replacement protocol (NRP) are reported. A retrospective observational study was conducted in a community hospital evaluating protocol adherence, effectiveness, and safety for 2 potassium-replacement protocols. All adults on medical units with an order for potassium replacement per protocol during the 3-month trial periods were reviewed. All patients requiring potassium replacement per protocol were included in the analysis. Adherence to the protocol was assessed by evaluating the dose of potassium administered and performance of reassessments. Effectiveness of the protocol was assessed by evaluating the time to achieve target potassium levels. Safety was assessed by evaluating the route of administration and occurrence of hyperkalemia. A total of 300 patients treated using potassium-replacement protocols required potassium replacement during the study period, with 148 patients in the NRP group requiring 491 instances of potassium replacement. In the TARP group a total of 564 instances requiring potassium replacement corresponded to 152 patients. Of the 491 instances requiring replacement in the NRP group, the correct dose was administered and reassessment performed 117 times (23.8%). Overall adherence ( p < 0.05), correct dose given ( p < 0.05), average time from blood draw to potassium replacement ( p < 0.0001), use of oral replacement ( p < 0.05), and time to achieve target potassium level within 12 hours ( p < 0.05) were significantly improved in the TARP group. The TARP improved the effectiveness and safety of potassium-replacement therapy over the traditional NRP without negatively affecting timeliness of care. Copyright © 2017 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

Quantitative colorectal cancer perfusion measurement using dynamic contrast-enhanced multidetector-row computed tomography: effect of acquisition time and implications for protocols.

PubMed

Goh, Vicky; Halligan, Steve; Hugill, Jo-Ann; Gartner, Louise; Bartram, Clive I

2005-01-01

To determine the effect of acquisition time on quantitative colorectal cancer perfusion measurement. Dynamic contrast-enhanced computed tomography (CT) was performed prospectively in 10 patients with histologically proven colorectal cancer using 4-detector row CT (Lightspeed Plus; GE Healthcare Technologies, Waukesha, WI). Tumor blood flow, blood volume, mean transit time, and permeability were assessed for 3 acquisition times (45, 65, and 130 seconds). Mean values for all 4 perfusion parameters for each acquisition time were compared using the paired t test. Significant differences in permeability values were noted between acquisitions of 45 seconds and 65 and 130 seconds, respectively (P=0.02, P=0.007). There was no significant difference for values of blood volume, blood flow, and mean transit time between any of the acquisition times. Scan acquisitions of 45 seconds are too short for reliable permeability measurement in the abdomen. Longer acquisition times are required.

Multi-point estimation of total energy expenditure: a comparison between zinc-reduction and platinum-equilibration methodologies.

PubMed

Sonko, Bakary J; Miller, Leland V; Jones, Richard H; Donnelly, Joseph E; Jacobsen, Dennis J; Hill, James O; Fennessey, Paul V

2003-12-15

Reducing water to hydrogen gas by zinc or uranium metal for determining D/H ratio is both tedious and time consuming. This has forced most energy metabolism investigators to use the "two-point" technique instead of the "Multi-point" technique for estimating total energy expenditure (TEE). Recently, we purchased a new platinum (Pt)-equilibration system that significantly reduces both time and labor required for D/H ratio determination. In this study, we compared TEE obtained from nine overweight but healthy subjects, estimated using the traditional Zn-reduction method to that obtained from the new Pt-equilibration system. Rate constants, pool spaces, and CO2 production rates obtained from use of the two methodologies were not significantly different. Correlation analysis demonstrated that TEEs estimated using the two methods were significantly correlated (r=0.925, p=0.0001). Sample equilibration time was reduced by 66% compared to those of similar methods. The data demonstrated that the Zn-reduction method could be replaced by the Pt-equilibration method when TEE was estimated using the "Multi-Point" technique. Furthermore, D equilibration time was significantly reduced.

The optimisation of low-acceleration interstellar relativistic rocket trajectories using genetic algorithms

NASA Astrophysics Data System (ADS)

Fung, Kenneth K. H.; Lewis, Geraint F.; Wu, Xiaofeng

2017-04-01

A vast wealth of literature exists on the topic of rocket trajectory optimisation, particularly in the area of interplanetary trajectories due to its relevance today. Studies on optimising interstellar and intergalactic trajectories are usually performed in flat spacetime using an analytical approach, with very little focus on optimising interstellar trajectories in a general relativistic framework. This paper examines the use of low-acceleration rockets to reach galactic destinations in the least possible time, with a genetic algorithm being employed for the optimisation process. The fuel required for each journey was calculated for various types of propulsion systems to determine the viability of low-acceleration rockets to colonise the Milky Way. The results showed that to limit the amount of fuel carried on board, an antimatter propulsion system would likely be the minimum technological requirement to reach star systems tens of thousands of light years away. However, using a low-acceleration rocket would require several hundreds of thousands of years to reach these star systems, with minimal time dilation effects since maximum velocities only reached about 0.2 c . Such transit times are clearly impractical, and thus, any kind of colonisation using low acceleration rockets would be difficult. High accelerations, on the order of 1 g, are likely required to complete interstellar journeys within a reasonable time frame, though they may require prohibitively large amounts of fuel. So for now, it appears that humanity's ultimate goal of a galactic empire may only be possible at significantly higher accelerations, though the propulsion technology requirement for a journey that uses realistic amounts of fuel remains to be determined.

Wait Times Experienced by Lung Cancer Patients in the BC Southern Interior to Obtain Oncologic Care: Exploration of the Intervals from First Abnormal Imaging to Oncologic Treatment

PubMed Central

Chowdhury, Rezwan; Boyce, Andrew; Halperin, Ross

2015-01-01

Background: Lung cancer is associated with rapid disease progression, which can significantly progress over a duration of four to eight weeks. This study examines the time interval lung cancer patients from the interior of British Columbia (BC) experience while undergoing diagnostic evaluation, biopsy, staging, and preparation for treatment. Methods: A chart review of lung cancer patients (n=231) referred to the BC Cancer Agency Centre for the Southern Interior between January 1, 2010 and December 31, 2011 was performed. Time zero was defined as the date of the first abnormal chest imaging. Time intervals, expressed as median averages, to specialist consult, biopsy, oncologic referral, initial oncology consultation, and commencement of oncologic treatment were obtained. Results: The median time interval from first abnormal chest imaging to a specialist consultation was 18 days (interquartile range, IQR, 7-36). An additional nine days elapsed prior to biopsy in the form of bronchoscopy, CT-guided biopsy, or sputum cytology (median; IQR, 3-21); if lobectomy was required, 18 days elapsed (median; IQR, 9-28). Eight days were required for pathologic diagnosis and subsequent referral to the cancer centre (median; IQR, 3-16.5). Once referral was received, 10 days elapsed prior to consultation with either a medical or radiation oncologist (median, IQR 5-18). Finally, eight days was required for initiation of radiation and/or chemotherapy (median; IQR, 1-15). The median wait time from detection of lung cancer on imaging to oncologic treatment in the form of radiation and/or chemotherapy was 65.5 days (IQR, 41.5-104.3).  Interpretation: Patients in the BC Southern Interior experience considerable delays in accessing lung cancer care. During this time, the disease has the potential to significantly progress and it is possible that a subset of patients may lose their opportunity for curative intent treatment. PMID:26543688

CHEMICAL ENHANCEMENTS TO PUMP-AND-TREAT REMEDIATION

EPA Science Inventory

Conventional pump-and-treat technologies are among the most widely used systems for the remediation of contaminated ground-water. ithin recent years it has become recognized that these systems can require protracted periods of time to make significant reductions in the quantity o...

A new verification film system for routine quality control of radiation fields: Kodak EC-L.

PubMed

Hermann, A; Bratengeier, K; Priske, A; Flentje, M

2000-06-01

The use of modern irradiation techniques requires better verification films for determining set-up deviations and patient movements during the course of radiation treatment. This is an investigation of the image quality and time requirement of a new verification film system compared to a conventional portal film system. For conventional verifications we used Agfa Curix HT 1000 films which were compared to the new Kodak EC-L film system. 344 Agfa Curix HT 1000 and 381 Kodak EC-L portal films of different tumor sites (prostate, rectum, head and neck) were visually judged on a light box by 2 experienced physicians. Subjective judgement of image quality, masking of films and time requirement were checked. In this investigation 68% of 175 Kodak EC-L ap/pa-films were judged "good", only 18% were classified "moderate" or "poor" 14%, but only 22% of 173 conventional ap/pa verification films (Agfa Curix HT 1000) were judged to be "good". The image quality, detail perception and time required for film inspection of the new Kodak EC-L film system was significantly improved when compared with standard portal films. They could be read more accurately and the detection of set-up deviation was facilitated.

Dexmedetomidine and propofol sedation requirements in an autistic rat model.

PubMed

Elmorsy, Soha A; Soliman, Ghada F; Rashed, Laila A; Elgendy, Hamed

2018-05-30

Autism is a challenging neurodevelopmental disorder. Previous clinical observations suggest altered sedation requirements for autistic children. Our study aimed to test this observation experimentally with an animal model and, to explore its possible mechanisms. Eight adult pregnant female Sprague Dawley rats were randomly selected into two groups. Four were injected with intraperitoneal sodium valproate on the gestational day 12 and four were injected with normal saline. On post-natal day 28 the newborn male rats were subjected to an open field test to confirm autistic features. Each rat was injected intraperitoneally with a single dose of propofol (50 mg/kg) or dexmedetomidine (0.2 mg/kg). Times to Loss of Righting Reflex (LORR) and to Return of Righting Reflex (RORR) were recorded. On the next day, all rats were re-sedated and their EEGs were recorded. The rats were sacrificed and hippocampal GABAA and glutamate NMDA receptor gene expression were assessed. Autistic rats showed significantly longer time to LORR and a shorter time to RORR compared to controls (Median time to LORR: 12.0 versus 5.0 for dexmedetomidine and 22.0 and 8.0 for propofol; p < 0.05). EEG showed a low frequency, high amplitude wave pattern two minutes after LORR in control rats. Autistic rats showed a high frequency, low amplitude awake pattern. Hippocampal GABAA receptor gene expression was significantly less in autistic rats and NMDA gene expression was greater. This study in rat supports the clinical observations of increased anesthetic sedative requirements in autistic children and proposes a mechanism for it.

Effect of perineural dexmedetomidine on the quality of supraclavicular brachial plexus block with 0.5% ropivacaine and its interaction with general anaesthesia.

PubMed

Gurajala, Indira; Thipparampall, Anil Kumar; Durga, Padmaja; Gopinath, R

2015-02-01

The effect of perineural dexmedetomidine on the time to onset, quality and duration of motor block with ropivacaine has been equivocal and its interaction with general anaesthesia (GA) has not been reported. We assessed the influence of dexmedetomidine added to 0.5% ropivacaine on the characteristics of supraclavicular brachial plexus block and its interaction with GA. In a randomised, double blind study, 36 patients scheduled for orthopaedic surgery on the upper limb under supraclavicular block and GA were divided into either R group (35 ml of 0.5% ropivacaine with 0.5 ml of normal saline [n - 18]) or RD group (35 mL of 0.5% ropivacaine with 50 μg dexmedetomidine [n - 18]). The onset time and duration of motor and sensory blockade were noted. The requirement of general anaesthetics was recorded. Both the groups were comparable in demographic characteristics. The time of onset of sensory block was not significantly different. The proportion of patients who achieved complete motor blockade was more in the RD group. The onset of motor block was earlier in group RD than group R (P < 0.05). The durations of analgesia, sensory and motor blockade were significantly prolonged in group RD (P < 0.00). The requirement of entropy guided anaesthetic agents was not different in both groups. The addition of dexmedetomidine to 0.5% ropivacaine improved the time of onset, quality and duration of supraclavicular brachial plexus block but did not decrease the requirement of anaesthetic agents during GA.

Telerehabilitation: remote multimedia-supported assistance and mobile monitoring of balance training outcomes can facilitate the clinical staff's effort.

PubMed

Krpič, Andrej; Savanović, Arso; Cikajlo, Imre

2013-06-01

Telerehabilitation can offer prolonged rehabilitation for patients with stroke after being discharged from the hospital, whilst remote diagnostics may reduce the frequency of the outpatient services required. Here, we compared a novel telerehabilitation system for virtual reality-supported balance training with balance training with only a standing frame and with conventional therapy in the hospital. The proposed low-cost experimental system for balance training enabling multiple home systems, real-time tracking of task's performance and different views of captured data with balance training, consists of a standing frame equipped with a tilt sensor, a low-cost computer, display, and internet connection. Goal-based tasks for balance training in the virtual environment proved motivating for the participating individuals. The physiotherapist, located in the remote healthcare center, could remotely adjust the level of complexity and difficulty or preview the outcomes and instructions with the application on the mobile smartphone. Patients using the virtual reality-supported balance training showed an improvement in the task performance time of 45% and number of collisions of 68%, showing significant improvements in the Berg Balance Scale, Timed 'Up and Go', and 10 m Walk Test. The clinical outcomes were not significantly different from balance training with only the standing frame or conventional therapy. The proposed telerehabilitation can facilitate the physiotherapists' work and thus enable rehabilitation to a larger number of patients after release from the hospital because it requires less time and infrequent presence of the clinical staff. However, a comprehensive clinical evaluation is required to confirm the applicability of the concept.

Lower complication rate and faster return to sports in patients with acute syndesmotic rupture treated with a new knotless suture button device.

PubMed

Colcuc, Christian; Blank, Marc; Stein, Thomas; Raimann, Florian; Weber-Spickschen, Sanjay; Fischer, Sebastian; Hoffmann, Reinhard

2017-12-09

Suture button devices for tibiofibular syndesmosis injuries provide semirigid dynamic stabilization, but complications including knot irritation have been reported. No randomized trials of the new knotless suture button devices have been performed. We hypothesized that knotless suture button devices eliminate knot irritation and facilitate quicker return to sports. This study was performed to compare the clinical outcomes, complication rates, and time to return to sports between a new knotless suture button device and syndesmotic screw fixation. This study included 54 patients treated for ankle syndesmotic injury from 2012 to 2014 with a knotless suture button device or syndesmotic screw fixation. Clinical outcomes were measured using the American Orthopaedics Foot and Ankle Society score, Foot and Ankle Disability Index, Olerud and Molander score, and visual analog scale for pain and function. Secondary outcome measures were the complication rate and time required to return to sports. Patients underwent clinical and radiological evaluations preoperatively and three times during the 1-year postoperative follow-up. 54 of 62 eligible patients were analyzed, median age 37 (18-60) and underwent the 1-year follow-up. The screw fixation and knotless suture button groups comprised 26 and 28 patients, respectively. The complication rate was significantly lower (p = 0.03) and time to return to sports was significantly shorter in the knotless suture button than screw fixation group (average, 14 versus 19 weeks, respectively; p = 0.006). No significant differences were identified in clinical outcomes or visual analog scale scores for pain and function between the groups. Age, injury mechanism, and body mass index did not significantly affect the time required to return to sports activities. The type of fixation was the only independent variable that reached statistical significance (p = 0.006). Syndesmotic screw fixation and the new knotless suture button device both resulted in good clinical results. Lower complication rate and the earlier time to return to sports make the new knotless suture button device recommendable especially for highly active patients. Randomized controlled trial, Level I.

Time-Dependent Decline in Multifocal Electroretinogram Requires Faster Recording Procedures in Anesthetized Pigs

PubMed Central

Sørensen, Nina Buus; Christiansen, Anders Tolstrup; Kjær, Troels Wesenberg; Klemp, Kristian; la Cour, Morten; Kiilgaard, Jens Folke

2017-01-01

Purpose The time-dependent effect of anesthetics on the retinal function is debated. We hypothesize that in anesthetized animals there is a time-dependent decline that requires optimized multifocal electroretinogram (mfERG) recording procedures. Methods Conventional and four-frame global-flash mfERG recordings were obtained approximately 15, 60, and 150 minutes after the induction of propofol anesthesia (20 pigs) and isoflurane anesthesia (nine pigs). In six of the propofol-anesthetized pigs, the mfERG recordings were split in 3-minute segments. Two to 4 weeks after initial recordings, an intraocular injection of tetrodotoxin (TTX) was given and the mfERG was rerecorded as described above. Data were analyzed using mixed models in SAS statistical software. Results Propofol significantly decreases the conventional and global-flash amplitudes over time. The only significant effect of isoflurane is a decrease in the global-flash amplitudes. At 15 minutes after TTX injection several of the mfERG amplitudes are significantly decreased. There is a linear correlation between the conventional P1 and the global-flash DR mfERG-amplitude (R2 = 0.82, slope = 0.72, P < 0.0001). There is no significant difference between the 3-minute and the prolonged mfERG recordings for conventional amplitudes and the global-flash direct response. The global flash–induced component significantly decreases with prolonged mfERG recordings. Conclusions A 3-minute mfERG recording and a single stimulation protocol is sufficient in anesthetized pigs. Recordings should be obtained immediately after the induction of anesthesia. The effect of TTX is significant 15 minutes after injection, but is contaminated by the effect of anesthesia 90 minutes after injection. Therefore, the quality of mfERG recordings can be further improved by determining the necessary time-of-delay from intraocular injection of a drug to full effect. Translational Relevance General anesthesia is a possible source of error in mfERG recordings. Therefore, it is important to investigate the translational relevance of the results to mfERG recordings in children in general anesthesia. PMID:28377845

Integrated SeismoGeodetic Systsem with High-Resolution, Real-Time GNSS and Accelerometer Observation For Earthquake Early Warning Application.

NASA Astrophysics Data System (ADS)

Passmore, P. R.; Jackson, M.; Zimakov, L. G.; Raczka, J.; Davidson, P.

2014-12-01

The key requirements for Earthquake Early Warning and other Rapid Event Notification Systems are: Quick delivery of digital data from a field station to the acquisition and processing center; Data integrity for real-time earthquake notification in order to provide warning prior to significant ground shaking in the given target area. These two requirements are met in the recently developed Trimble SG160-09 SeismoGeodetic System, which integrates both GNSS and acceleration measurements using the Kalman filter algorithm to create a new high-rate (200 sps), real-time displacement with sufficient accuracy and very low latency for rapid delivery of the acquired data to a processing center. The data acquisition algorithm in the SG160-09 System provides output of both acceleration and displacement digital data with 0.2 sec delay. This is a significant reduction in the time interval required for real-time transmission compared to data delivery algorithms available in digitizers currently used in other Earthquake Early Warning networks. Both acceleration and displacement data are recorded and transmitted to the processing site in a specially developed Multiplexed Recording Format (MRF) that minimizes the bandwidth required for real-time data transmission. In addition, a built in algorithm calculates the τc and Pd once the event is declared. The SG160-09 System keeps track of what data has not been acknowledged and re-transmits the data giving priority to current data. Modified REF TEK Protocol Daemon (RTPD) receives the digital data and acknowledges data received without error. It forwards this "good" data to processing clients of various real-time data processing software including Earthworm and SeisComP3. The processing clients cache packets when a data gap occurs due to a dropped packet or network outage. The cache packet time is settable, but should not exceed 0.5 sec in the Earthquake Early Warning network configuration. The rapid data transmission algorithm was tested with different communication media, including Internet, DSL, Wi-Fi, GPRS, etc. The test results show that the data latency via most communication media do not exceed 0.5 sec nominal from a first sample in the data packet. Detailed acquisition algorithm and results of data transmission via different communication media are presented.

Need for tissue plasminogen activator for central venous catheter dysfunction is significantly associated with thrombosis in pediatric cancer patients.

PubMed

MacLean, Jessica; MacDonald, Tamara; Digout, Carol; Smith, Nadine; Rigby, Krista; Kulkarni, Ketan

2018-06-01

Central venous catheter (CVC) dysfunction is a common complication among pediatric cancer patients. Tissue plasminogen activator (tPA) is administered to resolve CVC dysfunction. The present study was designed to determine risk factors associated with requirement of tPA for CVC dysfunction and to assess the clinical impact of CVC dysfunction in terms of CVC loss and venous thrombotic events (VTE). Case records of all pediatric patients with cancer from the Maritimes, Canada were reviewed following ethics approval. Data regarding demographics, clinical diagnosis, CVC dysfunction, characteristics of CVCs, and VTE were pooled from multiple data sources. Seven hundred and forty-one patients required ≥1 CVC. 26.3% of patients required tPA for ≥1 episodes of CVC dysfunction. Requirement of one or more doses of tPA for episodes of CVC dysfunction increased the odds of VTE by two times (95% confidence interval, 1.1-3.6). Patients that required ≥1 doses of tPA required significantly more CVCs (2.05 ± 1.29 per individual patient, 55% of the patients needed >1 CVCs) as compared to the remainder (1.52 ± 0.95 per individual patient, 32% needed >1 CVCs) (P = 0.0001). Multivariate analysis revealed age > 10 years, diagnosis of sarcoma, and tunneled line were independently associated with tPA requirement. We determined independent risk factors associated with requirement of tPA for CVC dysfunction. Requirement of tPA for CVC dysfunction was associated with significantly increased risk of VTE and requirement of more CVCs. These observations can assist in identification of patients at increased risk of CVC dysfunction and inform approaches to reduce CVC loss and VTE. © 2018 Wiley Periodicals, Inc.

A randomised control study comparing the Infant Flow Driver with nasal continuous positive airway pressure in preterm infants

PubMed Central

Mazzella, M; Bellini, C; Calevo, M; Campone, F; Massocco, D; Mezzano, P; Zullino, E; Scopesi, F; Arioni, C; Bonacci, W; Serra, G

2001-01-01

OBJECTIVE—To compare the effectiveness of the Infant Flow Driver (IFD) with single prong nasal continuous positive airway pressure (nCPAP) in preterm neonates affected by respiratory distress syndrome.
DESIGN—Randomised controlled study.
PATIENTS—Between September 1997 and March 1999, 36 preterm infants who were eligible for CPAP treatment were randomly selected for either nCPAP or IFD and studied prospectively for changes in oxygen requirement and/or respiratory rate. The requirement for mechanical ventilation, complications of treatment, and effects on mid-term outcome were also evaluated.
RESULTS—Use of the IFD had a significantly beneficial effect on both oxygen requirement and respiratory rate (p < 0.0001) when compared with nCPAP. Moreover, O2 requirement and respiratory rate were significantly decreased by four hours (p < 0.001 and p < 0.03 respectively). The probability of remaining supplementary oxygen free over the first 48 hours of treatment was significantly higher in patients treated with the IFD than with nCPAP (p < 0.02). IFD treated patients had a higher success (weaning) rate (94% v 72%) and shorter duration of treatment (49.3 (31) v 56 (29.7) hours respectively; mean (SD)), although the difference was not significant.
CONCLUSIONS—IFD appears to be a feasible device for managing respiratory distress syndrome in preterm infants, and benefits may be had with regard to oxygen requirement and respiratory rate when compared with nCPAP. The trend towards reduced requirement for mechanical ventilation, shorter clinical recovery time, and shorter duration of treatment requires further evaluation in a multicentre randomised clinical trial.

 PMID:11517199

A prospective, randomized, open-label study comparing the efficacy and safety of preprandial and prandial insulin in combination with acarbose in elderly, insulin-requiring patients with type 2 diabetes mellitus.

PubMed

Yang, Guang; Li, Chunlin; Gong, Yanping; Li, Jian; Cheng, Xiaoling; Tian, Hui

2013-06-01

By delaying absorption of carbohydrates, acarbose can reduce preprandial hyperglycemia and delay the emergence of postprandial hyperglycemia. To evaluate whether acarbose can shorten the desirable time interval between insulin injection and meals, 60 elderly (≥60 years) patients with unsatisfactorily controlled type 2 diabetes mellitus despite insulin use were enrolled in a randomized, open-label study of 16 weeks' duration. Two groups (n=20 each) were randomized to receive isophane protamine biosynthetic human insulin 70/30 injections twice daily 30 min before meals plus acarbose 50 mg once daily (Group A) or three times daily (Group B) before meals, whereas the third group (n=20) received isophane protamine biosynthetic human insulin 70/30 injections twice daily immediately before meals plus acarbose 50 mg three times daily before meals (Group C). The required insulin dosage at study end was significantly less in Groups B and C than in Group A. Both continuous glucose monitoring data and the patients' self-monitoring data indicated that blood glucose variability parameters were significantly improved in Groups B and C in comparison with Group A, but there were no significant differences between Groups B and C. The incidence of hypoglycemia was low in all three groups. The absence of a significant difference in glucose variability between Groups B and C suggests that the addition of acarbose permitted adjustment of the insulin administration time from 30 min before meals to immediately before meals-which may be more convenient for patients-without affecting glycemic control.

Transverse vs torsional ultrasound: prospective randomized contralaterally controlled study comparing two phacoemulsification-system handpieces.

PubMed

Assil, Kerry K; Harris, Lindsay; Cecka, Jeannie

2015-01-01

To compare surgical efficiency and multiple early clinical outcome variables in eyes undergoing phacoemulsification using either transversal or torsional ultrasound systems. Assil Eye Institute, Beverly Hills, CA, USA. Prospective, randomized, clinician-masked, contralaterally controlled single-center evaluation. Patients seeking cataract removal in both eyes with implantation of multifocal intraocular lenses were randomly assigned to one of two treatment rooms for phacoemulsification with either a transverse ultrasound system or torsional handpiece system. The contralateral eye was treated at a later date with the alternate device. A total of 54 eyes of 27 patients having similar degrees of cataract, astigmatism, and visual potential were included. All operative data were collected for analysis, and patients were followed for 3 months after surgery. Similar visual acuity was reported at all postoperative visits between the two groups. Mean phacoemulsification time and total power required were both significantly lower with the transverse system than with the torsional technique (P<0.05 for both). Similarly, mean total balanced salt solution used was significantly less with the transverse system vs torsional (P<0.05). Postoperative safety demonstrated significantly lower endothelial cell loss at 1 day and 1 month (P<0.05) with transverse vs torsional. Macular swelling was less at 1 week, 1 month, and 3 months with transverse vs torsional, although the difference did not achieve significance (P=0.1) at any single time point. Clinically detectable corneal edema was reported less frequently at all postoperative time points with the transverse system. The transverse ultrasound system was found to be possibly associated with less balanced salt-solution use, less phacoemulsification time, and less power required than the torsional phaco system. Postoperative data suggested that improved phaco efficiency may translate to a better overall safety profile for the patient.

Determination of real-time polymerase chain reaction uncertainty of measurement using replicate analysis and a graphical user interface with Fieller’s theorem

PubMed Central

Stuart, James Ian; Delport, Johan; Lannigan, Robert; Zahariadis, George

2014-01-01

BACKGROUND: Disease monitoring of viruses using real-time polymerase chain reaction (PCR) requires knowledge of the precision of the test to determine what constitutes a significant change. Calculation of quantitative PCR confidence limits requires bivariate statistical methods. OBJECTIVE: To develop a simple-to-use graphical user interface to determine the uncertainty of measurement (UOM) of BK virus, cytomegalovirus (CMV) and Epstein-Barr virus (EBV) real-time PCR assays. METHODS: Thirty positive clinical samples for each of the three viral assays were repeated once. A graphical user interface was developed using a spreadsheet (Excel, Microsoft Corporation, USA) to enable data entry and calculation of the UOM (according to Fieller’s theorem) and PCR efficiency. RESULTS: The confidence limits for the BK virus, CMV and EBV tests were ∼0.5 log, 0.5 log to 1.0 log, and 0.5 log to 1.0 log, respectively. The efficiencies of these assays, in the same order were 105%, 119% and 90%. The confidence limits remained stable over the linear range of all three tests. DISCUSSION: A >5 fold (0.7 log) and a >3-fold (0.5 log) change in viral load were significant for CMV and EBV when the results were ≤1000 copies/mL and >1000 copies/mL, respectively. A >3-fold (0.5 log) change in viral load was significant for BK virus over its entire linear range. PCR efficiency was ideal for BK virus and EBV but not CMV. Standardized international reference materials and shared reporting of UOM among laboratories are required for the development of treatment guidelines for BK virus, CMV and EBV in the context of changes in viral load. PMID:25285125

Determination of real-time polymerase chain reaction uncertainty of measurement using replicate analysis and a graphical user interface with Fieller's theorem.

PubMed

Stuart, James Ian; Delport, Johan; Lannigan, Robert; Zahariadis, George

2014-07-01

Disease monitoring of viruses using real-time polymerase chain reaction (PCR) requires knowledge of the precision of the test to determine what constitutes a significant change. Calculation of quantitative PCR confidence limits requires bivariate statistical methods. To develop a simple-to-use graphical user interface to determine the uncertainty of measurement (UOM) of BK virus, cytomegalovirus (CMV) and Epstein-Barr virus (EBV) real-time PCR assays. Thirty positive clinical samples for each of the three viral assays were repeated once. A graphical user interface was developed using a spreadsheet (Excel, Microsoft Corporation, USA) to enable data entry and calculation of the UOM (according to Fieller's theorem) and PCR efficiency. The confidence limits for the BK virus, CMV and EBV tests were ∼0.5 log, 0.5 log to 1.0 log, and 0.5 log to 1.0 log, respectively. The efficiencies of these assays, in the same order were 105%, 119% and 90%. The confidence limits remained stable over the linear range of all three tests. A >5 fold (0.7 log) and a >3-fold (0.5 log) change in viral load were significant for CMV and EBV when the results were ≤1000 copies/mL and >1000 copies/mL, respectively. A >3-fold (0.5 log) change in viral load was significant for BK virus over its entire linear range. PCR efficiency was ideal for BK virus and EBV but not CMV. Standardized international reference materials and shared reporting of UOM among laboratories are required for the development of treatment guidelines for BK virus, CMV and EBV in the context of changes in viral load.

Predicting Operator Execution Times Using CogTool

NASA Technical Reports Server (NTRS)

Santiago-Espada, Yamira; Latorella, Kara A.

2013-01-01

Researchers and developers of NextGen systems can use predictive human performance modeling tools as an initial approach to obtain skilled user performance times analytically, before system testing with users. This paper describes the CogTool models for a two pilot crew executing two different types of a datalink clearance acceptance tasks, and on two different simulation platforms. The CogTool time estimates for accepting and executing Required Time of Arrival and Interval Management clearances were compared to empirical data observed in video tapes and registered in simulation files. Results indicate no statistically significant difference between empirical data and the CogTool predictions. A population comparison test found no significant differences between the CogTool estimates and the empirical execution times for any of the four test conditions. We discuss modeling caveats and considerations for applying CogTool to crew performance modeling in advanced cockpit environments.

Randomized Prospective Double-Blind Studies to Evaluate the Cognitive Effects of Inositol-Stabilized Arginine Silicate in Healthy Physically Active Adults

PubMed Central

Kalman, Douglas; Harvey, Philip D.; Perez Ojalvo, Sara; Komorowski, James

2016-01-01

Inositol-stabilized arginine silicate (ASI; Nitrosigine®) has been validated to increase levels of arginine, silicon and nitric oxide production. To evaluate potential enhancement of mental focus and clarity, ASI (1500 mg/day) was tested in two double-blind placebo-controlled crossover (DBPC-X) studies using the Trail Making Test (TMT, Parts A and B). In the two studies, healthy males took ASI for 14 and 3 days, respectively. In the first study, after 14 days of dosing, TMT B time decreased significantly from baseline (28% improvement, p = 0.045). In the second study evaluating shorter-term effects, TMT B time decreased significantly compared to placebo (33% improvement, p = 0.024) in a 10-min period. After 3 days of dosing, TMT B time significantly decreased from baseline scores (35% improvement, p < 0.001). These findings show that ASI significantly improved the ability to perform complex cognitive tests requiring mental flexibility, processing speed and executive functioning. PMID:27869715

Minimized extracorporeal circulation is improving outcome of coronary artery bypass surgery in the elderly.

PubMed

Freundt, Miriam; Ried, Michael; Philipp, Alois; Diez, Claudius; Kolat, Philipp; Hirt, Stephan W; Schmid, Christof; Haneya, Assad

2016-03-01

Advanced age is a known risk factor for morbidity and mortality after coronary artery bypass grafting (CABG). Minimized extracorporeal circulation (MECC) has been shown to reduce the negative effects associated with conventional extracorporeal circulation (CECC). This trial assesses the impact of MECC on the outcome of elderly patients undergoing CABG. Eight hundred and seventy-five patients (mean age 78.35 years) underwent isolated CABG using CECC (n=345) or MECC (n=530). The MECC group had a significantly shorter extracorporeal circulation time (ECCT), cross-clamp time and reperfusion time and lower transfusion needs. Postoperatively, these patients required significantly less inotropic support, fewer blood transfusions, less postoperative hemodialysis and developed less delirium compared to CECC patients. In the MECC group, intensive care unit (ICU) stay was significantly shorter and 30-day mortality was significantly reduced [2.6% versus 7.8%; p<0.001]. In conclusion, MECC improves outcome in elderly patients undergoing CABG surgery. © The Author(s) 2015.

Spatial and temporal evolutions of ozone in a nanosecond pulse corona discharge at atmospheric pressure

NASA Astrophysics Data System (ADS)

Duten, X.; Redolfi, M.; Aggadi, N.; Vega, A.; Hassouni, K.

2011-10-01

This paper deals with the experimental determination of the spatial and temporal evolutions of the ozone concentration in an atmospheric pressure pulsed plasma, working in the nanosecond regime. We observed that ozone was produced in the localized region of the streamer. The ozone transport requires a characteristic time well above the millisecond. The numerical modelling of the streamer expansion confirms that the hydrodynamic expansion of the filamentary discharge region during the streamer propagation does not lead to a significant transport of atomic oxygen and ozone. It appears therefore that only diffusional transport can take place, which requires a characteristic time of the order of 50 ms.

Microwave Protocols for Paraffin Microtechnique and In Situ Localization in Plants

NASA Astrophysics Data System (ADS)

Schichnes, Denise; Nemson, Jeff; Sohlberg, Lorraine; Ruzin, Steven E.

1998-10-01

: We have developed a microwave protocol for a paraffin-embedding microtechnique of the shoot apical meristem of ZEA MAYS and have successfully applied this protocol to other plant tissues. This protocol decreases the time required for all aspects of microtechnique tissue processing, including fixation (24 hr to 15 min), dehydration (73 hr to 10 min), and infiltration (96 hr to 3 hr). Additionally, the time required to adhere paraffin ribbons to gelatin-coated slides and for the Johanson's safranin O, fast green FCF staining protocol has been significantly decreased. Using this technique, the quality of tissue preservation and subsequent in situ localization of KNOTTED mRNA was increased by using microwaves.

The MGTX Experience: Challenges in Planning and Executing an International, Multicenter Clinical Trial

PubMed Central

Aban, Inmaculada B.; Wolfe, Gil I.; Cutter, Gary R.; Kaminski, Henry J.; Jaretzki, Alfred; Minisman, Greg; Conwit, Robin; Newsom-Davis, John

2008-01-01

We present our experience planning and launching a multinational, NIH/NINDS funded study of thymectomy in myasthenia gravis. We highlight the additional steps required for international sites and analyze and contrast the time investment required to bring U.S. and non-U.S. sites into full regulatory compliance. Results show the mean time for non- U.S. centers to achieve regulatory approval was significantly longer (mean 13.4 ± 0.96 months) than for U.S. sites (9.67 ± 0.74 months; p = 0.003, t-test). The delay for non- U.S. sites was mainly attributable to Federalwide Assurance certification and State Department clearance. PMID:18675464

Intrafraction Motion in Stereotactic Body Radiation Therapy for Non-Small Cell Lung Cancer: Intensity Modulated Radiation Therapy Versus Volumetric Modulated Arc Therapy

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

Rossi, Maddalena M.G.; Peulen, Heike M.U.; Belderbos, Josè S.A.

Purpose: Stereotactic body radiation therapy (SBRT) for early-stage inoperable non-small cell lung cancer (NSCLC) patients delivers high doses that require high-precision treatment. Typically, image guidance is used to minimize day-to-day target displacement, but intrafraction position variability is often not corrected. Currently, volumetric modulated arc therapy (VMAT) is replacing intensity modulated radiation therapy (IMRT) in many departments because of its shorter delivery time. This study aimed to evaluate whether intrafraction variation in VMAT patients is reduced in comparison with patients treated with IMRT. Methods and Materials: NSCLC patients (197 IMRT and 112 VMAT) treated with a frameless SBRT technique to amore » prescribed dose of 3 × 18 Gy were evaluated. Image guidance for both techniques was identical: pretreatment cone beam computed tomography (CBCT) (CBCT{sub precorr}) for setup correction followed immediately before treatment by postcorrection CBCT (CBCT{sub postcorr}) for verification. Then, after either a noncoplanar IMRT technique or a VMAT technique, a posttreatment (CBCT{sub postRT}) scan was acquired. The CBCT{sub postRT} and CBCT{sub postcorr} scans were then used to evaluate intrafraction motion. Treatment delivery times, systematic (Σ) and random (σ) intrafraction variations, and associated planning target volume (PTV) margins were calculated. Results: The median treatment delivery time was significantly reduced by 20 minutes (range, 32-12 minutes) using VMAT compared with noncoplanar IMRT. Intrafraction tumor motion was significantly larger for IMRT in all directions up to 0.5 mm systematic (Σ) and 0.7 mm random (σ). The required PTV margins for IMRT and VMAT differed by less than 0.3 mm. Conclusion: VMAT-based SBRT for NSCLC was associated with significantly shorter delivery times and correspondingly smaller intrafraction motion compared with noncoplanar IMRT. However, the impact on the required PTV margin was small.« less

Deceleration-stats save much time during phototrophic culture optimization.

PubMed

Hoekema, Sebastiaan; Rinzema, Arjen; Tramper, Johannes; Wijffels, René H; Janssen, Marcel

2014-04-01

In case of phototrophic cultures, photobioreactor costs contribute significantly to the total operating costs. Therefore one of the most important parameters to be determined is the maximum biomass production rate, if biomass or a biomass associated product is the desired product. This is traditionally determined in time consuming series of chemostat cultivations. The goal of this work is to assess the experimental time that can be saved by applying the deceleration stat (D-stat) technique to assess the maximum biomass production rate of a phototrophic cultivation system, instead of a series of chemostat cultures. A mathematical model developed by Geider and co-workers was adapted in order to describe the rate of photosynthesis as a function of the local light intensity. This is essential for the accurate description of biomass productivity in phototrophic cultures. The presented simulations demonstrate that D-stat experiments executed in the absence of pseudo steady-state (i.e., the arbitrary situation that the observed specific growth rate deviates <5% from the dilution rate) can still be used to accurately determine the maximum biomass productivity of the system. Moreover, this approach saves up to 94% of the time required to perform a series of chemostat experiments that has the same accuracy. In case more information on the properties of the system is required, the reduction in experimental time is reduced but still significant. © 2013 Wiley Periodicals, Inc.

Comparison of surgical time and IOP spikes with two ophthalmic viscosurgical devices following Visian STAAR (ICL, V4c model) insertion in the immediate postoperative period.

PubMed

Ganesh, Sri; Brar, Sheetal

2016-01-01

To compare the effect of two ocular viscosurgical devices (OVDs) on intraocular pressure (IOP) and surgical time in immediate postoperative period after bilateral implantable collamer lens (using the V4c model) implantation. A total of 20 eligible patients were randomized to receive 2% hydroxypropylmethylcellulose (HPMC) in one eye and 1% hyaluronic acid in fellow eye. Time taken for complete removal of OVD and total surgical time were recorded. At the end of surgery, IOP was adjusted between 15 and 20 mmHg in both the eyes. Mean time for complete OVD evacuation and total surgical time were significantly higher in the HPMC group (P=0.00). Four eyes in the HPMC group had IOP spike, requiring treatment. IOP values with noncontact tonometry at 1, 2, 4, 24, and 48 hours were not statistically significant (P>0.05) for both the groups. The study concluded that 1% hyaluronic acid significantly reduces total surgical time, and incidence of acute spikes may be lower compared to 2% HPMC when used for implantable collamer lens (V4c model).

Comparison of surgical time and IOP spikes with two ophthalmic viscosurgical devices following Visian STAAR (ICL, V4c model) insertion in the immediate postoperative period

PubMed Central

Ganesh, Sri; Brar, Sheetal

2016-01-01

Purpose To compare the effect of two ocular viscosurgical devices (OVDs) on intraocular pressure (IOP) and surgical time in immediate postoperative period after bilateral implantable collamer lens (using the V4c model) implantation. Methods A total of 20 eligible patients were randomized to receive 2% hydroxypropylmethylcellulose (HPMC) in one eye and 1% hyaluronic acid in fellow eye. Time taken for complete removal of OVD and total surgical time were recorded. At the end of surgery, IOP was adjusted between 15 and 20 mmHg in both the eyes. Results Mean time for complete OVD evacuation and total surgical time were significantly higher in the HPMC group (P=0.00). Four eyes in the HPMC group had IOP spike, requiring treatment. IOP values with noncontact tonometry at 1, 2, 4, 24, and 48 hours were not statistically significant (P>0.05) for both the groups. Conclusion The study concluded that 1% hyaluronic acid significantly reduces total surgical time, and incidence of acute spikes may be lower compared to 2% HPMC when used for implantable collamer lens (V4c model). PMID:26869754

THE EFFECTS OF INTRATHECAL NEOSTIGMINE ADDED TO BUPIVACAINE ON POSTOPERATIVE ANALGESIC REQUIREMENT IN PATIENTS UNDERGOING LOWER LIMB ORTHOPEDIC SURGERY.

PubMed

Kayalha, Hamid; Mousavi, Zinat; Sadat Barikani, Ameneh; Yaghoobi, Siamak; Khezri, Marzieh Beigom

2015-06-01

Several additives have been suggested to enhance analgesic effect of local anesthetic agents to decrease the adverse effects of them and increase the degree of satisfaction. We designed this randomized double-blind controlled study to evaluate the analgesic efficacy of the neostigmine added to bupivacaine using spinal anesthesia in patients undergoing lower limb orthopedic surgery. Sixty patients 18-80 yr old American Society of Anesthesiologists (ASA) physical status I or II, scheduled for femur surgery under spinal anesthesia, were recruited in a prospective, double-blinded, randomized way. The patients were randomly allocated to one of two groups of 30 each. The neostigmine group (group N) received bupivacaine 20 mg combined with 25 µg neostigmine, and the placebo group (group C) received bupivacaine 20 mg combined with 0.5ml distilled water (intrathecally) 5 minutes prior to surgery. The time to the first analgesic request, analgesic requirement in the first 12 hours after surgery, the duration of sensory and motor blockade, the incidence of adverse effects such as nausea,vomiting,hypotension, ephedrine requirements, bradycardia, and hypoxemia were recorded. Patients receiving neostigmine had a significantly prolonged duration of motor block (C95% CI 30.27 to 87.65; P < 0.001) and sensory block (C95% CI 101.04 to 224.64; P < 0.001) compared to the control group. The difference of the mean time to the first analgesic request was also significantly longer in neostigmine group (C95% CI 83.139 to 208.526; P < 0.001). The total analgesic consumption during the first 12 hours after surgery was devoid of any significant difference between groups N and C (p = 0.41).The two groups were not significantly different in terms of intraoperative and postoperative side effects. Intrathecal neostigmine 25 µg with bupivacaine caused a prolonged time to the first analgesic request and its use was not associated with any side effects.

Two Aspects of Activation: Arousal and Subjective Significance – Behavioral and Event-Related Potential Correlates Investigated by Means of a Modified Emotional Stroop Task

PubMed Central

Imbir, Kamil; Spustek, Tomasz; Bernatowicz, Gabriela; Duda, Joanna; Żygierewicz, Jarosław

2017-01-01

The arousal level of words presented in a Stroop task was found to affect their interference on the required naming of the words’ color. Based on a dual-processes approach, we propose that there are two aspects to activation: arousal and subjective significance. Arousal is crucial for automatic processing. Subjective significance is specific to controlled processing. Based on this conceptual model, we predicted that arousal would enhance interference in a Stroop task, as attention would be allocated to the meaning of the inhibited word. High subjective significance should have the opposite effect, i.e., it should enhance the controlled and explicit part of Stroop task processing, which is color naming. We found that response latencies were modulated by the interaction between the arousal and subjective significance levels of words. The longest reaction times were observed for highly arousing words of medium subjective significance level. Arousal shaped event related potentials in the 150–290 ms time range, while effects of subjective significance were found for 50–150, 150–290, and 290–530 ms time ranges. PMID:29311872

Effect of a single intra-articular injection of bupivacaine on synovial fluid prostaglandin E2 concentrations in normal canine stifles.

PubMed

Giangarra, Jenna E; Barry, Sabrina L; Dahlgren, Linda A; Lanz, Otto I; Benitez, Marian E; Werre, Stephen R

2018-04-25

To identify if synovial fluid prostaglandin E 2 increases in response to a single intra-articular dose of bupivacaine in the normal canine stifle. There were no significant differences in synovial fluid prostaglandin E 2 (PGE 2 ) concentrations between treatment groups or over time within bupivacaine or saline groups. Samples requiring ≥ 3 arthrocentesis attempts had significantly higher PGE 2 concentrations compared to samples requiring 1 or 2 attempts. Following correction for number of arthrocentesis attempts, PGE 2 concentrations were significantly higher than baseline at 24 and 48 h in the bupivacaine group; however there were no significant differences between the bupivacaine and saline groups. In normal dogs, a single bupivacaine injection did not cause significant synovial inflammation, as measured by PGE 2 concentrations, compared to saline controls. Future research should minimize aspiration attempts and include evaluation of the synovial response to bupivacaine in clinical cases with joint disease.

Variable-Field Analytical Ultracentrifugation: I. Time-Optimized Sedimentation Equilibrium

PubMed Central

Ma, Jia; Metrick, Michael; Ghirlando, Rodolfo; Zhao, Huaying; Schuck, Peter

2015-01-01

Sedimentation equilibrium (SE) analytical ultracentrifugation (AUC) is a gold standard for the rigorous determination of macromolecular buoyant molar masses and the thermodynamic study of reversible interactions in solution. A significant experimental drawback is the long time required to attain SE, which is usually on the order of days. We have developed a method for time-optimized SE (toSE) with defined time-varying centrifugal fields that allow SE to be attained in a significantly (up to 10-fold) shorter time than is usually required. To achieve this, numerical Lamm equation solutions for sedimentation in time-varying fields are computed based on initial estimates of macromolecular transport properties. A parameterized rotor-speed schedule is optimized with the goal of achieving a minimal time to equilibrium while limiting transient sample preconcentration at the base of the solution column. The resulting rotor-speed schedule may include multiple over- and underspeeding phases, balancing the formation of gradients from strong sedimentation fluxes with periods of high diffusional transport. The computation is carried out in a new software program called TOSE, which also facilitates convenient experimental implementation. Further, we extend AUC data analysis to sedimentation processes in such time-varying centrifugal fields. Due to the initially high centrifugal fields in toSE and the resulting strong migration, it is possible to extract sedimentation coefficient distributions from the early data. This can provide better estimates of the size of macromolecular complexes and report on sample homogeneity early on, which may be used to further refine the prediction of the rotor-speed schedule. In this manner, the toSE experiment can be adapted in real time to the system under study, maximizing both the information content and the time efficiency of SE experiments. PMID:26287634

The effect of intraoperative dexmedetomidine on postoperative analgesia and sedation in pediatric patients undergoing tonsillectomy and adenoidectomy.

PubMed

Olutoye, Olutoyin A; Glover, Chris D; Diefenderfer, John W; McGilberry, Michael; Wyatt, Matthew M; Larrier, Deidre R; Friedman, Ellen M; Watcha, Mehernoor F

2010-08-01

The immediate postoperative period after tonsillectomy and adenoidectomy, one of the most common pediatric surgical procedures, is often difficult. These children frequently have severe pain but postoperative airway edema along with increased sensitivity to the respiratory-depressant effects of opioids may result in obstructive symptoms and hypoxemia. Opioid consumption may be reduced by nonsteroidal antiinflammatory drugs, but these drugs may be associated with increased bleeding after this operation. Dexmedetomidine has mild analgesic properties, causes sedation without respiratory depression, and does not have an effect on coagulation. We designed a prospective, double-blind, randomized controlled study to determine the effects of intraoperative dexmedetomidine on postoperative recovery including pain, sedation, and hemodynamics in pediatric patients undergoing tonsillectomy and adenoidectomy. One hundred nine patients were randomized to receive a single intraoperative dose of dexmedetomidine 0.75 microg/kg, dexmedetomidine 1 microg/kg, morphine 50 microg/kg, or morphine 100 microg/kg over 10 minutes after endotracheal intubation. There were no significant differences among the 4 groups in patient demographics, ASA physical status, postoperative opioid requirements, sedation scores, duration of oxygen supplementation in the postanesthetic care unit, and time to discharge readiness. The median time to first postoperative rescue analgesic was similar in patients receiving dexmedetomidine 1 microg/kg and morphine 100 microg/kg, but significantly longer compared with patients receiving dexmedetomidine 0.75 microg/kg or morphine 50 microg/kg (P < 0.01). In addition, the number of patients requiring >1 rescue analgesic dose was significantly higher in the dexmedetomidine 0.75 microg/kg group compared with the dexmedetomidine 1 microg/kg and morphine 100 microg/kg groups, but not the morphine 50 microg/kg group. Patients receiving dexmedetomidine had significantly slower heart rates in the first 30 minutes after surgery compared with those receiving morphine (P < 0.05). There was no significant difference in sedation scores among the groups. The total postoperative rescue opioid requirements were similar in tonsillectomy patients receiving intraoperative dexmedetomidine or morphine. However, the use of dexmedetomidine 1 microg/kg and morphine 100 microg/kg had the advantages of an increased time to first analgesic and a reduced need for additional rescue analgesia doses, without increasing discharge times.

Occupational cognitive requirements and late-life cognitive aging.

PubMed

Pool, Lindsay R; Weuve, Jennifer; Wilson, Robert S; Bültmann, Ute; Evans, Denis A; Mendes de Leon, Carlos F

2016-04-12

To examine whether occupational cognitive requirements, as a marker of adulthood cognitive activity, are associated with late-life cognition and cognitive decline. Main lifetime occupation information for 7,637 participants aged >65 years of the Chicago Health and Aging Project (CHAP) was linked with standardized data on worker attributes and job characteristics from the Occupational Information Network (O*NET). Ratings of cognitive processes required in 10 work-related tasks were used to create a summary measure of occupational cognitive requirements (possible range 0-7). Multivariable-adjusted linear mixed models were used to estimate the association of occupational cognitive requirements score (OCRS) with cognitive function and rate of cognitive decline. Higher OCRS corresponded to significantly better late-life cognitive performance at baseline in 1993 (p < 0.001) and to slower decline in global cognitive function over time (p = 0.004). Within a genotyped subsample (n = 4,104), the associations of OCRS with rate of cognitive decline did not differ significantly by APOE ε4 carriership (p = 0.11). Findings suggest that occupational cognitive requirements are associated with better cognition and a slower rate of cognitive decline in older age. Adulthood cognitive activity may contribute to cognitive reserve in late life. © 2016 American Academy of Neurology.

47 CFR 73.1510 - Experimental authorizations.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 47 Telecommunication 4 2010-10-01 2010-10-01 false Experimental authorizations. 73.1510 Section 73... conducted at any time the station is authorized to operate, but the minimum required schedule of programming... regularly scheduled programming concurrently with the experimental transmission if there is no significant...

47 CFR 73.1510 - Experimental authorizations.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 47 Telecommunication 4 2011-10-01 2011-10-01 false Experimental authorizations. 73.1510 Section 73... conducted at any time the station is authorized to operate, but the minimum required schedule of programming... regularly scheduled programming concurrently with the experimental transmission if there is no significant...

75 FR 71007 - Department of the Interior Implementation of OMB Guidance on Drug-Free Workplace Requirements...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-11-22

... publish a timely revision of the rule. Executive Order 12866 This document is not a significant rule and... transfer a thing of value to the recipient to carry out a public purpose of support or stimulation...

RESEARCH ACTIVITIES AT U.S. GOVERNMENT AGENCIES IN SUBSURFACE REACTIVE TRANSPORT MODELING

EPA Science Inventory

The fate of contaminants in the environment is controlled by both chemical reactions and transport phenomena in the subsurface. Our ability to understand the significance of these processes over time requires an accurate conceptual model that incorporates the various mechanisms ...

Compatibility of aggregate, asphalt cement and antistrip materials : final report.

DOT National Transportation Integrated Search

1995-12-01

Studies undertaken for the FHWA revealed a significant moisture damage problem in Louisiana hot mix pavements. At that time an antistrip additive from a qualified products list was required at the set rate of 0.5 percent weight of asphalt cement. The...

Efficient Transition Probability Computation for Continuous-Time Branching Processes via Compressed Sensing.

PubMed

Xu, Jason; Minin, Vladimir N

2015-07-01

Branching processes are a class of continuous-time Markov chains (CTMCs) with ubiquitous applications. A general difficulty in statistical inference under partially observed CTMC models arises in computing transition probabilities when the discrete state space is large or uncountable. Classical methods such as matrix exponentiation are infeasible for large or countably infinite state spaces, and sampling-based alternatives are computationally intensive, requiring integration over all possible hidden events. Recent work has successfully applied generating function techniques to computing transition probabilities for linear multi-type branching processes. While these techniques often require significantly fewer computations than matrix exponentiation, they also become prohibitive in applications with large populations. We propose a compressed sensing framework that significantly accelerates the generating function method, decreasing computational cost up to a logarithmic factor by only assuming the probability mass of transitions is sparse. We demonstrate accurate and efficient transition probability computations in branching process models for blood cell formation and evolution of self-replicating transposable elements in bacterial genomes.

Hemostasis in tubeless PNL: point of technique.

PubMed

Aron, Monish; Goel, Rajiv; Kesarwani, Pawan K; Gupta, Narmada P

2004-01-01

Tubeless PNL (percutaneous nephrolithotomy), in a highly selected group of patients, is a modification aimed at reducing the morbidity of PNL. We present a simple technique of achieving tract hemostasis as an adjunct to the safe performance of a tubeless PNL. Charts of 40 consecutive patients who underwent tubeless PNL at our center were reviewed. In the latter 20 consecutive patients, diathermy coagulation of the intrarenal bleeders and tract was done and these patients were compared with the earlier 20 patients in whom fulguration was not done. Drop in hemoglobin, postoperative analgesic requirement, operating time, length of hospitalization and postoperative complications were compared. No statistical difference was found between the operative times and drop in hemoglobin for both the groups. The length of hospitalization and postoperative analgesic requirement were significantly less in the fulguration group. No significant complications were noted in either of the two groups. Fulguration of visible intrarenal and tract bleeders is a simple, safe and effective hemostatic adjunct in patients undergoing tubeless PNL. copyright 2004 S. Karger AG, Basel

a Study of Women Engineering Students and Time to Completion of First-Year Required Courses at Texas A&M University

NASA Astrophysics Data System (ADS)

Kimball, Jorja; Cole, Bryan; Hobson, Margaret; Watson, Karan; Stanley, Christine

This paper reports findings on gender that were part of a larger study reviewing time to completion of course work that includes the first two semesters of calculus, chemistry, and physics, which are often considered the stumbling points or "barrier courses" to an engineering baccalaureate degree. Texas A&M University terms these courses core body of knowledge (CBK), and statistical analysis was conducted on two cohorts of first-year enrolling engineering students at the institution. Findings indicate that gender is statistically significantly related to completion of CBK with female engineering students completing required courses faster than males at the .01 level (p = 0.008). Statistical significance for gender and ethnicity was found between white male and white female students at the .01 level (p = 0.008). Descriptive analysis indicated that of the five majors studied (chemical, civil, computer, electrical, and mechanical engineering), women completed CBK faster than men, and African American and Hispanic women completed CBK faster than males of the same ethnicity.

Efficient Transition Probability Computation for Continuous-Time Branching Processes via Compressed Sensing

PubMed Central

Xu, Jason; Minin, Vladimir N.

2016-01-01

Branching processes are a class of continuous-time Markov chains (CTMCs) with ubiquitous applications. A general difficulty in statistical inference under partially observed CTMC models arises in computing transition probabilities when the discrete state space is large or uncountable. Classical methods such as matrix exponentiation are infeasible for large or countably infinite state spaces, and sampling-based alternatives are computationally intensive, requiring integration over all possible hidden events. Recent work has successfully applied generating function techniques to computing transition probabilities for linear multi-type branching processes. While these techniques often require significantly fewer computations than matrix exponentiation, they also become prohibitive in applications with large populations. We propose a compressed sensing framework that significantly accelerates the generating function method, decreasing computational cost up to a logarithmic factor by only assuming the probability mass of transitions is sparse. We demonstrate accurate and efficient transition probability computations in branching process models for blood cell formation and evolution of self-replicating transposable elements in bacterial genomes. PMID:26949377

Elimination sequence optimization for SPAR

NASA Technical Reports Server (NTRS)

Hogan, Harry A.

1986-01-01

SPAR is a large-scale computer program for finite element structural analysis. The program allows user specification of the order in which the joints of a structure are to be eliminated since this order can have significant influence over solution performance, in terms of both storage requirements and computer time. An efficient elimination sequence can improve performance by over 50% for some problems. Obtaining such sequences, however, requires the expertise of an experienced user and can take hours of tedious effort to affect. Thus, an automatic elimination sequence optimizer would enhance productivity by reducing the analysts' problem definition time and by lowering computer costs. Two possible methods for automating the elimination sequence specifications were examined. Several algorithms based on the graph theory representations of sparse matrices were studied with mixed results. Significant improvement in the program performance was achieved, but sequencing by an experienced user still yields substantially better results. The initial results provide encouraging evidence that the potential benefits of such an automatic sequencer would be well worth the effort.

Effect of steady and time-harmonic magnetic fields on macrosegragation in alloy solidification

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

Incropera, F.P.; Prescott, P.J.

Buoyancy-induced convection during the solidification of alloys can contribute significantly to the redistribution of alloy constituents, thereby creating large composition gradients in the final ingot. Termed macrosegregation, the condition diminishes the quality of the casting and, in the extreme, may require that the casting be remelted. The deleterious effects of buoyancy-driven flows may be suppressed through application of an external magnetic field, and in this study the effects of both steady and time-harmonic fields have been considered. For a steady magnetic field, extremely large field strengths would be required to effectively dampen convection patterns that contribute to macrosegregation. However, bymore » reducing spatial variations in temperature and composition, turbulent mixing induced by a time-harmonic field reduces the number and severity of segregates in the final casting.« less

Influence of Field Position on Rugby League Players Requiring Shoulder Reconstruction.

PubMed

Bokor, D J; Sundaram, A; Graham, P L

2016-06-01

A consecutive series of patients sustaining their index anterior instability while playing Rugby League and requiring shoulder reconstruction was retrospectively reviewed and evaluated. The details of their on-field position and hand dominance at time of injury, the side of injury, and mechanism of injury were collated and statistically analyzed. A total of 173 Bankart repairs were performed on 132 patients, and 102 players had one injury while 30 had 2 or more injuries. Players are more likely to injure their non-dominant side (P=0.009) in the first-time injury. Whereas second and subsequent injuries were not associated with a particular side (P=0.81). Applying a Bonferroni correction to the chi-squared goodness-of-fit test of position at time of injury revealed players on the wing had a significantly lower frequency of injury (P<0.001), whereas the full back had a significantly higher frequency of injury (P<0.001). 30 players sustained 69 re-dislocations with the lock and fullback positions incurring significantly more re-injuries and the wing position fewer re-injuries than expected (P<0.006). Understanding which player positions on the rugby league field are more likely to sustain an anterior instability will assist medical and support staff to optimize the pre-season conditioning and post surgical rehabilitation of players. © Georg Thieme Verlag KG Stuttgart · New York.

NDMA formation in secondary wastewater effluent.

PubMed

Hatt, J W; Lamy, C; Germain, E; Tupper, M; Judd, S J

2013-03-01

Concern over prospective levels of N-nitrosodimethylamine (NDMA) in waters has increased in recent years due to its disinfection byproduct formation potential from chloramination. It has been mooted that this is promoted by organic precursors from municipal wastewaters, such that there is a more significant risk of excessive levels in water reuse applications. Experiments conducted on chloramination and chlorination of secondary wastewater have confirmed that that significant NDMA formation arises only from chloramination, with its concentration varying with test conditions used. A full factor analysis revealed all parameters studied (temperature, pH, monochloramine dose and contact time), both individually and synergistically, to have a statistically significant impact on NDMA formation with contact time being the most important. At raw water temperatures below 10 °C, the NDMA concentration can be minimised to below the 10 ng L(-1) threshold by not exceeding a monochloramine dose of 2 mg L(-1) as Cl(2). However, at higher water temperatures other measures are required to suppress NDMA formation, such as reducing the contact time (which could prove impractical in most applications) or maintaining a pH below 6. Further trials are required to fully develop the operating envelope to ensure NDMA concentrations do not exceed the 10 ng L(-1) threshold, or else to identify effective pretreatment methods for removing the NDMA precursors. Copyright © 2012 Elsevier Ltd. All rights reserved.

Maintenance energy requirements of odor detection, explosive detection and human detection working dogs.

PubMed

Mullis, Rebecca A; Witzel, Angela L; Price, Joshua

2015-01-01

Despite their important role in security, little is known about the energy requirements of working dogs such as odor, explosive and human detection dogs. Previous researchers have evaluated the energy requirements of individual canine breeds as well as dogs in exercise roles such as sprint racing. This study is the first to evaluate the energy requirements of working dogs trained in odor, explosive and human detection. This retrospective study evaluated twenty adult dogs who maintained consistent body weights over a six month period. During this time, the average energy consumption was [Formula: see text] or two times the calculated resting energy requirement ([Formula: see text]). No statistical differences were found between breeds, age or sex, but a statistically significant association (p = 0.0033, R-square = 0.0854) was seen between the number of searches a dog performs and their energy requirement. Based on this study's population, it appears that working dogs have maintenance energy requirements similar to the 1974 National Research Council's (NRC) maintenance energy requirement of [Formula: see text] (National Research Council (NRC), 1974) and the [Formula: see text] reported for young laboratory beagles (Rainbird & Kienzle, 1990). Additional research is needed to determine if these data can be applied to all odor, explosive and human detection dogs and to determine if other types of working dogs (tracking, search and rescue etc.) have similar energy requirements.

77 FR 29935 - 2012 Technical Corrections, Clarifying and Other Amendments to the Greenhouse Gas Reporting Rule...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-05-21

...The EPA is proposing to amend specific provisions of the Greenhouse Gas Reporting Rule to provide greater clarity and flexibility to facilities subject to reporting emissions from certain source categories. These source categories will report greenhouse gas (GHG) data for the first time in September of 2012. The proposed changes are not expected to significantly change the overall calculation and monitoring requirements of the Greenhouse Gas Reporting Rule or add additional requirements for reporters, but are expected to correct errors and clarify existing requirements in order to facilitate accurate and timely reporting. The EPA is also proposing confidentiality determinations for four new data elements for the fluorinated gas production source category of the Greenhouse Gas Reporting Rule. Lastly, we are proposing an amendment to Table A-7 of the general provisions to add a data element used as an input to an emission equation in the fluorinated gas production source category.

Complete exchange on the iPSC-860

NASA Technical Reports Server (NTRS)

Bokhari, Shahid H.

1991-01-01

The implementation of complete exchange on the circuit switched Intel iPSC-860 hypercube is described. This pattern, also known as all-to-all personalized communication, is the densest requirement that can be imposed on a network. On the iPSC-860, care needs to be taken to avoid edge contention, which can have a disastrous impact on communication time. There are basically two classes of algorithms that achieve contention-free complete exchange. The first contains the classical standard exchange algorithm that is generally useful for small message sizes. The second includes a number of optimal or near-optimal algorithms that are best for large messages. Measurement of communication overhead on the iPSC-860 are given and a notation for analyzing communication link usage is developed. It is shown that for the two classes of algorithms, there is substantial variation in performance with synchronization technique and choice of message protocol. Timings of six implementations are given; each of these is useful over a particular range of message size and cube dimension. Since the complete exchange is a superset of communication patterns, these timings represent upper bounds on the time required by an arbitrary communication requirement. These results indicate that the programmer needs to evaluate several possibilities before finalizing an implementation - a careful choice can lead to very significant savings in time.

Correlation between sexual maturation and induction of persistent estrus by continuous illumination.

PubMed

Takeo, Y; Shirama, K; Shimizu, K; Maekawa, K

1975-10-01

The rats brought up under continuous illumination from the neonatal day persist in the rhythmic estrous cycle for long time and do not easily reveal so-called continuous vaginal estrus. On the contrary, immature rats at about 30 days of age show the persistent estrus soon after exposure to continuous illumination as well as adult rats. The purpose of this paper was to examine the relation of the age placed under continuous illumination and the time required to reach the persistent estrus. As the results, it was found that the younger rats need proportionally the longer time to reach the persistent estrus; the rats which were transferred into continuously illuminated environment at 0 (group A), 5 (group B), 10 (group C), 15-16 (group D) and 30 (group E) days of age required a mean time of 132.1 +/- 8.4, 126.8 +/- 8.9, 89.7 +/- 6.2, 91.5 +/- 3.8 and 70.3 +/- 3.0 days after birth to reach the persistent estrus, respectively. In the present data, a significant difference was seen between group B and C. Though all rats were killed after the same length of persistently estrous periods, actual endocrine level appeared to differ among the groups; the rats required longer time to reach the persistent estrus had smaller ovaries and adrenals.

Nose and vein, speed and pain: comparing the use of intranasal diamorphine and intravenous morphine in a Scottish paediatric emergency department.

PubMed

Regan, Luke; Chapman, Andrew R; Celnik, Anna; Lumsden, Lesley; Al-Soufi, Reem; McCullough, Nicola P

2013-01-01

Urgent analgesia is essential for all children who present in severe pain, but difficulties in obtaining venous access can delay the use of adequate opiate analgesia. Intranasal diamorphine (IND) is now in use in around 60% of emergency departments and is the preferred choice of analgesia as reported by both parents and healthcare professionals. While IND has similar efficacy to intramuscular morphine in children, no study has compared its use against the current gold standard, intravenous morphine (IVM). IND was introduced to the Royal Aberdeen Children's Hospital on 24 December 2009. A retrospective case series was constructed to compare its clinical performance with its predecessor IVM. Three unexplored factors were investigated: time to opiate analgesia, the requirement for further analgesia when still in the emergency department and the effect of simple coanalgesia (eg, paracetamol/ibuprofen) on these requirements. 297 patients were eligible for the study (147 IND, 150 IVM) over a 28-month period. There was a non-significant trend to a longer median time to administration of analgesia in patients receiving IND (p=0.170). Patients who received IND were less likely to require further analgesia (p<0.001). Both groups were less likely to require further analgesia when simple coanalgesia was given (p=0.049). The authors found no significant difference in time to administration of analgesia between agents, but a learning curve has been identified. Sustained effort should be placed on the use of simple coanalgesia. The clinical performance of IND compares favourably with IVM in children with severe pain, and it remains an appropriate preferred agent.

Geomagnetic referencing in the arctic environment

USGS Publications Warehouse

Podjono, Benny; Beck, Nathan; Buchanan, Andrew; Brink, Jason; Longo, Joseph; Finn, Carol A.; Worthington, E. William

2011-01-01

Geomagnetic referencing is becoming an increasingly attractive alternative to north-seeking gyroscopic surveys to achieve the precise wellbore positioning essential for success in today's complex drilling programs. However, the greater magnitude of variations in the geomagnetic environment at higher latitudes makes the application of geomagnetic referencing in those areas more challenging. Precise, real-time data on those variations from relatively nearby magnetic observatories can be crucial to achieving the required accuracy, but constructing and operating an observatory in these often harsh environments poses a number of significant challenges. Operational since March 2010, the Deadhorse Magnetic Observatory (DED), located in Deadhorse, Alaska, was created through collaboration between the United States Geological Survey (USGS) and a leading oilfield services supply company. DED was designed to produce real-time geomagnetic data at the required level of accuracy, and to do so reliably under the extreme temperatures and harsh weather conditions often experienced in the area. The observatory will serve a number of key scientific communities as well as the oilfield drilling industry, and has already played a vital role in the success of several commercial ventures in the area, providing essential, accurate data while offering significant cost and time savings, compared with traditional surveying techniques.

Geomagnetic referencing in the arctic environment

USGS Publications Warehouse

Poedjono, B.; Beck, N.; Buchanan, A. C.; Brink, J.; Longo, J.; Finn, C.A.; Worthington, E.W.

2011-01-01

Geomagnetic referencing is becoming an increasingly attractive alternative to north-seeking gyroscopic surveys to achieve the precise wellbore positioning essential for success in today's complex drilling programs. However, the greater magnitude of variations in the geomagnetic environment at higher latitudes makes the application of geomagnetic referencing in those areas more challenging. Precise, real-time data on those variations from relatively nearby magnetic observatories can be crucial to achieving the required accuracy, but constructing and operating an observatory in these often harsh environments poses a number of significant challenges. Operational since March 2010, the Deadhorse Magnetic Observatory (DED), located in Deadhorse, Alaska, was created through collaboration between the United States Geological Survey (USGS) and a leading oilfield services supply company. DED was designed to produce real-time geomagnetic data at the required level of accuracy, and to do so reliably under the extreme temperatures and harsh weather conditions often experienced in the area. The observatory will serve a number of key scientific communities as well as the oilfield drilling industry, and has already played a vital role in the success of several commercial ventures in the area, providing essential, accurate data while offering significant cost and time savings, compared with traditional surveying techniques. Copyright 2011, Society of Petroleum Engineers.

The effect of ordinances requiring smoke-free restaurants and bars on revenues: a follow-up.

PubMed Central

Glantz, S A; Smith, L R

1997-01-01

OBJECTIVES: The purpose of this study was to extend an earlier evaluation of the economic effects of ordinances requiring smoke-free restaurants and bars. METHODS: Sales tax data for 15 cities with smoke-free restaurant ordinances, 5 cities and 2 counties with smoke-free bar ordinances, and matched comparison locations were analyzed by multiple regression, including time and a dummy variable for the ordinance. RESULTS: Ordinances had no significant effect on the fraction of total retail sales that went to eating and drinking places or on the ratio between sales in communities with ordinances and sales in comparison communities. Ordinances requiring smoke-free bars had no significant effect on the fraction of revenues going to eating and drinking places that serve all types of liquor. CONCLUSIONS: Smoke-free ordinances do not adversely affect either restaurant or bar sales. PMID:9357356

Systematic Evaluation of the Efficacy of Chlorine Dioxide in Decontamination of Building Interior Surfaces Contaminated with Anthrax Spores▿

PubMed Central

Rastogi, Vipin K.; Ryan, Shawn P.; Wallace, Lalena; Smith, Lisa S.; Shah, Saumil S.; Martin, G. Blair

2010-01-01

Efficacy of chlorine dioxide (CD) gas generated by two distinct generation systems, Sabre (wet system with gas generated in water) and ClorDiSys (dry system with gas generated in air), was evaluated for inactivation of Bacillus anthracis spores on six building interior surfaces. The six building materials included carpet, acoustic ceiling tile, unpainted cinder block, painted I-beam steel, painted wallboard, and unpainted pinewood. There was no statistically significant difference in the data due to the CD generation technology at a 95% confidence level. Note that a common method of CD gas measurement was used for both wet and dry CD generation types. Doses generated by combinations of different concentrations of CD gas (500, 1,000, 1,500, or 3,000 parts per million of volume [ppmv]) and exposure times (ranging between 0.5 and 12 h) were used to evaluate the relative role of fumigant exposure period and total dose in the decontamination of building surfaces. The results showed that the time required to achieve at least a 6-log reduction in viable spores is clearly a function of the material type on which the spores are inoculated. The wood and cinder block coupons required a longer exposure time to achieve a 6-log reduction. The only material showing a clear statistical difference in rate of decay of viable spores as a function of concentration was cinder block. For all other materials, the profile of spore kill (i.e., change in number of viable spores with exposure time) was not dependent upon fumigant concentration (500 to 3,000 ppmv). The CD dose required for complete spore kill on biological indicators (typically, 1E6 spores of Bacillus atrophaeus on stainless steel) was significantly less than that required for decontamination of most of the building materials tested. PMID:20305025

Systematic evaluation of the efficacy of chlorine dioxide in decontamination of building interior surfaces contaminated with anthrax spores.

PubMed

Rastogi, Vipin K; Ryan, Shawn P; Wallace, Lalena; Smith, Lisa S; Shah, Saumil S; Martin, G Blair

2010-05-01

Efficacy of chlorine dioxide (CD) gas generated by two distinct generation systems, Sabre (wet system with gas generated in water) and ClorDiSys (dry system with gas generated in air), was evaluated for inactivation of Bacillus anthracis spores on six building interior surfaces. The six building materials included carpet, acoustic ceiling tile, unpainted cinder block, painted I-beam steel, painted wallboard, and unpainted pinewood. There was no statistically significant difference in the data due to the CD generation technology at a 95% confidence level. Note that a common method of CD gas measurement was used for both wet and dry CD generation types. Doses generated by combinations of different concentrations of CD gas (500, 1,000, 1,500, or 3,000 parts per million of volume [ppmv]) and exposure times (ranging between 0.5 and 12 h) were used to evaluate the relative role of fumigant exposure period and total dose in the decontamination of building surfaces. The results showed that the time required to achieve at least a 6-log reduction in viable spores is clearly a function of the material type on which the spores are inoculated. The wood and cinder block coupons required a longer exposure time to achieve a 6-log reduction. The only material showing a clear statistical difference in rate of decay of viable spores as a function of concentration was cinder block. For all other materials, the profile of spore kill (i.e., change in number of viable spores with exposure time) was not dependent upon fumigant concentration (500 to 3,000 ppmv). The CD dose required for complete spore kill on biological indicators (typically, 1E6 spores of Bacillus atrophaeus on stainless steel) was significantly less than that required for decontamination of most of the building materials tested.

Defective sensorimotor integration in preparation for reaction time tasks in patients with multiple sclerosis.

PubMed

Cabib, Christopher; Llufriu, Sara; Casanova-Molla, Jordi; Saiz, Albert; Valls-Solé, Josep

2015-03-01

Slowness of voluntary movements in patients with multiple sclerosis (MS) may be due to various factors, including attentional and cognitive deficits, delays in motor conduction time, and impairment of specific central nervous system circuits. In 13 healthy volunteers and 20 mildly disabled, relapsing-remitting MS patients, we examined simple reaction time (SRT) tasks requiring sensorimotor integration in circuits involving the corpus callosum and the brain stem. A somatosensory stimulus was used as the imperative signal (IS), and subjects were requested to react with either the ipsilateral or the contralateral hand (uncrossed vs. crossed SRT). In 33% of trials, a startling auditory stimulus was presented together with the IS, and the percentage reaction time change with respect to baseline SRT trials was measured (StartReact effect). The difference between crossed and uncrossed SRT, which requires interhemispheric conduction, was significantly larger in patients than in healthy subjects (P = 0.021). The StartReact effect, which involves activation of brain stem motor pathways, was reduced significantly in patients with respect to healthy subjects (uncrossed trials: P = 0.015; crossed trials: P = 0.005). In patients, a barely significant correlation was found between SRT delay and conduction abnormalities in motor and sensory pathways (P = 0.02 and P = 0.04, respectively). The abnormalities found specifically in trials reflecting interhemispheric transfer of information, as well as the evidence for reduced subcortical motor preparation, indicate that a delay in reaction time execution in MS patients cannot be explained solely by conduction slowing in motor and sensory pathways but suggest, instead, defective sensorimotor integration mechanisms in at least the two circuits examined. Copyright © 2015 The American Physiological Society.

Surgeon motivations behind the timing of breast reconstruction in patients requiring postmastectomy radiation therapy.

PubMed

Lee, Ming; Reinertsen, Erik; McClure, Evan; Liu, Shuling; Kruper, Laura; Tanna, Neil; Brian Boyd, J; Granzow, Jay W

2015-11-01

Although postmastectomy radiation therapy (PMRT) has been shown to reduce breast cancer burden and improve survival, PMRT may negatively influence outcomes after reconstruction. The goal of this study was to compare current opinions of plastic and reconstructive surgeons (PRS) and surgical oncologists (SO) regarding the optimal timing of breast reconstruction for patients requiring PMRT. Members of the American Society of Plastic Surgeons (ASPS), the American Society of Breast Surgeons (ASBS), and the Society of Surgical Oncology (SSO) were asked to participate in an anonymous web-based survey. Responses were solicited in accordance to the Dillman method, and they were analyzed using standard descriptive statistics. A total of 330 members of the ASPS and 348 members of the ASBS and SSO participated in our survey. PRS and SO differed in patient-payor mix (p < 0.01) and practice setting (p < 0.01), but they did not differ by urban versus rural setting (p = 0.65) or geographic location (p = 0.30). Although PRS favored immediate reconstruction versus SO, overall timing did not significantly differ between the two specialists (p = 0.14). The primary rationale behind delayed breast reconstruction differed significantly between PRS and SO (p < 0.01), with more PRS believing that the reconstructive outcome is significantly and adversely affected by radiation. Both PRS and SO cited "patient-driven desire to have immediate reconstruction" (p = 0.86) as the primary motivation for immediate reconstruction. Although the optimal timing of reconstruction is controversial between PRS and SO, our study suggests that the timing of reconstruction in PMRT patients is ultimately driven by patient preferences and the desire of PRS to optimize aesthetic outcomes. Copyright © 2015 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

A Meta-Analysis Examining Differences in Short-Term Outcomes Between Sutureless and Conventional Aortic Valve Prostheses.

PubMed

Hurley, Eoghan T; O'Sullivan, Katie E; Segurado, Ricardo; Hurley, John P

2015-01-01

Sutureless aortic valve prostheses are anchored by radial force in a mechanism similar to that of transcatheter aortic valve implantation. Transcatheter aortic valve implantation is associated with an increased permanent pacemaker (PPM) requirement in a significant proportion of patients. We undertook a meta-analysis to examine the incidence of PPM insertion associated with sutureless compared with conventional surgical aortic valve replacement. A systematic review was conducted in accordance with the Prisma guidelines. All searches were performed on August 10, 2014. Studies between 2007 and 2014 were included in the search. A total of 832 patients were included in the sutureless group and 3,740 in the conventional group. Aortic cross-clamp (39.8 vs 62.4 minutes; P < 0.001) and cardiopulmonary bypass (64.9 vs 86.7 minutes; P = 0.002) times were shorter in the sutureless group. Permanent pacemaker implantation rate was higher in the sutureless cohort (9.1% vs 2.4%; P = 0.025). Sutureless aortic valve prostheses are associated with significantly shorter cardiopulmonary bypass and aortic cross-clamp times and a higher incidence of PPM insertion than conventional. Further investigation of the prognostic significance is required.

Comparison of the performance of rapid prescreening, 10% random review, and clinical risk criteria as methods of internal quality control in cervical cytopathology.

PubMed

Tavares, Suelene B N; Alves de Sousa, Nadja L; Manrique, Edna J C; Pinheiro de Albuquerque, Zair B; Zeferino, Luiz C; Amaral, Rita G

2008-06-25

Rapid prescreening (RPS) is an internal quality-control (IQC) method that is used both to reduce errors in the laboratory and to measure the sensitivity of routine screening (RS). Little direct comparison data are available comparing RPS with other more widely used IQC methods. The authors compared the performance of RPS, 10% random review of negative smears (R-10%), and directed rescreening of negative smears based on clinical risk criteria (RCRC) over 1 year in a community clinic setting. In total, 6,135 smears were evaluated. The sensitivity of RS alone was 71.3%. RPS detected significantly more (132 cases) false-negative (FN) cases than either R-10% (7 cases) or RCRC (32 cases). RPS significantly improved the overall sensitivity of the laboratory (71.3-92.2%; P = .001); neither R-10% nor RCRC significantly changed the sensitivity of RS. RPS was not as specific as the other methods, although nearly 68% of all abnormalities detected by RPS were verified as real. RPS of 100% of smears required the same amount of time as RCRC but required twice as much time as R-10%. The current results demonstrated that RPS is a much more effective IQC method than either R-10% or RCRC. RPS detects significantly more errors and can improve the overall sensitivity of a laboratory with either a modest increase or no increase in overall time spent on IQC. R-10% is an insensitive IQC method, and neither R-10% nor RCRC can significantly improve the overall sensitivity of a laboratory. (c) 2008 American Cancer Society.

Impact of the Removal of the Monthly Liver Function Test Requirement for Ambrisentan

PubMed Central

Durst, Louise A.; Carlsen, John; Kuchinski, Megan; Harner, Lauren; Neves, Daniel; Harris, Stephanie J.; Traiger, Glenna L.

2012-01-01

Background The management of patients with pulmonary arterial hypertension (PAH) requires extensive coordination between patients, their support system, third-party payers, and healthcare professionals. For patients with PAH who are receiving endothelin receptor antagonists (ERAs), such cross-stakeholder coordination was needed to ensure compliance with a US Food and Drug Administration (FDA) Risk Evaluation and Mitigation Strategy (REMS) requirement for monthly liver function tests (LFTs). In March 2011, the FDA removed this requirement for ambrisentan (Letairis) in conjunction with a change to the product label. Objective This study sought to explore the impact of the ambrisentan label change on payers, providers who treat PAH, and specialty pharmacies. Methods This study, conducted in June and July 2011, involved telephone interviews with 5 medical/pharmacy directors in commercial health plans (representing 78,345,000 covered lives collectively); written surveys and telephone interviews with 6 nurses managing patients with PAH; and written surveys and telephone interviews with 4 staff members from specialty pharmacies to determine direct and indirect cost-savings associated with the removal of the monthly LFT requirement for ambrisentan. Qualitative telephone interviews with payer decision makers informed the cost-savings for payers. Direct cost-savings were calculated from the responses of the nurses managing PAH regarding the prescribing trends of their practices and the frequency of LFTs. Indirect cost-savings were calculated using time-savings data collected from the PAH-managing nurses and the specialty pharmacy staff, as well as from the US Bureau of Labor Statistics data regarding national wage averages for the respective staff. Results: Payers reported that REMS requirements did not play a large role in their plan's coverage or management of ERAs; although direct cost-savings resulting from the label change were an estimated $28 per patient per month, this amount is relatively small compared with the overall cost of PAH treatment for payers. The impact of the ambrisentan label change was more significant for providers and specialty pharmacies. The label change resulted in a significant, average 69% reduction in the frequency of LFTs for patients using ambrisentan. The average monthly time-savings realized by providers as a result of the label change was 12 minutes per patient receiving ambrisentan, and the average monthly direct and indirect cost-savings totaled $10.75 and $29.75, respectively, per patient taking ambrisentan. Telephone interviews with specialty pharmacies indicated that the average monthly time-savings for the 4 specialty pharmacies surveyed was 14 minutes per patient using ambrisentan, representing an 86.7% decrease in the amount of time specialty pharmacies spent on LFT-related administrative tasks for patients using ambrisentan. Conclusion Findings from this study indicate that the ambrisentan label change significantly reduced the number of LFTs for patients with PAH, resulting in time-savings or cost-savings for payers, providers, and specialty pharmacies. PMID:24991314

The Utility of a Wireless Implantable Hemodynamic Monitoring System in Patients Requiring Mechanical Circulatory Support.

PubMed

Feldman, David S; Moazami, Nader; Adamson, Philip B; Vierecke, Juliane; Raval, Nir; Shreenivas, Satya; Cabuay, Barry M; Jimenez, Javier; Abraham, William T; O'Connell, John B; Naka, Yoshifumi

Proper timing of left ventricular assist device (LVAD) implantation in advanced heart failure patients is not well established and is an area of intense interest. In addition, optimizing LVAD performance after implantation remains difficult and represents a significant clinical need. Implantable hemodynamic monitoring systems may provide physicians with the physiologic information necessary to improve the timing of LVAD implantation as well as LVAD performance when compared with current methods. The CardioMEMS Heart sensor Allows for Monitoirng of Pressures to Improve Outcomes in NYHA Class III heart failure patients (CHAMPION) Trial enrolled 550 previously hospitalized patients with New York Heart Association (NYHA) class III heart failure. All patients were implanted with a pulmonary artery (PA) pressure monitoring system and randomized to a treatment and control groups. In the treatment group, physicians used the hemodynamic information to make heart failure management decisions. This information was not available to physicians for the control group. During an average of 18 month randomized follow-up, 27 patients required LVAD implantation. At the time of PA pressure sensor implantation, patients ultimately requiring advanced therapy had higher PA pressures, lower systemic pressure, and similar cardiac output measurements. Treatment and control patients in the LVAD subgroup had similar clinical profiles at the time of enrollment. There was a trend toward a shorter length of time to LVAD implantation in the treatment group when hemodynamic information was available. After LVAD implantation, most treatment group patients continued to provide physicians with physiologic information from the hemodynamic monitoring system. As expected PA pressures declined significantly post LVAD implant in all patients, but the magnitude of decline was higher in patients with PA pressure monitoring. Implantable hemodynamic monitoring appeared to improve the timing of LVAD implantation as well as optimize LVAD performance when compared with current methods. Further studies are necessary to evaluate these findings in a prospective manner.

Multicenter Clinical Evaluation of BacT/Alert Virtuo Blood Culture System.

PubMed

Jacobs, Michael R; Mazzulli, Tony; Hazen, Kevin C; Good, Caryn E; Abdelhamed, Ayman M; Lo, Pauline; Shum, Bianche; Roman, Katharine P; Robinson, Danielle C

2017-08-01

BacT/Alert Virtuo is an advanced, automated blood culture system incorporating improved automation and an enhanced detection algorithm to shorten time to detection. A multicenter study of the investigational Virtuo system (bioMérieux, Inc., Durham, NC) compared to BacT/Alert 3D (BTA3D) for detection of bacteremia/fungemia in four bottle types, SA and FA Plus (aerobic) and SN and FN Plus (anaerobic), was performed in a clinical setting with patient samples in a matched system design clinical trial. Blood was added to paired aerobic or anaerobic bottles, with the volume in each bottle in each pair required to be ≤10 ml and with the volumes required to be within 30% of each other. Of 5,709 bottle sets (52.5% aerobic pairs and 47.5% anaerobic pairs), 430 (7.5%) were positive for bacterial or fungal growth, with 342 (6.0%) clinically significant and 83 (1.5%) contaminated. A total of 3,539 sets (62.0%) were volume compliant, with 203 sets (5.7%) clinically significant. The positivity rates for volume-compliant bottle pairs determined by the two systems were comparable, with 68.7% of clinically significant isolates detected by both instruments, 15.7% by Virtuo only, and 15.7% by BTA3D only. Virtuo detected microbial growth nearly 2 h sooner overall than BTA3D (mean, 15.9 h versus 17.7 h). Shorter time to detection by Virtuo was related to organism group, with the time to detection being significantly shorter for enteric Gram-negative bacilli and enterococci (means, 3.6 h and 2.3 h shorter, respectively). This large clinical study demonstrated that the Virtuo blood culture system produced results comparable to those seen with the long-established BTA3D system, with significantly shorter time to detection. Copyright © 2017 Jacobs et al.

The impact of introducing intensity modulated radiotherapy into routine clinical practice.

PubMed

Miles, Elizabeth A; Clark, Catharine H; Urbano, M Teresa Guerrero; Bidmead, Margaret; Dearnaley, David P; Harrington, Kevin J; A'Hern, Roger; Nutting, Christopher M

2005-12-01

Intensity modulated radiotherapy (IMRT) at the Royal Marsden Hospital London was introduced in July 2001. Treatment delivery was dynamic using a single-phase technique. Concerns were raised regarding increased clinical workload due to introduction of new technology. The potential increased use of resources was assessed. IMRT patient selection was within guidelines of clinical trials and included patients undergoing prostate plus pelvic lymph node (PPN) irradiation and head and neck cancer (HNC) treatment. Patient planning, quality assurance and treatment times were collected for an initial IMRT patient group. A comparative group of patients with advanced HNC undergoing two- or three-phase conventional radiotherapy, requiring matched photon and electron fields, were also timed. The median overall total planning time for IMRT was greater for HNC patients compared to the PPN cohort. For HNC the overall IMRT planning time was significantly longer than for conventional. The median treatment time for conventional two- or three-phase HNC treatments, encompassing similar volumes to those treated with IMRT, was greater than that for the IMRT HNC patient cohort. A reduction in radiographer man hours per patient of 4.8h was recorded whereas physics time was increased by 4.9h per patient. IMRT currently increases overall planning time. Additional clinician input is required for target volume localisation. Physics time is increased, a significant component of this being patient specific QA. Radiographer time is decreased. For HNC a single phase IMRT treatment has proven to be more efficient than a multiple phase conventional treatment. IMRT has been integrated smoothly and efficiently into the existing treatment working day. This preliminary study suggests that IMRT could be a routine treatment with efficient use of current radiotherapy resources.

The use of a prospective audit proforma to improve door-to-mask times for acute exacerbations chronic obstructive pulmonary disease (COPD) requiring non-invasive ventilation (NIV).

PubMed

Mandal, S; Howes, T Q; Parker, M; Roberts, C M

2014-12-01

Non-invasive ventilation (NIV) is an evidence based management of acidotic, hypercapnic exacerbations of COPD. Previous national and international audits of clinical practice have shown variation against guideline standards with significant delays in initiating NIV. We aimed to map the clinical pathway to better understand delays and reduce the door-to-NIV time to less than 3 hours for all patients with acidotic, hypercapnic exacerbations of COPD requiring this intervention, by mandating the use of a guideline based educational management proforma.The proforma was introduced at 7 acute hospitals in North London and Essex and initiated at admission of the patient. It was used to record the clinical pathway and patient outcomes until the point of discharge or death. Data for 138 patients were collected. 48% of patients commenced NIV within 3 hours with no reduction in door-to-mask time during the study period. Delays in starting NIV were due to: time taken for review by the medical team (101 minutes) and time taken for NIV to be started once a decision had been made (49 minutes). There were significant differences in door-to-NIV decision and mask times between differing respiratory on-call systems, p < 0.05). The introduction of the proforma had no effect on door-to-mask times over the study period. Main reasons for delay were related to timely access to medical staff and to NIV equipment; however, a marked variation in practice within these hospitals was been noted, with a 9-5 respiratory on-call system associated with shorter NIV initiation times.

Shuttle's 160 hour ground turnaround - A design driver

NASA Technical Reports Server (NTRS)

Widick, F.

1977-01-01

Turnaround analysis added a new dimension to the Space Program with the advent of the Space Shuttle. The requirement to turn the flight hardware around in 160 working hours from landing to launch was a significant design driver and a useful tool in forcing the integration of flight and ground systems design to permit an efficient ground operation. Although there was concern that time constraints might increase program costs, the result of the analysis was to minimize facility requirements and simplify operations with resultant cost savings.

A study of space station needs, attributes and architectural options

NASA Technical Reports Server (NTRS)

1983-01-01

The mission requirements, economic benefits, and time table of deployment of the space station are discussed. It is concluded that: (1) mission requirements overwhelmingly support the need for a space station; (2) a single space station is the way to begin; (3) the space station must evolve its capability; (4) the orbit transfer vehicle aspect of the space station will provide significant economic benefit; and (5) an early, affordable, effective way to start the space station program is needed.

Benchmarking Dutch and U.S. Naval Shipbuilding: Reducing U.S. Naval Shipbuilding Costs Using Collaborative PLM and 3D Imaging

DTIC Science & Technology

2012-11-02

Scanning Technology (3D LST) and Collaborative Product Lifecycle Management (CPLM) are two technologies that are currently being leveraged by international ... international ship construction organizations to achieve significant cost savings. 3D LST dramatically reduces the time required to scan ship surfaces as...technology does not meet the accuracy requirements, 0.030” accuracy minimum , for naval shipbuilding. The report delivered to the CSNT shows that if the

Development and Evaluation of a Casualty Evacuation Model for a European Conflict.

DTIC Science & Technology

1985-12-01

EVAC, the computer code which implements our technique, has been used to solve a series of test problems in less time and requiring less memory than...the order of 1/K the amount of main memory for a K-commodity problem, so it can solve significantly larger problems than MCNF. I . 10 CHAPTER II A...technique may require only half the memory of the general L.P. package [6]. These advances are due to the efficient data structures which have been

[Trampoline injuries in children].

PubMed

Sinikumpu, Juha-Jaakko; Antila, Eeva; Korhonen, Jussi; Rättyä, Johanna; Serlo, Willy

2012-01-01

Trampolines for home use have become common in Finland during the past ten years, being especially favored by children. Trampoline jumping is beneficial and constructive physical exercise, but poses a significant risk for injuries. The most common injuries include sprains and strains. During summertime, trampoline injuries account for as many as 13% of children's accidents requiring hospital care. Fractures are by far the most common trampoline injuries requiring hospital care. Injuries can be prevented by using safety nets. Only one child at a time is allowed to jump on the trampoline.

Hydrogen and Methane Generation in Serpentinizing Systems: An Experimental Perspective

NASA Astrophysics Data System (ADS)

McCollom, T. M.; Klein, F.

2018-05-01

Experimental studies indicate rates of serpentinization as well as H2 and CH4 production are very sluggish at low temperatures. Temperatures >200–300 C or prolonged reaction times may be required to produce significant H2 and CH4 within icy worlds.

Why Service-Learning?

ERIC Educational Resources Information Center

Speck, Bruce W.

2001-01-01

Describes two significant theoretical approaches to service learning (philanthropic and civil) so that professors are aware of two different impulses that inform service learning. In addition, addresses three critical concerns about service learning: it takes too much time and too many resources, it should not be required, and it should be…

Accelerating sample preparation through enzyme-assisted microfiltration of Salmonella in chicken extract

USDA-ARS?s Scientific Manuscript database

Microfiltration of chicken extracts has the potential to significantly decrease the time required to detect Salmonella, as long as the extract can be efficiently filtered and the pathogenic microorganisms kept in a viable state during this process. We present conditions that enable microfiltration ...

Report of CEC Study Committee on Construction Management.

ERIC Educational Resources Information Center

Consulting Engineers Council of the U.S., Washington, DC.

Changing times place new demands on those involved in the implementation of construction projects. Within a relatively few years, the size and complexity of projects has grown substantially. Environmental and other public and social considerations are increasingly significant. With growing complexity, the requirements for effective project…

Correlation of rapid hydrometer analysis for select material to existing procedure LDH-TR-407-66 : final report.

DOT National Transportation Integrated Search

1968-05-01

Conditions arise during construction of bases with Portland cement stabilized soils which require close programming of work. Therefore, time is of significant importance. : That is the objective of this report; to evaluate a method by which considera...

A COMPARISON OF BULK SEDIMENT TOXICITY TESTING METHODS AND SEDIMENT ELUTRIATE TOXICITY

EPA Science Inventory

Bulk sediment toxicity tests are routinely used to assess the level and extent of contamination in natural sediments. While reliable, these tests can be resource intensive, requiring significant outlays of time and materials. The purpose of this study was to compare the results ...

Effects of oxytocin on high intensity focused ultrasound (HIFU) ablation of adenomysis: a prospective study.

PubMed

Zhang, Xin; Zou, Min; Zhang, Cai; He, Jia; Mao, Shihua; Wu, Qingrong; He, Min; Wang, Jian; Zhang, Ruitao; Zhang, Lian

2014-09-01

To investigate the effects of oxytocin on high-intensity focused ultrasound (HIFU) ablation for the treatment of adenomyosis. Eighty-six patients with adenomyosis from three hospitals were randomly assigned to the oxytocin group or control group for HIFU treatment. During HIFU treatment, 80 units of oxytocin was added in 500ml of 0.9% normal saline running at the rate of 2ml/min (0.32U/min) in the oxytocin group, while 0.9% normal saline was used in the control group. Both patients and HIFU operators were blinded to oxytocin or saline application. Treatment results, adverse effects were compared. When using oxytocin, the non-perfused volume (NPV) ratio was 80.7±11.6%, the energy-efficiency factor (EEF) was 8.1±9.9J/mm(3), and the sonication time required to ablate 1cm(3) was 30.0±36.0s/cm(3). When not using oxytocin, the non-perfused volume ratio was 70.8±16.7%, the EEF was 15.8±19.6J/mm(3), and the sonication time required to ablate 1cm(3) was 58.2±72.7S/cm(3). Significant difference in the NPV ratio, EEF, and the sonication time required to ablate 1cm(3) between the two groups was observed. No oxytocin related adverse effects occurred. Oxytocin could significantly decrease the energy for ablating adenomyosis with HIFU, safely enhance the treatment efficiency. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Who pays for the health benefits of exclusive breastfeeding? An analysis of maternal time costs.

PubMed

Smith, J P; Forrester, Robert

2013-11-01

The benefits of exclusive breastfeeding, including public health cost savings, are widely recognized, but breastfeeding requires maternal time investments. This study investigates the time taken to exclusively breastfeed at 6 months compared with not exclusively breastfeeding. Time use data were examined from an Australian survey of new mothers conducted during 2005-2006. Data from 139 mothers with infants age 6 months were analyzed using chi-square tests of independence to examine socioeconomic and demographic characteristics and 2-sided t tests to compare average weekly hours spent on milk feeding, feeding solids, preparing feeds, and the total of these. The comparison was of exclusively breastfeeding mothers with other mothers. We also compared exclusively breastfeeding with partially breastfeeding and formula feeding mothers using a 1-way between-groups analysis of variance (ANOVA). The exclusively breastfeeding (vs other) mothers spent 7 hours extra weekly on milk feeding their infants but 2 hours less feeding solids. These differences were statistically significant. ANOVA revealed significant differences between exclusively breastfeeding mothers, breastfeeding mothers who had introduced solids, and mothers who fed any formula, in time spent feeding milk, and solids, and preparing feeds. Exclusive breastfeeding is time intensive, which is economically costly to women. This may contribute to premature weaning for women who are time-stressed, lack household help from family, or cannot afford paid help. Gaining public health benefits of exclusive breastfeeding requires strategies to share maternal lactation costs more widely, such as additional help with housework or caring for children, enhanced leave, and workplace lactation breaks and suitable child care.

Incorporating the gas analyzer response time in gas exchange computations.

PubMed

Mitchell, R R

1979-11-01

A simple method for including the gas analyzer response time in the breath-by-breath computation of gas exchange rates is described. The method uses a difference equation form of a model for the gas analyzer in the computation of oxygen uptake and carbon dioxide production and avoids a numerical differentiation required to correct the gas fraction wave forms. The effect of not accounting for analyzer response time is shown to be a 20% underestimation in gas exchange rate. The present method accurately measures gas exchange rate, is relatively insensitive to measurement errors in the analyzer time constant, and does not significantly increase the computation time.

Treatment comfort, time perception, and preference for conventional and digital impression techniques: A comparative study in young patients.

PubMed

Burhardt, Lukasz; Livas, Christos; Kerdijk, Wouter; van der Meer, Wicher Joerd; Ren, Yijin

2016-08-01

The aim of this crossover study was to assess perceptions and preferences for impression techniques in young orthodontic patients receiving alginate and 2 different digital impressions. Thirty-eight subjects aged 10 to 17 years requiring impressions for orthodontic treatment were randomly allocated to 3 groups that differed in the order that an alginate impressions and 2 different intraoral scanning procedures were administered. After each procedure, the patients were asked to score their perceptions on a 5-point Likert scale for gag reflex, queasiness, difficulty to breathe, uncomfortable feeling, perception of the scanning time, state of anxiety, and use of a powder, and to select the preferred impression system. Chairside time and maximal mouth opening were also registered. More queasiness (P = 0.00) and discomfort (P = 0.02) during alginate impression taking of the maxilla were perceived compared with the scans with the CEREC Omnicam (Sirona Dental Systems, Bensheim, Germany). There were no significant differences in perceptions between the alginate impressions and the Lava C.O.S. (3M ESPE, St Paul, Minn) and between the 2 scanners. Chairside times for the alginate impressions (9.7 ± 1.8 minutes) and the CEREC Omnicam (10.7 ± 1.8 minutes) were significantly lower (P <0.001) than for the Lava C.O.S. (17.8 ± 4.0 minutes). Digital impressions were favored by 51% of the subjects, whereas 29% chose alginate impressions, and 20% had no preference. Regardless of the significant differences in the registered times among the 3 impression-taking methods, the distributions of the Likert scores of time perception and maximal mouth opening were similar in all 3 groups. Young orthodontic patients preferred the digital impression techniques over the alginate method, although alginate impressions required the shortest chairside time. Copyright © 2016 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.

Digital timing: sampling frequency, anti-aliasing filter and signal interpolation filter dependence on timing resolution.

PubMed

Cho, Sanghee; Grazioso, Ron; Zhang, Nan; Aykac, Mehmet; Schmand, Matthias

2011-12-07

The main focus of our study is to investigate how the performance of digital timing methods is affected by sampling rate, anti-aliasing and signal interpolation filters. We used the Nyquist sampling theorem to address some basic questions such as what will be the minimum sampling frequencies? How accurate will the signal interpolation be? How do we validate the timing measurements? The preferred sampling rate would be as low as possible, considering the high cost and power consumption of high-speed analog-to-digital converters. However, when the sampling rate is too low, due to the aliasing effect, some artifacts are produced in the timing resolution estimations; the shape of the timing profile is distorted and the FWHM values of the profile fluctuate as the source location changes. Anti-aliasing filters are required in this case to avoid the artifacts, but the timing is degraded as a result. When the sampling rate is marginally over the Nyquist rate, a proper signal interpolation is important. A sharp roll-off (higher order) filter is required to separate the baseband signal from its replicates to avoid the aliasing, but in return the computation will be higher. We demonstrated the analysis through a digital timing study using fast LSO scintillation crystals as used in time-of-flight PET scanners. From the study, we observed that there is no significant timing resolution degradation down to 1.3 Ghz sampling frequency, and the computation requirement for the signal interpolation is reasonably low. A so-called sliding test is proposed as a validation tool checking constant timing resolution behavior of a given timing pick-off method regardless of the source location change. Lastly, the performance comparison for several digital timing methods is also shown.

Recovery of photoinduced reversible dark States utilized for molecular diffusion measurements.

PubMed

Chmyrov, Andriy; Sandén, Tor; Widengren, Jerker

2010-12-15

For a spatially restricted excitation volume, the effective modulation of the excitation in time is influenced by the passage times of the molecules through the excitation volume. By applying an additional time-modulated excitation, the buildup of photoinduced reversible dark states in fluorescent molecules can be made to vary significantly with their passage times through the excitation volume. The variations in the dark state populations are reflected by the time-averaged fluorescence intensity, which thus can be used to characterize the mobilities of the molecules. The concept was experimentally verified by measuring the fluorescence response of freely diffusing cyanine fluorophores (Cy5), undergoing trans-cis isomerization when subject to time-modulated excitation in a focused laser beam. From the fluorescence response, and by applying a simple photodynamic model, the transition times of the Cy5 molecules could be well reproduced when applying different laminar flow speeds through the detection volume. The presented approach puts no constraints on sample concentration, no requirements for high time resolution or sensitivity in the detection, nor requires a high fluorescence brightness of the characterized molecules. This can make the concept useful for a broad range of biomolecular mobility studies.

Rapid Fuel Quality Surveillance Through Chemometric Modeling of Near-Infrared Spectra

DTIC Science & Technology

2009-01-01

measurements also have a first order advantage and are not time-dependent as is the case for chromatography. Thus, the data preprocessing requirements, while...due in part to the nature of hydrocarbon fuels, which imposes significant technical challenges that must be overcome, and in many cases , traditional...properties. The statistical significance of some other fuel properties is given in Table 2. Note also that in those cases where the property models

MyD88-Dependent Recruitment of Monocytes and Dendritic Cells Required for Protection from Pulmonary Burkholderia mallei Infection

PubMed Central

Goodyear, Andrew; Troyer, Ryan; Bielefeldt-Ohmann, Helle

2012-01-01

The Gram-negative bacterium Burkholderia mallei causes rapidly fatal illness in equines and humans when contracted by inhalation and also has the potential to be used as a bioweapon. However, little is known regarding the early innate immune responses and signaling mechanisms required to generate protection from pneumonic B. mallei infection. We showed previously that monocyte chemoattractant protein 1 (MCP-1) was a critical chemokine required for protection from pneumonic B. mallei infection. We have now extended those studies to identify key Toll-like receptor (TLR) signaling pathways, effector cells, and cytokines required for protection from respiratory B. mallei infection. We found that MyD88−/− mice were highly susceptible to pulmonary challenge with B. mallei and had significantly short survival times, increased bacterial burdens, and severe organ pathology compared to wild-type mice. Notably, MyD88−/− mice had significantly fewer monocytes and dendritic cells (DCs) in lung tissues and airways than infected wild-type mice despite markedly higher bacterial burdens. The MyD88−/− mice were also completely unable to produce gamma interferon (IFN-γ) at any time points following infection. In wild-type mice, NK cells were the primary cells producing IFN-γ in the lungs following B. mallei infection, while DCs and monocytes were the primary cellular sources of interleukin-12 (IL-12) production. Treatment with recombinant IFN-γ (rIFN-γ) was able to significantly restore protective immunity in MyD88−/− mice. Thus, we conclude that the MyD88-dependent recruitment of inflammatory monocytes and DCs to the lungs and the local production of IL-12, followed by NK cell production of IFN-γ, are the key initial cellular responses required for early protection from B. mallei infection. PMID:22025508

A comparison of the relative efficacies of four hand and rotary instrumentation techniques during endodontic retreatment.

PubMed

Imura, N; Kato, A S; Hata, G I; Uemura, M; Toda, T; Weine, F

2000-07-01

The purpose of this study was to quantify the amount of remaining gutta-percha/scaler on the walls of root canals when two engine-driven instruments (Quantec and ProFile) and two hand instruments (K-file and Hedström file) were used to remove these materials. The amount of apically extruded debris and the time required for treatment were also recorded. One hundred extracted mandibular premolars were prepared using a modified step-back, flare technique and obturated with the lateral condensation technique. After repreparation with the test instruments, the specimens were cut transversally at the cervical, middle and apical thirds with steel discs and the three sections were split longitudinally. The amount of residual debris on the canal walls in each section was examined using a stereomicroscope. In all groups the cervical and middle thirds showed no debris. In the apical third, obturating material was observed in some specimens. No statistically significant difference was found between the two groups for incidence of debris, although the Hedström group showed a greater number of samples with remaining gutta-percha/sealer. When analysing dirty specimens only, there was a statistically significant difference between the four groups (P < 0.01) with the Hedström group having significantly less length of canal wall with remaining obturation material than the Quantec group. There was no significant difference amongst the groups for weight of extruded debris. However, there was a significant difference amongst the groups for mean treatment time with the Hedström file group requiring significantly less time than the Quantec group (P < 0.001); no significant differences were found between the other groups. Six instruments fractured in the Quantec group, four in the ProFile group, two in the Hedström group and two in the K-type group. The results showed that overall, all instruments may leave filling material inside the root canal. During retreatment there is a risk of instrument breakage, especially rotary instruments.

A Pilot Study of Peritoneal Perfusion with a Novel Hemoglobin Based Oxygen Carrier in Swine (Sus scrofa)

DTIC Science & Technology

2016-10-12

has a high rate of complications, obliges systemic anticoagulation, and requires a significant level of logistics support as well as expertise. In...the endotracheal tube was clamped, ceasing gas exchange in the lung. Arterial blood gases and time to death were then recorded. No differences were...observed between treatment and control animals in terms of C02, 02 and time to death . Peritoneal gas exchange did not improve oxygenation, ventilation or time to death in this severe model of lung injury.

Premenstrual syndrome and premenstrual dysphoric disorder: definitions and diagnosis.

PubMed

Freeman, Ellen W

2003-08-01

Because of the prevalence, chronicity and distress caused by premenstrual symptoms (PMS), diagnosis and effective treatments are important information for clinicians. The DSM-IV requires at least five specified symptoms for premenstrual dysphoric disorder (PMDD), a severe dysphoric form of PMS, while the ICD-10 requires only one distressing symptom for a diagnosis of PMS. Many women who seek treatment fall between these two diagnostic approaches, and standard diagnostic criteria for clinically significant PMS are needed. A diagnosis of PMS consists of determining the timing of the symptoms in relation to menses, meaningful change between post- and premenstrual symptom severity and a clinically significant severity of the symptoms. A differential diagnosis to distinguish PMS from other medical and psychiatric conditions is important for appropriate treatment. No hormone or laboratory test indicates a PMS diagnosis. The current diagnostic standard requires confirmation of subjective symptom reports by prospective daily diaries. Diagnostic criteria for PMS must recognize the broad range of symptoms, the temporal pattern of the symptoms and the critical issue of symptom severity, which differentiates clinically significant PMS from normal menstrual cycle changes.

[Influence of multiple sintering on wear behavior of Cercon veneering ceramic].

PubMed

Gao, Qing-ping; Chao, Yong-lie; Jian, Xin-chun; Guo, Feng

2010-04-01

To investigate the influence of multiple sintering on wear behavior of Cercon veneering ceramic. Samples were fabricated according to the manufacture's requirement for different sintering times (1, 3, 5, 7 times). The wear test was operated with a modified MM-200 friction and wear machine in vitro. The wear scars were characterized by scanning electron microscope (SEM) and atomic force microscopy (AFM). With the sintering times increasing, the wear scar width became larger. The correlation was significant at the 0.01 level. Significant difference was observed in wear scar width among different samples (P < 0.05). SEM and AFM results showed that veneering ceramic wear facets demonstrated grooves characteristic of abrasive wear. Multiple sintering can decrease the wear ability of Cercon veneer, and the wear pattern has the tendency to severe wear.

Dynamic behavior of particles in spacecraft

NASA Technical Reports Server (NTRS)

Perrine, B. S.

1981-01-01

The behavior of particles relative to a spacecraft frame of reference was examined. Significant spatial excursions of particles in space can occur relative to the spacecraft frame of reference as a result of drag deceleration of the vehicle. These vehicle excursions tend to be large as time increases. Thus, if the particle is required to remain in a specified volume, constraints may be required. Thus, for example, in levitation experiments it may be extremely difficult to turn off the forces of constraint which keep the particles in a specified region. This means experiments which are sensitive to disturbances may be very difficult to perform if perturbation forces are required to be absent.

[Preparation and administration of cytotoxic drugs: prickly innovation].

PubMed

Mullot, H; Simon, L; Payen, C; Gentes, P

2005-06-01

The requirement for safe and optimal administration of cytotoxic drugs led us to test a new product manufactured by Codan. The transfer set (CONNECT SET) and the administration set (CYTO-AD-SET) were assessed successively by pharmacist assistance within a centralized unit for cytotoxic drug preparation and by the nursing staff in an ambulatory unit. Transfer sets can be handled in the centralized units without using needles, but with an increased sterilization load and production cost. Assessment of the administration sets demonstrated time saving for the nursing staff. These materials require significant expenditures, careful training, and a change in treatment routine, but provide important time savings for the nursing staff and considerable improvement in the safety of handling cytotoxic drugs.

Comparison of spring-loaded, loss of resistance and hanging drop techniques in lumbar epidural blocks.

PubMed

Gülen, Güven; Akkaya, Taylan; Ozkan, Derya; Kaydul, Mehmet; Gözaydin, Orhan; Gümüş, Haluk

2012-01-01

The spring-loaded syringe is a loss of resistance syringe that provide a more objective sign that the epidural space has been entered compared with the traditional techniques. The aim of this study was to compare the time required to locate the epidural space and the backache incidence with the spring-loaded (SL), loss of resistance (LOR) and the hanging drop (HD) techniques for epidural blocks in patients undergoing transurethral resection procedure. Sixty patients undergoing transurethral resections were enrolled in the study. The patients were randomly assigned to one of three groups. Epidural block was performed in the first group with a spring-loaded syringe (n=20), in the second group with loss-of-resistance syringe (n=20), and in the third group with the hanging drop technique (n=20). The required time to locate the epidural space, the number of attempts, the incidence of dural puncture and the backache incidence were assessed during the procedure and for four weeks after the procedure in all patients. The required time to locate the epidural space was 29.1 ± 9.16 seconds in Group 1; 45.25 ± 19.58 seconds in Group 2, and 47.35 ± 11.42 seconds in Group 3 (p<0.001). In Group 1 this was significantly shorter than the other two groups. There was no significant difference in the number of attempts, the incidence of dural puncture and backache incidence between the three groups (p>0.05). The use of SL syringe was found to have a shorter time period to locate the epidural space when compared with the LOR syringe and hanging drop technique.

77 FR 47399 - Funding Opportunity: Tribal Self-Governance Program; Planning Cooperative Agreement

Federal Register 2010, 2011, 2012, 2013, 2014

2012-08-08

... timely and efficient. Planning helps to identify issues in advance and ensures that the Tribe is fully... and financial management capability. Applicants are required to submit complete annual audit reports... the Planning Cooperative Agreement, the Tribe has had no uncorrected significant and material audit...

14 CFR 255.4 - Display of information.

Code of Federal Regulations, 2010 CFR

2010-01-01

... with the requirements of this section. (1) Each system must offer an integrated display that uses the.... (2) Each integrated display offered by a system must either use elapsed time as a significant factor in selecting service options from the database or give single-plane flights a preference over...

A Meta-Analysis of Individualized Instruction in Dental Education.

ERIC Educational Resources Information Center

Dacanay, Lakshmi S; Cohen, Peter A.

1992-01-01

Meta-analysis of 34 comparative studies on conventional vs. individualized instruction (II) found most favored the latter but with small-moderate overall effect. Pacing had significant effect, with teacher-pacing more effective than student-paced learning. On average, II required less time than conventional teaching. Additional research on this…

Moving toward climate-informed agricultural decision support - can we use PRISM data for more than just monthly averages?

USDA-ARS?s Scientific Manuscript database

Decision support systems/models for agriculture are varied in target application and complexity, ranging from simple worksheets to near real-time forecast systems requiring significant computational and manpower resources. Until recently, most such decision support systems have been constructed with...

The feasibility of using computer graphics in environmental evaluations : interim report, documenting historic site locations using computer graphics.

DOT National Transportation Integrated Search

1981-01-01

This report describes a method for locating historic site information using a computer graphics program. If adopted for use by the Virginia Department of Highways and Transportation, this method should significantly reduce the time now required to de...

Financing of a College Education: Theory vs. Reality

ERIC Educational Resources Information Center

Boyd, Joseph D.; Fenske, Robert F.

1976-01-01

A longitudinal study clearly indicates that changes over time require continual evaluation in both how students are financing their education and the impact of certain forms of student aid on both access to and choice of institutions. Parental and student attitudes toward financial support and financial independence are significant. (LBH)

Assimilating Digital Immigrants into High-Access Learning Environments

ERIC Educational Resources Information Center

Roseberry, Jason

2016-01-01

As schools have placed an increased emphasis on instructional technology, the amount of money spent on hardware and student devices in classrooms has increased significantly (Nagel, 2014). Because administrators are underestimating the instructional shift required for effective integration of these devices, they are not allocating enough time and…

Geometric multigrid for an implicit-time immersed boundary method

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

Guy, Robert D.; Philip, Bobby; Griffith, Boyce E.

2014-10-12

The immersed boundary (IB) method is an approach to fluid-structure interaction that uses Lagrangian variables to describe the deformations and resulting forces of the structure and Eulerian variables to describe the motion and forces of the fluid. Explicit time stepping schemes for the IB method require solvers only for Eulerian equations, for which fast Cartesian grid solution methods are available. Such methods are relatively straightforward to develop and are widely used in practice but often require very small time steps to maintain stability. Implicit-time IB methods permit the stable use of large time steps, but efficient implementations of such methodsmore » require significantly more complex solvers that effectively treat both Lagrangian and Eulerian variables simultaneously. Moreover, several different approaches to solving the coupled Lagrangian-Eulerian equations have been proposed, but a complete understanding of this problem is still emerging. This paper presents a geometric multigrid method for an implicit-time discretization of the IB equations. This multigrid scheme uses a generalization of box relaxation that is shown to handle problems in which the physical stiffness of the structure is very large. Numerical examples are provided to illustrate the effectiveness and efficiency of the algorithms described herein. Finally, these tests show that using multigrid as a preconditioner for a Krylov method yields improvements in both robustness and efficiency as compared to using multigrid as a solver. They also demonstrate that with a time step 100–1000 times larger than that permitted by an explicit IB method, the multigrid-preconditioned implicit IB method is approximately 50–200 times more efficient than the explicit method.« less

Time to adjust to changes in ventilation settings varies significantly between different T-piece resuscitators, self-inflating bags, and manometer equipped self-inflating bags.

PubMed

Hartung, Julia C; Dold, Simone K; Thio, Marta; tePas, Arjan; Schmalisch, Gerd; Roehr, Charles Christoph

2014-06-01

Resuscitation guidelines give no preference over use of self-inflating bags (SIBs) or T-piece resuscitators (TPR) for manual neonatal ventilation. We speculated that devices would differ significantly regarding time required to adjust to changed ventilation settings. This was a laboratory study. Time to adjust from baseline peak inflation pressure (PIP) (20 cmH2O) to target PIP (25 and 40 cmH2O), ability to adhere to predefined ventilation settings (PIP, PEEP, and inflation rate [IR]), and the variability within and between operators were assessed for a SIB without manometer, SIB with manometer (SIBM), and two TPRs. Adjustment time was significantly longer with TPRs, compared with SIB and SIBM. The SIBM and TPRs were < 5% (median) off target PIP, and the SIB was 14% off target PIP. Significant variability between operators (interquartile range [IQR]: 71%) was seen with SIBs. PIP adjustment takes longer with TPRs, compared with SIB/SIBM. TPRs and SIBM allow satisfactory adherence to ventilation parameters. SIBs should only be used with manometer attached. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Electrokinetically driven microfluidic mixing with patchwise surface heterogeneity and AC applied electric field

NASA Astrophysics Data System (ADS)

Luo, Win-Jet; Yue, Cheng-Feng

2004-12-01

This paper investigates two-dimensional, time-dependent electroosmotic flows driven by an AC electric field via patchwise surface heterogeneities distributed along the microchannel walls. The time-dependent flow fields through the microchannel are simulated for various patchwise heterogeneous surface patterns using the backwards-Euler time stepping numerical method. Different heterogeneous surface patterns are found to create significantly different electrokinetic transport phenomena. It is shown that the presence of oppositely charged surface heterogeneities on the microchannel walls results in the formation of localized flow circulations within the bulk flow. These circulation regions grow and decay periodically in accordance with the applied periodic AC electric field intensity. The circulations provide an effective means of enhancing species mixing in the microchannel. A suitable design of the patchwise heterogeneous surface pattern permits the mixing channel length and the retention time required to attain a homogeneous solution to be reduced significantly.

Prior topical anesthesia reduces time to full cycloplegia in Chinese.

PubMed

Siu, A W; Sum, A C; Lee, D T; Tam, K W; Chan, S W

1999-01-01

To investigate the effect of prior anesthesia on the time to full cycloplegia in young Chinese subjects. The amplitude of accommodation was monitored over a 50-minute interval after the application of 1% cyclopentolate hydrochloride with a pretreatment of 0.4% benoxinate (oxybuprocaine) or 0.9% saline solution (control). Using a nonlinear mathematical model, the rate of accommodative loss (k) and the time required for 95% of total cycloplegia (T95%) were determined. Statistical analysis revealed a significantly faster rate of accommodative loss (P < .0001) after prior anesthesia (0.129 +/- 0.05) compared with the controls (0.103 +/- 0.04). T95% was noted at 26.43 +/- 10.22 minutes after prior anesthesia, which was significantly shorter (P < .0001) than that after the saline treatment (35.28 +/- 16.51 minutes). Prior application of topical anesthetic can shorten the time to full cycloplegia for people, such as the Chinese, with dark irides.

Explicit symplectic algorithms based on generating functions for relativistic charged particle dynamics in time-dependent electromagnetic field

NASA Astrophysics Data System (ADS)

Zhang, Ruili; Wang, Yulei; He, Yang; Xiao, Jianyuan; Liu, Jian; Qin, Hong; Tang, Yifa

2018-02-01

Relativistic dynamics of a charged particle in time-dependent electromagnetic fields has theoretical significance and a wide range of applications. The numerical simulation of relativistic dynamics is often multi-scale and requires accurate long-term numerical simulations. Therefore, explicit symplectic algorithms are much more preferable than non-symplectic methods and implicit symplectic algorithms. In this paper, we employ the proper time and express the Hamiltonian as the sum of exactly solvable terms and product-separable terms in space-time coordinates. Then, we give the explicit symplectic algorithms based on the generating functions of orders 2 and 3 for relativistic dynamics of a charged particle. The methodology is not new, which has been applied to non-relativistic dynamics of charged particles, but the algorithm for relativistic dynamics has much significance in practical simulations, such as the secular simulation of runaway electrons in tokamaks.

Tailored Excitation for Multivariable Stability-Margin Measurement Applied to the X-31A Nonlinear Simulation

NASA Technical Reports Server (NTRS)

Bosworth, John T.; Burken, John J.

1997-01-01

Safety and productivity of the initial flight test phase of a new vehicle have been enhanced by developing the ability to measure the stability margins of the combined control system and vehicle in flight. One shortcoming of performing this analysis is the long duration of the excitation signal required to provide results over a wide frequency range. For flight regimes such as high angle of attack or hypersonic flight, the ability to maintain flight condition for this time duration is difficult. Significantly reducing the required duration of the excitation input is possible by tailoring the input to excite only the frequency range where the lowest stability margin is expected. For a multiple-input/multiple-output system, the inputs can be simultaneously applied to the control effectors by creating each excitation input with a unique set of frequency components. Chirp-Z transformation algorithms can be used to match the analysis of the results to the specific frequencies used in the excitation input. This report discusses the application of a tailored excitation input to a high-fidelity X-31A linear model and nonlinear simulation. Depending on the frequency range, the results indicate the potential to significantly reduce the time required for stability measurement.

Much ado about nothing: the effect of tourniquet time on an accelerated rehabilitation programme following total knee replacement (TKR).

PubMed

Wynell-Mayow, William; Saeed, Muhammad Zahid

2018-03-14

The WHO includes osteoarthritis as a disease of priority, owing to its significant impact on quality of life, and globally increasing prevalence. Hospital budgets are under pressure to ration knee replacements and shorten inpatient stays. Prolonged tourniquet application has been hypothesised to extend recovery through pain and reduced mobility. A total of 123 elective total knee replacements meeting inclusion criteria took place from July 2015 to October 2017 at the Royal Free Hospital. Cases were standardised by method of TKR, implant, physiotherapy and analgesic regime according to the trust Enhanced Recovery after Surgery pathway. Tourniquet time was compared to length-of-stay post-operatively and total opioid analgesia requirement over 24 h. Median tourniquet time overall was 74 min and was decreased year-on-year from 108 to 60 min (p = 0.000). Inpatient median length-of-stay was 5 days and did not decrease (p = 0.667). Increased tourniquet time was not associated with longer length-of-stay but in fact shorter (p = 0.03199), likely due to this confounding temporal trend. Increased tourniquet time was not associated with increased opioid requirement (p = 0.78591). No association was found between tourniquet time and other complications including DVT and infection. Our study finds no evidence that reductions in tourniquet time in TKR improve recovery including length-of-stay or opioid requirement. This clinical data is expected to augment PROMs collected by the National Joint Registry.

Standardized Testing Practices: Effect on Graduation and NCLEX® Pass Rates.

PubMed

Randolph, Pamela K

The use standardized testing in pre-licensure nursing programs has been accompanied by conflicting reports of effective practices. The purpose of this project was to describe standardized testing practices in one states' nursing programs and discover if the use of a cut score or oversight of remediation had any effect on (a) first time NCLEX® pass rates, (b) on-time graduation (OTG) or (c) the combination of (a) and (b). Administrators of 38 nursing programs in one Southwest state were sent surveys; surveys were returned by 34 programs (89%). Survey responses were compared to each program's NCLEX pass rate and on-time graduation rate; t-tests were conducted for significant differences associated with a required minimum score (cut score) and oversight of remediation. There were no significant differences in NCLEX pass or on-time graduation rates related to establishment of a cut score. There was a significant difference when the NCLEX pass rate and on-time graduation rate were combined (Outcome Index "OI") with significantly higher program outcomes (P=.02.) for programs without cut-scores. There were no differences associated with faculty oversight of remediation. The results of this study do not support establishment of a cut-score when implementing a standardized testing. Copyright © 2016. Published by Elsevier Inc.

Time Varying Compensator Design for Reconfigurable Structures Using Non-Collocated Feedback

NASA Technical Reports Server (NTRS)

Scott, Michael A.

1996-01-01

Analysis and synthesis tools are developed to improved the dynamic performance of reconfigurable nonminimum phase, nonstrictly positive real-time variant systems. A novel Spline Varying Optimal (SVO) controller is developed for the kinematic nonlinear system. There are several advantages to using the SVO controller, in which the spline function approximates the system model, observer, and controller gain. They are: The spline function approximation is simply connected, thus the SVO controller is more continuous than traditional gain scheduled controllers when implemented on a time varying plant; ft is easier for real-time implementations in storage and computational effort; where system identification is required, the spline function requires fewer experiments, namely four experiments; and initial startup estimator transients are eliminated. The SVO compensator was evaluated on a high fidelity simulation of the Shuttle Remote Manipulator System. The SVO controller demonstrated significant improvement over the present arm performance: (1) Damping level was improved by a factor of 3; and (2) Peak joint torque was reduced by a factor of 2 following Shuttle thruster firings.

Continued Data Acquisition Development

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

Schwellenbach, David

This task focused on improving techniques for integrating data acquisition of secondary particles correlated in time with detected cosmic-ray muons. Scintillation detectors with Pulse Shape Discrimination (PSD) capability show the most promise as a detector technology based on work in FY13. Typically PSD parameters are determined prior to an experiment and the results are based on these parameters. By saving data in list mode, including the fully digitized waveform, any experiment can effectively be replayed to adjust PSD and other parameters for the best data capture. List mode requires time synchronization of two independent data acquisitions (DAQ) systems: the muonmore » tracker and the particle detector system. Techniques to synchronize these systems were studied. Two basic techniques were identified: real time mode and sequential mode. Real time mode is the preferred system but has proven to be a significant challenge since two FPGA systems with different clocking parameters must be synchronized. Sequential processing is expected to work with virtually any DAQ but requires more post processing to extract the data.« less

Platform-Independence and Scheduling In a Multi-Threaded Real-Time Simulation

NASA Technical Reports Server (NTRS)

Sugden, Paul P.; Rau, Melissa A.; Kenney, P. Sean

2001-01-01

Aviation research often relies on real-time, pilot-in-the-loop flight simulation as a means to develop new flight software, flight hardware, or pilot procedures. Often these simulations become so complex that a single processor is incapable of performing the necessary computations within a fixed time-step. Threads are an elegant means to distribute the computational work-load when running on a symmetric multi-processor machine. However, programming with threads often requires operating system specific calls that reduce code portability and maintainability. While a multi-threaded simulation allows a significant increase in the simulation complexity, it also increases the workload of a simulation operator by requiring that the operator determine which models run on which thread. To address these concerns an object-oriented design was implemented in the NASA Langley Standard Real-Time Simulation in C++ (LaSRS++) application framework. The design provides a portable and maintainable means to use threads and also provides a mechanism to automatically load balance the simulation models.

Products cooked in preheated versus non-preheated ovens. Baking times, calculated energy consumption, and product quality compared.

PubMed

Odland, D; Davis, C

1982-08-01

Plain muffins, yellow cake, baked custard, apple pie, tuna casserole, frozen tuna casserole, cheese soufflé, and meat loaf were baked in preheated and non-preheated standard gas, continuous-clean gas, standard electric, and self-cleaning electric ovens. Products generally required 5 min. or less extra baking time when cooked in non-preheated rather than in preheated ovens. The variability in baking times often was less between preheated and non-preheated ovens than among oven types. Calculated energy consumption values showed that usually less energy was required to bake products in non-preheated than in preheated ovens; savings averaged about 10 percent. Few significant differences were found in physical measurements or eating quality either between preheated and non-preheated ovens or among oven types. Overall, for the products tested, findings confirmed that preheating the oven is not essential for good product quality and, therefore, is an unnecessary use of energy.

Purging of multilayer insulation by gas diffusion

NASA Technical Reports Server (NTRS)

Sumner, I. E.; Spuckler, C. M.

1976-01-01

An experimental investigation was conducted to determine the time required to purge a multilayer insulation (MLI) panel with gaseous helium by means of gas diffusion to obtain a condensable (nitrogen) gas concentration of less than 1 percent within the panel. Two flat, rectangular MLI panel configurations, one incorporating a butt joint, were tested. The insulation panels consisted of 15 double-aluminized Mylar radiation shields separated by double silk net spacers. The test results indicated that the rate which the condensable gas concentration at the edge or at the butt joint of an MLI panel was reduced was a significant factor in the total time required to reduce the condensable gas concentration within the panel to less than 1 percent. The experimental data agreed well with analytical predictions made by using a simple, one-dimensional gas diffusion model in which the boundary conditions at the edge of the MLI panel were time dependent.

A sense of urgency: Evaluating the link between clinical trial development time and the accrual performance of cancer therapy evaluation program (NCI-CTEP) sponsored studies.

PubMed

Cheng, Steven K; Dietrich, Mary S; Dilts, David M

2010-11-15

Postactivation barriers to oncology clinical trial accruals are well documented; however, potential barriers prior to trial opening are not. We investigate one such barrier: trial development time. National Cancer Institute Cancer Therapy Evaluation Program (CTEP)-sponsored trials for all therapeutic, nonpediatric phase I, I/II, II, and III studies activated between 2000 and 2004 were investigated for an 8-year period (n = 419). Successful trials were those achieving 100% of minimum accrual goal. Time to open a study was the calendar time from initial CTEP submission to trial activation. Multivariate logistic regression analysis was used to calculate unadjusted and adjusted odds ratios (OR), controlling for study phase and size of expected accruals. Among the CTEP-approved oncology trials, 37.9% (n = 221) failed to attain the minimum accrual goals, with 70.8% (n = 14) of phase III trials resulting in poor accrual. A total of 16,474 patients (42.5% of accruals) accrued to those studies were unable to achieve the projected minimum accrual goal. Trials requiring less than 12 months of development were significantly more likely to achieve accrual goals (OR, 2.15; 95% confidence interval, 1.29-3.57, P = 0.003) than trials with the median development times of 12 to 18 months. Trials requiring a development time of greater than 24 months were significantly less likely to achieve accrual goals (OR, 0.40; 95% confidence interval, 0.20-0.78; P = 0.011) than trials with the median development time. A large percentage of oncology clinical trials do not achieve minimum projected accruals. Trial development time appears to be one important predictor of the likelihood of successfully achieving the minimum accrual goals. ©2010 AACR.

Quantification of left ventricular functional parameter values using 3D spiral bSSFP and through-time non-Cartesian GRAPPA.

PubMed

Barkauskas, Kestutis J; Rajiah, Prabhakar; Ashwath, Ravi; Hamilton, Jesse I; Chen, Yong; Ma, Dan; Wright, Katherine L; Gulani, Vikas; Griswold, Mark A; Seiberlich, Nicole

2014-09-11

The standard clinical acquisition for left ventricular functional parameter analysis with cardiovascular magnetic resonance (CMR) uses a multi-breathhold multi-slice segmented balanced SSFP sequence. Performing multiple long breathholds in quick succession for ventricular coverage in the short-axis orientation can lead to fatigue and is challenging in patients with severe cardiac or respiratory disorders. This study combines the encoding efficiency of a six-fold undersampled 3D stack of spirals balanced SSFP sequence with 3D through-time spiral GRAPPA parallel imaging reconstruction. This 3D spiral method requires only one breathhold to collect the dynamic data. Ten healthy volunteers were recruited for imaging at 3 T. The 3D spiral technique was compared against 2D imaging in terms of systolic left ventricular functional parameter values (Bland-Altman plots), total scan time (Welch's t-test) and qualitative image rating scores (Wilcoxon signed-rank test). Systolic left ventricular functional values were not significantly different (i.e. 3D-2D) between the methods. The 95% confidence interval for ejection fraction was -0.1 ± 1.6% (mean ± 1.96*SD). The total scan time for the 3D spiral technique was 48 s, which included one breathhold with an average duration of 14 s for the dynamic scan, plus 34 s to collect the calibration data under free-breathing conditions. The 2D method required an average of 5 min 40s for the same coverage of the left ventricle. The difference between 3D and 2D image rating scores was significantly different from zero (Wilcoxon signed-rank test, p < 0.05); however, the scores were at least 3 (i.e. average) or higher for 3D spiral imaging. The 3D through-time spiral GRAPPA method demonstrated equivalent systolic left ventricular functional parameter values, required significantly less total scan time and yielded acceptable image quality with respect to the 2D segmented multi-breathhold standard in this study. Moreover, the 3D spiral technique used just one breathhold for dynamic imaging, which is anticipated to reduce patient fatigue as part of the complete cardiac examination in future studies that include patients.

Effect of power system technology and mission requirements on high altitude long endurance aircraft

NASA Technical Reports Server (NTRS)

Colozza, Anthony J.

1994-01-01

An analysis was performed to determine how various power system components and mission requirements affect the sizing of a solar powered long endurance aircraft. The aircraft power system consists of photovoltaic cells and a regenerative fuel cell. Various characteristics of these components, such as PV cell type, PV cell mass, PV cell efficiency, fuel cell efficiency, and fuel cell specific mass, were varied to determine what effect they had on the aircraft sizing for a given mission. Mission parameters, such as time of year, flight altitude, flight latitude, and payload mass and power, were also altered to determine how mission constraints affect the aircraft sizing. An aircraft analysis method which determines the aircraft configuration, aspect ratio, wing area, and total mass, for maximum endurance or minimum required power based on the stated power system and mission parameters is presented. The results indicate that, for the power system, the greatest benefit can be gained by increasing the fuel cell specific energy. Mission requirements also substantially affect the aircraft size. By limiting the time of year the aircraft is required to fly at high northern or southern latitudes, a significant reduction in aircraft size or increase in payload capacity can be achieved.

Effects of competition on video-task performance in monkeys (Macaca mulatta)

NASA Technical Reports Server (NTRS)

Washburn, David A.; Hopkins, William D.; Rumbaugh, Duane M.

1990-01-01

The effects of competition on performance of a video-formatted task were examined in a series of experiments. Two rhesus monkeys (Macaca mulatta) were trained to manipulate a joystick to shoot at moving targets on a computer screen. The task was made competitive by requiring both animals to shoot at the same target and by rewarding only the animal that hit the target first each trial. The competitive task produced a significant and robust speed-accuracy trade-off in performance. The monkeys hit the target in significantly less time on contested than on uncontested trials. However, they required significantly more shots to hit the target on contested trials in relation to uncontested trials. This effect was unchanged when various schedules of reinforcement were introduced in the uncontested trials. This supports the influence of competition qua competition on performance, a point further bolstered by other findings of behavioral contrast presented here.

A comparison of caffeine versus pseudoephedrine on cycling time-trial performance.

PubMed

Spence, Angela L; Sim, Marc; Landers, Grant; Peeling, Peter

2013-10-01

Both caffeine (CAF) and pseudoephedrine (PSE) are proposed to be central nervous system stimulants. However, during competition, CAF is a permitted substance, whereas PSE is a banned substance at urinary levels >150 μg · ml(-1). As a result, this study aimed to compare the effect of CAF versus PSE use on cycling time trial (TT) performance to explore whether the legal stimulant was any less ergogenic than the banned substance. Here, 10 well-trained male cyclists or triathletes were recruited for participation. All athletes were required to attend the laboratory on four separate occasions--including a familiarization trial and three experimental trials, which required participants to complete a simulated 40 km (1,200 kJ) cycling TT after the ingestion of either 200 mg CAF, 180 mg PSE or a nonnutritive placebo (PLA). The results showed that the total time taken and the mean power produced during each TT was not significantly different (p > .05) between trials, despite a 1.3% faster overall time (~57 s) after CAF consumption. Interestingly, the time taken to complete the second half of the TT was significantly faster (p < .05) in CAF as compared with PSE (by 99 s), with magnitude based inferences suggesting a 91% beneficial effect of CAF during the second half of the TT. This investigation further confirms the ergogenic benefits of CAF use during TT performances and further suggests this legal CNS stimulant has a better influence than a supra-therapeutic dose of PSE.

Time required for institutional review board review at one Veterans Affairs medical center.

PubMed

Hall, Daniel E; Hanusa, Barbara H; Stone, Roslyn A; Ling, Bruce S; Arnold, Robert M

2015-02-01

Despite growing concern that institutional review boards (IRBs) impose burdensome delays on research, little is known about the time required for IRB review across different types of research. To measure the overall and incremental process times for IRB review as a process of quality improvement. After developing a detailed process flowchart of the IRB review process, 2 analysts abstracted temporal data from the records pertaining to all 103 protocols newly submitted to the IRB at a large urban Veterans Affairs medical center from June 1, 2009, through May 31, 2011. Disagreements were reviewed with the principal investigator to reach consensus. We then compared the review times across review types using analysis of variance and post hoc Scheffé tests after achieving normally distributed data through logarithmic transformation. Calendar days from initial submission to final approval of research protocols. Initial IRB review took 2 to 4 months, with expedited and exempt reviews requiring less time (median [range], 85 [23-631] and 82 [16-437] days, respectively) than full board reviews (median [range], 131 [64-296] days; P = .008). The median time required for credentialing of investigators was 1 day (range, 0-74 days), and review by the research and development committee took a median of 15 days (range, 0-184 days). There were no significant differences in credentialing or research and development times across review types (exempt, expedited, or full board). Of the extreme delays in IRB review, 80.0% were due to investigators' slow responses to requested changes. There were no systematic delays attributable to the information security officer, privacy officer, or IRB chair. Measuring and analyzing review times is a critical first step in establishing a culture and process of continuous quality improvement among IRBs that govern research programs. The review times observed at this IRB are substantially longer than the 60-day target recommended by expert panels. The method described here could be applied to other IRBs to begin identifying and improving inefficiencies.

Evaluating outcomes of endoscopic full-thickness plication for gastroesophageal reflux disease (GERD) with impedance monitoring.

PubMed

von Renteln, Daniel; Schmidt, Arthur; Riecken, Bettina; Caca, Karel

2010-05-01

Endoscopic full-thickness plication allows transmural suturing at the gastroesophageal junction to recreate the antireflux barrier. Multichannel intraluminal impedance monitoring (MII) can be used to detect nonacid or weakly acidic reflux, acidic swallows, and esophageal clearance time. This study used MII to evaluate the outcome of endoscopic full-thickness plication. In this study, 12 subsequent patients requiring maintenance proton pump inhibitor therapy underwent endoscopic full-thickness plication for treatment of gastroesophageal reflux disease. With patients off medication, MII was performed before and 6-months after endoscopic full-thickness plication. The total median number of reflux episodes was significantly reduced from 105 to 64 (p = 0.016). The median number of acid reflux episodes decreased from 73 to 43 (p = 0.016). Nonacid reflux episodes decreased from 23 to 21 (p = 0.306). The median bolus clearance time was 12 s before treatment and 11 s at 6 months (p = 0.798). The median acid exposure time was reduced from 6.8% to 3.4% (p = 0.008), and the DeMeester scores were reduced from 19 to 12 (p = 0.008). Endoscopic full-thickness plication significantly reduced total reflux episodes, acid reflux episodes, and total reflux exposure time. The DeMeester scores and total acid exposure time for the distal esophagus were significantly improved. No significant changes in nonacid reflux episodes and median bolus clearance time were encountered.

Impression management or real change? Reports of depressive symptoms before and after the preoperative psychological evaluation for bariatric surgery.

PubMed

Fabricatore, Anthony N; Sarwer, David B; Wadden, Thomas A; Combs, Christopher J; Krasucki, Jennifer L

2007-09-01

Many bariatric surgery programs require that candidates undergo a preoperative mental health evaluation. Candidates may be motivated to suppress or exaggerate psychiatric symptoms (i.e., engage in impression management), if they believe doing so will enhance their chances of receiving a recommendation to proceed with surgery. 237 candidates for bariatric surgery completed the Beck Depression Inventory-II (BDI-ll) as part of their preoperative psychological evaluation (Time 1). They also completed the BDI-II approximately 2-4 weeks later, for research purposes, after they had received the mental health professional's unconditional recommendation to proceed with surgery (Time 2). There was a small but statistically significant increase in mean BDI-II scores from Time 1 to Time 2 (11.4 vs 12.7, P<.001). Clinically significant changes, defined as a change from one range of symptom severity to another, were observed in 31.2% of participants, with significant increases in symptoms occurring nearly twice as often as reductions (20.7% vs 10.5%, P<.008). Demographic variables were largely unrelated to changes in BDI-II scores from Time 1 to Time 2. Approximately one-third of bariatric surgery candidates reported a clinically significant change in depressive symptoms after receiving psychological "clearance" for surgery. Possible explanations for these findings include measurement error, impression management, and true changes in psychiatric status.

Fast Formal Analysis of Requirements via "Topoi Diagrams"

NASA Technical Reports Server (NTRS)

Menzies, Tim; Powell, John; Houle, Michael E.; Kelly, John C. (Technical Monitor)

2001-01-01

Early testing of requirements can decrease the cost of removing errors in software projects. However, unless done carefully, that testing process can significantly add to the cost of requirements analysis. We show here that requirements expressed as topoi diagrams can be built and tested cheaply using our SP2 algorithm, the formal temporal properties of a large class of topoi can be proven very quickly, in time nearly linear in the number of nodes and edges in the diagram. There are two limitations to our approach. Firstly, topoi diagrams cannot express certain complex concepts such as iteration and sub-routine calls. Hence, our approach is more useful for requirements engineering than for traditional model checking domains. Secondly, out approach is better for exploring the temporal occurrence of properties than the temporal ordering of properties. Within these restrictions, we can express a useful range of concepts currently seen in requirements engineering, and a wide range of interesting temporal properties.

Comparing the 810nm diode laser with conventional surgery in orthodontic soft tissue procedures.

PubMed

Ize-Iyamu, I N; Saheeb, B D; Edetanlen, B E

2013-09-01

To compare the use of the 810nm diode laser with conventional surgery in the management of soft tissue mucogingival problems associated with orthodontic treatment. Orthodontic patients requiring different soft tissue surgical procedures were randomly assigned to receive conventional surgery or soft tissue diode laser, (wavelength 810 nm). Parameters documented include the type of anaesthesia used, intra and post operative pain, bleeding, the use of scalpel and sutures. The chi-squared test was used to test for significance at 95% confidence level. Probability values (p-values) less than 0.05 were regarded as significant. Only 2(16.7%) of the procedures carried out with the soft tissue laser required infiltration anaesthesia compared to 10 (90.9%) with conventional surgery and this was significant (P<0.001). Post operative pain was significantly reduced in all cases treated with the diode laser (P<0.001). There was also a significant difference (P<0.05) in post operative bleeding in all cases treated with the diode laser. No sutures were used in all soft tissue cases managed with the diode laser and this was significant (P<0.001). There was no statistically significant difference in treatment time in the use of the laser compared with conventional surgery. Orthodontic patients treated with the diode laser required less infiltration anaesthesia, had reduced bleeding during and after surgery, rapid postoperative haemostasis, elimination of the need for sutures and an improved postoperative comfort and healing.

Speed of response in ultrabrief and brief pulse width right unilateral ECT.

PubMed

Loo, Colleen K; Garfield, Joshua B B; Katalinic, Natalie; Schweitzer, Isaac; Hadzi-Pavlovic, Dusan

2013-05-01

Ultrabrief pulse width stimulation electroconvulsive therapy (ECT) results in less cognitive side-effects than brief pulse ECT, but recent work suggests that more treatment sessions may be required to achieve similar efficacy. In this retrospective analysis of subjects pooled from three research studies, time to improvement was analysed in 150 depressed subjects who received right unilateral ECT with a brief pulse width (at five times seizure threshold) or ultrabrief pulse width (at six times seizure threshold). Multivariate Cox regression analyses compared the number of treatments required for 50% reduction in depression scores (i.e. speed of response) in these two samples. The analyses controlled for clinical, demographic and treatment variables that differed between the samples or that were found to be significant predictors of speed of response in univariate analyses. In the multivariate analysis, older age predicted faster speed of response. There was a non-significant trend for faster time to 50% improvement with brief pulse ECT (p = 0.067). Remission rates were higher after brief pulse ECT than ultrabrief pulse ECT (p = 0.007) but response rates were similar. This study, the largest of its kind reported to date, suggests that fewer treatments may be needed to attain response with brief than ultrabrief pulse ECT and that remission rates are higher with brief pulse ECT. Further research with a larger randomized and blinded study is recommended.

Accelerating solutions of one-dimensional unsteady PDEs with GPU-based swept time-space decomposition

NASA Astrophysics Data System (ADS)

Magee, Daniel J.; Niemeyer, Kyle E.

2018-03-01

The expedient design of precision components in aerospace and other high-tech industries requires simulations of physical phenomena often described by partial differential equations (PDEs) without exact solutions. Modern design problems require simulations with a level of resolution difficult to achieve in reasonable amounts of time-even in effectively parallelized solvers. Though the scale of the problem relative to available computing power is the greatest impediment to accelerating these applications, significant performance gains can be achieved through careful attention to the details of memory communication and access. The swept time-space decomposition rule reduces communication between sub-domains by exhausting the domain of influence before communicating boundary values. Here we present a GPU implementation of the swept rule, which modifies the algorithm for improved performance on this processing architecture by prioritizing use of private (shared) memory, avoiding interblock communication, and overwriting unnecessary values. It shows significant improvement in the execution time of finite-difference solvers for one-dimensional unsteady PDEs, producing speedups of 2 - 9 × for a range of problem sizes, respectively, compared with simple GPU versions and 7 - 300 × compared with parallel CPU versions. However, for a more sophisticated one-dimensional system of equations discretized with a second-order finite-volume scheme, the swept rule performs 1.2 - 1.9 × worse than a standard implementation for all problem sizes.

A Kernel-based Lagrangian method for imperfectly-mixed chemical reactions

NASA Astrophysics Data System (ADS)

Schmidt, Michael J.; Pankavich, Stephen; Benson, David A.

2017-05-01

Current Lagrangian (particle-tracking) algorithms used to simulate diffusion-reaction equations must employ a certain number of particles to properly emulate the system dynamics-particularly for imperfectly-mixed systems. The number of particles is tied to the statistics of the initial concentration fields of the system at hand. Systems with shorter-range correlation and/or smaller concentration variance require more particles, potentially limiting the computational feasibility of the method. For the well-known problem of bimolecular reaction, we show that using kernel-based, rather than Dirac delta, particles can significantly reduce the required number of particles. We derive the fixed width of a Gaussian kernel for a given reduced number of particles that analytically eliminates the error between kernel and Dirac solutions at any specified time. We also show how to solve for the fixed kernel size by minimizing the squared differences between solutions over any given time interval. Numerical results show that the width of the kernel should be kept below about 12% of the domain size, and that the analytic equations used to derive kernel width suffer significantly from the neglect of higher-order moments. The simulations with a kernel width given by least squares minimization perform better than those made to match at one specific time. A heuristic time-variable kernel size, based on the previous results, performs on par with the least squares fixed kernel size.

Gas-Dynamic Designing of the Exhaust System for the Air Brake

NASA Astrophysics Data System (ADS)

Novikova, Yu; Goriachkin, E.; Volkov, A.

2018-01-01

Each gas turbine engine is tested some times during the life-cycle. The test equipment includes the air brake that utilizes the power produced by the gas turbine engine. In actual conditions, the outlet pressure of the air brake does not change and is equal to atmospheric pressure. For this reason, for the air brake work it is necessary to design the special exhaust system. Mission of the exhaust system is to provide the required level of backpressure at the outlet of the air brake. The backpressure is required for the required power utilization by the air brake (the air brake operation in the required points on the performance curves). The paper is described the development of the gas dynamic canal, designing outlet guide vane and the creation of a unified exhaust system for the air brake. Using a unified exhaust system involves moving the operating point to the performance curve further away from the calculated point. However, the applying of one exhaust system instead of two will significantly reduce the cash and time costs.

Study of space shuttle EVA/IVA support requirements. Volume 1: Technical summary report

NASA Technical Reports Server (NTRS)

Copeland, R. J.; Wood, P. W., Jr.; Cox, R. L.

1973-01-01

Results are summarized which were obtained for equipment requirements for the space shuttle EVA/IVA pressure suit, life support system, mobility aids, vehicle support provisions, and energy 4 support. An initial study of tasks, guidelines, and constraints and a special task on the impact of a 10 psia orbiter cabin atmosphere are included. Supporting studies not related exclusively to any one group of equipment requirements are also summarized. Representative EVA/IVA task scenarios were defined based on an evaluation of missions and payloads. Analysis of the scenarios resulted in a total of 788 EVA/IVA's in the 1979-1990 time frame, for an average of 1.3 per shuttle flight. Duration was estimated to be under 4 hours on 98% of the EVA/IVA's, and distance from the airlock was determined to be 70 feet or less 96% of the time. Payload water vapor sensitivity was estimated to be significant on 9%-17% of the flights. Further analysis of the scenarios was carried out to determine specific equipment characteristics, such as suit cycle and mobility requirements.

Wound healing in pre-tibial injuries--an observation study.

PubMed

McClelland, Heather M; Stephenson, John; Ousey, Karen J; Gillibrand, Warren P; Underwood, Paul

2012-06-01

Pre-tibial lacerations are complex wounds affecting a primarily aged population, with poor healing and a potentially significant impact on social well-being. Management of these wounds has changed little in 20 years, despite significant advances in wound care. A retrospective observational study was undertaken to observe current wound care practice and to assess the effect of various medical factors on wound healing time on 24 elderly patients throughout their wound journey. Wound length was found to be substantively and significantly associated with wound healing time, with a reduction in instantaneous healing rate of about 30% for every increase of 1 cm in wound length. Hence, longer wounds are associated with longer wound healing times. Prescription of several categories of drugs, including those for ischaemic heart disease (IHD), hypertension, respiratory disease or asthma; and the age of the patient were not significantly associated with wound healing times, although substantive significance could be inferred in the case of prescription for IHD and asthma. Despite the small sample size, this study identified a clear association between healing and length of wound. Neither the comorbidities nor prescriptions explored showed any significant association although some seem to be more prevalent in this patient group. The study also highlighted other issues that require further exploration including the social and economic impact of these wounds. © 2011 The Authors. © 2011 Blackwell Publishing Ltd and Medicalhelplines.com Inc.

Whey protein enhances normal inflammatory responses during cutaneous wound healing in diabetic rats

PubMed Central

2011-01-01

Background Prolonged wound healing is a complication of diabetes that contributes to mortality. Impaired wound healing occurs as a consequence of excessive reactive oxygen species (ROS) production. Whey protein (WP) is able to reduce the oxygen radicals and increase the levels of the antioxidant glutathione. Thus, the aim of this study was to determine whether dietary supplementation with WP could enhance normal inflammatory responses during wound healing in diabetic rats. Animals were assigned into a wounded control group (WN), a wounded diabetic group (WD) and a wounded diabetic group orally supplemented with whey protein (WDWP) at a dose of 100 mg/kg body weight. Results Whey protein was found to significantly decrease the levels of malondialdehyde (MDA), nitric oxide (NO) and ROS. A significant restoration of the glutathione level was observed in WDWP rats. During the early wound healing stage, IL-1β, TNF-α, IL-6, IL-4 and neutrophil infiltration were significantly decreased in WD mice. WP supplementation was found to restore the levels of these inflammatory markers to the levels observed in control animals. In addition, the time required for wound healing was significantly prolonged in diabetic rats. WP was found to significantly decrease the time required for wound healing in WDWP rats. Conclusion In conclusion, dietary supplementation with WP enhances the normal inflammatory responses during wound healing in diabetic mice by restoring the levels of oxidative stress and inflammatory cytokines. PMID:22168406

Improving hydraulic excavator performance through in line hydraulic oil contamination monitoring

NASA Astrophysics Data System (ADS)

Ng, Felix; Harding, Jennifer A.; Glass, Jacqueline

2017-01-01

It is common for original equipment manufacturers (OEMs) of high value products to provide maintenance or service packages to customers to ensure their products are maintained at peak efficiency throughout their life. To quickly and efficiently plan for maintenance requirements, OEMs require accurate information about the use and wear of their products. In recent decades, the aerospace industry in particular has become expert in using real time data for the purpose of product monitoring and maintenance scheduling. Significant quantities of real time usage data from product monitoring are commonly generated and transmitted back to the OEMs, where diagnostic and prognostic analysis will be carried out. More recently, other industries such as construction and automotive, are also starting to develop capabilities in these areas and condition based maintenance (CBM) is increasing in popularity as a means of satisfying customers' demands. CBM requires constant monitoring of real time product data by the OEMs, however the biggest challenge for these industries, in particular construction, is the lack of accurate and real time understanding of how their products are being used possibly because of the complex supply chains which exist in construction projects. This research focuses on current dynamic data acquisition techniques for mobile hydraulic systems, in this case the use of a mobile inline particle contamination sensor; the aim was to assess suitability to achieve both diagnostic and prognostic requirements of Condition Based Maintenance. It concludes that hydraulic oil contamination analysis, namely detection of metallic particulates, offers a reliable way to measure real time wear of hydraulic components.

Effects of prenatal /sup 60/Co irradiation on postnatal neural, learning, and hormonal development of the squirrel monkey

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

Ordy, J.M.; Brizzee, K.R.; Dunlap, W.P.

1982-02-01

The goals of this study were to examine the effects of 0, 50, and 100 rad of /sup 60/Co administered prenatally on postnatal development of neuromuscular coordination, visual discrimination learning, spontaneous light-dark stabilimeter activity, plasma cortisol, and somatometric growth rates of diurnal squirrel monkeys from birth to 90 days. In terms of accuracy, completeness, and time required for performance of reflexes and neuromuscular coordination, the performance of 50- and 100-rad offspring was less accurate and poorly coordinated and required more time for completion to that of controls. In visual orientation, discrimination, and reversal learning, the percentage correct responses of themore » 50- and 100-rad offspring were significantly lower than those of controls. Spontaneous light-dark stabilimeter activity of 50- and 100-rad offspring was significantly higher in the dark session than that of controls. Plasma cortisol was significantly higher in 100-rad infants than in controls. Comparisons of somatometric growth rates indicated that postnatal head circumference, crown-rump length, and to a lesser extent body weight increased at significantly slower rates in 50- and 100-rad offspring. These findings should provide essential information for formulating and carrying out multivariate behavioral, biochemical, and morphometric assessments of low-dose effects on the brain of primate offspring within demonstrable dose-response curves.« less

The determination of the pulse pile-up reject (PUR) counting for X and gamma ray spectrometry

NASA Astrophysics Data System (ADS)

Karabıdak, S. M.; Kaya, S.

2017-02-01

The collection the charged particles produced by the incident radiation on a detector requires a time interval. If this time interval is not sufficiently short compared with the peaking time of the amplifier, a loss in the recovered signal amplitude occurs. Another major constraint on the throughput of modern x or gamma-ray spectrometers is the time required for the subsequent the pulse processing by the electronics. Two above-mentioned limitations are cause of counting losses resulting from the dead time and the pile-up. The pulse pile-up is a common problem in x and gamma ray radiation detection systems. The pulses pile-up in spectroscopic analysis can cause significant errors. Therefore, inhibition of these pulses is a vital step. A way to reduce errors due to the pulse pile-up is a pile-up inspection circuitry (PUR). Such a circuit rejects some of the pulse pile-up. Therefore, this circuit leads to counting losses. Determination of these counting losses is an important problem. In this work, a new method is suggested for the determination of the pulse pile-up reject.

Adolescent Immunization Coverage and Implementation of New School Requirements in Michigan, 2010

PubMed Central

DeVita, Stefanie F.; Vranesich, Patricia A.; Boulton, Matthew L.

2014-01-01

Objectives. We examined the effect of Michigan’s new school rules and vaccine coadministration on time to completion of all the school-required vaccine series, the individual adolescent vaccines newly required for sixth grade in 2010, and initiation of the human papillomavirus (HPV) vaccine series, which was recommended but not required for girls. Methods. Data were derived from the Michigan Care Improvement Registry, a statewide Immunization Information System. We assessed the immunization status of Michigan children enrolled in sixth grade in 2009 or 2010. We used univariable and multivariable Cox regression models to identify significant associations between each factor and school completeness. Results. Enrollment in sixth grade in 2010 and coadministration of adolescent vaccines at the first adolescent visit were significantly associated with completion of the vaccines required for Michigan’s sixth graders. Children enrolled in sixth grade in 2010 had higher coverage with the newly required adolescent vaccines by age 13 years than did sixth graders in 2009, but there was little difference in the rate of HPV vaccine initiation among girls. Conclusions. Education and outreach efforts, particularly regarding the importance and benefits of coadministration of all recommended vaccines in adolescents, should be directed toward health care providers, parents, and adolescents. PMID:24922144

Comprehensive evaluation of contemporary assisted reproduction technology laboratory operations to determine staffing levels that promote patient safety and quality care.

PubMed

Alikani, Mina; Go, Kathryn J; McCaffrey, Caroline; McCulloh, David H

2014-11-01

To consider how staffing requirements have changed with evolving and increasingly more complex assisted reproduction technology (ART) laboratory practice. Analysis by four laboratory directors from three different ART programs of the level of complexity and time requirements for contemporary ART laboratory activities to determine adequate staffing levels. University-based and private ART programs. None. None. Human resource requirements for ART procedures. Both complexity and time required for completion of a contemporary ART cycle have increased significantly compared with the same requirements for the "traditional cycle" of the past. The latter required roughly 9 personnel hours, but a contemporary cycle can require up to 20 hours for completion. Consistent with this increase, a quantitative analysis shows that the number of embryologists required for safe and efficient operation of the ART laboratory has also increased. This number depends on not only the volume but also the types of procedures performed: the higher the number of complex procedures, the more personnel required. An interactive Personnel Calculator is introduced that can help determine staffing needs. The increased complexity of the contemporary ART laboratory requires a new look at the allocation of human resources. Our work provides laboratory directors with a practical, individualized tool to determine their staffing requirements with a view to increasing the safety and efficiency of operations. The work could serve as the basis for revision of the 2008 American Society for Reproductive Medicine (ASRM) staffing guidelines. Copyright © 2014 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

Implementation of 3D spatial indexing and compression in a large-scale molecular dynamics simulation database for rapid atomic contact detection.

PubMed

Toofanny, Rudesh D; Simms, Andrew M; Beck, David A C; Daggett, Valerie

2011-08-10

Molecular dynamics (MD) simulations offer the ability to observe the dynamics and interactions of both whole macromolecules and individual atoms as a function of time. Taken in context with experimental data, atomic interactions from simulation provide insight into the mechanics of protein folding, dynamics, and function. The calculation of atomic interactions or contacts from an MD trajectory is computationally demanding and the work required grows exponentially with the size of the simulation system. We describe the implementation of a spatial indexing algorithm in our multi-terabyte MD simulation database that significantly reduces the run-time required for discovery of contacts. The approach is applied to the Dynameomics project data. Spatial indexing, also known as spatial hashing, is a method that divides the simulation space into regular sized bins and attributes an index to each bin. Since, the calculation of contacts is widely employed in the simulation field, we also use this as the basis for testing compression of data tables. We investigate the effects of compression of the trajectory coordinate tables with different options of data and index compression within MS SQL SERVER 2008. Our implementation of spatial indexing speeds up the calculation of contacts over a 1 nanosecond (ns) simulation window by between 14% and 90% (i.e., 1.2 and 10.3 times faster). For a 'full' simulation trajectory (51 ns) spatial indexing reduces the calculation run-time between 31 and 81% (between 1.4 and 5.3 times faster). Compression resulted in reduced table sizes but resulted in no significant difference in the total execution time for neighbour discovery. The greatest compression (~36%) was achieved using page level compression on both the data and indexes. The spatial indexing scheme significantly decreases the time taken to calculate atomic contacts and could be applied to other multidimensional neighbor discovery problems. The speed up enables on-the-fly calculation and visualization of contacts and rapid cross simulation analysis for knowledge discovery. Using page compression for the atomic coordinate tables and indexes saves ~36% of disk space without any significant decrease in calculation time and should be considered for other non-transactional databases in MS SQL SERVER 2008.

Implementation of 3D spatial indexing and compression in a large-scale molecular dynamics simulation database for rapid atomic contact detection

PubMed Central

2011-01-01

Background Molecular dynamics (MD) simulations offer the ability to observe the dynamics and interactions of both whole macromolecules and individual atoms as a function of time. Taken in context with experimental data, atomic interactions from simulation provide insight into the mechanics of protein folding, dynamics, and function. The calculation of atomic interactions or contacts from an MD trajectory is computationally demanding and the work required grows exponentially with the size of the simulation system. We describe the implementation of a spatial indexing algorithm in our multi-terabyte MD simulation database that significantly reduces the run-time required for discovery of contacts. The approach is applied to the Dynameomics project data. Spatial indexing, also known as spatial hashing, is a method that divides the simulation space into regular sized bins and attributes an index to each bin. Since, the calculation of contacts is widely employed in the simulation field, we also use this as the basis for testing compression of data tables. We investigate the effects of compression of the trajectory coordinate tables with different options of data and index compression within MS SQL SERVER 2008. Results Our implementation of spatial indexing speeds up the calculation of contacts over a 1 nanosecond (ns) simulation window by between 14% and 90% (i.e., 1.2 and 10.3 times faster). For a 'full' simulation trajectory (51 ns) spatial indexing reduces the calculation run-time between 31 and 81% (between 1.4 and 5.3 times faster). Compression resulted in reduced table sizes but resulted in no significant difference in the total execution time for neighbour discovery. The greatest compression (~36%) was achieved using page level compression on both the data and indexes. Conclusions The spatial indexing scheme significantly decreases the time taken to calculate atomic contacts and could be applied to other multidimensional neighbor discovery problems. The speed up enables on-the-fly calculation and visualization of contacts and rapid cross simulation analysis for knowledge discovery. Using page compression for the atomic coordinate tables and indexes saves ~36% of disk space without any significant decrease in calculation time and should be considered for other non-transactional databases in MS SQL SERVER 2008. PMID:21831299

Vision readiness of the reserve forces of the U.S. Army.

PubMed

Weaver, J L; McAlister, W H

2001-01-01

In 1996 and 1997, the Army conducted an exercise to assess the ability to rapidly mobilize the reserve forces. In accordance with Army requirements, each soldier was evaluated to determine if he or she met vision and optical readiness standards. Of the 1,947 individuals processed through the optometry section, 40% met vision requirements without correction and 32% met vision requirements with their current spectacles. The remaining 28% required examination. A major impediment to processing reserve units for deployment is the lack of vision and optical readiness. In the mobilization for the Persian Gulf War, significant delays were incurred because of the time required to perform eye examinations and fabricate eyewear. However, as a result of this exercise, current prescriptions will be available in the event of mobilization. To ensure readiness, all units should perform such exercises periodically.

Development and application of a modified dynamic time warping algorithm (DTW-S) to analyses of primate brain expression time series

PubMed Central

2011-01-01

Background Comparing biological time series data across different conditions, or different specimens, is a common but still challenging task. Algorithms aligning two time series represent a valuable tool for such comparisons. While many powerful computation tools for time series alignment have been developed, they do not provide significance estimates for time shift measurements. Results Here, we present an extended version of the original DTW algorithm that allows us to determine the significance of time shift estimates in time series alignments, the DTW-Significance (DTW-S) algorithm. The DTW-S combines important properties of the original algorithm and other published time series alignment tools: DTW-S calculates the optimal alignment for each time point of each gene, it uses interpolated time points for time shift estimation, and it does not require alignment of the time-series end points. As a new feature, we implement a simulation procedure based on parameters estimated from real time series data, on a series-by-series basis, allowing us to determine the false positive rate (FPR) and the significance of the estimated time shift values. We assess the performance of our method using simulation data and real expression time series from two published primate brain expression datasets. Our results show that this method can provide accurate and robust time shift estimates for each time point on a gene-by-gene basis. Using these estimates, we are able to uncover novel features of the biological processes underlying human brain development and maturation. Conclusions The DTW-S provides a convenient tool for calculating accurate and robust time shift estimates at each time point for each gene, based on time series data. The estimates can be used to uncover novel biological features of the system being studied. The DTW-S is freely available as an R package TimeShift at http://www.picb.ac.cn/Comparative/data.html. PMID:21851598

Development and application of a modified dynamic time warping algorithm (DTW-S) to analyses of primate brain expression time series.

PubMed

Yuan, Yuan; Chen, Yi-Ping Phoebe; Ni, Shengyu; Xu, Augix Guohua; Tang, Lin; Vingron, Martin; Somel, Mehmet; Khaitovich, Philipp

2011-08-18

Comparing biological time series data across different conditions, or different specimens, is a common but still challenging task. Algorithms aligning two time series represent a valuable tool for such comparisons. While many powerful computation tools for time series alignment have been developed, they do not provide significance estimates for time shift measurements. Here, we present an extended version of the original DTW algorithm that allows us to determine the significance of time shift estimates in time series alignments, the DTW-Significance (DTW-S) algorithm. The DTW-S combines important properties of the original algorithm and other published time series alignment tools: DTW-S calculates the optimal alignment for each time point of each gene, it uses interpolated time points for time shift estimation, and it does not require alignment of the time-series end points. As a new feature, we implement a simulation procedure based on parameters estimated from real time series data, on a series-by-series basis, allowing us to determine the false positive rate (FPR) and the significance of the estimated time shift values. We assess the performance of our method using simulation data and real expression time series from two published primate brain expression datasets. Our results show that this method can provide accurate and robust time shift estimates for each time point on a gene-by-gene basis. Using these estimates, we are able to uncover novel features of the biological processes underlying human brain development and maturation. The DTW-S provides a convenient tool for calculating accurate and robust time shift estimates at each time point for each gene, based on time series data. The estimates can be used to uncover novel biological features of the system being studied. The DTW-S is freely available as an R package TimeShift at http://www.picb.ac.cn/Comparative/data.html.

The Milestones Passport: A Learner-Centered Application of the Milestone Framework to Prompt Real-Time Feedback in the Emergency Department.

PubMed

Yarris, Lalena M; Jones, David; Kornegay, Joshua G; Hansen, Matthew

2014-09-01

In July 2013, emergency medicine residency programs implemented the Milestone assessment as part of the Next Accreditation System. We hypothesized that applying the Milestone framework to real-time feedback in the emergency department (ED) could affect current feedback processes and culture. We describe the development and implementation of a Milestone-based, learner-centered intervention designed to prompt real-time feedback in the ED. We developed and implemented the Milestones Passport, a feedback intervention incorporating subcompetencies, in our residency program in July 2013. Our primary outcomes were feasibility, including faculty and staff time and costs, number of documented feedback encounters in the first 2 months of implementation, and user-reported time required to complete the intervention. We also assessed learner and faculty acceptability. Development and implementation of the Milestones Passport required 10 hours of program coordinator time, 120 hours of software developer time, and 20 hours of faculty time. Twenty-eight residents and 34 faculty members generated 257 Milestones Passport feedback encounters. Most residents and faculty reported that the encounters required fewer than 5 minutes to complete, and 48% (12 of 25) of the residents and 68% (19 of 28) of faculty reported satisfaction with the Milestones Passport intervention. Faculty satisfaction with overall feedback in the ED improved after the intervention (93% versus 54%, P  =  .003), whereas resident satisfaction with feedback did not change significantly. The Milestones Passport feedback intervention was feasible and acceptable to users; however, learner satisfaction with the Milestone assessment in the ED was modest.

Nurses in the workplace: expectations and needs.

PubMed

DeCola, P R; Riggins, P

2010-09-01

It is important to understand nurses' attitudes toward their work environment. Prior studies in this area have been conducted. The interest was to identify a relative assessment of workplace challenges by studying nurses within developed and developing economies. A representative survey of 2203 nurses in 11 countries was conducted via a structured survey. Data from open-ended questions were content analysed and grouped thematically. The overall margin of error is +/-2.1% and +/-6.9% for country level results. Key findings included that 92% of nurses say they face time constraints and 96% say that spending more time with individual patients would have a significant impact on patient health. Forty-six per cent of nurses say their workload is worse today than it was 5 years ago. While only 53% of nurses say it is very likely they will be practising nursing in 5 years, national differences existed. Statistically significant parameters influencing the likelihood to stay in nursing included having greater independence and control over their practice area, sufficient staff, greater involvement in decisions impacting their work and patient care, and improved work-life balance. There is agreement across the surveyed countries regarding the existence of high workloads that are contributing to time constraints and the belief that patient outcomes are significantly impacted. These conditions contribute to nurses' lack of firm commitment to their profession. The systemic changes required to deliver quality health care to patients require these challenges to be addressed.

Deep tissue near infrared second derivative spectrophotometry for the assessment of claudication in peripheral arterial disease.

PubMed

Koutsiaris, Aristotle G

2017-01-01

The purpose of this study was the application of a second derivative near infrared spectrophotometric (NIRS) technique to the human calf muscle in order to see if peripheral arterial disease (PAD) patients can be discriminated from control subjects, before, during and after a standard treadmill exercise test. Three groups of human subjects were studied: group A consisted of 10 control subjects and groups B and C were formed by PAD patients classified as Fontaine's stage 2a (5 patients) and 2b (10 patients), respectively. The measurement protocol for all groups was 9.75 minutes of standing up (phase 1), 1 minute of exercise (phase 2) and 1 minute of rest (phase 3). Seven variables were defined at different times from the onset of the measurement protocol. All variables were significantly higher (p < 0.05) in group A in comparison to groups B and C. The level of significance was ten times higher (p < 0.005) at the onset (15 seconds) of the experiment and during phases 2 and 3. However, none of the variables in group B was significantly different from those in group C. It is shown for the first time that a second derivative NIRS technique can discriminate (p = 0.003) healthy subjects from PAD patients, in just 15 seconds of standing, with no exercise requirement. More experiments are required in order to uncover the full potential of the technique in the diagnosis of the PAD.

Age-Related Changes in Bimanual Instrument Playing with Rhythmic Cueing

PubMed Central

Kim, Soo Ji; Cho, Sung-Rae; Yoo, Ga Eul

2017-01-01

Deficits in bimanual coordination of older adults have been demonstrated to significantly limit their functioning in daily life. As a bimanual sensorimotor task, instrument playing has great potential for motor and cognitive training in advanced age. While the process of matching a person’s repetitive movements to auditory rhythmic cueing during instrument playing was documented to involve motor and attentional control, investigation into whether the level of cognitive functioning influences the ability to rhythmically coordinate movement to an external beat in older populations is relatively limited. Therefore, the current study aimed to examine how timing accuracy during bimanual instrument playing with rhythmic cueing differed depending on the degree of participants’ cognitive aging. Twenty one young adults, 20 healthy older adults, and 17 older adults with mild dementia participated in this study. Each participant tapped an electronic drum in time to the rhythmic cueing provided using both hands simultaneously and in alternation. During bimanual instrument playing with rhythmic cueing, mean and variability of synchronization errors were measured and compared across the groups and the tempo of cueing during each type of tapping task. Correlations of such timing parameters with cognitive measures were also analyzed. The results showed that the group factor resulted in significant differences in the synchronization errors-related parameters. During bimanual tapping tasks, cognitive decline resulted in differences in synchronization errors between younger adults and older adults with mild dimentia. Also, in terms of variability of synchronization errors, younger adults showed significant differences in maintaining timing performance from older adults with and without mild dementia, which may be attributed to decreased processing time for bimanual coordination due to aging. Significant correlations were observed between variability of synchronization errors and performance of cognitive tasks involving executive control and cognitive flexibility when asked for bimanual coordination in response to external timing cues at adjusted tempi. Also, significant correlations with cognitive measures were more prevalent in variability of synchronization errors during alternative tapping compared to simultaneous tapping. The current study supports that bimanual tapping may be predictive of cognitive processing of older adults. Also, tempo and type of movement required for instrument playing both involve cognitive and motor loads at different levels, and such variables could be important factors for determining the complexity of the task and the involved task requirements for interventions using instrument playing. PMID:29085309

[Comparison of the results of laparotomy and laparoscopic surgery in patients with Crohn's disease].

PubMed

Horváth, Gyula; Simonka, Zsolt; Lázár, György

2014-01-05

Crohn's disease is an inflammatory bowel disease which may affect different parts of the gastrointestinal tract. To compare retrospectively the results of laparotomy and laparoscopic surgery performed in patients with Crohn's disease between January 1, 2005 and October 31, 2012 in the Department of Surgery, University of Szeged, Hungary. Patients were divided into two groups based on the types of surgery; 103 patients underwent laparotomy and 30 patients had laparoscopic surgery programmed. 22 patients had 24 primary acute interventions. The mean age was significantly lower in the laparoscopic surgery group (p = 0.042). The laparoscopic ileocecal resections have been found significantly shorter than laparotomies (p = 0.033). When ileocecal resection was performed the operation time was significantly longer (p = 0.033) while hospitalization time (p = 0.025) and intensive care unit treatment time (p<0.001) were shorter and the bowel passage also started earlier in the laparoscopic group as compared to the laparotomy group. Laparoscopic surgery results in smaller surgical trauma, better cosmetic outcome, shorter hospitalization time and not higher complication- and morbidity-rate as well as shorter operation time in certain cases. However, it requires more qualified surgical team and the operation expenses are higher.

Labour time required for piglet castration with isoflurane-anaesthesia using shared and stationary inhaler devices.

PubMed

Weber, Sabrina; Das, Gürbüz; Waldmann, Karl-Heinz; Gauly, Matthias

2014-01-01

Isoflurane-anaesthesia combined with an analgesic represents a welfare-friendly method of pain mitigation for castration of piglets. However, it requires an inhaler device, which is uneconomic for small farms. Sharing a device among farms may be an economical option if the shared use does not increase labour time and the resulting costs. This study aimed to investigate the amount and components of labour time required for piglet castration with isoflurane anaesthesia performed with stationary and shared devices. Piglets (N = 1579) were anaesthetised with isoflurane (using either stationary or shared devices) and castrated.The stationary devices were used in a group (n = 5) of larger farms (84 sows/farm on an average), whereas smaller farms (n = 7; 32 sows/farm on an average) shared one device. Each farm was visited four times and labour time for each process-step was recorded. The complete process included machine set-up, anaesthesia and castration by a practitioner, and preparation, collection and transport of piglets by a farmer. Labour time of the complete process was increased (P = 0.012) on farms sharing a device (266 s/piglet) compared to farms using stationary devices (177 s/ piglet), due to increased time for preparation (P = 0.055), castration (P = 0.026) and packing (P = 0.010) when sharing a device. However, components of the time budget of farms using stationary or shared devices did not differ significantly (P > 0.05). Cost arising from time spent by farmers did not differ considerably between the use of stationary (0.28 Euro per piglet) and shared (0.26 Euro) devices. It is concluded that costs arising from the increased labour time due to sharing a device can be considered marginal, since the high expenses originating from purchasing an inhaler device are shared among several farms.

Variation in incubation periods and egg metabolism in mallards: Intrinsic mechanisms to promote hatch synchrony

USGS Publications Warehouse

MacCluskie, Margaret C.; Flint, Paul L.; Sedinger, James S.

1997-01-01

We investigated factors affecting incubation time and metabolic rates of Mallard (Anas platyrhynchos) eggs incubated under constant environmental conditions. Time required to reach the star-pipped stage of hatch varied significantly among females, but not with laying sequence or egg size. Metabolic rate of eggs varied positively with position in the laying sequence and tended to vary among females. Metabolic rate did not vary with egg volume or incubation length. Our results indicate metabolic rate may act as one synchronization mechanism for hatch. The role of maternal effects in development time should be considered in subsequent studies of incubation time in ducks.

Recent Advances in Microwave Imaging for Breast Cancer Detection

PubMed Central

Kwon, Sollip

2016-01-01

Breast cancer is a disease that occurs most often in female cancer patients. Early detection can significantly reduce the mortality rate. Microwave breast imaging, which is noninvasive and harmless to human, offers a promising alternative method to mammography. This paper presents a review of recent advances in microwave imaging for breast cancer detection. We conclude by introducing new research on a microwave imaging system with time-domain measurement that achieves short measurement time and low system cost. In the time-domain measurement system, scan time would take less than 1 sec, and it does not require very expensive equipment such as VNA. PMID:28096808

Real-Time Operation of the International Space Station

NASA Astrophysics Data System (ADS)

Suffredini, M. T.

2002-01-01

The International Space Station is on orbit and real-time operations are well underway. Along with the assembly challenges of building and operating the International Space Station , scientific activities are also underway. Flight control teams in three countries are working together as a team to plan, coordinate and command the systems on the International Space Station.Preparations are being made to add the additional International Partner elements including their operations teams and facilities. By October 2002, six Expedition crews will have lived on the International Space Station. Management of real-time operations has been key to these achievements. This includes the activities of ground teams in control centers around the world as well as the crew on orbit. Real-time planning is constantly challenged with balancing the requirements and setting the priorities for the assembly, maintenance, science and crew health functions on the International Space Station. It requires integrating the Shuttle, Soyuz and Progress requirements with the Station. It is also necessary to be able to respond in case of on-orbit anomalies and to set plans and commands in place to ensure the continues safe operation of the Station. Bringing together the International Partner operations teams has been challenging and intensely rewarding. Utilization of the assets of each partner has resulted in efficient solutions to problems. This paper will describe the management of the major real-time operations processes, significant achievements, and future challenges.

Copy Number Variation Affecting the Photoperiod-B1 and Vernalization-A1 Genes Is Associated with Altered Flowering Time in Wheat (Triticum aestivum)

PubMed Central

Isaac, Peter; Laurie, David A.

2012-01-01

The timing of flowering during the year is an important adaptive character affecting reproductive success in plants and is critical to crop yield. Flowering time has been extensively manipulated in crops such as wheat (Triticum aestivum L.) during domestication, and this enables them to grow productively in a wide range of environments. Several major genes controlling flowering time have been identified in wheat with mutant alleles having sequence changes such as insertions, deletions or point mutations. We investigated genetic variants in commercial varieties of wheat that regulate flowering by altering photoperiod response (Ppd-B1 alleles) or vernalization requirement (Vrn-A1 alleles) and for which no candidate mutation was found within the gene sequence. Genetic and genomic approaches showed that in both cases alleles conferring altered flowering time had an increased copy number of the gene and altered gene expression. Alleles with an increased copy number of Ppd-B1 confer an early flowering day neutral phenotype and have arisen independently at least twice. Plants with an increased copy number of Vrn-A1 have an increased requirement for vernalization so that longer periods of cold are required to potentiate flowering. The results suggest that copy number variation (CNV) plays a significant role in wheat adaptation. PMID:22457747

Fast cooldown coaxial pulse tube microcooler

NASA Astrophysics Data System (ADS)

Nast, T.; Olson, J. R.; Champagne, P.; Roth, E.; Kaldas, G.; Saito, E.; Loung, V.; McCay, B. S.; Kenton, A. C.; Dobbins, C. L.

2016-05-01

We report the development and initial testing of the Lockheed Martin first-article, single-stage, compact, coaxial, Fast Cooldown Pulse Tube Microcryocooler (FC-PTM). The new cryocooler supports cooling requirements for emerging large, high operating temperature (105-150K) infrared focal plane array sensors with nominal cooling loads of ~300 mW @105K @293K ambient. This is a sequel development that builds on our inline and coaxial pulse tube microcryocoolers reported at CEC 20137, ICC188,9, and CEC201510. The new FC-PTM and the prior units all share our long life space technology attributes, which typically have 10 year life requirements1. The new prototype microcryocooler builds on the previous development by incorporating cold head design improvements in two key areas: 1) reduced cool-down time and 2) novel repackaging that greatly reduces envelope. The new coldhead and Dewar were significantly redesigned from the earlier versions in order to achieve a cooldown time of 2-3 minutes-- a projected requirement for tactical applications. A design approach was devised to reduce the cold head length from 115mm to 55mm, while at the same time reducing cooldown time. We present new FC-PTM performance test measurements with comparisons to our previous pulse-tube microcryocooler measurements and design predictions. The FC-PTM exhibits attractive small size, volume, weight, power and cost (SWaP-C) features with sufficient cooling capacity over required ambient conditions that apply to an increasing variety of space and tactical applications.

Fast cool-down coaxial pulse tube microcooler

NASA Astrophysics Data System (ADS)

Nast, T.; Olson, J. R.; Champagne, P.; Roth, E.; Kaldas, G.; Saito, E.; Loung, V.; McCay, B. S.; Kenton, A. C.; Dobbins, C. L.

2016-09-01

We report the development and initial testing of the Lockheed Martin first-article, single-stage, compact, coaxial, Fast Cooldown Pulse Tube Microcryocooler (FC-PTM). The new cryocooler supports cooling requirements for emerging large, high operating temperature (105-150K) infrared focal plane array sensors with nominal cooling loads of 300 mW @105K @293K ambient. This is a sequel development that builds on our inline and coaxial pulse tube microcryocoolers reported at CEC 20137, ICC188,9, and CEC201510. The new FC-PTM and the prior units all share our long life space technology attributes, which typically have 10 year life requirements1. The new prototype microcryocooler builds on the previous development by incorporating cold head design improvements in two key areas: 1) reduced cool-down time and 2) novel repackaging that greatly reduces envelope. The new coldhead and Dewar were significantly redesigned from the earlier versions in order to achieve a cooldown time of 2-3 minutes- a projected requirement for tactical applications. A design approach was devised to reduce the cold head length from 115mm to 55mm, while at the same time reducing cooldown time. We present new FC-PTM performance test measurements with comparisons to our previous pulse-tube microcryocooler measurements and design predictions. The FC-PTM exhibits attractive small size, volume, weight, power and cost (SWaP-C) features with sufficient cooling capacity over required ambient conditions that apply to an increasing variety of space and tactical applications.

Dose potential of sludge contaminated and/or TRU contaminated waste in B-25s for tornado and straight wind events

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

Aponte, C.I.

F and H Tank Farms generate supernate and sludge contaminated Low-Level Waste. The waste is collected, characterized, and packaged for disposal. Before the waste can be disposed of, however, it must be properly characterized. Since the radionuclide distribution in typical supernate is well known, its characterization is relatively straight forward and requires minimal effort. Non-routine waste, including potentially sludge contaminated, requires much more effort to effectively characterize. The radionuclide distribution must be determined. In some cases the waste can be contaminated by various sludge transfers with unique radionuclide distributions. In these cases, the characterization can require an extensive effort. Evenmore » after an extensive characterization effort, the container must still be prepared for shipping. Therefore a significant amount of time may elapse from the time the waste is generated until the time of disposal. During the time it is possible for a tornado or high wind scenario to occur. The purpose of this report is to determine the effect of a tornado on potential sludge contaminated waste, or Transuranic (TRU) waste in B-25s [large storage containers], to evaluate the potential impact on F and H Tank Farms, and to help establish a B-25 control program for tornado events.« less

Real-time model learning using Incremental Sparse Spectrum Gaussian Process Regression.

PubMed

Gijsberts, Arjan; Metta, Giorgio

2013-05-01

Novel applications in unstructured and non-stationary human environments require robots that learn from experience and adapt autonomously to changing conditions. Predictive models therefore not only need to be accurate, but should also be updated incrementally in real-time and require minimal human intervention. Incremental Sparse Spectrum Gaussian Process Regression is an algorithm that is targeted specifically for use in this context. Rather than developing a novel algorithm from the ground up, the method is based on the thoroughly studied Gaussian Process Regression algorithm, therefore ensuring a solid theoretical foundation. Non-linearity and a bounded update complexity are achieved simultaneously by means of a finite dimensional random feature mapping that approximates a kernel function. As a result, the computational cost for each update remains constant over time. Finally, algorithmic simplicity and support for automated hyperparameter optimization ensures convenience when employed in practice. Empirical validation on a number of synthetic and real-life learning problems confirms that the performance of Incremental Sparse Spectrum Gaussian Process Regression is superior with respect to the popular Locally Weighted Projection Regression, while computational requirements are found to be significantly lower. The method is therefore particularly suited for learning with real-time constraints or when computational resources are limited. Copyright © 2012 Elsevier Ltd. All rights reserved.

Associated Clinical and Laboratory Markers of Donor on Allograft Function After Heart Transplant.

PubMed

Braulio, Renato; Sanches, Marcelo Dias; Teixeira Junior, Antonio Lúcio; Costa, Paulo Henrique Nogueira; Moreira, Maria da Consolação Vieira; Rocha, Monaliza Angela; Andrade, Silvio Amadeu de; Gelape, Cláudio Léo

2016-04-01

Primary graft dysfunction is a major cause of mortality after heart transplantation. To evaluate correlations between donor-related clinical/biochemical markers and the occurrence of primary graft dysfunction/clinical outcomes of recipients within 30 days of transplant. The prospective study involved 43 donor/recipient pairs. Data collected from donors included demographic and echocardiographic information, noradrenaline administration rates and concentrations of soluble tumor necrosis factor receptors (sTNFR1 and sTNFR2), interleukins (IL-6 and IL-10), monocyte chemoattractant protein-1, C-reactive protein and cardiac troponin I. Data collected from recipients included operating, cardiopulmonary bypass, intensive care unit and hospitalization times, inotrope administration and left/right ventricular function through echocardiography. Recipients who developed moderate/severe left ventricular dysfunction had received organs from significantly older donors (P =0.020). Recipients from donors who required moderate/high doses of noradrenaline (>0.23 µg/kg/min) around harvesting time exhibited lower post-transplant ventricular ejection fractions (P =0.002) and required longer CPB times (P =0.039). Significantly higher concentrations of sTNFR1 (P =0.014) and sTNFR2 (P =0.030) in donors were associated with reduced intensive care unit times (≤5 days) in recipients, while higher donor IL-6 (P =0.029) and IL-10 (P =0.037) levels were correlated with reduced hospitalization times (≤25 days) in recipients. Recipients who required moderate/high levels of noradrenaline for weaning off cardiopulmonary bypass were associated with lower donor concentrations of sTNFR2 (P =0.028) and IL-6 (P =0.001). High levels of sTNFR1, sTNFR2, IL-6 and IL-10 in donors were associated with enhanced evolution in recipients. Allografts from older donors, or from those treated with noradrenaline doses >0.23 µg/kg/min, were more frequently affected by primary graft dysfunction within 30 days of surgery.

On a fast calculation of structure factors at a subatomic resolution.

PubMed

Afonine, P V; Urzhumtsev, A

2004-01-01

In the last decade, the progress of protein crystallography allowed several protein structures to be solved at a resolution higher than 0.9 A. Such studies provide researchers with important new information reflecting very fine structural details. The signal from these details is very weak with respect to that corresponding to the whole structure. Its analysis requires high-quality data, which previously were available only for crystals of small molecules, and a high accuracy of calculations. The calculation of structure factors using direct formulae, traditional for 'small-molecule' crystallography, allows a relatively simple accuracy control. For macromolecular crystals, diffraction data sets at a subatomic resolution contain hundreds of thousands of reflections, and the number of parameters used to describe the corresponding models may reach the same order. Therefore, the direct way of calculating structure factors becomes very time expensive when applied to large molecules. These problems of high accuracy and computational efficiency require a re-examination of computer tools and algorithms. The calculation of model structure factors through an intermediate generation of an electron density [Sayre (1951). Acta Cryst. 4, 362-367; Ten Eyck (1977). Acta Cryst. A33, 486-492] may be much more computationally efficient, but contains some parameters (grid step, 'effective' atom radii etc.) whose influence on the accuracy of the calculation is not straightforward. At the same time, the choice of parameters within safety margins that largely ensure a sufficient accuracy may result in a significant loss of the CPU time, making it close to the time for the direct-formulae calculations. The impact of the different parameters on the computer efficiency of structure-factor calculation is studied. It is shown that an appropriate choice of these parameters allows the structure factors to be obtained with a high accuracy and in a significantly shorter time than that required when using the direct formulae. Practical algorithms for the optimal choice of the parameters are suggested.

Characteristics of Paraspinal Muscle Spindle Response to Mechanically Assisted Spinal Manipulation: A Preliminary Report.

PubMed

Reed, William R; Pickar, Joel G; Sozio, Randall S; Liebschner, Michael A K; Little, Joshua W; Gudavalli, Maruti R

The purpose of this preliminary study is to determine muscle spindle response characteristics related to the use of 2 solenoid powered clinical mechanically assisted manipulation (MAM) devices. L6 muscle spindle afferents with receptive fields in paraspinal muscles were isolated in 6 cats. Neural recordings were made during L7 MAM thrusts using the Activator V (Activator Methods Int. Ltd., Phoenix, AZ) and/or Pulstar (Sense Technology Inc., Pittsburgh, PA) devices at their 3 lowest force settings. Mechanically assisted manipulation response measures included (a) the time required post-thrust until the first action potential, (b) differences in mean frequency (MF) and mean instantaneous frequency (MIF) 2 seconds before and after MAM, and (c) the time required for muscle spindle discharge (MF and MIF) to return to 95% of baseline after MAM. Depending on device setting, between 44% to 80% (Pulstar) and 11% to 63% (Activator V) of spindle afferents required >6 seconds to return to within 95% of baseline MF values; whereas 66% to 89% (Pulstar) and 75% to 100% (Activator V) of spindle responses returned to within 95% of baseline MIF in <6 seconds after MAM. Nonparametric comparisons between the 22 N and 44 N settings of the Pulstar yielded significant differences for the time required to return to baseline MF and MIF. Short duration (<10 ms) MAM thrusts decrease muscle spindle discharge with a majority of afferents requiring prolonged periods (>6 seconds) to return to baseline MF activity. Physiological consequences and clinical relevance of described MAM mechanoreceptor responses will require additional investigation. Copyright © 2017. Published by Elsevier Inc.

New technologies for supporting real-time on-board software development

NASA Astrophysics Data System (ADS)

Kerridge, D.

1995-03-01

The next generation of on-board data management systems will be significantly more complex than current designs, and will be required to perform more complex and demanding tasks in software. Improved hardware technology, in the form of the MA31750 radiation hard processor, is one key component in addressing the needs of future embedded systems. However, to complement these hardware advances, improved support for the design and implementation of real-time data management software is now needed. This will help to control the cost and risk assoicated with developing data management software development as it becomes an increasingly significant element within embedded systems. One particular problem with developing embedded software is managing the non-functional requirements in a systematic way. This paper identifies how Logica has exploited recent developments in hard real-time theory to address this problem through the use of new hard real-time analysis and design methods which can be supported by specialized tools. The first stage in transferring this technology from the research domain to industrial application has already been completed. The MA37150 Hard Real-Time Embedded Software Support Environment (HESSE) is a loosely integrated set of hardware and software tools which directly support the process of hard real-time analysis for software targeting the MA31750 processor. With further development, this HESSE promises to provide embedded system developers with software tools which can reduce the risks associated with developing complex hard real-time software. Supported in this way by more sophisticated software methods and tools, it is foreseen that MA31750 based embedded systems can meet the processing needs for the next generation of on-board data management systems.

Pre-flight testing of preterm infants with neonatal lung disease: a retrospective review.

PubMed

Udomittipong, K; Stick, S M; Verheggen, M; Oostryck, J; Sly, P D; Hall, G L

2006-04-01

The low oxygen environment during air travel may result in hypoxia in patients with respiratory disease. However, little information exists on the oxygen requirements of infants with respiratory disease planning to fly. A study was undertaken to identify the clinical factors predictive of an in-flight oxygen requirement from a retrospective review of hypoxia challenge tests (inhalation of 14-15% oxygen for 20 minutes) in infants referred for fitness to fly assessment. Data from 47 infants (median corrected age 1.4 months) with a history of neonatal lung disease but not receiving supplemental oxygen at the time of hypoxia testing are reported. The neonatal and current clinical information of the infants were analysed in terms of their ability to predict the hypoxia test results. Thirty eight infants (81%) desaturated below 85% and warranted prescription of supplemental in-flight oxygen. Baseline oxygen saturation was >95% in all infants. Age at the time of the hypoxia test, either postmenstrual or corrected, significantly predicted the outcome of the hypoxia test (odds ratio 0.82; 95% confidence intervals 0.62 to 0.95; p = 0.005). Children passing the hypoxia test were significantly older than those requiring in-flight oxygen (median corrected age (10-90th centiles) 12.7 (3.0-43.4) v 0 (-0.9-10.9) months; p < 0.0001). A high proportion of ex-preterm infants not currently requiring supplemental oxygen referred for fitness-to-fly assessment and less than 12 months corrected age are at a high risk of requiring in-flight oxygen. Referral of this patient group for fitness to fly assessment including a hypoxia test may be indicated.

Day care PNL using 'Santosh-PGI hemostatic seal' versus standard PNL: A randomized controlled study.

PubMed

Kumar, Santosh; Singh, Shivanshu; Singh, Prashant; Singh, Shrawan Kumar

2016-01-01

To compare the outcomes of tubeless day care PNL using hemostatic seal in the access tract versus standard PNL. It was a prospective randomized controlled study. Cases were randomized to either the day care group with hemostatic seal (DCS) or the control group where patients were admitted and a nephrostomy tube was placed at the conclusion of surgery. A total of 180 cases were screened and out of these, 113 were included in the final analysis. The stone clearance rates were comparable in both the groups. The mean drop in hemoglobin was significantly lower in DCS group than the control group (1.05 ±0.68 vs. 1.30 ±0.58 gm/dl, p = 0.038).Mean postoperative pain score, analgesic requirement (paracetamol) and duration of hospital stay were also significantly lower in the DCS group (3.79 ±1.23 vs. 6.12 ±0.96, 1.48 ±0.50 vs. 4.09 ±1.11 grams and 0.48 ±0.26 vs. 4.74 ±1.53 days respectively; p <0.05). The incidence of urine leakage through the access tract site was significantly lower in the DCS subgroup when compared to the controls (3.6% vs. 21.1%, p <0.05). Cases in the DCS group resumed their normal activities in a significantly shorter time (8.05 ±3.05 vs.18.42 ±4.42 days; p <0.05). Higher proportion of cases in the DCS group got re-admitted, although it was not a statistically significant number (7.1% vs. 1.8%; p = 0.21). Tubeless day care PNL with composite hemostatic tract seal is considered safe. It resulted in a significant reduction of blood loss and analgesic requirement with significantly reduced hospital stay, nephrostomy tube site morbidity and time required to resume normal activity when compared to the standard PNL. However, patients must be compliant with the given instructions and should have access to a health care facility, as few of them may need re-admission.

Day care PNL using ‘Santosh-PGI hemostatic seal’ versus standard PNL: A randomized controlled study

PubMed Central

Singh, Shivanshu; Singh, Prashant; Singh, Shrawan Kumar

2016-01-01

Introduction To compare the outcomes of tubeless day care PNL using hemostatic seal in the access tract versus standard PNL. Material and methods It was a prospective randomized controlled study. Cases were randomized to either the day care group with hemostatic seal (DCS) or the control group where patients were admitted and a nephrostomy tube was placed at the conclusion of surgery. Results A total of 180 cases were screened and out of these, 113 were included in the final analysis. The stone clearance rates were comparable in both the groups. The mean drop in hemoglobin was significantly lower in DCS group than the control group (1.05 ±0.68 vs. 1.30 ±0.58 gm/dl, p = 0.038).Mean postoperative pain score, analgesic requirement (paracetamol) and duration of hospital stay were also significantly lower in the DCS group (3.79 ±1.23 vs. 6.12 ±0.96, 1.48 ±0.50 vs. 4.09 ±1.11 grams and 0.48 ±0.26 vs. 4.74 ±1.53 days respectively; p <0.05). The incidence of urine leakage through the access tract site was significantly lower in the DCS subgroup when compared to the controls (3.6% vs. 21.1%, p <0.05). Cases in the DCS group resumed their normal activities in a significantly shorter time (8.05 ±3.05 vs.18.42 ±4.42 days; p <0.05). Higher proportion of cases in the DCS group got re-admitted, although it was not a statistically significant number (7.1% vs. 1.8%; p = 0.21). Conclusions Tubeless day care PNL with composite hemostatic tract seal is considered safe. It resulted in a significant reduction of blood loss and analgesic requirement with significantly reduced hospital stay, nephrostomy tube site morbidity and time required to resume normal activity when compared to the standard PNL. However, patients must be compliant with the given instructions and should have access to a health care facility, as few of them may need re-admission. PMID:27551557

Use of electronarcosis to immobilize juvenile lake and shortnose sturgeons for handling and the effects on their behavior

USGS Publications Warehouse

Henyey, E.; Kynard, B.; Zhuang, P.

2002-01-01

Low voltage constant direct current was used to immobilize juvenile lake (Acipenser fulvescens) and shortnose sturgeons (A. brevirostrum). There was no significant difference in time/ the lake or shortnose sturgeons required to exhibit positive rheotaxis between fish immobilized with electricity and control fish (two-way ANOVA, P = 0.11). Fish immobilized with 80 mg L-1 tricaine took a significantly longer time to orient than control fish or fish immobilized with electricity for 5 or 30 min (one-way ANOVA, P = 0.003). Electronarcosis, which produces effects like a chemical anesthetic, is a useful technique for immobilizing juvenile sturgeons for handling. Fish can swim upright as soon as the electricity is turned off, recovery time is shorter than with chemical anesthetics, and the cost of equipment is < 400 USD.

78 FR 8273 - Approval of Air Quality Implementation Plans; Navajo Nation; Regional Haze Requirements for...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-02-05

... in significant visibility improvement that is well-balanced with the cost of those controls. For a... visibility benefits over time and that there may be changes in energy demand, supply or other developments... encourages a robust public discussion of our proposed BART determination and alternative, the additional...

A Choice Reaction Time Index of Callosal Anatomical Homotopy

ERIC Educational Resources Information Center

Desjardins, Sameul; Braun, Claude M. J.; Achim, Andre; Roberge, Carl

2009-01-01

Tachistoscopically presented bilateral stimulus pairs not parallel to the meridian produced significantly longer RTs on a task requiring discrimination of shapes (Go/no-Go) than pairs emplaced symmetrically on each side of the meridian in Desjardins and Braun [Desjardins, S., & Braun, C. M. J. (2006). Homotopy and heterotopy and the bilateral…

Automatic Grading of 3D Computer Animation Laboratory Assignments

ERIC Educational Resources Information Center

Lamberti, Fabrizio; Sanna, Andrea; Paravati, Gianluca; Carlevaris, Gilles

2014-01-01

Assessment is a delicate task in the overall teaching process because it may require significant time and may be prone to subjectivity. Subjectivity is especially true for disciplines in which perceptual factors play a key role in the evaluation. In previous decades, computer-based assessment techniques were developed to address the…

The Dynamic Theory, A New View of Space, Time, and Matter

DTIC Science & Technology

1978-03-01

UQ = 0, system the principle of increasing entropy requires that (dqo)2 > 0 so that f (do)2 > 0. Introducing the quantitization conditions results in...added significance in considering the differential change in entropy or dq° =f do. Thus the only mathematically consistent difinition for is 1 lanf ax

A Glance at Institutional Support for Faculty Teaching in an Online Learning Environment

ERIC Educational Resources Information Center

Lion, Robert W.; Stark, Gary

2010-01-01

With continued advances in web-based learning, colleges and universities strive to meet the needs and interests of students, faculty, and staff. New instructional technologies have at least one thing in common: the learning curve associated with users becoming adept. Mastery requires significant time and attention. Providing the best quality…

Testing for Seed Quality in Southern Oaks

Treesearch

F.T. Bonner

1984-01-01

Expressions of germination rate, such as peak value (PV) or mean germination time (MGT), provide good estimates of acorn quality, but test completion requires a minimum of 3 weeks. For more rapid estimates, tetrazolium staining is recommended. Some seed test results were significantly correlated with nursery germination of cherrybark and water oaks, but not with...

A Teacher Educator Who Challenged Minds and Changed Lives for African Americans

ERIC Educational Resources Information Center

Gentry, Ruben

2012-01-01

The path to quality education for African Americans has been rough and often fraught with resistance from the time that they were denied any education, to "separate" education, and even to "no child left behind" education. Any significant achievement for them in the American educational system required blood, sweat, and tears…

Point Cloud-Based Automatic Assessment of 3D Computer Animation Courseworks

ERIC Educational Resources Information Center

Paravati, Gianluca; Lamberti, Fabrizio; Gatteschi, Valentina; Demartini, Claudio; Montuschi, Paolo

2017-01-01

Computer-supported assessment tools can bring significant benefits to both students and teachers. When integrated in traditional education workflows, they may help to reduce the time required to perform the evaluation and consolidate the perception of fairness of the overall process. When integrated within on-line intelligent tutoring systems,…

The Amygdalo-Nigrostriatal Network Is Critical for an Optimal Temporal Performance

ERIC Educational Resources Information Center

Es-seddiqi, Mouna; El Massioui, Nicole; Samson, Nathalie; Brown, Bruce L.; Doyère, Valérie

2016-01-01

The amygdalo-nigrostriatal (ANS) network plays an essential role in enhanced attention to significant events. Interval timing requires attention to temporal cues. We assessed rats having a disconnected ANS network, due to contralateral lesions of the medial central nucleus of the amygdala (CEm) and dopaminergic afferents to the lateral striatum,…

Investigating Rural Pre-Service Teachers' Mathematics Anxiety Using the Revised Mathematics Anxiety Scale (RMARS)

ERIC Educational Resources Information Center

Wilson, Sue

2013-01-01

Engaging successfully in the modern technological society requires a command of mathematics. Hence, successfully engaging with mathematics has social, economic and political implications. There has been a history over a long period of time of significant numbers of people not forming productive relationships with learning mathematics. Failure in…

Automated Test for NASA CFS

NASA Technical Reports Server (NTRS)

McComas, David C.; Strege, Susanne L.; Carpenter, Paul B. Hartman, Randy

2015-01-01

The core Flight System (cFS) is a flight software (FSW) product line developed by the Flight Software Systems Branch (FSSB) at NASA's Goddard Space Flight Center (GSFC). The cFS uses compile-time configuration parameters to implement variable requirements to enable portability across embedded computing platforms and to implement different end-user functional needs. The verification and validation of these requirements is proving to be a significant challenge. This paper describes the challenges facing the cFS and the results of a pilot effort to apply EXB Solution's testing approach to the cFS applications.

Comparative Response of Platelet fV and Plasma fV to Activated Protein C and Relevance to a Model of Acute Traumatic Coagulopathy

DTIC Science & Technology

2014-06-12

inducing concen tration. To test this hypothesis, we investigated the concentration of aPC required to induce significant delays in clot time, decrease...instructions and mixed with 50 ml plasma ( pre incubated at 37 uC). The Mean Normal PT is listed as 13.5 s for this device, and INR is calculated by...and pair wise comparison Bonferroni posttests . Results Nanomolar aPC Is Required to Prolong PT/INR PT measurements in fVdp are delayed compared to

Potential of laser for SPS power transmission

NASA Technical Reports Server (NTRS)

Bain, C. N.

1978-01-01

Research on the feasibility of using a laser subsystem as an additional option for the transmission of the satellite power system (STS) power is presented. Current laser work and predictions for future laser performance provide a level of confidence that the development of a laser power transmission system is technologically feasible in the time frame required to develop the SBS. There are significant economic advantages in lower ground distribution costs and a reduction of more than two orders of magnitude in real estate requirements for ground based receiving/conversion sites.

Qualities Required from Engineers of the Global Times

NASA Astrophysics Data System (ADS)

Senuma, Takehide

In this paper, the qualities and characteristics required from an engineer who works globally are discussed based on my own experience of a joint research project with a European company. The most important qualities and characteristics are integrity, one‧s own initiative, basic and expert knowledge, creativity, communicative skills and broad world view. Having initiative seems to be especially significant but is a weak point of young engineers in Japan at present. Ways to develop students‧ initiative are discussed in detail from a view point of the engineering education.

Maple syrup urine disease: tailoring a plan for pregnancy.

PubMed

Brown, James; Tchan, Michel; Nayyar, Roshini

2018-06-01

Maple syrup urine disease (MSUD) is an autosomal metabolic condition that can cause significant morbidity in pregnant women and their infants. Advances in nutritional management mean more mothers with congenital metabolic disorders are becoming pregnant, and presenting challenges in obstetric care. In particular, the increase in protein requirements during pregnancy and metabolic stress of childbirth require careful planning and caloric titration. We report a case of a second time mother with MSUD and demonstrate a treatment scaffold to help achieve successful pregnancies for women with this and similar conditions.

Modular Detection of GFP-Labeled Proteins for Rapid Screening by Electron Microscopy in Cells and Organisms.

PubMed

Ariotti, Nicholas; Hall, Thomas E; Rae, James; Ferguson, Charles; McMahon, Kerrie-Ann; Martel, Nick; Webb, Robyn E; Webb, Richard I; Teasdale, Rohan D; Parton, Robert G

2015-11-23

Reliable and quantifiable high-resolution protein localization is critical for understanding protein function. However, the time required to clone and characterize any protein of interest is a significant bottleneck, especially for electron microscopy (EM). We present a modular system for enzyme-based protein tagging that allows for improved speed and sampling for analysis of subcellular protein distributions using existing clone libraries to EM-resolution. We demonstrate that we can target a modified soybean ascorbate peroxidase (APEX) to any GFP-tagged protein of interest by engineering a GFP-binding peptide (GBP) directly to the APEX-tag. We demonstrate that APEX-GBP (1) significantly reduces the time required to characterize subcellular protein distributions of whole libraries to less than 3 days, (2) provides remarkable high-resolution localization of proteins to organelle subdomains, and (3) allows EM localization of GFP-tagged proteins, including proteins expressed at endogenous levels, in vivo by crossing existing GFP-tagged transgenic zebrafish lines with APEX-GBP transgenic lines. Copyright © 2015 Elsevier Inc. All rights reserved.

Viscous Dissipation and Heat Conduction in Binary Neutron-Star Mergers.

PubMed

Alford, Mark G; Bovard, Luke; Hanauske, Matthias; Rezzolla, Luciano; Schwenzer, Kai

2018-01-26

Inferring the properties of dense matter is one of the most exciting prospects from the measurement of gravitational waves from neutron star mergers. However, it requires reliable numerical simulations that incorporate viscous dissipation and energy transport as these can play a significant role in the survival time of the post-merger object. We calculate time scales for typical forms of dissipation and find that thermal transport and shear viscosity will not be important unless neutrino trapping occurs, which requires temperatures above 10 MeV and gradients over length scales of 0.1 km or less. On the other hand, if direct-Urca processes remain suppressed, leaving modified-Urca processes to establish flavor equilibrium, then bulk viscous dissipation could provide significant damping to density oscillations right after merger. When comparing with data from state-of-the-art merger simulations, we find that the bulk viscosity takes values close to its resonant maximum in a typical merger, motivating a more careful assessment of the role of bulk viscous dissipation in the gravitational-wave signal from merging neutron stars.

Viscous Dissipation and Heat Conduction in Binary Neutron-Star Mergers

NASA Astrophysics Data System (ADS)

Alford, Mark G.; Bovard, Luke; Hanauske, Matthias; Rezzolla, Luciano; Schwenzer, Kai

2018-01-01

Inferring the properties of dense matter is one of the most exciting prospects from the measurement of gravitational waves from neutron star mergers. However, it requires reliable numerical simulations that incorporate viscous dissipation and energy transport as these can play a significant role in the survival time of the post-merger object. We calculate time scales for typical forms of dissipation and find that thermal transport and shear viscosity will not be important unless neutrino trapping occurs, which requires temperatures above 10 MeV and gradients over length scales of 0.1 km or less. On the other hand, if direct-Urca processes remain suppressed, leaving modified-Urca processes to establish flavor equilibrium, then bulk viscous dissipation could provide significant damping to density oscillations right after merger. When comparing with data from state-of-the-art merger simulations, we find that the bulk viscosity takes values close to its resonant maximum in a typical merger, motivating a more careful assessment of the role of bulk viscous dissipation in the gravitational-wave signal from merging neutron stars.

Robot-assisted intracorporeal ileal conduit: Marionette technique and initial experience at Roswell Park Cancer Institute.

PubMed

Guru, Khurshid; Seixas-Mikelus, Stéfanie A; Hussain, Abid; Blumenfeld, Aaron J; Nyquist, John; Chandrasekhar, Rameela; Wilding, Gregory E

2010-10-01

To present our technique and initial experience with patients who underwent robot-assisted intracorporeal creation of ileal conduit and to compare them with patients who underwent extracorporeal ileal diversion after robot-assisted radical cystectomy. Twenty-six patients diagnosed with invasive transitional cell carcinoma of the bladder underwent a robot-assisted radical cystectomy with bilateral extended pelvic lymphadenectomy with ileal conduit diversion. Total intracorporeal ileal conduit creation was performed in the last 13 patients. Operative data and short-term outcomes between the 2 groups were assessed. The novel surgical technique for intracorporeal ileal conduit will be presented. The intracorporeal group (IC) included 2 female and 11 male patients (mean age 71 years). The extracorporeal group (EC) included 4 female and 9 male patients (mean age 66 years). No significant differences were noted between the groups in terms of patient age, BMI, sex, prior surgery, or pathologic stage. Overall operative time and intraoperative complications were similar. No significant differences were noted between the 2 groups in terms of diversion time or estimated blood loss. There were 4 complications recorded in IC patients, including nonspecific colitis, small bowel obstruction requiring exploratory laparotomy with lysis of adhesions, a urine leak that eventually resolved but required a temporary nephrostomy tube, and a fever of unknown origin that resolved without intervention. Robot-assisted intracorporeal ileal conduit can be accomplished safely with acceptable operative times even during early experience. Larger series with favorable results will be required to add this new paradigm to minimally invasive surgery for bladder cancer. Copyright © 2010 Elsevier Inc. All rights reserved.

From self to social cognition: Theory of Mind mechanisms and their relation to Executive Functioning.

PubMed

Bradford, Elisabeth E F; Jentzsch, Ines; Gomez, Juan-Carlos

2015-05-01

'Theory of Mind' refers to the ability to attribute mental states to oneself and other people (Premack & Woodruff, 1978). This study examined the extent to which 'Self' and 'Other' belief-attribution processes within the Theory of Mind (ToM) mechanism could be distinguished behaviourally, and whether these separable components differentially related to Executive Functioning (EF) abilities. A computerized false-belief task, utilizing a matched-design to allow direct comparison of self-oriented vs. other-oriented belief-attribution, was used to assess ToM, and a face-image Stroop task was employed to assess EF, within a population of typically-developed adults. Results revealed significantly longer reaction times when attributing beliefs to other people as opposed to recognizing and attributing beliefs to oneself. Intriguingly, results revealed that 'perspective-shift' requirements (i.e. changing from adoption of the 'self' perspective to the perspective of the 'other', or vice versa) across false-belief trials influenced reaction times. Reaction times were significantly longer when the perspective shift was from self-to-other than from other-to-self. It is suggested that the 'self' forms the stem of understanding the 'other', and is therefore processed regardless of ultimate task demands; in contrast, the 'other' perspective is only processed when explicitly required. We conclude that adopting another person's perspective, even when their belief state is matched to one's own, requires more cognitive effort than recalling and reflecting on self-oriented belief-states. Copyright © 2015 The Authors. Published by Elsevier B.V. All rights reserved.

Postoperative Intravenous Acetaminophen for Craniotomy Patients: A Randomized Controlled Trial.

PubMed

Greenberg, Steven; Murphy, Glenn S; Avram, Michael J; Shear, Torin; Benson, Jessica; Parikh, Kruti N; Patel, Aashka; Newmark, Rebecca; Patel, Vimal; Bailes, Julian; Szokol, Joseph W

2018-01-01

To determine whether opioids during the first 24 postoperative hours were significantly altered when receiving intravenous (IV) acetaminophen during that time compared with those receiving placebo (normal saline). One hundred forty patients undergoing any type of craniotomy were randomly assigned to receive either 1 g of IV acetaminophen or placebo upon surgical closure, and every 6 hours thereafter, up to 18 hours postoperatively. Analgesic requirements for the first 24 postoperative hours were recorded. Time to rescue medications in the postanesthesia care unit (PACU)/intensive care unit (ICU), amount of rescue medication, ICU and hospital lengths of stay, number of successful neurological examinations, sedation, delirium, satisfaction, and visual analog scale pain scores were also recorded. Compared with the placebo group, more patients in the IV acetaminophen group (10/66 [15.2%] vs. 4/65 [6.2%] in the placebo group) did not require opioids within the first 24 postoperative hours, but this did not reach significance (odds ratio, -9.0%, 95% confidence interval -20.5% to 1.8%; P = 0.166). Both groups had similar times to rescue medications, amounts of rescue medications, ICU and hospital lengths of stay, numbers of successful neurological examinations, sedation, delirium, satisfaction scores, visual analog scale pain scores, and temperatures within the first 24 postoperative hours. The opioid requirements within the first 24 postoperative hours were similar in the placebo and acetaminophen groups. This study is informative for the design and planning of future studies investigating the management of postoperative pain in patients undergoing craniotomies. Copyright © 2017 Elsevier Inc. All rights reserved.

Standardized versus custom parenteral nutrition: impact on clinical and cost-related outcomes.

PubMed

Blanchette, Lisa M; Huiras, Paul; Papadopoulos, Stella

2014-01-15

Results of a study comparing clinical and cost outcomes with the use of standardized versus custom-prepared parenteral nutrition (PN) in an acute care setting are reported. In a retrospective pre-post analysis, nutritional target attainment, electrolyte abnormalities, and other outcomes were compared in patients 15 years of age or older who received custom PN (n = 49) or a standardized PN product (n = 57) for at least 72 hours at a large medical center over a 13-month period; overall, 45% of the cases were intensive care unit (ICU) admissions. A time-and-motion assessment was conducted to determine PN preparation times. There were no significant between-group differences in the percentage of patients who achieved estimated caloric requirements or in mean ICU or hospital length of stay. However, patients who received standardized PN were significantly less likely than those who received custom PN to achieve the highest protein intake goal (63% versus 92%, p = 0.003) and more likely to develop hyponatremia (37% versus 14%, p = 0.01). Pharmacy preparation times averaged 20 minutes for standardized PN and 80 minutes for custom PN; unit costs were $61.06 and $57.84, respectively. A standardized PN formulation was as effective as custom PN in achieving estimated caloric requirements, but it was relatively less effective in achieving 90% of estimated protein requirements and was associated with a higher frequency of hyponatremia. The standardized PN product may be a cost-effective formulation for institutions preparing an average of five or fewer PN orders per day.

Optimization of Primary Drying in Lyophilization during Early Phase Drug Development using a Definitive Screening Design with Formulation and Process Factors.

PubMed

Goldman, Johnathan M; More, Haresh T; Yee, Olga; Borgeson, Elizabeth; Remy, Brenda; Rowe, Jasmine; Sadineni, Vikram

2018-06-08

Development of optimal drug product lyophilization cycles is typically accomplished via multiple engineering runs to determine appropriate process parameters. These runs require significant time and product investments, which are especially costly during early phase development when the drug product formulation and lyophilization process are often defined simultaneously. Even small changes in the formulation may require a new set of engineering runs to define lyophilization process parameters. In order to overcome these development difficulties, an eight factor definitive screening design (DSD), including both formulation and process parameters, was executed on a fully human monoclonal antibody (mAb) drug product. The DSD enables evaluation of several interdependent factors to define critical parameters that affect primary drying time and product temperature. From these parameters, a lyophilization development model is defined where near optimal process parameters can be derived for many different drug product formulations. This concept is demonstrated on a mAb drug product where statistically predicted cycle responses agree well with those measured experimentally. This design of experiments (DoE) approach for early phase lyophilization cycle development offers a workflow that significantly decreases the development time of clinically and potentially commercially viable lyophilization cycles for a platform formulation that still has variable range of compositions. Copyright © 2018. Published by Elsevier Inc.

RF beam transmission of x-band PAA system utilizing large-area, polymer-based true-time-delay module developed using imprinting and inkjet printing

NASA Astrophysics Data System (ADS)

Pan, Zeyu; Subbaraman, Harish; Zhang, Cheng; Li, Qiaochu; Xu, Xiaochuan; Chen, Xiangning; Zhang, Xingyu; Zou, Yi; Panday, Ashwin; Guo, L. Jay; Chen, Ray T.

2016-02-01

Phased-array antenna (PAA) technology plays a significant role in modern day radar and communication networks. Truetime- delay (TTD) enabled beam steering networks provide several advantages over their electronic counterparts, including squint-free beam steering, low RF loss, immunity to electromagnetic interference (EMI), and large bandwidth control of PAAs. Chip-scale and integrated TTD modules promise a miniaturized, light-weight system; however, the modules are still rigid and they require complex packaging solutions. Moreover, the total achievable time delay is still restricted by the wafer size. In this work, we propose a light-weight and large-area, true-time-delay beamforming network that can be fabricated on light-weight and flexible/rigid surfaces utilizing low-cost "printing" techniques. In order to prove the feasibility of the approach, a 2-bit thermo-optic polymer TTD network is developed using a combination of imprinting and ink-jet printing. RF beam steering of a 1×4 X-band PAA up to 60° is demonstrated. The development of such active components on large area, light-weight, and low-cost substrates promises significant improvement in size, weight, and power (SWaP) requirements over the state-of-the-art.

Impact of Remote Monitoring on Clinical Outcomes.

PubMed

Varma, Niraj; Ricci, Renato Pietro

2015-12-01

Follow-up of patients with cardiac implantable electronic devices is challenging due to both their increasing volume and technical complexity coupled to increasing clinical complexity of recipient patients. Remote monitoring (RM) offers an opportunity to resolve some of these difficulties by improving clinic efficiencies and providing a mechanism for device monitoring and patient management. Several recent randomized clinical trials and registries have demonstrated that RM may reduce in-hospital visit numbers, time required for patient follow-up, physician and nurse time, and hospital and social costs. Furthermore, patient retention and adherence to follow-up schedule are significantly improved by RM. Continuous wireless monitoring of data stored in the device memory with automatic alerts allows early detection of device malfunctions and of events, such as atrial fibrillation, ventricular arrhythmias, and heart failure suitable for clinical intervention. Early reaction may improve patient outcome. RM is easy to use and patients showed a high level of acceptance and satisfaction. Implementing RM in daily practice may require changes in clinic workflow. New organizational models promote significant efficiencies regarding physician and nursing time. Data management techniques are under development. Despite these demonstrable advantages of RM, adoption still remains modest, even in health care systems incentivized to use this follow-up method. © 2015 Wiley Periodicals, Inc.

A novel 3-dimensional electromagnetic guidance system increases intraoperative microwave antenna placement accuracy.

PubMed

Sastry, Amit V; Swet, Jacob H; Murphy, Keith J; Baker, Erin H; Vrochides, Dionisios; Martinie, John B; McKillop, Iain H; Iannitti, David A

2017-12-01

Failure to locate lesions and accurately place microwave antennas can lead to incomplete tumor ablation. The Emprint™ SX Ablation Platform employs real-time 3D-electromagnetic spatial antenna tracking to generate intraoperative laparoscopic antenna guidance. We sought to determine whether Emprint™ SX affected time/accuracy of antenna-placement in a laparoscopic training model. Targets (7-10 mm) were set in agar within a laparoscopic training device. Novices (no surgical experience), intermediates (surgical residents), and experts (HPB-surgeons) were asked to locate and hit targets using a MWA antenna (10-ultrasound only, 10-Emprint™ SX). Time to locate target, number of attempts to hit the target, first-time hit rate, and time from initiating antenna advance to hitting the target were measured. Participants located 100% of targets using ultrasound, with experts taking significantly less time than novices and intermediates. Using ultrasound only, successful hit-rates were 70% for novices and 90% for intermediates and experts. Using Emprint™ SX, successful hit rates for all 3-groups were 100%, with significantly increased first-time hit-rates and reduced time required to hit targets compared to ultrasound only. Emprint™ SX significantly improved accuracy and speed of antenna-placement independent of experience, and was particularly beneficial for novice users. Copyright © 2017 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.

Synchronization for Optical PPM with Inter-Symbol Guard Times

NASA Astrophysics Data System (ADS)

Rogalin, R.; Srinivasan, M.

2017-05-01

Deep space optical communications promises orders of magnitude growth in communication capacity, supporting high data rate applications such as video streaming and high-bandwidth science instruments. Pulse position modulation is the modulation format of choice for deep space applications, and by inserting inter-symbol guard times between the symbols, the signal carries the timing information needed by the demodulator. Accurately extracting this timing information is crucial to demodulating and decoding this signal. In this article, we propose a number of timing and frequency estimation schemes for this modulation format, and in particular highlight a low complexity maximum likelihood timing estimator that significantly outperforms the prior art in this domain. This method does not require an explicit synchronization sequence, freeing up channel resources for data transmission.

Extending nonlinear analysis to short ecological time series.

PubMed

Hsieh, Chih-hao; Anderson, Christian; Sugihara, George

2008-01-01

Nonlinearity is important and ubiquitous in ecology. Though detectable in principle, nonlinear behavior is often difficult to characterize, analyze, and incorporate mechanistically into models of ecosystem function. One obvious reason is that quantitative nonlinear analysis tools are data intensive (require long time series), and time series in ecology are generally short. Here we demonstrate a useful method that circumvents data limitation and reduces sampling error by combining ecologically similar multispecies time series into one long time series. With this technique, individual ecological time series containing as few as 20 data points can be mined for such important information as (1) significantly improved forecast ability, (2) the presence and location of nonlinearity, and (3) the effective dimensionality (the number of relevant variables) of an ecological system.

The effect of timing errors in optical digital systems.

NASA Technical Reports Server (NTRS)

Gagliardi, R. M.

1972-01-01

The use of digital transmission with narrow light pulses appears attractive for data communications, but carries with it a stringent requirement on system bit timing. The effects of imperfect timing in direct-detection (noncoherent) optical binary systems are investigated using both pulse-position modulation and on-off keying for bit transmission. Particular emphasis is placed on specification of timing accuracy and an examination of system degradation when this accuracy is not attained. Bit error probabilities are shown as a function of timing errors from which average error probabilities can be computed for specific synchronization methods. Of significance is the presence of a residual or irreducible error probability in both systems, due entirely to the timing system, which cannot be overcome by the data channel.

The impact of RAC audits on US hospitals.

PubMed

Harrison, Jeffrey P; Barksdale, Rachel M

2013-01-01

The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) authorized a three-year demonstration program using recovery audit contractors (RACs) to identify and correct improper payments in the Medicare Fee-For-Service program. More recently, Section 6411 of the Affordable Care Act (ACA) expanded the RAC program to include the Medicaid program. This shows the Cent ers for Medicare & Medicaid Services (CMS) believe RAC audits are a cost-effective method to ensure health care providers are paid correctly and thereby protect the Medicare Trust Fund. RAC audits are highly complex and require significant manpower to handle the large volume of requests received during a short period of time. Additionally, the RAC audit appeal process is complicated and requires a high level of technical expertise. The demonstration project found that RAC audits resulted in sizeable amounts of overpayments collected ("take-backs") from many providers. This research study assesses the potential impact of the RAC audit program on US acute care hospitals. Data obtained from CMS show that RAC overpayments collected for FY 2010 were $75.4 million, increased to $797.4 million in FY 2011, and increased to $986.2 million in the first six months of FY 2012. According to the American Hospital Association (AHA) RACTrac audit survey, the vast majority of these collections represent complex denials where hospitals are required to provide medical record documents in support of their billed claims. This study found that the RAC audit program collections are increasing significantly over time. As a result, these collections are having a significant negative impact on the profitability of US hospitals.

Impact of fungal species cultured on outcome in horses with fungal keratitis.

PubMed

Sherman, Amanda B; Clode, Alison B; Gilger, Brian C

2017-03-01

To determine the significance of Aspergillus and Fusarium spp., as identified by culture, on clinical outcome in equine keratomycosis. Retrospective analysis of 66 horses (66 eyes) evaluated at the NCSU-VH diagnosed with keratomycosis from which Aspergillus or Fusarium spp. were cultured. Horses were classified into those who improved with medical management alone or those who required surgical intervention to improve. Horses who underwent surgery were divided into globe-sparing procedures or enucleation. Effects of bacterial co-infection, previous topical steroid or antifungal use, and time of year on fungal genus and outcome were evaluated. Aspergillus spp. was cultured from 41 eyes (63%), while 24 eyes (37%) cultured Fusarium spp. One horse cultured both species and was not included in further evaluation. From the horses that cultured Aspergillus spp., 28 eyes (68%) required surgical intervention to control the infection: 21 (75%) of these eyes maintained globe integrity, while 7 eyes (25%) were enucleated. Of those horses with Fusarium spp., 14 eyes (58%) required surgical intervention: 11 (79%) of these eyes maintained globe integrity, while 3 eyes (21%) were enucleated. Genus of fungus cultured was not significantly associated with the need for surgical intervention nor was it significantly associated with the necessity of globe-sparing surgery versus enucleation. Additionally, bacterial co-infection, previous steroidal or antifungal use, and time of year did not affect outcome or type of fungal species cultured. Equine keratomycosis from Fusarium spp. compared to keratomycosis from Aspergillus spp. is not associated with a different clinical outcome. © 2016 American College of Veterinary Ophthalmologists.

Single-step affinity purification of enzyme biotherapeutics: a platform methodology for accelerated process development.

PubMed

Brower, Kevin P; Ryakala, Venkat K; Bird, Ryan; Godawat, Rahul; Riske, Frank J; Konstantinov, Konstantin; Warikoo, Veena; Gamble, Jean

2014-01-01

Downstream sample purification for quality attribute analysis is a significant bottleneck in process development for non-antibody biologics. Multi-step chromatography process train purifications are typically required prior to many critical analytical tests. This prerequisite leads to limited throughput, long lead times to obtain purified product, and significant resource requirements. In this work, immunoaffinity purification technology has been leveraged to achieve single-step affinity purification of two different enzyme biotherapeutics (Fabrazyme® [agalsidase beta] and Enzyme 2) with polyclonal and monoclonal antibodies, respectively, as ligands. Target molecules were rapidly isolated from cell culture harvest in sufficient purity to enable analysis of critical quality attributes (CQAs). Most importantly, this is the first study that demonstrates the application of predictive analytics techniques to predict critical quality attributes of a commercial biologic. The data obtained using the affinity columns were used to generate appropriate models to predict quality attributes that would be obtained after traditional multi-step purification trains. These models empower process development decision-making with drug substance-equivalent product quality information without generation of actual drug substance. Optimization was performed to ensure maximum target recovery and minimal target protein degradation. The methodologies developed for Fabrazyme were successfully reapplied for Enzyme 2, indicating platform opportunities. The impact of the technology is significant, including reductions in time and personnel requirements, rapid product purification, and substantially increased throughput. Applications are discussed, including upstream and downstream process development support to achieve the principles of Quality by Design (QbD) as well as integration with bioprocesses as a process analytical technology (PAT). © 2014 American Institute of Chemical Engineers.

Dietary protein level and performance of growing Baladi kids.

PubMed

Abdelrahman, M M; Aljumaah, R S

2014-01-01

A study was conducted to evaluate the effect of feeding different levels of protein to black Baladi breed kids. Weanling Baladi kids (n=18; 75 to 90 days old) were selected and individually housed at our experimental farm. Kids were divided randomly to one of the three treatments for 12 weeks. The three dietary treatments were: T1: control ration, formulated according to NRC to cover the protein (level 1) and other nutrients requirements. T2: ration formulated to cover only 75% of protein (level 2) recommended by NRC. T3: control diet + 2.4 g undegradable methionine (Smartamine®)/day/kid (level 3). Feed intake, initial and monthly body weights were recorded. Blood samples were collected monthly and analyzed for metabolites and Co, Zn and Cu levels. Decreasing the dietary level of protein (T2) negatively affected (P<0.05) the total live weight gain, average daily gain and feed conversion ratio when compared with the control and T3 groups. Moreover, treatment, time and time × treatment caused a significant change on Co concentration in blood serum with higher value at the end of the experiment. Treatments had a significant effect (P<0.05) on blood serum cholesterol and protein levels. Undegradable methionine supplementation (T3) significantly increased longissimus dorsi weight, fat thickness and omental fat%. In conclusion, feeding Baladi kids below the NRC requirements of protein negatively affect the growth performance and feed efficiency. The recommended protein level by NRC for growing kids cover the requirements of growing black Baladi kids for maximum growth and productivity.

Dietary protein level and performance of growing Baladi kids

PubMed Central

Abdelrahman, M. M.; Aljumaah, R. S.

2014-01-01

A study was conducted to evaluate the effect of feeding different levels of protein to black Baladi breed kids. Weanling Baladi kids (n=18; 75 to 90 days old) were selected and individually housed at our experimental farm. Kids were divided randomly to one of the three treatments for 12 weeks. The three dietary treatments were: T1: control ration, formulated according to NRC to cover the protein (level 1) and other nutrients requirements. T2: ration formulated to cover only 75% of protein (level 2) recommended by NRC. T3: control diet + 2.4 g undegradable methionine (Smartamine®)/day/kid (level 3). Feed intake, initial and monthly body weights were recorded. Blood samples were collected monthly and analyzed for metabolites and Co, Zn and Cu levels. Decreasing the dietary level of protein (T2) negatively affected (P<0.05) the total live weight gain, average daily gain and feed conversion ratio when compared with the control and T3 groups. Moreover, treatment, time and time × treatment caused a significant change on Co concentration in blood serum with higher value at the end of the experiment. Treatments had a significant effect (P<0.05) on blood serum cholesterol and protein levels. Undegradable methionine supplementation (T3) significantly increased longissimus dorsi weight, fat thickness and omental fat%. In conclusion, feeding Baladi kids below the NRC requirements of protein negatively affect the growth performance and feed efficiency. The recommended protein level by NRC for growing kids cover the requirements of growing black Baladi kids for maximum growth and productivity. PMID:27175130

The Intubating Laryngeal Mask Airway Allows Tracheal Intubation When the Cervical Spine Is Immobilized by a Rigid Collar

PubMed Central

Komatsu, Ryu; Nagata, Osamu; Kamata, Kotoe; Yamagata, Katsuyuki; Sessler, Daniel I.; Ozaki, Makoto

2005-01-01

Summary An intubating laryngeal mask airway (ILMA) facilitates tracheal intubation with the neck in neutral position, which is similar to the neck position maintained by a rigid cervical collar. However, a cervical collar virtually obliterates neck movement, even the small movements that normally facilitate airway insertion. We therefore tested the hypothesis that the ILMA facilitates tracheal intubation even in patients wearing a rigid cervical collar. In 50 cervical spine surgery patients with a rigid Philadelphia collar in place and 50 general surgery patients under general anaesthesia, we performed blind tracheal intubation via an ILMA. The time required for intubation, intubation success rate, and numbers and type of adjusting manoeuvres employed were recorded. Inter-incisor distance was significantly smaller (4.1 [0.8] cm vs. 4.6 [0.7] cm, mean [SD], P<0.01) and Mallampati scores were significantly greater (P<0.001) in the collared patients. ILMA insertion took longer (30 [25] vs. 22 [6] seconds), more patients required 2 insertion attempts (15 vs. 3; P<0.005), and ventilation adequacy with ILMA was worse (P<0.05) in collared patients. However, there were no significant differences between the collared and control patients in terms of total time required for intubation (60 [41] vs. 50 [30] seconds), number of intubation attempts, overall intubation success rate (96 vs. 98%), or the incidence of intubation complications. Blind intubation through an ILMA is thus a reasonable strategy for controlling the airway in patients who are immobilized with a rigid cervical collar, especially when urgency precludes a fiberoptic approach. PMID:15321932

Efficacy of protocol-based pharmacotherapy management on anticoagulation with warfarin for patients with cardiovascular surgery.

PubMed

Katada, Y; Nakagawa, S; Minakata, K; Odaka, M; Taue, H; Sato, Y; Yonezawa, A; Kayano, Y; Yano, I; Nakatsu, T; Sakamoto, K; Uehara, K; Sakaguchi, H; Yamazaki, K; Minatoya, K; Sakata, R; Matsubara, K

2017-10-01

Anticoagulation therapy with warfarin requires periodic monitoring of prothrombin time-international normalized ratio (PT-INR) and adequate dose adjustments based on the data to minimize the risk of bleeding and thromboembolic events. In our hospital, we have developed protocol-based pharmaceutical care, which we called protocol-based pharmacotherapy management (PBPM), for warfarin therapy. The protocol requires pharmacists to manage timing of blood sampling for measuring PT-INR and warfarin dosage determination based on an algorithm. This study evaluated the efficacy of PBPM in warfarin therapy by comparing to conventional pharmaceutical care. From October 2013 to June 2015, a total of 134 hospitalized patients who underwent cardiovascular surgeries received post-operative warfarin therapy. The early series of patients received warfarin therapy as the conventional care (control group, n=77), whereas the latter received warfarin therapy based on the PBPM (PBPM group, n=68). These patients formed the cohort of the present study and were retrospectively analysed. The indications for warfarin included aortic valve replacement (n=56), mitral valve replacement (n=4), mitral valve plasty (n=22) and atrial fibrillation (n=29). There were no differences in patients' characteristics between both groups. The percentage time in therapeutic range in the first 10 days was significantly higher in the PBPM group (47.1%) than that in the control group (34.4%, P<.005). The average time to reach the steady state was significantly (P<.005) shorter in the PBPM group compared to the control group (7.3 vs 8.6 days). Warfarin therapy based on our novel PBPM was clinically safe and resulted in significantly better anticoagulation control compared to conventional care. © 2017 John Wiley & Sons Ltd.

Cost-effective way to reduce stimulant-abuse among gay/bisexual men and transgender women: a randomized clinical trial with a cost comparison.

PubMed

Zhang, S X; Shoptaw, S; Reback, C J; Yadav, K; Nyamathi, A M

2018-01-01

A randomized controlled study was conducted with 422 homeless, stimulant-using gay/bisexual (G/B) men and 29 transgender women (n = 451) to assess two community-based interventions to reduce substance abuse and improve health: (a) a nurse case-managed program combined with contingency management (NCM + CM) versus (b) standard education plus contingency management (SE + CM). Hypotheses tested included: a) completion of hepatitis A/B vaccination series; b) reduction in stimulant use; and c) reduction in number of sexual partners. A deconstructive cost analysis approach was utilized to capture direct costs associated with the delivery of both interventions. Based on an analysis of activity logs and staff interviews, specific activities and the time required to complete each were analyzed as follows: a) NCM + CM only; b) SE + CM only; c) time to administer/record vaccines; and d) time to receive and record CM visits. Cost comparison of the interventions included only staffing costs and direct cash expenditures. The study outcomes showed significant over time reductions in all measures of drug use and multiple sex partners, compared to baseline, although no significant between-group differences were detected. Cost analysis favored the simpler SE + CM intervention over the more labor-intensive NCM + CM approach. Because of the high levels of staffing required for the NCM relative to SE, costs associated with it were significantly higher. Findings suggest that while both intervention strategies were equally effective in achieving desired health outcomes, the brief SE + CM appeared less expensive to deliver. Copyright © 2017 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

Comparison of flexible ureterorenoscopy and mini-percutaneous nephrolithotomy in treatment of lower calyceal stones smaller than 2 cm.

PubMed

Akbulut, Fatih; Kucuktopcu, Onur; Kandemir, Emre; Sonmezay, Erkan; Simsek, Abdulmuttalip; Ozgor, Faruk; Binbay, Murat; Muslumanoglu, Ahmet Yaser; Gurbuz, Gokhan

2016-01-01

To compare the outcomes of flexible ureterorenoscopy (F-URS) and mini-percutaneous nephrolithotomy (mini-PNL) in the treatment of lower calyceal stones smaller than 2 cm. Patients who underwent F-URS and mini-PNL for the treatment of lower calyceal stones smaller than 2 cm between March 2009 and December 2014 were retrospectively evaluated. Ninety-four patients were divided into two groups by treatment modality: F-URS (Group 1: 63 patients) and mini-PNL (Group 2: 31 patients). All patients were preoperatively diagnosed with intravenous pyelography or computed tomography. Success rates for F-URS and mini-PNL at postoperative first month were 85.7% and 90.3%, respectively. Operation time, fluoroscopy time, and hospitalization time for F-URS and mini-PNL patients were 44.40 min, 2.9 min, 22.4 h, and 91.9 min, 6.4 min, and 63.8 h, respectively. All three parameters were significantly shorter among the F-URS group (p < 0.001). Postoperative hemoglobin drop was significantly lower in F-URS group compared to mini-PNL group (0.39 mg/dL vs. 1.15 mg/dL, p = 0.001). A comparison of complications according to the Clavien classification demonstrated significant differences between the groups (p = 0.001). More patients in the F-URS groups require antibiotics due to urinary tract infection, and more patients in the mini-PNL group required ureteral double J catheter insertion under general anesthesia. Although both F-URS and mini-PNL have similar success rates for the treatment of lower calyceal stones, F-URS appears to be more favorable due to shorter fluoroscopy and hospitalization times; and lower hemoglobin drops. Multicenter and studies using higher patient volumes are needed to confirm these findings.

Intramuscular temperature changes during and after 2 different cryotherapy interventions in healthy individuals.

PubMed

Rupp, Kimberly A; Herman, Daniel C; Hertel, Jay; Saliba, Susan A

2012-08-01

Crossover. To compare the time required to decrease intramuscular temperature 8°C below baseline temperature, and to compare intramuscular temperature 90 minutes posttreatment, between 2 cryotherapy modalities. Cryotherapy is used to treat pain from muscle injuries. Cooler intramuscular temperatures may reduce cellular metabolism and secondary hypoxic injury to attenuate acute injury response, specifically the rate of chemical mediator activity. Modalities that decrease intramuscular temperature quickly may be beneficial in the treatment of muscle injuries. Eighteen healthy subjects received 2 cryotherapy conditions, crushed-ice bag (CIB) and cold-water immersion (CWI), in a randomly allocated order, separated by 72 hours. Each condition was applied until intramuscular temperature decreased 8°C below baseline. Intramuscular temperature was monitored in the gastrocnemius, 1 cm below subcutaneous adipose tissue. The primary outcome was time to decrease intramuscular temperature 8°C below baseline. A secondary outcome was intramuscular temperature at the end of a 90-minute rewarming period. Paired t tests were used to examine outcomes. Time to reach an 8°C reduction in intramuscular temperature was not significantly different between CIB and CWI (mean difference, 2.6 minutes; 95% confidence interval: -3.10, 8.30). Intramuscular temperature remained significantly colder 90 minutes post-CWI compared to CIB (mean difference, 2.8°C; 95% confidence interval: 2.07°C, 3.52°C). There was no difference in time required to reduce intramuscular temperature 8°C 1 cm below adipose tissue using CIB and CWI. However, intramuscular temperature remained significantly colder 90 minutes following CWI. These results provide clinicians with information that may guide treatment-modality decisions.

Implementation of a standardized handoff protocol for post-operative admissions to the surgical intensive care unit.

PubMed

Mukhopadhyay, Dhriti; Wiggins-Dohlvik, Katie C; MrDutt, Mary M; Hamaker, Jeffrey S; Machen, Graham L; Davis, Matthew L; Regner, Justin L; Smith, Randall W; Ciceri, David P; Shake, Jay G

2018-01-01

The transfer of critically ill patients from the operating room (OR) to the surgical intensive care unit (SICU) involves handoffs between multiple providers. Incomplete handoffs lead to poor communication, a major contributor to sentinel events. Our aim was to determine whether handoff standardization led to improvements in caregiver involvement and communication. A prospective intervention study was designed to observe thirty one patient handoffs from OR to SICU for 49 critical parameters including caregiver presence, peri-operative details, and time required to complete key steps. Following a six month implementation period, thirty one handoffs were observed to determine improvement. A significant improvement in presence of physician providers including intensivists and surgeons was observed (p = 0.0004 and p < 0.0001, respectively). Critical details were communicated more consistently, including procedure performed (p = 0.0048), complications (p < 0.0001), difficult airways (p < 0.0001), ventilator settings (p < 0.0001) and pressor requirements (p = 0.0134). Conversely, handoff duration did not increase significantly (p = 0.22). Implementation of a standardized protocol for handoffs between OR and SICU significantly improved caregiver involvement and reduced information omission without affecting provider time commitment. Copyright © 2017 Elsevier Inc. All rights reserved.

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

PubMed

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

2014-05-01

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

Effects of methylprednisolone on the duration of rocuronium-induced neuromuscular block

PubMed Central

Geng, Weilian; Nie, Yuyan; Huang, Shaoqiang

2017-01-01

Abstract Background: We aim to investigate whether intraoperative use of methylprednisolone could affect the duration of rocuronium-induced neuromuscular blockade. Methods: A double blind, randomized, placebo-controlled trial was conducted. A total of 136 patients underwent gynecologic laparoscopic surgery were randomly divided into 3 groups: pregroup, receiving intravenous injection of methylprednisolone (40 mg) 30 minutes before induction of anesthesia; postgroup, receiving intravenous injection of methylprednisolone (40 mg) immediately after induction of anesthesia and intubation; and control group, receiving intravenous injection of normal saline. Patients were intravenously administrated with rocuronium 0.6 mg/kg, and changes in adductor policies evoked twitch responses were measured by ulnar nerve stimulator. Results: We found that all patients achieved maximum blockade effects, and there was no difference in onset time among the 2 groups. For time required to achieve train-of-four ratio (TOFR) 90%, pregroup (64.50 ± 10.52 minutes) and postgroup (65.29 ± 11.64 minutes) were significantly shorter than that of the control group (71.04 ± 10.55 minutes, P = .027), whereas clinical duration and total duration were significantly shorter in the 2 groups received methylprednisolone than the control group. However, there was no significant difference between the 2 treatment groups either in clinical duration and total duration of muscle relaxants, or time required to achieve TOFR 90%. No significant difference was found in recovery index among the 3 groups. Conclusion: Our findings suggest that a single intravenous injection of methylprednisolone, no matter preoperatively or intraoperatively, could shorten the duration of rocuronium-induced neuromuscular blockade. PMID:28953616

Differences in the profile of neonatal abstinence syndrome signs in methadone- versus buprenorphine-exposed neonates

PubMed Central

Gaalema, Diann E.; Scott, Teresa Linares; Heil, Sarah H.; Coyle, Mara G.; Kaltenbach, Karol; Badger, Gary J.; Arria, Amelia M.; Stine, Susan M.; Martin, Peter R.; Jones, Hendrée E.

2014-01-01

Aims To compare the profile of signs of neonatal abstinence syndrome (NAS) in methadone- versus buprenorphine-exposed infants. Design, setting and participants Secondary analysis of NAS data from a multi-site, double-blind, double-dummy, flexible-dosing, randomized clinical trial. Data from a total of 129 neonates born to opioid-dependent women who had been assigned to receive methadone or buprenorphine treatment during pregnancy were examined. Measurements For 10 days after delivery, neonates (methadone = 72, buprenorphine = 57) were assessed regularly using a 19-item modified Finnegan scale. Data from neonates who required pharmacological treatment (methadone = 41, buprenorphine = 27) were included up to the time treatment was initiated. The incidence and mean severity of the total NAS score and each individual sign of NAS were calculated and compared between medication conditions, as was the median time until morphine treatment initiation among treated infants in each condition. Findings Two NAS signs (undisturbed tremors and hyperactive Moro reflex) were observed significantly more frequently in methadone-exposed neonates and three (nasal stuffiness, sneezing, loose stools) were observed more frequently in buprenorphine-exposed neonates. Mean severity scores on the total NAS score and five individual signs (disturbed and undisturbed tremors, hyperactive Moro reflex, excessive irritability, failure to thrive) were significantly higher among methadone-exposed neonates, while sneezing was higher among buprenorphine-exposed neonates. Among treated neonates, methadone-exposed infants required treatment significantly earlier than buprenorphine-exposed infants (36 versus 59 hours postnatal, respectively). Conclusions The profile of neonatal abstinence syndrome differs in methadone- versus buprenorphine-exposed neonates, with significant differences in incidence, severity and treatment initiation time. Overall, methadone-exposed neonates have a more severe neonatal abstinence syndrome. PMID:23106927

Evaluating the effect of three-dimensional visualization on force application and performance time during robotics-assisted mitral valve repair.

PubMed

Currie, Maria E; Trejos, Ana Luisa; Rayman, Reiza; Chu, Michael W A; Patel, Rajni; Peters, Terry; Kiaii, Bob B

2013-01-01

The purpose of this study was to determine the effect of three-dimensional (3D) binocular, stereoscopic, and two-dimensional (2D) monocular visualization on robotics-assisted mitral valve annuloplasty versus conventional techniques in an ex vivo animal model. In addition, we sought to determine whether these effects were consistent between novices and experts in robotics-assisted cardiac surgery. A cardiac surgery test-bed was constructed to measure forces applied during mitral valve annuloplasty. Sutures were passed through the porcine mitral valve annulus by the participants with different levels of experience in robotics-assisted surgery and tied in place using both robotics-assisted and conventional surgery techniques. The mean time for both the experts and the novices using 3D visualization was significantly less than that required using 2D vision (P < 0.001). However, there was no significant difference in the maximum force applied by the novices to the mitral valve during suturing (P = 0.7) and suture tying (P = 0.6) using either 2D or 3D visualization. The mean time required and forces applied by both the experts and the novices were significantly less using the conventional surgical technique than when using the robotic system with either 2D or 3D vision (P < 0.001). Despite high-quality binocular images, both the experts and the novices applied significantly more force to the cardiac tissue during 3D robotics-assisted mitral valve annuloplasty than during conventional open mitral valve annuloplasty. This finding suggests that 3D visualization does not fully compensate for the absence of haptic feedback in robotics-assisted cardiac surgery.

Maxillomandibular Fixation by Plastic Surgeons: Cost Analysis and Utilization of Resources.

PubMed

Farber, Scott J; Snyder-Warwick, Alison K; Skolnick, Gary B; Woo, Albert S; Patel, Kamlesh B

2016-09-01

Maxillomandibular fixation (MMF) can be performed using various techniques. Two common approaches used are arch bars and bone screws. Arch bars are the gold standard and inexpensive, but often require increased procedure time. Bone screws with wire fixation is a popular alternative, but more expensive than arch bars. The differences in costs of care, complications, and operative times between these 2 techniques are analyzed. A chart review was conducted on patients treated over the last 12 years at our institution. Forty-four patients with CPT code 21453 (closed reduction of mandible fracture with interdental fixation) with an isolated mandible fracture were used in our data collection. The operating room (OR) costs, procedure duration, and complications for these patients were analyzed. Operative times were significantly shorter for patients treated with bone screws (P < 0.002). The costs for one trip to the OR for either method of fixation did not show any significant differences (P < 0.840). More patients with arch bar fixation (62%) required a second trip to the OR for removal in comparison to those with screw fixation (31%) (P < 0.068). This additional trip to the OR added significant cost. There were no differences in patient complications between these 2 fixation techniques. The MMF with bone screws represents an attractive alternative to fixation with arch bars in appropriate scenarios. Screw fixation offers reduced costs, fewer trips to the OR, and decreased operative duration without a difference in complications. Cost savings were noted most significantly in a decreased need for secondary procedures in patients who were treated with MMF screws. Screw fixation offers potential for reducing the costs of care in treating patients with minimally displaced or favorable mandible fractures.

Evaluation of the efficacy of six supraglottic devices for airway management in dark conditions: a crossover randomized simulation trial.

PubMed

Ohchi, Fumihiro; Komasawa, Nobuyasu; Imagawa, Kentaro; Okamoto, Kaori; Minami, Toshiaki

2015-12-01

During out-of-hospital cardiopulmonary resuscitation, several factors can render tracheal intubation more difficult, such as when rescuers must secure the airway in complete darkness or with limited illumination. The purpose of this study was to evaluate the efficacy of six supraglottic devices (SGDs), ProSeal(®) (ProSeal), Classic(®) (Classic), Supreme(®) (Supreme), Laryngeal Tube(®) (LT), air-Q(®) (air-Q), and i-gel(®) (i-gel), for airway management under light and dark conditions using a manikin. Seventeen novice doctors and 15 experienced doctors performed insertion of six SGDs under light and dark conditions using an adult manikin. Insertion time, successful ventilation rate, and subjective insertion difficulty on a visual analogue scale (VAS) were measured. Both novice and experienced doctors had a significantly lower ventilation success rate in the dark than in the light when ProSeal and Classic were used, but not with the other four SGDs. Novice doctors required a significantly longer insertion time in the dark than in the light with all SGDs. Experienced doctors required a significantly longer insertion time in the dark than in the light with ProSeal or Classic, but not with the other four SGDs. VAS was significantly higher for both novice and experienced doctors when ProSeal and Classic were used, as compared with the other four SGDs in the dark. Compared to ProSeal and Classic, Supreme, i-gel, LT, and air-Q are more effective for airway management in the dark. Our findings suggest that anatomically shaped SGDs may help novice doctors secure the airway under dark conditions.

Mixed Criticality Scheduling for Industrial Wireless Sensor Networks

PubMed Central

Jin, Xi; Xia, Changqing; Xu, Huiting; Wang, Jintao; Zeng, Peng

2016-01-01

Wireless sensor networks (WSNs) have been widely used in industrial systems. Their real-time performance and reliability are fundamental to industrial production. Many works have studied the two aspects, but only focus on single criticality WSNs. Mixed criticality requirements exist in many advanced applications in which different data flows have different levels of importance (or criticality). In this paper, first, we propose a scheduling algorithm, which guarantees the real-time performance and reliability requirements of data flows with different levels of criticality. The algorithm supports centralized optimization and adaptive adjustment. It is able to improve both the scheduling performance and flexibility. Then, we provide the schedulability test through rigorous theoretical analysis. We conduct extensive simulations, and the results demonstrate that the proposed scheduling algorithm and analysis significantly outperform existing ones. PMID:27589741

Simulation Training for the Office-Based Anesthesia Team.

PubMed

Ritt, Richard M; Bennett, Jeffrey D; Todd, David W

2017-05-01

An OMS office is a complex environment. Within such an environment, a diverse scope of complex surgical procedures is performed with different levels of anesthesia, ranging from local anesthesia to general anesthesia, on patients with varying comorbidities. Optimal patient outcomes require a functional surgical and anesthetic team, who are familiar with both standard operational principles and emergency recognition and management. Offices with high volume and time pressure add further stress and potential risk to the office environment. Creating and maintaining a functional surgical and anesthetic team that is competent with a culture of patient safety and risk reduction is a significant challenge that requires time, commitment, planning, and dedication. This article focuses on the role of simulation training in office training and preparation. Copyright © 2017 Elsevier Inc. All rights reserved.

Bolometric detector systems for IR and mm-wave space astronomy

NASA Technical Reports Server (NTRS)

Church, S. E.; Lange, A. E.; Mauskopf, P. D.; Hristov, V.; Bock, J. J.; DelCastillo, H. M.; Beeman, J.; Ade, P. A. R.; Griffin, M. J.

1996-01-01

Recent developments in bolometric detector systems for millimeter and submillimeter wave space astronomy are described. Current technologies meet all the requirements for the high frequency instrument onboard the cosmic background radiation anisotropy satellite/satellite for the measurement of background anisotropies (COBRAS/SAMBA) platform. It is considered that the technologies that are currently being developed will significantly reduce the effective time constant and/or the cooling requirements of bolometric detectors. These technologies lend themselves to the fabrication of the large format arrays required for the Far Infrared and Submillimeter Space Telescope (FIRST). The scientific goals and detector requirements of the COBRAS/SAMBA platform that will use infrared bolometers are reviewed and the baseline detector system is described, including the feed optics, the infrared filters, the cold amplifiers and the warm readout electronics.

Ozone: depression of frond multiplication and floral production in duckweed. [Lemna perpusilla

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

Feder, W.A.; Sullivan, F.

1969-09-26

Plants of Lemna perpusilla number6746 grown in an environment charged daily with a low concentration of ozone over 2 weeks were slower to begin multiplying, had a significantly lower rate of frond doubling, and required longer to produce fewer flowers than control plants. Treated plants produced smaller slightly yellow fronds but had no symptoms of acute injury. Control plants produced four times as many fronds and six times as many flowers as plants continuously exposed to ozone (0.1 part per million).

Tissue stimulator enclosure welding fixture

NASA Technical Reports Server (NTRS)

Mcclure, S. R.

1977-01-01

It was demonstrated that the thickness of the stimulator titanium enclosure is directly related to the battery recharge time cycle. Reduction of the titanium enclosure thickness from approximately 0.37 mm (0.015 inch) to 0.05 mm (0.002 inch) significantly reduced the recharge time cycle and thereby patient inconvenience. However, fabrication of titanium enclosures from the thinner material introduced problems in forming, holding, and welding that required improvement in state of the art shop practices. The procedures that were utilized to resolve these fabrication problems are described.

Method for Reducing the Refresh Rate of Fiber Bragg Grating Sensors

NASA Technical Reports Server (NTRS)

Parker, Allen R., Jr. (Inventor)

2014-01-01

The invention provides a method of obtaining the FBG data in final form (transforming the raw data into frequency and location data) by taking the raw FBG sensor data and dividing the data into a plurality of segments over time. By transforming the raw data into a plurality of smaller segments, processing time is significantly decreased. Also, by defining the segments over time, only one processing step is required. By employing this method, the refresh rate of FBG sensor systems can be improved from about 1 scan per second to over 20 scans per second.

Physical characteristics cannot be used to predict cooling time using cold-water immersion as a treatment for exertional hyperthermia.

PubMed

Poirier, Martin P; Notley, Sean R; Flouris, Andreas D; Kenny, Glen P

2018-03-12

We examined if physical characteristics could be used to predict cooling time during cold water immersion (CWI, 2°C) following exertional hyperthermia (rectal temperature ≥39.5°C) in a physically heterogeneous group of men and women (n=62). Lean body mass was the only significant predictor of cooling time following CWI (R²=0.137; P<0.001); however that prediction did not provide the precision (mean residual square error: 3.18±2.28 min) required to act as a safe alternative to rectal temperature measurements.

Intrathecal Midazolam as an Adjuvant in Pregnancy-Induced Hypertensive Patients Undergoing an Elective Caesarean Section: A Clinical Comparative Study

PubMed Central

Dodawad, Ravichandra; G. B., Sumalatha; Pandarpurkar, Sandeep; Jajee, Parashuram

2016-01-01

Background A pain-free postoperative period is essential following a caesarean section so new mothers may care for and bond with their neonates. Intrathecal adjuvants are often administered during this procedure to provide significant analgesia, but they may also have bothersome side effects. Intrathecal midazolam produces effective postoperative analgesia with no significant side effects. Objectives This prospective, randomized, double-blind study was designed to compare the analgesic efficacy and safety of intrathecal midazolam vs. plain bupivacaine as an adjunct to bupivacaine in pregnancy-induced hypertension patients scheduled for elective caesarean section. Methods Sixty patients diagnosed with pregnancy-induced hypertension on regular treatment who were scheduled for a caesarean section were randomly allocated into two groups: a control group (Group BC, n = 30) and a midazolam group (Group BM, n = 30). Both groups received 10 mg (2 mL) of 0.5% hyperbaric bupivacaine. Group BC received 0.4 mL of distilled water, while group BM received 0.4 mL (2 mg) of midazolam intrathecally. The duration of postoperative analgesia, analgesic requirements during the first 24 hours after surgery, onset times and durations of sensory and motor blocks, incidence of hypotension, vasopressor requirements, and side effects were recorded. Results Postoperative analgesia was significantly longer in the midazolam group compared to the control group (201.5 minutes vs. 357.6 minutes). The mean onset times of the sensory and motor blocks were significantly faster (P < 0.01) in the midazolam group compared to the control group. The mean times to attain the maximum sensory level and motor blocks were also significantly faster in the midazolam group compared to the control group (P < 0.05). The incidence of hypotension was 6.6% in the midazolam group and 36.6% in the control group, which was highly significant. In addition, the number of patients with side effects was significantly lower in the midazolam group compared to the control group. Conclusions Intrathecal midazolam 2 mg provides significantly longer and effective postoperative analgesia with no side effects. PMID:27847698

The Significance of Temperature Based Approach Over the Energy Based Approaches in the Buildings Thermal Assessment

NASA Astrophysics Data System (ADS)

Albatayneh, Aiman; Alterman, Dariusz; Page, Adrian; Moghtaderi, Behdad

2017-05-01

The design of low energy buildings requires accurate thermal simulation software to assess the heating and cooling loads. Such designs should sustain thermal comfort for occupants and promote less energy usage over the life time of any building. One of the house energy rating used in Australia is AccuRate, star rating tool to assess and compare the thermal performance of various buildings where the heating and cooling loads are calculated based on fixed operational temperatures between 20 °C to 25 °C to sustain thermal comfort for the occupants. However, these fixed settings for the time and temperatures considerably increase the heating and cooling loads. On the other hand the adaptive thermal model applies a broader range of weather conditions, interacts with the occupants and promotes low energy solutions to maintain thermal comfort. This can be achieved by natural ventilation (opening window/doors), suitable clothes, shading and low energy heating/cooling solutions for the occupied spaces (rooms). These activities will save significant amount of operating energy what can to be taken into account to predict energy consumption for a building. Most of the buildings thermal assessment tools depend on energy-based approaches to predict the thermal performance of any building e.g. AccuRate in Australia. This approach encourages the use of energy to maintain thermal comfort. This paper describes the advantages of a temperature-based approach to assess the building's thermal performance (using an adaptive thermal comfort model) over energy based approach (AccuRate Software used in Australia). The temperature-based approach was validated and compared with the energy-based approach using four full scale housing test modules located in Newcastle, Australia (Cavity Brick (CB), Insulated Cavity Brick (InsCB), Insulated Brick Veneer (InsBV) and Insulated Reverse Brick Veneer (InsRBV)) subjected to a range of seasonal conditions in a moderate climate. The time required for heating and/or cooling using the adaptive thermal comfort approach and AccuRate predictions were estimated. Significant savings (of about 50 %) in energy consumption in minimising the time required for heating and cooling were achieved by using the adaptive thermal comfort model.

Orbiting Deep Space Relay Station (ODSRS). Volume 1: Requirement determination

NASA Technical Reports Server (NTRS)

Hunter, J. A.

1979-01-01

The deep space communications requirements of the post-1985 time frame are described and the orbiting deep space relay station (ODSRS) is presented as an option for meeting these requirements. Under current conditions, the ODSRS is not yet cost competitive with Earth based stations to increase DSN telemetry performance, but has significant advantages over a ground station, and these are sufficient to maintain it as a future option. These advantages include: the ability to track a spacecraft 24 hours per day with ground stations located only in the USA; the ability to operate at higher frequencies that would be attenuated by Earth's atmosphere; and the potential for building very large structures without the constraints of Earth's gravity.

The Clean Air Act: A time to assess impacts and management options

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

Goldberg, T.; Repa, E.

The Clean Air Act Amendments of 1990 significantly altered the complexion of air emission regulation and for the first time established requirements for comprehensive emission control strategies. None of the provisions of this act will have as great an impact on the waste management industry as will the General Operating Permit Provisions of Title V. Title V establishes a program for issuing operating permits to all major sources (and certain other sources) of air pollutants in the U.S. These permits will collect in one place all applicable requirements, limitations, and conditions governing regulated air emissions. While past air regulations governedmore » specific air emissions sources, as of November 1993 the law requires states and localities to regulate emissions from all major stationary sources that directly emit, or have the potential to emit, 100 tons or more of any pollutant, 10 tons or more of a single hazardous air pollutant, or 25 tons or more of two or more hazardous air pollutants.« less

ATTDES: An Expert System for Satellite Attitude Determination and Control. 2

NASA Technical Reports Server (NTRS)

Mackison, Donald L.; Gifford, Kevin

1996-01-01

The design, analysis, and flight operations of satellite attitude determintion and attitude control systems require extensive mathematical formulations, optimization studies, and computer simulation. This is best done by an analyst with extensive education and experience. The development of programs such as ATTDES permit the use of advanced techniques by those with less experience. Typical tasks include the mission analysis to select stabilization and damping schemes, attitude determination sensors and algorithms, and control system designs to meet program requirements. ATTDES is a system that includes all of these activities, including high fidelity orbit environment models that can be used for preliminary analysis, parameter selection, stabilization schemes, the development of estimators covariance analyses, and optimization, and can support ongoing orbit activities. The modification of existing simulations to model new configurations for these purposes can be an expensive, time consuming activity that becomes a pacing item in the development and operation of such new systems. The use of an integrated tool such as ATTDES significantly reduces the effort and time required for these tasks.

Ammonia sanitization of blackwater for safe use as fertilizer.

PubMed

Fidjeland, Jörgen; Svensson, Sven-Erik; Vinnerås, Björn

2015-01-01

Source-separated blackwater from low-flush toilets contains plant-available nutrients and can be used as a fertilizer. The aim of the study was to evaluate the impact on pathogen inactivation when treating blackwater with urea and/or lime. Blackwater was spiked with Salmonella typhimurium, Escherichia coli O157, Enterococcus faecalis, and Ascaris suum eggs, and treated with urea and/or lime in concentrations up to 0.1% w/w. The bottles were kept in a storage facility (manure slurry tank) for 102 days while monitoring the pathogen concentrations. The treatment time needed to meet the requirement for Salmonella and E. coli reduction could be reduced at least six-fold. The enterococci were more persistent, and only the highest treatment doses had a significantly higher inactivation than the controls. The Ascaris egg viability was only reduced by around 50%, so higher urea/lime doses and/or longer treatment times are required to fulfill the treatment requirements of 3 log10 reductions of parasite eggs.

Transverse vs torsional ultrasound: prospective randomized contralaterally controlled study comparing two phacoemulsification-system handpieces

PubMed Central

Assil, Kerry K; Harris, Lindsay; Cecka, Jeannie

2015-01-01

Purpose To compare surgical efficiency and multiple early clinical outcome variables in eyes undergoing phacoemulsification using either transversal or torsional ultrasound systems. Setting Assil Eye Institute, Beverly Hills, CA, USA. Design Prospective, randomized, clinician-masked, contralaterally controlled single-center evaluation. Patients and methods Patients seeking cataract removal in both eyes with implantation of multifocal intraocular lenses were randomly assigned to one of two treatment rooms for phacoemulsification with either a transverse ultrasound system or torsional handpiece system. The contralateral eye was treated at a later date with the alternate device. A total of 54 eyes of 27 patients having similar degrees of cataract, astigmatism, and visual potential were included. All operative data were collected for analysis, and patients were followed for 3 months after surgery. Results Similar visual acuity was reported at all postoperative visits between the two groups. Mean phacoemulsification time and total power required were both significantly lower with the transverse system than with the torsional technique (P<0.05 for both). Similarly, mean total balanced salt solution used was significantly less with the transverse system vs torsional (P<0.05). Postoperative safety demonstrated significantly lower endothelial cell loss at 1 day and 1 month (P<0.05) with transverse vs torsional. Macular swelling was less at 1 week, 1 month, and 3 months with transverse vs torsional, although the difference did not achieve significance (P=0.1) at any single time point. Clinically detectable corneal edema was reported less frequently at all postoperative time points with the transverse system. Conclusion The transverse ultrasound system was found to be possibly associated with less balanced salt-solution use, less phacoemulsification time, and less power required than the torsional phaco system. Postoperative data suggested that improved phaco efficiency may translate to a better overall safety profile for the patient. PMID:26345628

Evaluation of apically extruded debris during root canal retreatment with several NiTi systems.

PubMed

Dincer, A N; Er, O; Canakci, B C

2015-12-01

To compare the amount of debris extruded apically during root canal retreatment using ProTaper, Mtwo and Reciproc instruments with hand H-files. In total, 60 freshly extracted human mandibular incisor teeth were used. All root canals were prepared with a Reciproc R25 file than filled with Gutta-percha and AH Plus sealer using cold lateral condensation before being assigned randomly to four groups (n = 15 each). In group 1, root fillings were removed with the Protaper Universal retreatment system; ProTaper Universal F3 and F4 instruments were used for the final preparation. In group 2, root fillings were removed with the Mtwo retreatment system; Mtwo size 30, .06 taper, size 35, .06 taper and size 40, .06 taper files were used for the final preparation. In group 3, root fillings were removed with Reciproc R25 instruments; Reciproc R40 instruments were used for the final preparation. In group 4, the root fillings were removed with Gates Glidden burs and sizes 35, 30 and 25 H-files; for final preparation, a size 40 H-file was used. Glass vials were used for debris collection. The vials were weighed before and after Gutta-percha removal. Additionally, the times required for the retreatment procedures were recorded. Data were analysed statistically using one-way analysis of variance. The Reciproc system produced significantly smaller amounts of apical extruded debris than the other groups (P < 0.05). There was no significant difference between the Mtwo, H-file and ProTaper groups. The ProTaper and Reciproc groups required significantly less time than the Mtwo and H-file groups (P < 0.001). Use of the reciprocating single file system resulted in the extrusion of significantly less debris compared with the full-sequence rotary NiTi instruments and hand filing. Use of the ProTaper and Reciproc instruments required less time for retreatment procedures than use of the Mtwo or H-file. © 2014 International Endodontic Journal. Published by John Wiley & Sons Ltd.

Collaborator Support: Identification of Fundamental Visual, Auditory, and Cognitive Requirements for Command and Control Environments

DTIC Science & Technology

2009-04-01

generally involve display design for combat vehicles, such as aircraft or tanks. The strength of such displays is their non-intrusive nature , which...level .05 was used. 7 Table 1: ANOVA Summary Table for Reaction Time Due to a significant violation of the assumption of sphericity (p=.041...the Greenhouse- Geiser test was used to adjust the degrees of freedom. A significant main effect for cue type was found, F(1.693, 15.233) = 9.077

Fiberoptic endoscopic-assisted diverticulotomy: a novel technique for the management of Zenker's diverticulum.

PubMed

Altman, Jason I; Genden, Eric M; Moche, Jason

2005-05-01

Endoscopic diverticulotomy is rapidly becoming the procedure of choice for treatment of Zenker's diverticulum. The endoscopic approach has resulted in significant decreases in patient morbidity, time to resumption of oral intake, and overall cost as compared with open treatment. However, a small but significant patient population is unable to accommodate the rigid laryngoscope and therefore requires open treatment. We present a novel technique, flexible fiberoptic endoscopic-assisted diverticulotomy, for the management of patients who are unable to undergo rigid endoscopy.

Risk factors for drainage-requiring ascites after refractory peritonitis in peritoneal dialysis patients.

PubMed

Lee, Cheng-Chia; Tu, Kun-Hua; Chen, Hsiao-Hui; Chang, Ming-Yang; Hung, Cheng-Chieh

2016-10-01

Refractory peritonitis remains a thorny issue for patients with chronic peritoneal dialysis (PD). Shortly after catheter removal, some patients develop persistent peritoneal inflammation and ascites formation, which require percutaneous drainage for symptom relief. Our study aimed at finding the risk factors for this kind of event. A total of 47 PD patients complicated with refractory peritonitis who underwent catheter removal between January 2009 and December 2011 were enrolled in this study. Data were compared between patients with and without the development of symptomatic ascites requiring drainage during hospitalization. Among the 47 refractory peritonitis patients, 15 patients developed symptomatic ascites that needed further drainage shortly after catheter removal during hospitalization. The following factors were associated with an increased risk: longer dialysis duration, higher peritoneal Kt/V urea, and a significant rise in serum C-reactive protein (CRP) level after catheter removal. These patients had a prolonged hospital stay (62 vs 21 days, P < 0.001) and a significantly higher risk of recurrent loculated ascites during subsequent 6 months of follow-up (33.3 vs 6.2 %, P = 0.022) compared with patients who did not develop ascites requiring drainage during hospitalization. A significant portion of patients with refractory PD peritonitis experienced ascites requiring drainage shortly after catheter removal, which led to a prolonged hospitalization. Whether routine drain placement at the time of catheter removal for this high-risk group would be of benefit warrants further prospective studies.

Retrospective Review of the Anaesthetic Management of Maxillectomies and Mandibulectomies for Benign Tumours in Sub-Saharan Africa.

PubMed

White, Michelle C; Horner, Katherine C; Lai, Peggy S

2016-01-01

Safe anaesthesia is a crucial component of safe surgical care, yet anaesthetic complications are common in resource-limited settings. We describe differences in anaesthetic needs for Mandibulectomy vs. Maxillectomy in three sub-Saharan African countries. Retrospective review of patients undergoing minor Mandibulectomy, major Mandibulectomy, or Maxillectomy in Togo, Guinea and Republic of the Congo. Surgeries were performed on the Africa Mercy, an international non-governmental hospital ship. Primary outcomes were need for advanced airway management and intra-operative blood loss. Secondary outcomes were time under general anaesthesia and hospital length of stay. Multivariate regression determined the association between operation type and each outcome measure. 105 patients were included (25 minor Mandibulectomy, 58 major Mandibulectomy, 22 Maxillectomy procedures). In-hospital mortality was 0%. 44/105 (41.9%) required an advanced airway management technique to achieve intubation, although in all cases this was anticipated prior to the procedure; no differences were noted between surgical procedure (p = 0.72). Operative procedure was a significant risk factor for intra-operative blood loss. Patients undergoing Maxillectomy lost on average 851.5 (413.3, 1289.8, p = 0.0003) mL more blood than patients undergoing minor Mandibulectomy, and 507.3 (150.3, 864.3, p = 0.007) mL more blood than patients undergoing major Mandibulectomy. Patients undergoing Maxillectomy had a significantly higher time under general anaesthesia than those undergoing minor Mandibulectomy. There was no significant difference in hospital length of stay between operation type. Anaesthetic considerations for minor Mandibulectomy, major Mandibulectomy, and Maxillectomy differ with respect to intra-operative blood loss and time under general anaesthesia, but not need for advanced airway management or length of stay. Although advanced airway management was required in 41.9% of patients, there were no unanticipated difficult airways. With appropriate training and resources, safe anaesthesia can be delivered to patients from low-income countries requiring major head and neck surgery.

Retrospective Review of the Anaesthetic Management of Maxillectomies and Mandibulectomies for Benign Tumours in Sub-Saharan Africa

PubMed Central

White, Michelle C.; Horner, Katherine C.; Lai, Peggy S.

2016-01-01

Background Safe anaesthesia is a crucial component of safe surgical care, yet anaesthetic complications are common in resource-limited settings. We describe differences in anaesthetic needs for Mandibulectomy vs. Maxillectomy in three sub-Saharan African countries. Materials and Methods Retrospective review of patients undergoing minor Mandibulectomy, major Mandibulectomy, or Maxillectomy in Togo, Guinea and Republic of the Congo. Surgeries were performed on the Africa Mercy, an international non-governmental hospital ship. Primary outcomes were need for advanced airway management and intra-operative blood loss. Secondary outcomes were time under general anaesthesia and hospital length of stay. Multivariate regression determined the association between operation type and each outcome measure. Results 105 patients were included (25 minor Mandibulectomy, 58 major Mandibulectomy, 22 Maxillectomy procedures). In-hospital mortality was 0%. 44/105 (41.9%) required an advanced airway management technique to achieve intubation, although in all cases this was anticipated prior to the procedure; no differences were noted between surgical procedure (p = 0.72). Operative procedure was a significant risk factor for intra-operative blood loss. Patients undergoing Maxillectomy lost on average 851.5 (413.3, 1289.8, p = 0.0003) mL more blood than patients undergoing minor Mandibulectomy, and 507.3 (150.3, 864.3, p = 0.007) mL more blood than patients undergoing major Mandibulectomy. Patients undergoing Maxillectomy had a significantly higher time under general anaesthesia than those undergoing minor Mandibulectomy. There was no significant difference in hospital length of stay between operation type. Conclusion Anaesthetic considerations for minor Mandibulectomy, major Mandibulectomy, and Maxillectomy differ with respect to intra-operative blood loss and time under general anaesthesia, but not need for advanced airway management or length of stay. Although advanced airway management was required in 41.9% of patients, there were no unanticipated difficult airways. With appropriate training and resources, safe anaesthesia can be delivered to patients from low-income countries requiring major head and neck surgery. PMID:27788172

Web Service Model for Plasma Simulations with Automatic Post Processing and Generation of Visual Diagnostics*

NASA Astrophysics Data System (ADS)

Exby, J.; Busby, R.; Dimitrov, D. A.; Bruhwiler, D.; Cary, J. R.

2003-10-01

We present our design and initial implementation of a web service model for running particle-in-cell (PIC) codes remotely from a web browser interface. PIC codes have grown significantly in complexity and now often require parallel execution on multiprocessor computers, which in turn requires sophisticated post-processing and data analysis. A significant amount of time and effort is required for a physicist to develop all the necessary skills, at the expense of actually doing research. Moreover, parameter studies with a computationally intensive code justify the systematic management of results with an efficient way to communicate them among a group of remotely located collaborators. Our initial implementation uses the OOPIC Pro code [1], Linux, Apache, MySQL, Python, and PHP. The Interactive Data Language is used for visualization. [1] D.L. Bruhwiler et al., Phys. Rev. ST-AB 4, 101302 (2001). * This work is supported by DOE grant # DE-FG02-03ER83857 and by Tech-X Corp. ** Also University of Colorado.

International Space Station (ISS) Advanced Recycle Filter Tank Assembly (ARFTA)

NASA Technical Reports Server (NTRS)

Nasrullah, Mohammed K.

2013-01-01

The International Space Station (ISS) Recycle Filter Tank Assembly (RFTA) provides the following three primary functions for the Urine Processor Assembly (UPA): volume for concentrating/filtering pretreated urine, filtration of product distillate, and filtration of the Pressure Control and Pump Assembly (PCPA) effluent. The RFTAs, under nominal operations, are to be replaced every 30 days. This poses a significant logistical resupply problem, as well as cost in upmass and new tanks purchase. In addition, it requires significant amount of crew time. To address and resolve these challenges, NASA required Boeing to develop a design which eliminated the logistics and upmass issues and minimize recurring costs. Boeing developed the Advanced Recycle Filter Tank Assembly (ARFTA) that allowed the tanks to be emptied on-orbit into disposable tanks that eliminated the need for bringing the fully loaded tanks to earth for refurbishment and relaunch, thereby eliminating several hundred pounds of upmass and its associated costs. The ARFTA will replace the RFTA by providing the same functionality, but with reduced resupply requirements

Synthesis from Design Requirements of a Hybrid System for Transport Aircraft Longitudinal Control. Volume 1

NASA Technical Reports Server (NTRS)

Hynes, Charles S.; Hardy, Gordon H.; Sherry, Lance

2007-01-01

Volume I of this report presents a new method for synthesizing hybrid systems directly from design requirements, and applies the method to design of a hybrid system for longitudinal control of transport aircraft. The resulting system satisfies general requirement for safety and effectiveness specified a priori, enabling formal validation to be achieved. Volume II contains seven appendices intended to make the report accessible to readers with backgrounds in human factors, fli ght dynamics and control. and formal logic. Major design goals are (1) system desi g n integrity based on proof of correctness at the design level, (2), significant simplification and cost reduction in system development and certification, and (3) improved operational efficiency, with significant alleviation of human-factors problems encountered by pilots in current transport aircraft. This report provides for the first time a firm technical basis for criteria governing design and certification of avionic systems for transport aircraft. It should be of primary interest to designers of next-generation avionic systems.

Synthesis from Design Requirements of a Hybrid System for Transport Aircraft Longitudinal Control. Volume 2

NASA Technical Reports Server (NTRS)

Hynes, Charles S.; Hardy, Gordon H.; Sherry, Lance

2007-01-01

Volume I of this report presents a new method for synthesizing hybrid systems directly from desi gn requirements, and applies the method to design of a hybrid system for longitudinal control of transport aircraft. The resulting system satisfies general requirement for safety and effectiveness specified a priori, enabling formal validation to be achieved. Volume II contains seven appendices intended to make the report accessible to readers with backgrounds in human factors, flight dynamics and control, and formal logic. Major design goals are (1) system design integrity based on proof of correctness at the design level, (2) significant simplification and cost reduction in system development and certification, and (3) improved operational efficiency, with significant alleviation of human-factors problems encountered by pilots in current transport aircraft. This report provides for the first time a firm technical basis for criteria governing design and certification of avionic systems for transport aircraft. It should be of primary interest to designers of next-generation avionic systems.

Heated air humidification versus cold air nebulization in newly tracheostomized patients.

PubMed

Birk, Richard; Händel, Alexander; Wenzel, Angela; Kramer, Benedikt; Aderhold, Christoph; Hörmann, Karl; Stuck, Boris A; Sommer, J Ulrich

2017-12-01

After tracheostomy, the airway lacks an essential mechanism for warming and humidifying the inspired air with the consequent functional impairment and discomfort. The purpose of this study was to compare airway hydration with cold-air nebulization versus heated high-flow humidification on medical interventions and tracheal ciliary beat frequency (CBF). Newly tracheostomized patients (n = 20) were treated either with cold-air nebulization or heated humidification. The number of required tracheal suctioning procedures to clean the trachea and tracheal CBF were assessed. The number of required suctions per day was significantly lower in the heated humidification group with medians 3 versus 5 times per day. Mean CBF was significantly higher in the heated humidification group (6.36 ± 1.49 Hz) compared to the cold-air nebulization group (3.99 ± 1.39 Hz). The data suggest that heated humidification enhanced mucociliary transport leading to a reduced number of required suctioning procedures in the trachea, which may improve postoperative patient care. © 2017 The Authors Head & Neck Published by Wiley Periodicals, Inc.

Heated air humidification versus cold air nebulization in newly tracheostomized patients

PubMed Central

Händel, Alexander; Wenzel, Angela; Kramer, Benedikt; Aderhold, Christoph; Hörmann, Karl; Stuck, Boris A.; Sommer, J. Ulrich

2017-01-01

Abstract Background After tracheostomy, the airway lacks an essential mechanism for warming and humidifying the inspired air with the consequent functional impairment and discomfort. The purpose of this study was to compare airway hydration with cold‐air nebulization versus heated high‐flow humidification on medical interventions and tracheal ciliary beat frequency (CBF). Methods Newly tracheostomized patients (n = 20) were treated either with cold‐air nebulization or heated humidification. The number of required tracheal suctioning procedures to clean the trachea and tracheal CBF were assessed. Results The number of required suctions per day was significantly lower in the heated humidification group with medians 3 versus 5 times per day. Mean CBF was significantly higher in the heated humidification group (6.36 ± 1.49 Hz) compared to the cold‐air nebulization group (3.99 ± 1.39 Hz). Conclusion The data suggest that heated humidification enhanced mucociliary transport leading to a reduced number of required suctioning procedures in the trachea, which may improve postoperative patient care. PMID:28990261

The organic matter of the different ages fallow Luvisols

NASA Astrophysics Data System (ADS)

Giniyatullin, K. G.; Valeeva, A. A.; Smirnova, E. V.; Okunev, R. V.; Latipova, L. I.

2018-01-01

The study of the change in the humus state of the fallow Luvisols of different ages under the influence of weeds and meadow vegetation was carried out in dynamics (after 5 years). It is shown that both under weedy and meadow vegetation there is a statistically significant accumulation of organic matter in the upper part of the long-arable horizon. Based on the study of composition and spectral properties of soil organic matter in fallow soils of different ages concluded that the significant qualitative change of the humus state of fallow soils requires significant time, measured at least decades.

Circadian time-place (or time-route) learning in rats with hippocampal lesions.

PubMed

Cole, Emily; Mistlberger, Ralph E; Merza, Devon; Trigiani, Lianne J; Madularu, Dan; Simundic, Amanda; Mumby, Dave G

2016-12-01

Circadian time-place learning (TPL) is the ability to remember both the place and biological time of day that a significant event occurred (e.g., food availability). This ability requires that a circadian clock provide phase information (a time tag) to cognitive systems involved in linking representations of an event with spatial reference memory. To date, it is unclear which neuronal substrates are critical in this process, but one candidate structure is the hippocampus (HPC). The HPC is essential for normal performance on tasks that require allocentric spatial memory and exhibits circadian rhythms of gene expression that are sensitive to meal timing. Using a novel TPL training procedure and enriched, multidimensional environment, we trained rats to locate a food reward that varied between two locations relative to time of day. After rats acquired the task, they received either HPC or SHAM lesions and were re-tested. Rats with HPC lesions were initially impaired on the task relative to SHAM rats, but re-attained high scores with continued testing. Probe tests revealed that the rats were not using an alternation strategy or relying on light-dark transitions to locate the food reward. We hypothesize that transient disruption and recovery reflect a switch from HPC-dependent allocentric navigation (learning places) to dorsal striatum-dependent egocentric spatial navigation (learning routes to a location). Whatever the navigation strategy, these results demonstrate that the HPC is not required for rats to find food in different locations using circadian phase as a discriminative cue. Copyright © 2016 Elsevier Inc. All rights reserved.

Task analysis method for procedural training curriculum development.

PubMed

Riggle, Jakeb D; Wadman, Michael C; McCrory, Bernadette; Lowndes, Bethany R; Heald, Elizabeth A; Carstens, Patricia K; Hallbeck, M Susan

2014-06-01

A central venous catheter (CVC) is an important medical tool used in critical care and emergent situations. Integral to proper care in many circumstances, insertion of a CVC introduces the risk of central line-associated blood stream infections and mechanical adverse events; proper training is important for safe CVC insertion. Cognitive task analysis (CTA) methods have been successfully implemented in the medical field to improve the training of postgraduate medical trainees, but can be very time-consuming to complete and require a significant time commitment from many subject matter experts (SMEs). Many medical procedures such as CVC insertion are linear processes with well-documented procedural steps. These linear procedures may not require a traditional CTA to gather the information necessary to create a training curriculum. Accordingly, a novel, streamlined CTA method designed primarily to collect cognitive cues for linear procedures was developed to be used by medical professionals with minimal CTA training. This new CTA methodology required fewer trained personnel, fewer interview sessions, and less time commitment from SMEs than a traditional CTA. Based on this study, a streamlined CTA methodology can be used to efficiently gather cognitive information on linear medical procedures for the creation of resident training curricula and procedural skills assessments.

[Transfusional requirements for escharectomy in burned children].

PubMed

Julia, Analía R; Basílico, Hugo; Magaldi, Gustavo; Demirdjian, Graciela

2010-02-01

Early excision has considerably improved outcome in extensive burns, but massive resections usually mean copious bleeding that must be conveniently corrected. The purpose of this study was to measure blood component use during escharectomies in children. All pediatric patients with acute burns excised at the Burn Unit of the Hospital Garrahan during one year were included. Volume of blood component used during and immediately after surgery was analyzed and related to percent excised, time post-burn, and the coexistence of infection and autograft at the time of excision. Ninety-four surgeries in 51 children aged 0-14 years with total burned body surface areas of 5-80% who underwent resections of 3-70% were studied. Total blood use (intra + post-operatively) was 2.07 ml/kg/%excised for red blood cells (60% during surgery) and 0.7 ml/kg/% excised for plasma. Only 12% of patients required platelet transfusion. There was no significant requirement variation with the existence of infection, grafting or time post-burn. Approximately 2 ml/kg/% excised of red blood cells (2/3 for surgery) and 1 ml/kg/% excised of plasma are needed for escharectomies in children. The need for platelets must be judged considering the individual patient.

The reamer-irrigator-aspirator as a device for harvesting bone graft compared with iliac crest bone graft: union rates and complications.

PubMed

Dawson, John; Kiner, Dirk; Gardner, Warren; Swafford, Rachel; Nowotarski, Peter J

2014-10-01

This study was performed to compare patient outcomes after Reamer-Irrigator-Aspirator (RIA)-harvested bone grafting with the current gold standard, either anterior or posterior iliac crest bone graft (ICBG). Prospective randomized controlled trial. Multicenter study at 3 geographically separate Level 1 trauma centers. One hundred thirty-three patients with nonunion or posttraumatic segmental bone defect requiring operative intervention. Patients were prospectively randomized to receive ICBG or RIA autograft. Supplemental internal fixation was performed per surgeon preference. Operative data included amount of graft, time of harvest, and associated surgical costs. The Short Musculoskeletal Functional Assessment and the Visual Analog Scale were used to document baseline and postoperative function and pain. Clinical and radiographic union was the defined end point; patients considered to have failed treatment if they either developed an infection requiring operative treatment or had a persistent nonunion of the grafted extremity. One hundred thirteen of the 133 enrolled patients were followed until union and included in the final analysis. Intraoperative data showed anterior ICBG to yield 20.7 ± 12.8 (5-60) cm of autograft with an average harvest time of 33.2 ± 16.2 minutes, posterior ICBG yielded 36.1 ± 21.3 (20-100) cm of autograft in 40.6 ± 11.2 minutes, and RIA yielded 37.7 ± 12.9 (5-90) cm in 29.4 ± 15.1 minutes. Anterior ICBG produced significantly less bone graft than either RIA or posterior ICBG (P < 0.001). The RIA harvest was completed in significantly less operative time compared with posterior ICBG (P = 0.005). At $738, the RIA setup was considerably more expensive than the ∼$100 cost of a bone graft tray; however, when compared with posterior ICBG, the longer operative time required for a posterior harvest came at an additional incremental cost of $990-1880, making RIA the less expensive option. Patients were followed for an average of 56.9 ± 42.1 (11-250) weeks. Forty-nine of 57 patients (86.0%) who received ICBG united in an average of 22.5 ± 13.2 weeks; 46 of 56 patients (82.1%) who received RIA healed in an average of 25.8 ± 17.0 weeks. Union rates and time to union were comparable between the 2 procedures. There was no difference in complications requiring reoperation for persistent nonunion or infection at the grafted site, nor there was any difference in donor-site complications. Postoperative follow-up showed that RIA patients had significantly lower donor-site pain scores throughout follow-up. When compared with autograft obtained from the iliac crest, autograft harvested using the RIA technique achieves similar union rates with significantly less donor-site pain. RIA also yields a greater volume of graft compared with anterior ICBG and has a shorter harvest time compared with posterior ICBG. For larger volume harvests, cost analysis favors using RIA. Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Analysis of Nonstationary Time Series for Biological Rhythms Research.

PubMed

Leise, Tanya L

2017-06-01

This article is part of a Journal of Biological Rhythms series exploring analysis and statistics topics relevant to researchers in biological rhythms and sleep research. The goal is to provide an overview of the most common issues that arise in the analysis and interpretation of data in these fields. In this article on time series analysis for biological rhythms, we describe some methods for assessing the rhythmic properties of time series, including tests of whether a time series is indeed rhythmic. Because biological rhythms can exhibit significant fluctuations in their period, phase, and amplitude, their analysis may require methods appropriate for nonstationary time series, such as wavelet transforms, which can measure how these rhythmic parameters change over time. We illustrate these methods using simulated and real time series.

Time to aortic occlusion: It's all about access.

PubMed

Romagnoli, Anna; Teeter, William; Pasley, Jason; Hu, Peter; Hoehn, Melanie; Stein, Deborah; Scalea, Thomas; Brenner, Megan

2017-12-01

Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a less invasive method of proximal aortic occlusion compared with resuscitative thoracotomy with aortic cross-clamping (RTACC). This study compared time to aortic occlusion with REBOA and RTACC, both including and excluding time required for common femoral artery (CFA) cannulation. This was a retrospective, single-institution review of REBOA or RTACC performed between February 2013 and January 2016. Time of skin incision to aortic cross-clamp for RTACC, time required for CFA cannulation by percutaneous and open methods, and time from guide-wire insertion to balloon inflation at Zone 1 for REBOA, were obtained from videographic recordings. Eighteen RTACC and 21 REBOAs were performed. Median (Q1, Q3) time from skin incision to aortic cross-clamping was 317 seconds (227, 551 seconds). Median (Q1, Q3) time from start of arterial access to Zone 1 balloon occlusion was 474 seconds (431, 572 seconds) (vs. RTACC, p = 0.01). All REBOA procedures were performed with the same device. The median time to complete CFA cannulation was 247 seconds (range, 164-343 seconds), with no difference between percutaneous or open procedures (p = 0.07). The median (Q1, Q3) time to aortic occlusion in REBOA once arterial access had been established was 245 seconds (179, 295.5 seconds), which was significantly shorter than RTACC (p = 0.003). Once CFA access is achieved, time to aortic occlusion is faster with REBOA. Time to aortic occlusion is less than the time required to cannulate the CFA either by percutaneous or open approaches, emphasizing the importance of accurate and expedient CFA access. Resuscitative endovascular balloon occlusion of the aorta may represent a feasible alternative to thoracotomy for aortic occlusion. Time to aortic occlusion will likely decrease with the advent of newer REBOA technology. The rate-limiting portion of REBOA continues to be obtaining CFA access. Therapeutic, level V.

The association of students requiring remediation in the internal medicine clerkship with poor performance during internship.

PubMed

Hemann, Brian A; Durning, Steven J; Kelly, William F; Dong, Ting; Pangaro, Louis N; Hemmer, Paul A

2015-04-01

To determine whether the Uniformed Services University (USU) system of workplace performance assessment for students in the internal medicine clerkship at the USU continues to be a sensitive predictor of subsequent poor performance during internship, when compared with assessments in other USU third year clerkships. Utilizing Program Director survey results from 2007 through 2011 and U.S. Medical Licensing Examination (USMLE) Step 3 examination results as the outcomes of interest, we compared performance during internship for students who had less than passing performance in the internal medicine clerkship and required remediation, against students whose performance in the internal medicine clerkship was successful. We further analyzed internship ratings for students who received less than passing grades during the same time period on other third year clerkships such as general surgery, pediatrics, obstetrics and gynecology, family medicine, and psychiatry to evaluate whether poor performance on other individual clerkships were associated with future poor performance at the internship level. Results for this recent cohort of graduates were compared with previously published findings. The overall survey response rate for this 5 year cohort was 81% (689/853). Students who received a less than passing grade in the internal medicine clerkship and required further remediation were 4.5 times more likely to be given poor ratings in the domain of medical expertise and 18.7 times more likely to demonstrate poor professionalism during internship. Further, students requiring internal medicine remediation were 8.5 times more likely to fail USMLE Step 3. No other individual clerkship showed any statistically significant associations with performance at the intern level. On the other hand, 40% of students who successfully remediated and did graduate were not identified during internship as having poor performance. Unsuccessful clinical performance which requires remediation in the third year internal medicine clerkship at Uniformed Services University of the Health Sciences continues to be strongly associated with poor performance at the internship level. No significant associations existed between any of the other clerkships and poor performance during internship and Step 3 failure. The strength of this association with the internal medicine clerkship is most likely because of an increased level of sensitivity in detecting poor performance. Reprint & Copyright © 2015 Association of Military Surgeons of the U.S.

Patient navigation significantly reduces delays in breast cancer diagnosis in the District of Columbia.

PubMed

Hoffman, Heather J; LaVerda, Nancy L; Young, Heather A; Levine, Paul H; Alexander, Lisa M; Brem, Rachel; Caicedo, Larisa; Eng-Wong, Jennifer; Frederick, Wayne; Funderburk, William; Huerta, Elmer; Swain, Sandra; Patierno, Steven R

2012-10-01

Patient Navigation (PN) originated in Harlem as an intervention to help poor women overcome access barriers to timely breast cancer treatment. Despite rapid, nationally widespread adoption of PN, empirical evidence on its effectiveness is lacking. In 2005, National Cancer Institute initiated a multicenter PN Research Program (PNRP) to measure PN effectiveness for several cancers. The George Washington Cancer Institute, a project participant, established District of Columbia (DC)-PNRP to determine PN's ability to reduce breast cancer diagnostic time (number of days from abnormal screening to definitive diagnosis). A total of 2,601 women (1,047 navigated; 1,554 concurrent records-based nonnavigated) were examined for breast cancer from 2006 to 2010 at 9 hospitals/clinics in DC. Analyses included only women who reached complete diagnostic resolution. Differences in diagnostic time between navigation groups were tested with ANOVA models including categorical demographic and treatment variables. Log transformations normalized diagnostic time. Geometric means were estimated and compared using Tukey-Kramer P value adjustments. Average-geometric mean [95% confidence interval (CI)]-diagnostic time (days) was significantly shorter for navigated, 25.1 (21.7, 29.0), than nonnavigated women, 42.1 (35.8, 49.6). Subanalyses revealed significantly shorter average diagnostic time for biopsied navigated women, 26.6 (21.8, 32.5) than biopsied nonnavigated women, 57.5 (46.3, 71.5). Among nonbiopsied women, diagnostic time was shorter for navigated, 27.2 (22.8, 32.4), than nonnavigated women, 34.9 (29.2, 41.7), but not statistically significant. Navigated women, especially those requiring biopsy, reached their diagnostic resolution significantly faster than nonnavigated women. Results support previous findings of PN's positive influence on health care. PN should be a reimbursable expense to assure continuation of PN programs. 2012 AACR

Efficient analysis of complex natural materials using LA-ICP-MS

NASA Astrophysics Data System (ADS)

Kent, A. J.; Loewen, M. W.; Koleszar, A. M.; Miller, J.; Ungerer, C. "

2011-12-01

Many natural materials exhibit complex variations in chemical or isotopic composition over relatively short length scales, and these compositional variations often record important information about the environment or nature of the processes that lead to formation. Examples include complexly zoned crystals within volcanic rocks that record magmatic and volcanic signals, otoliths and other biominerals that record life history and environmental information, and speleothems that record climatic variables. Laser ablation ICP-MS analyses offer several advantages for quantifying compositional in chemically complex natural materials. These include the speed of analysis, the ability to sample at atmospheric pressures, the wide diversity of possible analytes, and the ability to make measurements in both spot and raster modes. The latter in particular offers advantages for analyses that require efficient acquisition of information over significant length scales, as in raster mode compositional data can be rapidly obtained by translating the laser laterally over a compositional variable material during a single analysis. In this fashion elemental or isotopic composition at a given analysis time corresponds to the lateral spatial dimension. This contrasts with a record obtained by a row of individual spots, which require a large number of discrete analyses, and requires significantly more analysis time. However there are also disadvantages to this style of analysis. Translation of the circular spots typically used for analysis results in significant signal attenuation and production of artifacts that may mirror natural diffusion profiles or other gradual changes. The ability to ablate using non-circular spots significantly reduces this effect, although the degree of attenuation is also increased by slower ablation cell response times. For single volume cells this may result in 50-100% additional attenuation than that produced by the translation of the spot alone, although two-volume and other rapid response cells significantly reduce this effect. Raster analyses are also highly sensitive to the presence of small contaminant phases along the raster trajectory, as the compositional signal from these can become attenuated and difficult to distinguish from natural compositional variations. It can also be difficult to establish exactly where compositional changes occur in materials that are visually homogenous. In this contribution we discuss these issues in more detail and present data acquisition and processing strategies that minimize these difficulties.

Associations of leisure-time sitting in cars with neighborhood walkability.

PubMed

Koohsari, Mohammad Javad; Sugiyama, Takemi; Kaczynski, Andrew T; Owen, Neville

2014-08-01

Too much sitting, including time spent sitting in cars, is associated with poor health outcomes. Identifying the built-environment attributes that may reduce vehicular sitting time can inform future initiatives linking the public health, urban design, and transportation sectors. Data collected in 2003-2004 from adult residents (n = 2521) of Adelaide, Australia were used. Logistic regression analyses examined associations of prolonged time spent sitting in cars during leisure time (30 min/day or more) with neighborhood walkability and its components (dwelling density; intersection density; land use mix; net retail area ratio). Lower overall walkability was significantly associated with a higher odds (OR = 1.43, 95% CI: 1.21-1.70) of spending prolonged time in cars. For analyses with walkability components, lower net retail area ratio, lower residential density, and lower intersection density were significantly associated with prolonged sitting in cars. This study found that residents of high walkable neighborhoods tended to spend less time sitting in cars. In particular, higher net retail area ratio, an indicator of tightly spaced commercial areas, was strongly associated with less time in cars. Policy and planning initiatives to reduce car use require further evidence, particularly on the influence of neighborhood retail areas.

Real-Time Simulation of Ares I Launch Vehicle

NASA Technical Reports Server (NTRS)

Tobbe, Patrick; Matras, Alex; Wilson, Heath; Alday, Nathan; Walker, David; Betts, Kevin; Hughes, Ryan; Turbe, Michael

2009-01-01

The Ares Real-Time Environment for Modeling, Integration, and Simulation (ARTEMIS) has been developed for use by the Ares I launch vehicle System Integration Laboratory (SIL) at the Marshall Space Flight Center (MSFC). The primary purpose of the Ares SIL is to test the vehicle avionics hardware and software in a hardware-in-the-loop (HWIL) environment to certify that the integrated system is prepared for flight. ARTEMIS has been designed to be the real-time software backbone to stimulate all required Ares components through high-fidelity simulation. ARTEMIS has been designed to take full advantage of the advances in underlying computational power now available to support HWIL testing. A modular real-time design relying on a fully distributed computing architecture has been achieved. Two fundamental requirements drove ARTEMIS to pursue the use of high-fidelity simulation models in a real-time environment. First, ARTEMIS must be used to test a man-rated integrated avionics hardware and software system, thus requiring a wide variety of nominal and off-nominal simulation capabilities to certify system robustness. The second driving requirement - derived from a nationwide review of current state-of-the-art HWIL facilities - was that preserving digital model fidelity significantly reduced overall vehicle lifecycle cost by reducing testing time for certification runs and increasing flight tempo through an expanded operational envelope. These two driving requirements necessitated the use of high-fidelity models throughout the ARTEMIS simulation. The nature of the Ares mission profile imposed a variety of additional requirements on the ARTEMIS simulation. The Ares I vehicle is composed of multiple elements, including the First Stage Solid Rocket Booster (SRB), the Upper Stage powered by the J- 2X engine, the Orion Crew Exploration Vehicle (CEV) which houses the crew, the Launch Abort System (LAS), and various secondary elements that separate from the vehicle. At launch, the integrated vehicle stack is composed of these stages, and throughout the mission, various elements separate from the integrated stack and tumble back towards the earth. ARTEMIS must be capable of simulating the integrated stack through the flight as well as propagating each individual element after separation. In addition, abort sequences can lead to other unique configurations of the integrated stack as the timing and sequence of the stage separations are altered.

Effects of ketorolac and bupivacaine on recovery after outpatient arthroscopy.

PubMed

Smith, I; Shively, R A; White, P F

1992-08-01

The effects of intraarticular bupivacaine, systemic ketorolac, and a combination of both treatments on postoperative pain and mobilization were evaluated in 60 healthy outpatients undergoing arthroscopic knee surgery under general anesthesia. After induction of anesthesia, patients received 2 mL of either ketorolac (60 mg) or saline solution (1 mL IV and 1 mL IM). On completion of surgery, the patient's knee joint was injected with 30 mL of either 0.5% bupivacaine or saline solution, according to a randomized, double-blind protocol. Only one patient (6%) receiving both medications complained of pain on awakening, compared with seven patients receiving either bupivacaine (37%) or ketorolac (41%) alone. Postoperative fentanyl was required by significantly fewer patients receiving combined therapy (n = 4, 21%) than either bupivacaine (n = 13, 62%) or ketorolac (n = 12, 60%) alone; however, there were no significant differences among the three treatment groups in terms of perioperative pain, nausea, or sedation visual analogue scale scores. Similarly, there were no differences in the times to ambulation or discharge or in analgesic requirements at home. In conclusion, a combination of systemic ketorolac and intraarticular bupivacaine decreased analgesic requirements and pain on awakening after arthroscopic surgery. However, the use of ketorolac alone or in combination with bupivacaine offered no advantage over bupivacaine alone with respect to recovery times after outpatient arthroscopy.

Screening and monitoring microbial xenobiotics' biodegradation by rapid, inexpensive and easy to perform microplate UV-absorbance measurements.

PubMed

Herzog, Bastian; Lemmer, Hilde; Horn, Harald; Müller, Elisabeth

2014-02-22

Evaluation of xenobiotics biodegradation potential, shown here for benzotriazoles (corrosion inhibitors) and sulfamethoxazole (sulfonamide antibiotic) by microbial communities and/or pure cultures normally requires time intensive and money consuming LC/GC methods that are, in case of laboratory setups, not always needed. The usage of high concentrations to apply a high selective pressure on the microbial communities/pure cultures in laboratory setups, a simple UV-absorbance measurement (UV-AM) was developed and validated for screening a large number of setups, requiring almost no preparation and significantly less time and money compared to LC/GC methods. This rapid and easy to use method was evaluated by comparing its measured values to LC-UV and GC-MS/MS results. Furthermore, its application for monitoring and screening unknown activated sludge communities (ASC) and mixed pure cultures has been tested and approved to detect biodegradation of benzotriazole (BTri), 4- and 5-tolyltriazole (4-TTri, 5-TTri) as well as SMX. In laboratory setups, xenobiotics concentrations above 1.0 mg L(-1) without any enrichment or preparation could be detected after optimization of the method. As UV-AM does not require much preparatory work and can be conducted in 96 or even 384 well plate formats, the number of possible parallel setups and screening efficiency was significantly increased while analytic and laboratory costs were reduced to a minimum.

Lessons Learned From an Epidemiologist-Led Countywide Community Assessment for Public Health Emergency Response (CASPER) in Oregon.

PubMed

Repp, Kimberly K; Hawes, Eva; Rees, Kathleen J; Vorderstrasse, Beth; Mohnkern, Sue

2018-06-07

Conducting a large-scale Community Assessment for Public Health Emergency Response (CASPER) in a geographically and linguistically diverse county presents significant methodological challenges that require advance planning. The Centers for Disease Control and Prevention (CDC) has adapted methodology and provided a toolkit for a rapid needs assessment after a disaster. The assessment provides representative data of the sampling frame to help guide effective distribution of resources. This article describes methodological considerations and lessons learned from a CASPER exercise conducted by Washington County Public Health in June 2016 to assess community emergency preparedness. The CDC's CASPER toolkit provides detailed guidance for exercises in urban areas where city blocks are well defined with many single family homes. Converting the exercise to include rural areas with challenging geographical terrain, including accessing homes without public roads, required considerable adjustments in planning. Adequate preparations for vulnerable populations with English linguistic barriers required additional significant resources. Lessons learned are presented from the first countywide CASPER exercise in Oregon. Approximately 61% of interviews were completed, and 85% of volunteers reported they would participate in another CASPER exercise. Results from the emergency preparedness survey will be presented elsewhere. This experience indicates the most important considerations for conducting a CASPER exercise are oversampling clusters, overrecruiting volunteers, anticipating the actual cost of staff time, and ensuring timely language services are available during the event.

Screening and monitoring microbial xenobiotics’ biodegradation by rapid, inexpensive and easy to perform microplate UV-absorbance measurements

PubMed Central

2014-01-01

Background Evaluation of xenobiotics biodegradation potential, shown here for benzotriazoles (corrosion inhibitors) and sulfamethoxazole (sulfonamide antibiotic) by microbial communities and/or pure cultures normally requires time intensive and money consuming LC/GC methods that are, in case of laboratory setups, not always needed. Results The usage of high concentrations to apply a high selective pressure on the microbial communities/pure cultures in laboratory setups, a simple UV-absorbance measurement (UV-AM) was developed and validated for screening a large number of setups, requiring almost no preparation and significantly less time and money compared to LC/GC methods. This rapid and easy to use method was evaluated by comparing its measured values to LC-UV and GC-MS/MS results. Furthermore, its application for monitoring and screening unknown activated sludge communities (ASC) and mixed pure cultures has been tested and approved to detect biodegradation of benzotriazole (BTri), 4- and 5-tolyltriazole (4-TTri, 5-TTri) as well as SMX. Conclusions In laboratory setups, xenobiotics concentrations above 1.0 mg L-1 without any enrichment or preparation could be detected after optimization of the method. As UV-AM does not require much preparatory work and can be conducted in 96 or even 384 well plate formats, the number of possible parallel setups and screening efficiency was significantly increased while analytic and laboratory costs were reduced to a minimum. PMID:24558966

Reduction of wafer-edge overlay errors using advanced correction models, optimized for minimal metrology requirements

NASA Astrophysics Data System (ADS)

Kim, Min-Suk; Won, Hwa-Yeon; Jeong, Jong-Mun; Böcker, Paul; Vergaij-Huizer, Lydia; Kupers, Michiel; Jovanović, Milenko; Sochal, Inez; Ryan, Kevin; Sun, Kyu-Tae; Lim, Young-Wan; Byun, Jin-Moo; Kim, Gwang-Gon; Suh, Jung-Joon

2016-03-01

In order to optimize yield in DRAM semiconductor manufacturing for 2x nodes and beyond, the (processing induced) overlay fingerprint towards the edge of the wafer needs to be reduced. Traditionally, this is achieved by acquiring denser overlay metrology at the edge of the wafer, to feed field-by-field corrections. Although field-by-field corrections can be effective in reducing localized overlay errors, the requirement for dense metrology to determine the corrections can become a limiting factor due to a significant increase of metrology time and cost. In this study, a more cost-effective solution has been found in extending the regular correction model with an edge-specific component. This new overlay correction model can be driven by an optimized, sparser sampling especially at the wafer edge area, and also allows for a reduction of noise propagation. Lithography correction potential has been maximized, with significantly less metrology needs. Evaluations have been performed, demonstrating the benefit of edge models in terms of on-product overlay performance, as well as cell based overlay performance based on metrology-to-cell matching improvements. Performance can be increased compared to POR modeling and sampling, which can contribute to (overlay based) yield improvement. Based on advanced modeling including edge components, metrology requirements have been optimized, enabling integrated metrology which drives down overall metrology fab footprint and lithography cycle time.

A Tool for the Automated Collection of Space Utilization Data: Three Dimensional Space Utilization Monitor

NASA Technical Reports Server (NTRS)

Vos, Gordon A.; Fink, Patrick; Ngo, Phong H.; Morency, Richard; Simon, Cory; Williams, Robert E.; Perez, Lance C.

2017-01-01

Space Human Factors and Habitability (SHFH) Element within the Human Research Program (HRP) and the Behavioral Health and Performance (BHP) Element are conducting research regarding Net Habitable Volume (NHV), the internal volume within a spacecraft or habitat that is available to crew for required activities, as well as layout and accommodations within the volume. NASA needs methods to unobtrusively collect NHV data without impacting crew time. Data required includes metrics such as location and orientation of crew, volume used to complete tasks, internal translation paths, flow of work, and task completion times. In less constrained environments methods exist yet many are obtrusive and require significant post-processing. ?Examplesused in terrestrial settings include infrared (IR) retro-reflective marker based motion capture, GPS sensor tracking, inertial tracking, and multi-camera methods ?Due to constraints of space operations many such methods are infeasible. Inertial tracking systems typically rely upon a gravity vector to normalize sensor readings,and traditional IR systems are large and require extensive calibration. ?However, multiple technologies have not been applied to space operations for these purposes. Two of these include: 3D Radio Frequency Identification Real-Time Localization Systems (3D RFID-RTLS) ?Depth imaging systems which allow for 3D motion capture and volumetric scanning (such as those using IR-depth cameras like the Microsoft Kinect or Light Detection and Ranging / Light-Radar systems, referred to as LIDAR)

Medical status of adolescents at time of admission to a juvenile detention center.

PubMed

Feinstein, R A; Lampkin, A; Lorish, C D; Klerman, L V; Maisiak, R; Oh, M K

1998-03-01

To examine the medical status and history of health care utilization of adolescents at the time of their admission to a juvenile detention facility. Data were collected over an 18-month period on all detainees admitted for the first time to a juvenile detention facility in a major southeastern city in the United States. Information was gathered through a private, confidential interview completed by a medical social worker and a physical examination by a physician. Information was obtained regarding past medical history, complaints at the time of admission, health care utilization, and physical examination. Approximately 10% of teenagers admitted to a detention facility have a significant medical problem (excluding drug/alcohol abuse, or uncomplicated sexually transmitted diseases) that requires medical follow-up. The majority of these conditions were known to the adolescent at the time of admission. Only a third of adolescents admitted to the detention facility reported a regular source of medical care, and only about 20% reported having a private physician. A majority of all the detainees had already fallen behind in or dropped out of school. More than half of the families of the adolescents with a medical problem appeared to be unable or unwilling to assist in ensuring proper medical follow-up. A significant percentage of adolescents entering a detention facility have a medical problem requiring health care services. Detention facilities offer an opportunity to deliver and coordinate medical care to high-risk adolescents. Programs linking public and private health care providers with the correctional care system may provide juveniles with an acceptable option for obtaining needed health care services.

Validation of ALFIA: a platform for quantifying near-infrared fluorescent images of lymphatic propulsion in humans

NASA Astrophysics Data System (ADS)

Rasmussen, John C.; Bautista, Merrick; Tan, I.-Chih; Adams, Kristen E.; Aldrich, Melissa; Marshall, Milton V.; Fife, Caroline E.; Maus, Erik A.; Smith, Latisha A.; Zhang, Jingdan; Xiang, Xiaoyan; Zhou, Shaohua Kevin; Sevick-Muraca, Eva M.

2011-02-01

Recently, we demonstrated near-infrared (NIR) fluorescence imaging for quantifying real-time lymphatic propulsion in humans following intradermal injections of microdose amounts of indocyanine green. However computational methods for image analysis are underdeveloped, hindering the translation and clinical adaptation of NIR fluorescent lymphatic imaging. In our initial work we used ImageJ and custom MatLab programs to manually identify lymphatic vessels and individual propulsion events using the temporal transit of the fluorescent dye. In addition, we extracted the apparent velocities of contractile propagation and time periods between propulsion events. Extensive time and effort were required to analyze the 6-8 gigabytes of NIR fluorescent images obtained for each subject. To alleviate this bottleneck, we commenced development of ALFIA, an integrated software platform which will permit automated, near real-time analysis of lymphatic function using NIR fluorescent imaging. However, prior to automation, the base algorithms calculating the apparent velocity and period must be validated to verify that they produce results consistent with the proof-of-concept programs. To do this, both methods were used to analyze NIR fluorescent images of two subjects and the number of propulsive events identified, the average apparent velocities, and the average periods for each subject were compared. Paired Student's t-tests indicate that the differences between their average results are not significant. With the base algorithms validated, further development and automation of ALFIA can be realized, significantly reducing the amount of user interaction required, and potentially enabling the near real-time, clinical evaluation of NIR fluorescent lymphatic imaging.

Validating the Use of Deep Learning Neural Networks for Correction of Large Hydrometric Datasets

NASA Astrophysics Data System (ADS)

Frazier, N.; Ogden, F. L.; Regina, J. A.; Cheng, Y.

2017-12-01

Collection and validation of Earth systems data can be time consuming and labor intensive. In particular, high resolution hydrometric data, including rainfall and streamflow measurements, are difficult to obtain due to a multitude of complicating factors. Measurement equipment is subject to clogs, environmental disturbances, and sensor drift. Manual intervention is typically required to identify, correct, and validate these data. Weirs can become clogged and the pressure transducer may float or drift over time. We typically employ a graphical tool called Time Series Editor to manually remove clogs and sensor drift from the data. However, this process is highly subjective and requires hydrological expertise. Two different people may produce two different data sets. To use this data for scientific discovery and model validation, a more consistent method is needed to processes this field data. Deep learning neural networks have proved to be excellent mechanisms for recognizing patterns in data. We explore the use of Recurrent Neural Networks (RNN) to capture the patterns in the data over time using various gating mechanisms (LSTM and GRU), network architectures, and hyper-parameters to build an automated data correction model. We also explore the required amount of manually corrected training data required to train the network for reasonable accuracy. The benefits of this approach are that the time to process a data set is significantly reduced, and the results are 100% reproducible after training is complete. Additionally, we train the RNN and calibrate a physically-based hydrological model against the same portion of data. Both the RNN and the model are applied to the remaining data using a split-sample methodology. Performance of the machine learning is evaluated for plausibility by comparing with the output of the hydrological model, and this analysis identifies potential periods where additional investigation is warranted.

Cost of assessing a child for possible autism spectrum disorder? An observational study of current practice in child development centres in the UK.

PubMed

Galliver, Mark; Gowling, Emma; Farr, William; Gain, Aaron; Male, Ian

2017-01-01

UK guidelines recommend that diagnosis of autism in children requires assessment by a multidisciplinary team. With growing numbers of referrals for assessment, diagnostic services have been under increasing pressure to meet the level of need. This study aimed to explore the number of hours of professional time required to complete such an assessment based on current practice in secondary care child development centres across the UK, and from this we calculate the cost of assessment. An online questionnaire, using SurveyMonkey.com, was sent to 20 child development centres asking them to retrospectively record team members involved at each stage of assessment and time taken, including report writing and administration for a typical assessment. Costs were estimated based on the hourly rate for each team member, including salary, on-costs and trust overheads. 12 questionnaires (60%) were returned. 10 centres adopted a two-stage approach to assessment with an initial 'screening' clinic determining whether the child needed to proceed to full multidisciplinary assessment. Median professional time involved was 13 hours (IQR 9.6-15.5 hours). This resulted in a median cost of £809 ($1213, based on conversion rate £1 equal to US$1.5 (November 2015)), (IQR £684-£925) ($1026-$1388)). This study confirms that multidisciplinary diagnostic assessment of a child with possible autism requires significant professional time, with staff costs of approximately £800 ($1200) per child. This does not include costs of intervention, parent psychological education, investigation and assessment and management of comorbidities. If growing waiting times for diagnostic assessment are to be avoided, funding for diagnostic services needs to reflect the human resources required and the resulting costs of that assessment.

Rat psychomotor vigilance task with fast response times using a conditioned lick behavior

PubMed Central

Walker, Jennifer L.; Walker, Brendan M.; Fuentes, Fernanda Monjaraz; Rector, David M.

2010-01-01

Investigations into the physiological mechanisms of sleep control require an animal psychomotor vigilance task (PVT) with fast response times (<300ms). Rats provide a good PVT model since whisker stimulation produces a rapid and robust cortical evoked response, and animals can be trained to lick following stimulation. Our prior experiments used deprivation-based approaches to maximize motivation for operant conditioned responses. However, deprivation can influence physiological and neurobehavioral effects. In order to maintain motivation without water deprivation, we conditioned rats for immobilization and head restraint, then trained them to lick for a 10% sucrose solution in response to whisker stimulation. After approximately 8 training sessions, animals produced greater than 80% correct hits to the stimulus. Over the course of training, reaction times became faster and correct hits increased. Performance in the PVT was examined after 3, 6 and 12 hours of sleep deprivation achieved by gentle handling. A significant decrease in percent correct hits occurred following 6 and 12 hours of sleep deprivation and reaction times increased significantly following 12 hours of sleep deprivation. While behaviorally the animals appeared to be awake, we observed significant increases in EEG delta power prior to misses. The rat PVT with fast response times allows investigation of sleep deprivation effects, time on task and pharmacological agents. Fast response times also allow closer parallel studies to ongoing human protocols. PMID:20696188

Using the MDCT thick slab MinIP method for the follow-up of pulmonary emphysema.

PubMed

Lan, Hai; Nishitani, Hiromu; Nishihara, Sadamitsu; Ueno, Junji; Takao, Shoichiro; Iwamoto, Seiji; Kawanaka, Takashi; Mahmut, Mawlan; Qingge, Si

2011-08-01

The purpose of this study was to evaluate the usefulness of thick slab minimum intensity projection (MinIP) as a follow-up method in patients with pulmonary emphysema. This method was used to determine the presence or absence of changes over time in the lung field based on multi-detector-row CT (MDCT) data. Among patients diagnosed with pulmonary emphysema who underwent 16-MDCT (slice thickness, 1 mm) twice at an interval of 6 months or more, 12 patients without changes in the lung field and 14 with clear changes in the lung field were selected as subjects. An image interpretation experiment was performed by five image interpreters. Pulmonary emphysema was followed up using two types of thick slab MinIP (thick slab MinIP 1 and 2) and multi-planar reformation (MPR), and the results of image interpretation were evaluated by receiver operating characteristic (ROC) analysis. In addition, the time required for image interpretation was compared among the three follow-up methods. The area under the ROC curve (Az) was 0.794 for thick slab MinIP 1, 0.778 for the thick slab MinIP 2, and 0.759 for MPR, showing no significant differences among the three methods. Individual differences in each item were significantly more marked for MPR than for thick slab MinIP. The time required for image interpretation was around 18 seconds for thick slab MinIP 1, 11 seconds for thick slab MinIP 2, and approximately 127 seconds for MPR, showing significant differences among the three methods. There were no significant differences in the results of image interpretation regarding the presence or absence of changes in the lung fields between thick slab MinIP and MPR. However, thick slab MinIP showed a shorter image interpretation time and smaller individual differences in the results among image interpreters than MPR, suggesting the usefulness of this method for determining the presence or absence of changes with time in the lung fields of patients with pulmonary emphysema.

Dual vs. single computer monitor in a Canadian hospital Archiving Department: a study of efficiency and satisfaction.

PubMed

Poder, Thomas G; Godbout, Sylvie T; Bellemare, Christian

This paper describes a comparative study of clinical coding by Archivists (also known as Clinical Coders in some other countries) using single and dual computer monitors. In the present context, processing a record corresponds to checking the available information; searching for the missing physician information; and finally, performing clinical coding. We collected data for each Archivist during her use of the single monitor for 40 hours and during her use of the dual monitor for 20 hours. During the experimental periods, Archivists did not perform other related duties, so we were able to measure the real-time processing of records. To control for the type of records and their impact on the process time required, we categorised the cases as major or minor, based on whether acute care or day surgery was involved. Overall results show that 1,234 records were processed using a single monitor and 647 records using a dual monitor. The time required to process a record was significantly higher (p= .071) with a single monitor compared to a dual monitor (19.83 vs.18.73 minutes). However, the percentage of major cases was significantly higher (p= .000) in the single monitor group compared to the dual monitor group (78% vs. 69%). As a consequence, we adjusted our results, which reduced the difference in time required to process a record between the two systems from 1.1 to 0.61 minutes. Thus, the net real-time difference was only 37 seconds in favour of the dual monitor system. Extrapolated over a 5-year period, this would represent a time savings of 3.1% and generate a net cost savings of $7,729 CAD (Canadian dollars) for each workstation that devoted 35 hours per week to the processing of records. Finally, satisfaction questionnaire responses indicated a high level of satisfaction and support for the dual-monitor system. The implementation of a dual-monitor system in a hospital archiving department is an efficient option in the context of scarce human resources and has the strong support of Archivists.

Comparison of Temporal Parameters of Swimming Rescue Elements When Performed Using Dolphin and Flutter Kick with Fins - Didactical Approach

PubMed Central

Rejman, Marek; Wiesner, Wojciech; Silakiewicz, Piotr; Klarowicz, Andrzej; Abraldes, J. Arturo

2012-01-01

The aim of this study was an analysis of the time required to swim to a victim and tow them back to shore, while perfoming the flutter-kick and the dolphin-kick using fins. It has been hypothesized that using fins while using the dolphin-kick when swimming leads to reduced rescue time. Sixteen lifeguards took part in the study. The main tasks performed by them, were to approach and tow (double armpit) a dummy a distance of 50m while applying either the flutter-kick, or the dolphin-kick with fins. The analysis of the temporal parameters of both techniques of kicking demonstrates that, during the approach to the victim, neither the dolphin (tmean = 32.9s) or the flutter kick (tmean = 33.0s) were significantly faster than the other. However, when used for towing a victim the flutter kick (tmean = 47.1s) was significantly faster when compared to the dolphin-kick (tmean = 52.8s). An assessment of the level of technical skills in competitive swimming, and in approaching and towing the victim, were also conducted. Towing time was significantly correlated with the parameter that linked the temporal and technical dimensions of towing and swimming (difference between flutter kick towing time and dolphin-kick towing time, 100m medley time and the four swimming strokes evaluation). No similar interdependency has been discovered in flutter kick towing time. These findings suggest that the dolphin-kick is a more difficult skill to perform when towing the victim than the flutter-kick. Since the hypothesis stated was not confirmed, postulates were formulated on how to improve dolphin-kick technique with fins, in order to reduce swimming rescue time. Key points The source of reduction of swimming rescue time was researched. Time required to approach and to tow the victim while doing the flutter kick and the dolphin-kick with fins was analyzed. The propulsion generated by dolphin-kick did not make the approach and tow faster than the flutter kick. More difficult skill to realize of dolphin-kick than the flutter-kick was postulated. The criteria for how improve dolphin kick technique with fins were formulated. PMID:24150079

Establishing Maximal Medical Improvement After Arthroscopic Rotator Cuff Repair.

PubMed

Zuke, William A; Leroux, Timothy S; Gregory, Bonnie P; Black, Austin; Forsythe, Brian; Romeo, Anthony A; Verma, Nikhil N

2018-03-01

As health care transitions from a pay-for-service to a pay-for-performance infrastructure, the value of orthopaedic care must be defined accurately. Significant efforts have been made in defining quality and cost in arthroplasty; however, there remains a lag in ambulatory orthopaedic care. Two-year follow-up has been a general requirement for reporting outcomes after rotator cuff repair. However, this time requirement has not been established scientifically and is of increasing importance in the era of value-based health care. Given that arthroscopic rotator cuff repair is a common ambulatory orthopaedic procedure, the purpose of this study was to establish a time frame for maximal medical improvement (the state when improvement has stabilized) after arthroscopic rotator cuff repair. Systematic review. A systematic review of the literature was conducted, identifying studies reporting sequential patient-reported outcomes up to a minimum of 2 years after arthroscopic rotator cuff repair. The primary clinical outcome was patient-reported outcomes at 3-month, 6-month, 1-year, and 2-year follow-up. Secondary clinical outcomes included range of motion, strength, retears, and complications. Clinically significant improvement was determined between various time intervals by use of the minimal clinically important difference. The review included 19 studies including 1370 patients who underwent rotator cuff repair. Clinically significant improvement in patient-reported outcomes was seen up to 1 year after rotator cuff repair, but no clinical significance was noted from 1 year to 2 years. The majority of improvement in strength and range of motion was seen up to 6 months, but no clinically meaningful improvement was seen thereafter. All reported complications and the majority of retears occurred within 6 months after rotator cuff repair. After rotator cuff repair, a clinically significant improvement in patient-reported outcomes, range of motion, and strength was seen up to 1 year after surgery, but not beyond this. This information is important not only to establish appropriate patient expectations but also to determine a time frame for outcome collection after surgery to better define value in orthopaedic care.

Male unemployment and cause-specific mortality in postwar Scotland.

PubMed

Forbes, J F; McGregor, A

1987-01-01

This article reports a time-series analysis of male unemployment and mortality in postwar Scotland. The results provide little evidence to support the hypothesis that unemployment exerts a significant and consistent positive impact on mortality from all causes, lung cancer, ischemic heart disease, and cerebrovascular disease. Although significant positive associations between unemployment and mortality from lung cancer and ischemic heart disease were detected for older males in the short term, the long-term association between unemployment and mortality tends to be negative. Further progress on establishing possible causal relationships between unemployment and health requires both the collaboration of medical and social scientists and a well designed prospective study that avoids many of the problems associated with time-series and cross-sectional analyses.

Challenges of Achieving 2012 IECC Air Sealing Requirements in Multifamily Dwellings

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

Klocke, S.; Faakye, O.; Puttagunta, S.

2014-10-01

While previous versions of the International Energy Conservation Code (IECC) have included provisions to improve the air tightness of dwellings, for the first time, the 2012 IECC mandates compliance verification through blower door testing. Simply completing the Air Barrier and Insulation Installation checklist through visual inspection is no longer sufficient by itself. In addition, the 2012 IECC mandates a significantly stricter air sealing requirement. In Climate Zones 3 through 8, air leakage may not exceed 3 ACH50, which is a significant reduction from the 2009 IECC requirement of 7 ACH50. This requirement is for all residential buildings, which includes low-risemore » multifamily dwellings. While this air leakage rate requirement is an important component to achieving an efficient building thermal envelope, currently, the code language doesn't explicitly address differences between single family and multifamily applications. In addition, the 2012 IECC does not provide an option to sample dwellings for larger multifamily buildings, so compliance would have to be verified on every unit. With compliance with the 2012 IECC air leakage requirements on the horizon, several of Consortium for Advanced Residential Building's (CARB’s) multifamily builder partners are evaluating how best to comply with this requirement. Builders are not sure whether it is more practical or beneficial to simply pay for guarded testing or to revise their air sealing strategies to improve compartmentalization to comply with code requirements based on unguarded blower door testing. This report summarizes CARB's research that was conducted to assess the feasibility of meeting the 2012 IECC air leakage requirements in 3 multifamily buildings.« less

Building America Case Study: Challenges of Achieving 2012 IECC Air Sealing Requirements in Multifamily Dwellings, Upstate New York (Fact Sheet)

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

Not Available

2014-11-01

While previous versions of the International Energy Conservation Code (IECC) have included provisions to improve the air tightness of dwellings, for the first time, the 2012 IECC mandates compliance verification through blower door testing. Simply completing the Air Barrier and Insulation Installation checklist through visual inspection is no longer sufficient by itself. In addition, the 2012 IECC mandates a significantly stricter air sealing requirement. In Climate Zones 3 through 8, air leakage may not exceed 3 ACH50, which is a significant reduction from the 2009 IECC requirement of 7 ACH50. This requirement is for all residential buildings, which includes low-risemore » multifamily dwellings. While this air leakage rate requirement is an important component to achieving an efficient building thermal envelope, currently, the code language doesn't explicitly address differences between single family and multifamily applications. In addition, the 2012 IECC does not provide an option to sample dwellings for larger multifamily buildings, so compliance would have to be verified on every unit. With compliance with the 2012 IECC air leakage requirements on the horizon, several of CARB's multifamily builder partners are evaluating how best to comply with this requirement. Builders are not sure whether it is more practical or beneficial to simply pay for guarded testing or to revise their air sealing strategies to improve compartmentalization to comply with code requirements based on unguarded blower door testing. This report summarizes CARB's research that was conducted to assess the feasibility of meeting the 2012 IECC air leakage requirements in 3 multifamily buildings.« less

Challenges of Achieving 2012 IECC Air Sealing Requirements in Multifamily Dwellings

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

Klocke, S.; Faakye, O.; Puttagunta, S.

2014-10-01

​While previous versions of the International Energy Conservation Code (IECC) have included provisions to improve the air tightness of dwellings, for the first time, the 2012 IECC mandates compliance verification through blower door testing. Simply completing the Air Barrier and Insulation Installation checklist through visual inspection is no longer sufficient by itself. In addition, the 2012 IECC mandates a significantly stricter air sealing requirement. In Climate Zones 3 through 8, air leakage may not exceed 3 ACH50, which is a significant reduction from the 2009 IECC requirement of 7 ACH50. This requirement is for all residential buildings, which includes low-risemore » multifamily dwellings. While this air leakage rate requirement is an important component to achieving an efficient building thermal envelope, currently, the code language doesn't explicitly address differences between single family and multifamily applications. In addition, the 2012 IECC does not provide an option to sample dwellings for larger multifamily buildings, so compliance would have to be verified on every unit. With compliance with the 2012 IECC air leakage requirements on the horizon, several of CARB's multifamily builder partners are evaluating how best to comply with this requirement. Builders are not sure whether it is more practical or beneficial to simply pay for guarded testing or to revise their air sealing strategies to improve compartmentalization to comply with code requirements based on unguarded blower door testing. This report summarizes CARB's research that was conducted to assess the feasibility of meeting the 2012 IECC air leakage requirements in 3 multifamily buildings.« less

When left-hemisphere reading is compromised: Comparing reading ability in participants after left cerebral hemispherectomy and participants with developmental dyslexia.

PubMed

Katzir, Tami; Christodoulou, Joanna A; de Bode, Stella

2016-10-01

We investigated reading skills in individuals who have undergone left cerebral hemispherectomy and in readers with developmental dyslexia to understand diverse characteristics contributing to reading difficulty. Although dyslexia is a developmental disorder, left hemispherectomy requires that patients (re)establish the language process needed to perform the language-based tasks in the nondominant (right) hemisphere to become readers. Participants with developmental dyslexia (DD; n = 11) and participants who had undergone left hemispherectomy (HEMI; n = 11) were matched on age and gender, and were compared on timed and untimed measures of single word and pseudo-word reading. The hemispherectomy group was subdivided into prenatal (in utero) and postnatal (>3 years) insult groups, indicating the timing of the primary lesion that ultimately required surgical intervention. On an untimed reading measure, the readers with DD were comparable to individuals who had undergone left hemispherectomy due to prenatal insult, but both scored higher than the postnatal hemispherectomy group. Timed word reading differed across groups. The hemispherectomy prenatal subgroup had low average scores on both timed and untimed tests. The group with dyslexia had average scores on untimed measures and below average scores on timed reading. The hemispherectomy postnatal group had the lowest scores among the groups by a significant margin, and the most pronounced reading difficulty. Patients with prenatal lesions leading to an isolated right hemisphere (RH) have the potential to develop reading to a degree comparable to that in persons with dyslexia for single word reading. This potential sharply diminishes in individuals who undergo hemispherectomy due to postnatal insult. The higher scores of the prenatal hemispherectomy group on timed reading suggest that under these conditions, individuals with an isolated RH can compensate to a significant degree. Wiley Periodicals, Inc. © 2016 International League Against Epilepsy.