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.

Operating efficiency of an emergency Burns theatre: An eight month analysis.

PubMed

Mohan, Arvind; Lutterodt, Christopher; Leon-Villapalos, Jorge

2017-11-01

The efficient use of operating theatres is important to insure optimum cost-benefit for the hospital. We used the emergency Burns theatre as a model to assess theatre efficiency at our institution. Data was collected retrospectively on every operation performed in the Burns theatre between 01/04/15 and 30/11/15. Each component of the operating theatre process was considered and integrated to calculate values for surgical/anaesthetic time, changeover time and ultimately theatre efficiency. A total of 426 operations were carried out over 887h of allocated theatre time (ATT). Actual operating time represented 67.7%, anaesthetic time 8.8% and changeover time 14.2% of ATT. The average changeover time between patients was 30.1min. Lists started on average 27.7min late each day. There were a total of 5.8h of overruns and 9.6h of no useful activity. Operating theatre efficiency was 69.3% for the 8 month period. Our study highlights areas where theatre efficiency can be improved. We suggest various strategies to improve this that may be applied universally. Copyright © 2017 Elsevier Ltd and ISBI. All rights reserved.

The costs and quality of operative training for residents in tympanoplasty type I.

PubMed

Wang, Mao-Che; Yu, Eric Chen-Hua; Shiao, An-Suey; Liao, Wen-Huei; Liu, Chia-Yu

2009-05-01

A teaching hospital would incur more operation room costs on training surgical residents. To evaluate the increased operation time and the increased operation room costs of operations performed by surgical residents. As a model we used a very common surgical otology procedure -- tympanoplasty type I. From January 1, 2004 to December 31, 2004, we included in this study 100 patients who received tympanoplasty type I in Taipei Veterans General Hospital. Fifty-six procedures were performed by a single board-certified surgeon and 44 procedures were performed by residents. We analyzed the operation time and surgical outcomes in these two groups of patients. The operation room cost per minute was obtained by dividing the total operation room expenses by total operation time in the year 2004. The average operation time of residents was 116.47 min, which was significantly longer (p<0.0001) than that of the board-certified surgeon (average 81.07 min). It cost USD $40.36 more for each operation performed by residents in terms of operation room costs. The surgical success rate of residents was 81.82%, which was significantly lower (p=0.016) than that of the board-certified surgeon (96.43%).

[The application status of the linear stapler device in the total laryngectomy].

PubMed

Wang, W U; Wei, X L; Su, J P

2017-01-01

Summary It is very obvious that the linear stapler can shorten the operation time, reduce the incidence of pharyngeal fistula, and shorten the oral feeding time in total laryngectomy. However the stapler was used in the total laryngectomy not as widespread as in gastrointestinal surgery. In order to further understanding the function of the linear stapler device in the total laryngectomy, the stapler's composition, working principle, classification，method to use, operation method, and application of advantages and disadvantages will be reviewed. Copyright© by the Editorial Department of Journal of Clinical Otorhinolaryngology Head and Neck Surgery.

Initial surgical management of ulcerative colitis in the biologic era.

PubMed

Geltzeiler, Cristina B; Lu, Kim C; Diggs, Brian S; Deveney, Karen E; Keyashian, Kian; Herzig, Daniel O; Tsikitis, Vassiliki L

2014-12-01

The initial minimum operation for ulcerative colitis is a total abdominal colectomy. Healthy patients may undergo proctectomy at the same time; however, for ill patients, proctectomy is delayed. Since the introduction of biologic medications in 2005, ulcerative colitis medical management has changed dramatically. We examined how operative management for ulcerative colitis has changed from the prebiologic to biologic eras. We conducted a retrospective review of data on patients with ulcerative colitis who were included in the Nationwide Inpatient Sample database. This study was conducted at a single university. A total of 1,547,852 patients with ulcerative colitis who were admitted to a US hospital from 1991 to 2011 were included in the study. We examined patients whose initial operation consisted of total abdominal colectomy without proctectomy versus a total proctocolectomy with or without a pouch. We also examined which operation was done at the time of the construction of an ileoanal pouch. Patients who underwent colectomy and pouch construction in the same hospitalization were compared with those who received pouch formation at a subsequent hospitalization. Ulcerative colitis-related admissions rose by 170% during the years examined, and the number of patients who required total abdominal colectomy increased by 44%. Total abdominal colectomy increased by 15%, as opposed to total proctocolectomy (p < 0.001). Pouch construction at a subsequent operation increased by 16% (p = 0.002). Since 2008, total abdominal colectomy has surpassed total proctocolectomy as the most common initial surgical intervention for ulcerative colitis. The Nationwide Inpatient Sample is a retrospective database, and we were limited to examining the variables within it. Total abdominal colectomy is currently the most common initial operation for patients with ulcerative colitis, and an ileoanal pouch is more frequently constructed at a subsequent hospitalization. These trends coincide with the initiation of biologic treatments and may imply that patients are acutely ill at the time of initial operation. Alternately, there may be surgeon-perceived bias of increased surgical risk or a shift in care to specialized surgeons for pouch construction.

Comparative study of Misgav-Ladach and Pfannenstiel-Kerr cesarean techniques: a randomized controlled trial.

PubMed

Naki, Mehmet Murat; Api, Oluş; Celik, Hasniye; Kars, Bülent; Yaşar, Esra; Unal, Orhan

2011-02-01

To compare Pfannenstiel-Kerr (PKM) and Misgav-Ladach (MLM) methods in terms of operation-related features and neonatal outcome in primary cesarean deliveries. A total of 180 pregnant women randomized into PKM (n = 90) or MLM (n = 90) groups were included in this study. Primary outcome measures were total operative and extraction times, Apgar score, blood loss, wound complications, and the suture use. Secondary outcome measures were wound seroma and infection incidence, time of bowel restitution, and the perceived pain. Total operation and extraction times were significantly shorter and less suture material was used in the MLM group than the PKM group (p < 0.001). Initially, higher scores obtained for 6 h-VAS in the MLM group (p < 0.05) were normalized after 24 h of the operation. PKM and MLM were similar in terms of preoperative and postoperative levels of hemoglobin and hematocrit, wound complication, bowel restitution, fever, seroma, infection, wound dehiscence and the need for transfusion, antibiotic, and analgesics. The operation-related morbidity of the MLM and PKM for primary C/S seem to be comparable; however, the MLM seems to be superior in terms of operation time and the amount of suture usage but inferior in pain scores in the early postoperative period.

Robotic thyroidectomy learning curve for beginning surgeons with little or no experience of endoscopic surgery.

PubMed

Park, Jae Hyun; Lee, Jandee; Hakim, Nor Azham; Kim, Ha Yan; Kang, Sang-Wook; Jeong, Jong Ju; Nam, Kee-Hyun; Bae, Keum-Seok; Kang, Seong Joon; Chung, Woong Youn

2015-12-01

This study assessed the results of robotic thyroidectomy by fellowship-trained surgeons in their initial independent practice, and whether standard fellowship training for robotic surgery shortens the learning curve. This prospective cohort study evaluated outcomes in 125 patients who underwent robotic thyroidectomy using gasless transaxillary single-incision technique by 2 recently graduated fellowship-trained surgeons. Learning curves were analyzed by operation time, with proficiency defined as the point at which the slope of the time curve became less steep. Of the 125 patients, 113 underwent robotic less-than-total thyroidectomy, 9 underwent robotic total thyroidectomy and 3 underwent robotic total thyroidectomy with modified radical neck dissection. Mean total times for these 3 operations were 100.8 ± 20.6 minutes, 134.2 ± 38.7 minutes, and 284.7 ± 60.4 minutes, respectively. For both surgeons, the operation times gradually decreased, reaching a plateau after 20 robotic less-than-total thyroidectomies. The surgical learning curve for robotic thyroidectomy performed by recently graduated fellowship-trained surgeons with little or no experience in endoscopic surgery showed excellent results compared with those in a large series of more experienced surgeons. © 2014 Wiley Periodicals, Inc.

Preventive Maintenance on Space Systems.

DTIC Science & Technology

1983-09-01

34 3200.3 SUM OF ALL HLTWTA S OP TIME (HRS) 705335.0 _ NUMBER OF HLTWTA (OPERATIONALLY USEO>.._’_. .32.0 ~" ’ ~’S._ TOTAL NUM3ER OF...CATHOOE NEAROUT . 46973.6 SUM OF ALL LLTWTA S OP TIME (HRS) 707664.0. NUMBER OF LLTWTA (OPERATIONALLY USEO ~~_~~. 25.0 TOTAL NUMBER OF FAILURES 3.0...LCL = 55783.48 FWTWTA KTTF AT 60 PER CENT LCL WITH 150000 HCUR CATHODE WEAROUT 51996.7 SUM OF A; . TEN WATT TVfTA S OP TIME (URS

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

PubMed

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

2015-08-01

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

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

PubMed

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

2015-01-01

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

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

PubMed

Sowerby, Leigh J; Wright, Erin D

2013-11-01

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

[Coronary artery bypass grafting without use of cardiopulmonary bypass].

PubMed

Mujanović, Emir; Bergsland, Jacob; Hadziselimović, Mehdin; Softić, Muniba; Azabagic, Azur; Stanimirović-Mujanović, Sanja; Kabil, Emir

2002-01-01

Although it is possible to find a number of comparative studies in the world literature discussing the results of coronary artery bypass surgery (CABG) with and without cardiopulmonary bypass (CPB), until now such analysis has not been made in Bosnia and Herzegovina. The main aim of this scientific work was to compare morbidity and mortality, need for blood transfusions, length of stay in the intensive care unit and total length of hospitalisation in two groups of patients operated with these methods. One hundred and four patients with coronary artery disease operated in Cardiovascular Clinic Tuzla, from September, 1998 to September 2002 divided in two groups, were included in this study. There were 52 patients in the first group operated with CPB and 52 patients in the second group operated without CPB. The groups were matched for gender, age, ejection fraction and preoperative risk factors. The incidence of postoperative complications was lower in patients operated without CPB (5.77% vs. 21.15%). The mortality rate was reduced in patients operated without CPB (0.00% vs. 5.76%). There were reduced need for transfusion in patients operated without CPB (0.28 vs. 1.11 units of blood). The average time spent on respirators was shorter in patients operated without CPB (1.50 vs. 4.76 hours). The average time of total hospitalisation was also shorter in patients operated withouth CPB (6.53 vs. 8.13 days). In conclusion CABG without CPB has many advantages compared to the conventional method. Mortality and morbidity are reduced and there is less need for transfusion. The time spent on mechanical ventilation is reduced and less time is spent in intensive care and the total hospitalisation time is also less.

78 FR 6128 - Agency Information Collection Activities: Accreditation of Commercial Testing Laboratories and...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-01-29

... Record Keepers: 100. Estimated Time per Record Keeper: 60 minutes. Estimated Total Burden Hours: 100... or record keepers from the collection of information (total capital/ startup costs and operations and.... Estimated Number of Responses per Respondent: 1. Estimated Number of Total Responses: 100. Estimated Time...

Impact of operative time on early joint infection and deep vein thrombosis in primary total hip arthroplasty.

PubMed

Wills, B W; Sheppard, E D; Smith, W R; Staggers, J R; Li, P; Shah, A; Lee, S R; Naranje, S M

2018-03-22

Infections and deep vein thrombosis (DVT) after total hip arthroplasty (THA) are challenging problems for both the patient and surgeon. Previous studies have identified numerous risk factors for infections and DVT after THA but have often been limited by sample size. We aimed to evaluate the effect of operative time on early postoperative infection as well as DVT rates following THA. We hypothesized that an increase in operative time would result in increased odds of acquiring an infection as well as a DVT. We conducted a retrospective analysis of prospectively collected data using the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database from 2006 to 2015 for all patients undergoing primary THA. Associations between operative time and infection or DVT were evaluated with multivariable logistic regressions controlling for demographics and several known risks factors for infection. Three different types of infections were evaluated: (1) superficial surgical site infection (SSI), an infection involving the skin or subcutaneous tissue, (2) deep SSI, an infection involving the muscle or fascial layers beneath the subcutaneous tissue, and (3) organ/space infection, an infection involving any part of the anatomy manipulated during surgery other than the incisional components. In total, 103,044 patients who underwent THA were included in our study. Our results suggested a significant association between superficial SSIs and operative time. Specifically, the adjusted odds of suffering a superficial SSI increased by 6% (CI=1.04-1.08, p<0.0001) for every 10-minute increase of operative time. When using dichotomized operative time (<90minutes or >90minutes), the adjusted odds of suffering a superficial SSI was 56% higher for patients with prolonged operative time (CI=1.05-2.32, p=0.0277). The adjusted odds of suffering a deep SSI increased by 7% for every 10-minute increase in operative time (CI=1.01-1.14, p=0.0335). No significant associations were detected between organ/space infection, wound dehiscence, or DVT and operative time either as continuous or as dichotomized. Prolonged operative times (>90min) are associated with increased rates of superficial SSIs, but not deep SSIs, organ/space infections, wound dehiscence, or DVT. III. Copyright © 2018 Elsevier Masson SAS. All rights reserved.

Feasibility of using portable, noninvasive pipe flowmeters and time totalizers for determining water use

USGS Publications Warehouse

Arvin, D.V.

1992-01-01

The feasibility of using time totalizers for determining water use was investigated by observing seven vibration time totalizers (VTT's) mounted at five sites. None of the units exhibited adverse effects from the heat, precipitation, or humidity associated with Indiana summers. One VTT was mounted at a public water-supply site where inductive time-totalizer measurements were available for comparison. The VTT agreed within 8 hours of the inductive time totalizer after 2,340 hours of pump operation. There were no mechanical prpblems with the VTT units used in this study.

Establishing a community pharmacy residency at an independent pharmacy: Time allocation and valuation.

PubMed

Shugart, Katherine; Bryant, Jason; Kress, Dean; Ziegler, Bryan; Connelly, Lynn; Brittain, Kristy

2015-12-01

The value of a first-year community pharmacy residency program (CPRP) at an independent pharmacy was estimated based on time allocation for resident responsibilities. Predefined time allocation categories for the pharmacy resident were used to consistently classify and document time completing residency activities. Benefit-to-cost ratio was determined by tabulating total costs and total benefits of the residency program. A retrospective-prospective comparison of overall change in revenue, operating expense, and prescription volume was performed between the preresident time period (July 2012 to June 2013) and the postresident time period (July 2013 to June 2014). This comparison accounted for resident activities that did not directly generate revenue. Time allocations for the resident out of 2,221 total hours logged were dispensing (40%), clinical setup (16%), research (8%), professional meetings (7%), clinical activities (5%), resident education (5%), site precepting (4%), residency meetings (4%), didactic teaching (3%), miscellaneous (3%), marketing (2%), training (2%), and public health promotion (1%). Total costs were $77,422, and total benefits were $118,410. The benefit-to-cost ratio was 1.53. The postresident time interval had $172,451 more revenue and $6,622 more in operating expenses than the preresident time interval, and prescription volume decreased by 2,000 prescriptions compared to the previous year. The benefit-to-cost analysis indicated a $1.53 return for every $1.00 invested into a CPRP. An increase in revenue and operating expenses for the pharmacy was observed after implementation of the CPRP compared to the previous year. Copyright © 2015 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

Time Management in the Operating Room: An Analysis of the Dedicated Minimally Invasive Surgery Suite

PubMed Central

Hsiao, Kenneth C.; Machaidze, Zurab

2004-01-01

Background: Dedicated minimally invasive surgery suites are available that contain specialized equipment to facilitate endoscopic surgery. Laparoscopy performed in a general operating room is hampered by the multitude of additional equipment that must be transported into the room. The objective of this study was to compare the preparation times between procedures performed in traditional operating rooms versus dedicated minimally invasive surgery suites to see whether operating room efficiency is improved in the specialized room. Methods: The records of 50 patients who underwent laparoscopic procedures between September 2000 and April 2002 were retrospectively reviewed. Twenty-three patients underwent surgery in a general operating room and 18 patients in an minimally invasive surgery suite. Nine patients were excluded because of cystoscopic procedures undergone prior to laparoscopy. Various time points were recorded from which various time intervals were derived, such as preanesthesia time, anesthesia induction time, and total preparation time. A 2-tailed, unpaired Student t test was used for statistical analysis. Results: The mean preanesthesia time was significantly faster in the minimally invasive surgery suite (12.2 minutes) compared with that in the traditional operating room (17.8 minutes) (P=0.013). Mean anesthesia induction time in the minimally invasive surgery suite (47.5 minutes) was similar to time in the traditional operating room (45.7 minutes) (P=0.734). The average total preparation time for the minimally invasive surgery suite (59.6 minutes) was not significantly faster than that in the general operating room (63.5 minutes) (P=0.481). Conclusion: The amount of time that elapses between the patient entering the room and anesthesia induction is statically shorter in a dedicated minimally invasive surgery suite. Laparoscopic surgery is performed more efficiently in a dedicated minimally invasive surgery suite versus a traditional operating room. PMID:15554269

Preoperative predictors of increased hospital costs in elective anterior cervical fusions: a single-institution analysis of 1,082 patients.

PubMed

Minhas, Shobhit V; Chow, Ian; Jenkins, Tyler J; Dhingra, Brian; Patel, Alpesh A

2015-05-01

The frequency of anterior cervical fusion (ACF) surgery and total hospital costs in spine surgery have substantially increased in the last several years. To determine which patient comorbidities are associated with increased total hospital costs after elective one- or two-level ACFs. Retrospective cohort analysis. Individuals who have undergone elective one- or two-level ACFs at our single institution. The total number of patients amounted to 1,082. Total hospital costs during single admission. Multivariate linear regression models were used to analyze independent effects of preoperative patient characteristics on total hospital costs. Univariate analysis was used to examine association of these characteristics on operative time, length of hospital stay (LOS), and complications. Age, obesity, and diabetes were independently associated with increased average hospital costs of $1,404 (95% confidence interval [CI], $857-$1,951; p<.001), $681 (95% CI, $285-$1,076; p=.001), and $1,877 (95% CI, $726-$3,072; p=.001), respectively. Age was associated with increased LOS (p<.001) and complications (p<.001) but not operative time (p=.431). Diabetes was associated with increased LOS (p<.001) and complications (p=.042) but not operative time (p=.234). Obesity was not associated with increased LOS (p=.164), complications (p=.890), or operative time (p=.067). This study highlights the patient comorbidities associated with increased hospital costs after one- or two-level ACFs and the potential drivers of these costs. Copyright © 2015 Elsevier Inc. All rights reserved.

Early experience with totally robotic Roux-en-Y gastric bypass for morbid obesity.

PubMed

Diamantis, Theodoros; Alexandrou, Andreas; Gouzis, Kostas; Alchanatis, Manos; Giannopoulos, Athanasios

2010-12-01

Laparoscopic Roux-en-Y gastric bypass (RYGBP) for morbid obesity is a challenging operation. The application of robotic techniques has been shown to ease the technical difficulties and reduce perioperative morbidity, mainly because it facilitates the construction of the gastrojejunal anastomosis (GJ). Robotic laparoscopic RYGBP (LRYGBP) has been reported either as totally robotic with manual suturing of the GJ or as robotically assisted with the use of the robot only for the construction of the GJ. A totally robotic LRYGBP with a combined stapled and manual GJ has never been reported. Nine consecutive patients underwent totally robotic LRYGBP. The GJ was fashioned with a combination of the linear stapler and manual suturing. Mean preoperative body mass index was 45.3 ± 4.7 kg/m(2). In 1 case, we had to undock the Da Vinci Surgical System at the time of the jejunojejunostomy due to unfavorable ergonomics. Mean time to dock the robot was 16.3 ± 3.3 minutes, whereas mean total operative time was 197.2 ± 12.3 minutes. Immediate postoperative morbidity and mortality equaled zero. One patient developed a stenosis of the GJ amenable to endoscopic dilatation. The mean excess weight loss rate 1-year postoperative was 79% ± 15%. Totally robotic LRYGBP can duplicate precisely any conventional technique without any compromise in operative time, short- or long-term results.

Investigating the Acquisition, Generalization, and Emergence of Untrained Verbal Operants for Mands Acquired Using the Picture Exchange Communication System in Adults with Severe Developmental Disabilities

ERIC Educational Resources Information Center

Ziomek, M. M.; Rehfeldt, R. A.

2008-01-01

This study compared the total amount of training time and total number of trial blocks for individuals with severe developmental disabilities to acquire mands under control of unconditioned establishing operations and mands under control of transitive conditioned establishing operations for manual sign and for the Picture Exchange Communication…

"Knife to skin" time is a poor marker of operating room utilization and efficiency in cardiac surgery.

PubMed

Luthra, Suvitesh; Ramady, Omar; Monge, Mary; Fitzsimons, Michael G; Kaleta, Terry R; Sundt, Thoralf M

2015-06-01

Markers of operation room (OR) efficiency in cardiac surgery are focused on "knife to skin" and "start time tardiness." These do not evaluate the middle and later parts of the cardiac surgical pathway. The purpose of this analysis was to evaluate knife to skin time as an efficiency marker in cardiac surgery. We looked at knife to skin time, procedure time, and transfer times in the cardiac operational pathway for their correlation with predefined indices of operational efficiency (Index of Operation Efficiency - InOE, Surgical Index of Operational Efficiency - sInOE). A regression analysis was performed to test the goodness of fit of the regression curves estimated for InOE relative to the times on the operational pathway. The mean knife to skin time was 90.6 ± 13 minutes (23% of total OR time). The mean procedure time was 282 ± 123 minutes (71% of total OR time). Utilization efficiencies were highest for aortic valve replacement and coronary artery bypass grafting and least for complex aortic procedures. There were no significant procedure-specific or team-specific differences for standard procedures. Procedure times correlated the strongest with InOE (r = -0.98, p < 0.01). Compared to procedure times, knife to skin is not as strong an indicator of efficiency. A statistically significant linear dependence on InOE was observed with "procedure times" only. Procedure times are a better marker of OR efficiency than knife to skin in cardiac cases. Strategies to increase OR utilization and efficiency should address procedure times in addition to knife to skin times. © 2015 Wiley Periodicals, Inc.

Division of overall duration of stay into operative stay and postoperative stay improves the overall estimate as a measure of quality of outcome in burn care

PubMed Central

Olofsson, Pia; Fredrikson, Mats; Sjoberg, Folke

2017-01-01

Total duration of stay adjusted for percentage of the total body surface area burned (TBSA%) is a commonly used outcome measure in burn care. However, it has been criticised as it is affected by many factors, some of which are not strictly part of burn care. A division into operative stay and postoperative stay may improve this measure. The aim was to evaluate if operative stay can serve as a more standardised measure by: comparing the variation in operative stay/TBSA% with the variation in total stay/TBSA%, and to study different factors associated with operative stay and postoperative stay. Patients and methods Surgically managed burn patients admitted between 2010–14 were included. Operative stay was defined as the time from admission until the last operation, postoperative stay as the time from the last operation until discharge. The difference in variation was analysed with F-test. A retrospective review of medical records was done to explore reasons for extended postoperative stay. Multivariable regression was used to assess factors associated with operative stay and postoperative stay. Results Operative stay/TBSA% showed less variation than total duration/TBSA% (F test = 2.38, p<0.01). The size of the burn, and the number of operations, were the independent factors that influenced operative stay (R2 0.65). Except for the size of the burn other factors were associated with duration of postoperative stay: wound related, psychological and other medical causes, advanced medical support, and accommodation arrangements before discharge, of which the two last were the most important with an increase of (mean) 12 and 17 days (p<0.001, R2 0.51). Conclusion Adjusted operative stay showed less variation than total hospital stay and thus can be considered a more accurate outcome measure for surgically managed burns. The size of burn and number of operations are the factors affecting this outcome measure. PMID:28362844

Operating room management and operating room productivity: the case of Germany.

PubMed

Berry, Maresi; Berry-Stölzle, Thomas; Schleppers, Alexander

2008-09-01

We examine operating room productivity on the example of hospitals in Germany with independent anesthesiology departments. Linked to anesthesiology group literature, we use the ln(Total Surgical Time/Total Anesthesiologists Salary) as a proxy for operating room productivity. We test the association between operating room productivity and different structural, organizational and management characteristics based on survey data from 87 hospitals. Our empirical analysis links improved operating room productivity to greater operating room capacity, appropriate scheduling behavior and management methods to realign interests. From this analysis, the enforcing jurisdiction and avoiding advance over-scheduling appear to be the implementable tools for improving operating room productivity.

Operating Room Time Savings with the Use of Splint Packs: A Randomized Controlled Trial

PubMed Central

Gonzalez, Tyler A.; Bluman, Eric M.; Palms, David; Smith, Jeremy T.; Chiodo, Christopher P.

2016-01-01

Background: The most expensive variable in the operating room (OR) is time. Lean Process Management is being used in the medical field to improve efficiency in the OR. Streamlining individual processes within the OR is crucial to a comprehensive time saving and cost-cutting health care strategy. At our institution, one hour of OR time costs approximately $500, exclusive of supply and personnel costs. Commercially prepared splint packs (SP) contain all components necessary for plaster-of-Paris short-leg splint application and have the potential to decrease splint application time and overall costs by making it a more lean process. We conducted a randomized controlled trial comparing OR time savings between SP use and bulk supply (BS) splint application. Methods: Fifty consecutive adult operative patients on whom post-operative short-leg splint immobilization was indicated were randomized to either a control group using BS or an experimental group using SP. One orthopaedic surgeon (EMB) prepared and applied all of the splints in a standardized fashion. Retrieval time, preparation time, splint application time, and total splinting time for both groups were measured and statistically analyzed. Results: The retrieval time, preparation time and total splinting time were significantly less (p<0.001) in the SP group compared with the BS group. There was no significant difference in application time between the SP group and BS group. Conclusion: The use of SP made the process of splinting more lean. This has resulted in an average of 2 minutes 52 seconds saved in total splinting time compared to BS, making it an effective cost-cutting and time saving technique. For high volume ORs, use of splint packs may contribute to substantial time and cost savings without impacting patient safety. PMID:26894212

Feasibility and Learning Curve of Robotic Laparoendoscopic Single-Site Surgery in Gynecology.

PubMed

Buckley de Meritens, Alexandre; Kim, Julia; Dinkelspiel, Helen; Chapman-Davis, Eloise; Caputo, Thomas; Holcomb, Kevin M

2017-02-01

Single-site laparoscopy has proven to be a desirable option for patients undergoing gynecologic surgery, with some studies indicating improved cosmesis and less perioperative pain compared with standard approaches. This study describes the safety and feasibility of a novel robotic laparoendoscopic single-site surgery (R-LESS) platform as it is incorporated into a surgeon's practice with extensive multiport robotic surgical experience but limited LESS experience. We reviewed 83 women undergoing R-LESS by a single surgeon from September 2013 through August 2015. Operative times (total operative time, console time, docking time) were collected prospectively for the first 53 cases, and total operative time was collected retrospectively for the next 30 cases. Clinical parameters, including age, estimated blood loss, body mass index (BMI), prior abdominal surgeries, conversion to laparotomy, procedure type, uterine weight, length of hospital stay, and complications, were retrospectively collected from medical charts. Eighty-two of 83 surgeries were completed successfully with a single incision. One surgery was converted to multiport robotics for para-aortic lymph node dissection. Twelve surgeries were performed for cancer (ovary 1, uterus 8, and cervix 3). Eight patients underwent pelvic lymph node biopsy. The median total operative time for hysterectomies was 128 minutes (range, 60-275). After the first 13 hysterectomies the total operative time and the console time decreased significantly from 165.3 to 131.1 minutes (p = .032) and from 84.9 to 57.1 minutes (p = .028), respectively. Mean docking time halved from 7.8 minutes to 3.4 minutes comparing the first 10 cases to the last 10 cases. Surgical times were longer with larger BMIs, but the console time decreased with experience regardless of BMI. The mean uterine weight was 164 g (range, 30-460). Complications included 2 umbilical hernias (2.4%) and 1 conversion to multiport. In conclusion, R-LESS is a feasible and safe surgical platform for gynecologic procedures. A small number of cases are needed to significantly improve operative times when it is introduced on a surgeon's practice with limited experience in LESS but familiar with robotic surgery. Further study is needed to investigate the cost, benefits, and long-term outcomes of R-LESS. Published by Elsevier Inc.

Increase in Cesarean Operative Time Following Institution of the 80-Hour Workweek

PubMed Central

Smrtka, Michael P.; Gunatilake, Ravindu P.; Harris, Benjamin; Yu, Miao; Lan, Lan; Brancazio, Leo R.; Valea, Fidel A.; Grotegut, Chad A.; Brown, Haywood L.

2015-01-01

Background  In 2003, the Accreditation Council for Graduate Medical Education limited resident duty hours to 80 hours per week. More than a decade later, the effect of the limits on resident clinical competence is not fully understood. Objective  We sought to assess the effect of duty hour restrictions on resident performance of an uncomplicated cesarean delivery. Methods  We reviewed unlabored primary cesarean deliveries at Duke University Hospital after 34 weeks gestation, between 2003 and 2011. Descriptive statistics and linear regression were used to compare total operative time with incision to delivery time as a function of years since institution of the 80-hour workweek. Resident training level, subject body mass index, estimated blood loss, and skin closure method were controlled for in the regression model. Results  We identified 444 deliveries that met study criteria. The mean (SD) total operative time in 2003–2004 was 43.3 (14.3) minutes and 59.6 (10.7) minutes in 2010–2011 (P < .001). Multivariable regression demonstrated an increase in total operative time of 1.9 min/y (P < .001) but no change in incision to delivery time (P = .05). The magnitude of increased operative time was seen among junior residents (2.0 min/y, P < .001) compared to that of senior residents (1.2 min/y, P = .06). Conclusions  Since introduction of the 2003 duty hour limits, there has been an increase of nearly 20 minutes in the time required for a routine cesarean delivery. It is unclear if the findings are due to a change in residency duty hours or to another aspect of residency training. PMID:26457141

77 FR 16266 - Division of Longshore and Harbor Workers' Compensation; Proposed Extension of Existing Collection...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-03-20

... Number: LS-426. Affected Public: Individuals or households. Total Respondents: 1,100. Total Annual Responses: 1,100. Estimated Total Burden Hours: 275. Estimated Time per Response: 15 minutes. Frequency: On occasion. Total Burden Cost (capital/startup): $0. Total Burden Cost (operating/maintenance): $528.00...

Initial experience with custom-fit total knee replacement: intra-operative events and long-leg coronal alignment.

PubMed

Spencer, Brian A; Mont, Michael A; McGrath, Mike S; Boyd, Bradley; Mitrick, Michael F

2009-12-01

New technology using magnetic resonance imaging (MRI) allows the surgeon to place total knee replacement components into each patient's pre-arthritic natural alignment. This study evaluated the initial intra-operative experience using this technique. Twenty-one patients had a sagittal MRI of their arthritic knee to determine component placement for a total knee replacement. Cutting guides were machined to control all intra-operative cuts. Intra-operative events were recorded and these knees were compared to a matching cohort of the senior surgeon's previous 30 conventional total knee replacements. Post-operative scanograms were obtained from each patient and coronal alignment was compared to previous studies using conventional and computer-assisted techniques. There were no intra-operative or acute post-operative complications. There were no differences in blood loss and there was a mean decrease in operative time of 14% compared to a cohort of patients with conventional knee replacements. The average deviation from the mechanical axis was 1.2 degrees of varus, which was comparable to previously reported conventional and computer-assisted techniques. Custom-fit total knee replacement appeared to be a safe procedure for uncomplicated cases of osteoarthritis.

Predictors factors for post-thyroidectomy hypocalcaemia.

PubMed

Sousa, Alexandre de Andrade; Salles, José Maria Porcaro; Soares, João Marcos Arantes; Moraes, Gustavo Meyer de; Carvalho, Jomar Rezende; Savassi-Rocha, Paulo Roberto

2012-12-01

To evaluate the incidence and predictors of post-thyroidectomy definitive hypocalcemia and hypoparathyroidism. We assessed ionic calcium preoperatively and postoperatively (first, second and 30th day) in 333 patients undergoing thyroidectomy. In those presenting hypocalcemia, measurements were also made 90 and 180 days after surgery, when parathormone was also dosed. Patients were grouped according to the presence or absence of hypocalcemia and evaluated according to age, gender, thyroid function, thyroid volume, number of parathyroid glands identified and need to parathyroid reimplantation, type of operation, operative time, and histopathological diagnosis. The incidence of temporary hypocalcemia was 40.8% (136 patients), and of definitive hypoparathyroidism 4.2% (14 patients). Reoperation or total thyroidectomy, neck dissection, hyperthyroidism, operative time and age above 50 years were factors related to higher incidence of hypocalcemia and definitive hypoparathyroidism (p <0.05). predictors of postoperative hypocalcemia included age (> 50 years), total thyroidectomy, reoperation, neck dissection and operative time. The predictors of post-thyroidectomy definitive hypoparathyroidism included type of operation, histological diagnosis and hyperthyroidism.

[Coronary bypass in treatment of high-risk patients].

PubMed

Avdagić, Harun; Mujanović, Emir; Mesanović, Nihad; Sijereić-Avdagić, Selma; Pirić, Melika

2009-01-01

Although it is possible to find a number of comparative studies in the world literature discussing the results of coronary artery bypass surgery (CABG) with and without cardiopulmonary bypass (CPB), until now such analysis has not been made in Bosnia and Herzegovina. The main aim of this scientific work was to compare morbidity and mortality, need for blood transfusions, length of stay in the intensive care unit, total length of hospitalisation and number of complication in two groups of patients operated with these methods. Patients with EuroScore > or =5 with CABG operated in Cardiovascular Clinic Tuzla, from May 2000 to May 2005 divided in two groups, were included in this study. There were 100 patients in the first group operated with CPB and 100 patients in the second group operated without CPB. The average time spent on respirators was shorter in patients operated without CPB (3.7 vs.9.74 hours, p = 0.023) and the time spent in Intensive care shorter too (19 vs. 23 days, p = 0.008). Volume of postoperative bleeding was less in patients operated without CPB (574.9 vs. 988.9 ml, p = 0.038), as volume after blood transfusion (168.8 vs. 350.3 mi, p = 0.001). Intraoperative inotrope support was less in patients operated without CPB (8.0 vs. 19.0%, p = 0.038) as postoperative inotrope support (6.0 vs. 17.0%, p = 0.027). The most usual postoperative complication was atrial fibrillation and there was no difference between patients operated with CPB and without CPB (24% vs. 17%, p = 0.293). Mortality was not different in patients operated with or without CPB (2.0% vs. 6.0%, p = 0.140). The average time of total hospitalisation was also shorter in patients operated without CPB (8.0 vs. 9.5 days, p = 0.039. In conclusion CABG without CPB has many advantages compared to the conventional method. Mortality and morbidity are reduced and there is less need for transfusion. The time spent on mechanical ventilation is reduced and less time is spent in intensive care. The total hospitalisation time is also reduced.

Blood management and transfusion strategies in 600 patients undergoing total joint arthroplasty: an analysis of pre-operative autologous blood donation.

PubMed

Perazzo, Paolo; Viganò, Marco; De Girolamo, Laura; Verde, Francesco; Vinci, Anna; Banfi, Giuseppe; Romagnoli, Sergio

2013-07-01

Blood loss during total joint arthroplasty strongly influences the time to recover after surgery and the quality of the recovery. Blood conservation strategies such as pre-operative autologous blood donation and post-operative cell salvage are intended to avoid allogeneic blood transfusions and their associated risks. Although widely investigated, the real effectiveness of these alternative transfusion practices remains controversial. The surgery reports of 600 patients undergoing total joint arthroplasty (312 hip and 288 knee replacements) were retrospectively reviewed to assess transfusion needs and related blood management at our institute. Evaluation parameters included post-operative blood loss, haemoglobin concentration measured at different time points, ASA score, and blood transfusion strategies. Autologous blood donation increased the odds of receiving a red blood cell transfusion. Reinfusion by a cell salvage system of post-operative shed blood was found to limit adverse effects in cases of severe post-operative blood loss. The peri-operative net decrease in haemoglobin concentration was higher in patients who had predeposited autologous blood than in those who had not. The strengths of this study are the high number of cases and the standardised procedures, all operations having been performed by a single orthopaedic surgeon and a single anaesthesiologist. Our data suggest that a pre-operative autologous donation programme may often be useless, if not harmful. Conversely, the use of a cell salvage system may be effective in reducing the impact of blood transfusion on a patient's physiological status. Basal haemoglobin concentration emerged as a useful indicator of transfusion probability in total joint replacement procedures.

Applied Research on Laparoscopic Simulator in the Resident Surgical Laparoscopic Operation Technical Training.

PubMed

Fu, Shangxi; Liu, Xiao; Zhou, Li; Zhou, Meisheng; Wang, Liming

2017-08-01

The purpose of this study was to estimate the effects of surgical laparoscopic operation course on laparoscopic operation skills after the simulated training for medical students with relatively objective results via data gained before and after the practice course of laparoscopic simulator of the resident standardized trainees. Experiment 1: 20 resident standardized trainees with no experience in laparoscopic surgery were included in the inexperienced group and finished simulated cholecystectomy according to simulator videos. Simulator data was collected (total operation time, path length, average speed of instrument movement, movement efficiency, number of perforations, the time cautery is applied without appropriate contact with adhesions, number of serious complications). Ten attending doctors were included in the experienced group and conducted the operation of simulated cholecystectomy directly. Data was collected with simulator. Data of two groups was compared. Experiment 2: Participants in inexperienced group were assigned to basic group (receiving 8 items of basic operation training) and special group (receiving 8 items of basic operation training and 4 items of specialized training), and 10 persons for each group. They received training course designed by us respectively. After training level had reached the expected target, simulated cholecystectomy was performed, and data was collected. Experimental data between basic group and special group was compared and then data between special group and experienced group was compared. Results of experiment 1 showed that there is significant difference between data in inexperienced group in which participants operated simulated cholecystectomy only according to instructors' teaching and operation video and data in experienced group. Result of experiment 2 suggested that, total operation time, number of perforations, number of serious complications, number of non-cauterized bleeding and the time cautery is applied without appropriate contact with adhesions in special group were all superior to those in basic group. There was no statistical difference on other data between special group and basic group. Comparing special group with experienced group, data of total operation time and the time cautery is applied without appropriate contact with adhesions in experienced group was superior to that in special group. There was no statistical difference on other data between special group and experienced group. Laparoscopic simulators are effective for surgical skills training. Basic courses could mainly improve operator's hand-eye coordination and perception of sense of the insertion depth for instruments. Specialized training courses could not only improve operator's familiarity with surgeries, but also reduce operation time and risk, and improve safety.

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.

76 FR 9806 - Agency Information Collection Activities: Notice of Detention

Federal Register 2010, 2011, 2012, 2013, 2014

2011-02-22

... keepers from the collection of information (a total capital/startup costs and operations and maintenance... in order to facilitate the determination for admissibility or may ask for an extension of time to... of Responses per Respondent: 1. Estimated Number of Total Annual Responses: 1,350. Estimated Time per...

47 CFR 73.1740 - Minimum operating schedule.

Code of Federal Regulations, 2010 CFR

2010-10-01

..., local time, each day of the week except Sunday. (i) Class D stations which have been authorized... any 5 broadcast days per calendar week and not less than a total of: (A) 12 hours per week during the... months of operation, not less than 2 hours in each day of the week and not less than a total of 28 hours...

47 CFR 73.1740 - Minimum operating schedule.

Code of Federal Regulations, 2011 CFR

2011-10-01

..., local time, each day of the week except Sunday. (i) Class D stations which have been authorized... any 5 broadcast days per calendar week and not less than a total of: (A) 12 hours per week during the... months of operation, not less than 2 hours in each day of the week and not less than a total of 28 hours...

Fluidized bed operations survey summary

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

Lombardi, C.

1996-12-31

A fluidized bed operations survey summary is presented. The survey contains information on: forced outage causes; forced outage concerns ranked numerically; 1996 boiler operation and maintenance (O&M) concerns; 1997 boiler O&M concerns; fluidized bed capacity factor results; and fluidized bed total outage time.

A randomized comparative study on modified Joel-Cohen incision versus Pfannenstiel incision for cesarean section

PubMed Central

Saha, Shyama Prasad; Bhattarcharjee, Nabendu; Das Mahanta, Sabysachi; Naskar, Animesh; Bhattacharyya, Sanjoy Kumar

2013-01-01

Objective: Pfanennstiel incision is the most commonly used incision for cesarean section, but may not be the best. This study compared the modified Joel-Cohen incision with the Pfannenstiel incision to evaluate whether techniques to open the abdomen might influence operative time, and maternal and neonatal outcomes. Material and Methods: In a randomized comparative trial, 302 women with gestational age >34 weeks, requiring cesarean section, were randomly assigned to either modified Joel-Cohen incision or Pfannenstiel incision for entry into the peritoneal cavity. The primary outcome measure was total time required for performing operation and secondary outcome measures were baby extraction time, number of haemostatic procedures used in the abdominal wall, postoperative morbidity, postoperative hospital stay and neonatal outcome. Results: Mean total operative time was significantly less in the modified Joel-Cohen group as compared to the Pfannenstiel group (29.81 vs 32.67 min, p<0.0001, 95%CI=2.253 to 3.467). Time taken to deliver the baby and haemostatic procedures required during operation were also significantly less in the modified Joel-Cohen group as compared to the Pfannenstiel group. Requirement of strong analgesics was higher in the Pfannenstiel group (53.64% vs 21.85%, p<0.0001). There was no statically significant difference in the incidence of postoperative wound complications but postoperative stay in hospital was significantly less in the modified Joel-Cohen group (p=0.002). Neonatal outcomes were similar in both groups. Conclusion: The modified Joel-Cohen incision for entry into peritoneal cavity during cesarean section is associated with reduced mean total operative and baby extraction times with less postoperative pain and shorter hospital stay, which may be beneficial and cost effective. PMID:24592067

Comparison between topical and intravenous administration of tranexamic acid in primary total hip arthroplasty.

PubMed

Ueno, Masaya; Sonohata, Motoki; Fukumori, Norio; Kawano, Shunsuke; Kitajima, Masaru; Mawatari, Masaaki

2016-01-01

Tranexamic acid has been reported to be safer with topical administration than with intravenous administration in total knee arthroplasty. However, the most effective administration route of tranexamic acid in total hip arthroplasty remains controversial. This study compared the effectiveness of topical tranexamic acid administration with that of intravenous tranexamic acid administration in total hip arthroplasty. We retrospectively examined the medical records of 886 patients with osteoarthritis of the hip joint, who had undergone unilateral primary total hip arthroplasty. The patients were divided into a control group (n = 302; did not receive tranexamic acid), topical group (n = 265; topically administered 2 g tranexamic acid in 30 mL normal saline via drain tubes placed in the joint before wound closure along with posterior soft tissue repair), and intravenous group (n = 319; intravenously administered 1 g tranexamic acid before skin incision along with posterior soft tissue repair). Data on blood loss, hemoglobin levels, transfusion rates, and occurrence of deep vein thrombosis and pulmonary embolization were collected. The mean operation times were approximately 40 min in all of the groups. The operation time and intra-operative blood loss were significantly lower in the control group than in the topical and intravenous groups. However, the post-operative blood loss, total blood loss, and decrease in the hemoglobin level were significantly higher in the control group than in the topical and intravenous groups. There were no significant differences in terms of blood loss and systemic complications between the tranexamic acid administration methods. Tranexamic acid reduces both post-operative and total blood loss in total hip arthroplasty. Moreover, a lower amount of tranexamic acid can be used to reduce blood loss in total hip arthroplasty with intravenous tranexamic acid administration than with topical tranexamic acid administration. Therefore, we suggest that tranexamic acid should be intravenously administered pre-operatively and the posterior soft tissue should be repaired to decrease total hip arthroplasty-related complications. Copyright © 2015 The Authors. Published by Elsevier B.V. All rights reserved.

77 FR 65900 - Agency Information Collection Activities: Delivery Ticket

Federal Register 2010, 2011, 2012, 2013, 2014

2012-10-31

... keepers from the collection of information (total capital/startup costs and operations and maintenance.... Estimated Number of Total Annual Responses: 200,000. Estimated Time per Response: 20 minutes. Estimated...

Totally laparoscopic radical BII gastrectomy for the treatment of gastric cancer: a comparison with open surgery.

PubMed

Lee, Wei-Jei; Wang, Weu; Chen, Tai-Chi; Chen, Jung-Chieh; Ser, Kong-Han

2008-08-01

Laparoscopically assisted distal gastrectomy has been used for distal part early gastric cancer resection. However, use of totally laparoscopic gastric cancer resection remains limited because of technical problems, especially when standard D2 nodal dissection was applied. We had reported the first totally laparoscopic Billroth II (BII) subtotal gastrectomy with lymphadenectomy for early gastric cancer in the year 1998. The aim of this study is to determine whether this procedure is superior to conventional open technique. The clinical course of 34 consecutive patients who underwent totally laparoscopic BII gastrectomy using an upper to lower, right to left, and clockwise quadrant-to-quadrant technique was compared with 34 sex-matched and age-matched patients who underwent open gastrectomy. Main outcome measures included operative time, blood loss, length of stay, morbidity and mortality, adequacy of lymphadenectomy, and long-term outcome. In the laparoscopic group, all the operations were completed by laparoscopic technique, but 1 patient required secondary laparotomy for total gastrectomy owing to inadequate resection margin. There was no operation mortality in this study. The postoperative complication rates were similar in these 2 groups. The mean operative time for laparoscopic group was 283+/-122 minutes (range: 186 to 480 min), significantly longer than the 195+/-26 minutes in the conventional group (P<0.001). Laparoscopic group was associated with less intraoperative blood loss (74 vs. 190 mL; P<0.01), early flatus passage (2.9 vs. 4.9 d; P<0.01), less usage of analgesics (3.5 vs. 5.8 doses; P<0.05), and a shorter postoperative hospital stay (8.5 vs. 12.1 d; P<0.01). There was no significant difference between laparoscopic and conventional open radical gastrectomy with regard to ratio of free margin, number of harvested lymph nodes, and survival. Although totally laparoscopic BII gastrectomy using the upper to lower technique required a longer surgical time and was technically more demanding than conventional open surgery, it resulted in shorter recovery time, less analgesic use, and less severe physical discomfort without compromising the operative curability and oncologic outcomes.

Impact of Hospital-Employed Physician Assistants on a Level II Community-Based Orthopaedic Trauma System.

PubMed

Althausen, Peter L; Shannon, Steven; Owens, Brianne; Coll, Daniel; Cvitash, Michael; Lu, Minggen; O'Mara, Timothy J; Bray, Timothy J

2016-12-01

The American Academy of Orthopedic Surgeons and the Orthopedic Trauma Association have released guidelines for the provision of orthopedic trauma services such as adequate stipends, designated operating rooms, ancillary staff, and guaranteed reimbursement for indigent care. One recommendation included a provision for hospital-based physician assistants (PAs). Given current reimbursement arrangements, PA collections for billable services may not meet their salary and benefit expenses. However, their actions may indirectly affect emergency room, operating room, and hospital reimbursement and patient care itself. The purpose of our study is to define the true impact of hospitalbased PAs on orthopaedic trauma care at a level II community hospital. Retrospective case series. Level II trauma center. One thousand one hundred four trauma patients with orthopaedic injuries. PA involvement. Emergency room data such as triage time, time until seen by the orthopedic service, and total emergency room time was recorded. Operating room data such as time to surgery, set-up time, total operating time, and out of room time was entered as well. Charts were reviewed to determine if patients were given postoperative antibiotics and Deep Venous Thrombosis (DVT) prophylaxis. Intraoperative and postoperative complications were noted, and lengths of stay were calculated for all patients. At our institution, PA collections from patient care cover only 50% of their costs for salary and benefits. However, with PA involvement, trauma patients with orthopedic injuries were seen 205 minutes faster (P = 0.006), total Emergency Room (ER) time decreased 175 minutes (P = 0.0001), and time to surgery improved 360 minutes (P . 0.03). Operating room parameters were minimally improved, but postoperative DVT prophylaxis increased by a mean of 6.73% (P = 0.0084), postoperative antibiotic administration increased by 2.88% (P = 0.0302), and there was a 4.67% decrease in postoperative complications (P = 0.0034). Average length of stay decreased by 0.61 days (P = 0.27). Although the PA's collections do not cover their costs, the indirect economic and patient care impacts are clear. By increasing emergency room pull through and decreasing times to Operating Room (OR), operative times, lengths of stay, and complications, their existence is clearly beneficial to hospitals, physicians, and patients as well. Economic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Blood management and transfusion strategies in 600 patients undergoing total joint arthroplasty: an analysis of pre-operative autologous blood donation

PubMed Central

Perazzo, Paolo; Viganò, Marco; de Girolamo, Laura; Verde, Francesco; Vinci, Anna; Banfi, Giuseppe; Romagnoli, Sergio

2013-01-01

Background Blood loss during total joint arthroplasty strongly influences the time to recover after surgery and the quality of the recovery. Blood conservation strategies such as pre-operative autologous blood donation and post-operative cell salvage are intended to avoid allogeneic blood transfusions and their associated risks. Although widely investigated, the real effectiveness of these alternative transfusion practices remains controversial. Materials and methods The surgery reports of 600 patients undergoing total joint arthroplasty (312 hip and 288 knee replacements) were retrospectively reviewed to assess transfusion needs and related blood management at our institute. Evaluation parameters included post-operative blood loss, haemoglobin concentration measured at different time points, ASA score, and blood transfusion strategies. Results Autologous blood donation increased the odds of receiving a red blood cell transfusion. Reinfusion by a cell salvage system of post-operative shed blood was found to limit adverse effects in cases of severe post-operative blood loss. The peri-operative net decrease in haemoglobin concentration was higher in patients who had predeposited autologous blood than in those who had not. Discussion The strengths of this study are the high number of cases and the standardised procedures, all operations having been performed by a single orthopaedic surgeon and a single anaesthesiologist. Our data suggest that a pre-operative autologous donation programme may often be useless, if not harmful. Conversely, the use of a cell salvage system may be effective in reducing the impact of blood transfusion on a patient’s physiological status. Basal haemoglobin concentration emerged as a useful indicator of transfusion probability in total joint replacement procedures. PMID:23736922

Effect of facility on the operative costs of distal radius fractures.

PubMed

Mather, Richard C; Wysocki, Robert W; Mack Aldridge, J; Pietrobon, Ricardo; Nunley, James A

2011-07-01

The purpose of this study was to investigate whether ambulatory surgery centers can deliver lower-cost care and to identify sources of those cost savings. We performed a cost identification analysis of outpatient volar plating for closed distal radius fractures at a single academic medical center. Multiple costs and time measures were taken from an internal database of 130 consecutive patients and were compared by venue of treatment, either an inpatient facility or an ambulatory, stand-alone surgery facility. The relationships between total cost and operative time and multiple variables, including fracture severity, patient age, gender, comorbidities, use of bone graft, concurrent carpal tunnel release, and surgeon experience, were examined, using multivariate analysis and regression modeling to identify other cost drivers or explanatory variables. The mean operative cost was considerably greater at the inpatient facility ($7,640) than at the outpatient facility ($5,220). Cost drivers of this difference were anesthesia services, post-anesthesia care unit, and operating room costs. Total surgical time, nursing time, set-up, and operative times were 33%, 109%, 105%, and 35% longer, respectively, at the inpatient facility. There was no significant difference between facilities for the additional variables, and none of those variables independently affected cost or operative time. The only predictor of cost and time was facility type. This study supports the use of ambulatory stand-alone surgical facilities to achieve efficient resource utilization in the operative treatment of distal radius fractures. We also identified several specific costs and time measurements that differed between facilities, which can serve as potential targets for tertiary facilities to improve utilization. Economic and Decisional Analysis III. Copyright © 2011 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

Benefits of xiphoidectomy in total gastrectomy: Technical note

PubMed Central

Mihmanlı, Mehmet; Köksal, Hakan Mustafa; Demir, Uygar; Işıl, Rıza Gürhan

2016-01-01

Objective: The esophago-gastric junction may be challenging during total gastrectomy due to gastric cancer. This situation may compromise the security of both the dissection and anastomosis. The purpose of this study was to investigate the usefulness of xiphoidectomy to overcome this issue. Material and Methods: The files of patients who underwent total gastrectomy + D2 lymph node dissection due to proximal gastric cancer or cardia cancer between April 2002–December 2013 were retrospectively evaluated. We assessed the outcome in patients with xiphoidectomy in addition to the midline incision in terms of xiphoidectomy technique, xiphoidectomy time, and operative and postoperative complications. Results: Thirty cases were identified to undergo xiphoidectomy. Nineteen patients were male and 11 were female, with a mean age of 51 (21–80) years. The time required for xiphoidectomy was 7–15 minutes (mean 8.7 minutes). The mean additional time required for the closure of the incision in cases with xiphoidectomy was 2 minutes. There was minimal arterial bleeding from the diaphragmatic surface in one patient, which was controlled by electrocautery. Only two patients developed wound infection. Conclusion: Performing xiphoidectomy is quite easy, after a certain learning phase. The operative time was 7–15 minutes longer due to excision of xiphoid and closure of the related defect. Minor hemorrhage was a problem during surgery. There were no early or late post-operative complications. We suggest that the procedure is beneficial in selected cases with requirement of a wider operative field or better exposure of the esophago-gastric junction during total gastrectomy for gastric cancer, and recommend removal of the xiphoid bone PMID:26985158

Benefits of xiphoidectomy in total gastrectomy: Technical note.

PubMed

Mihmanlı, Mehmet; Köksal, Hakan Mustafa; Demir, Uygar; Işıl, Rıza Gürhan

2016-01-01

The esophago-gastric junction may be challenging during total gastrectomy due to gastric cancer. This situation may compromise the security of both the dissection and anastomosis. The purpose of this study was to investigate the usefulness of xiphoidectomy to overcome this issue. The files of patients who underwent total gastrectomy + D2 lymph node dissection due to proximal gastric cancer or cardia cancer between April 2002-December 2013 were retrospectively evaluated. We assessed the outcome in patients with xiphoidectomy in addition to the midline incision in terms of xiphoidectomy technique, xiphoidectomy time, and operative and postoperative complications. Thirty cases were identified to undergo xiphoidectomy. Nineteen patients were male and 11 were female, with a mean age of 51 (21-80) years. The time required for xiphoidectomy was 7-15 minutes (mean 8.7 minutes). The mean additional time required for the closure of the incision in cases with xiphoidectomy was 2 minutes. There was minimal arterial bleeding from the diaphragmatic surface in one patient, which was controlled by electrocautery. Only two patients developed wound infection. Performing xiphoidectomy is quite easy, after a certain learning phase. The operative time was 7-15 minutes longer due to excision of xiphoid and closure of the related defect. Minor hemorrhage was a problem during surgery. There were no early or late post-operative complications. We suggest that the procedure is beneficial in selected cases with requirement of a wider operative field or better exposure of the esophago-gastric junction during total gastrectomy for gastric cancer, and recommend removal of the xiphoid bone.

Contributing Factors to Total Mission Time for Medical Evacuation Missions during Operation Iraqi Freedom II

DTIC Science & Technology

2007-05-01

critically lessens. Pamerneckas, Macas , Vaitkaitis, and Gudeniene (2003) suggest the concept of the "golden hour" remains relevant because of its...S6. Contributing Factors to Total Mission Time during OIF II 54 Pamerneckas, A., Macas , A., Vaitkaitis, D., & Gudeniene, R. (2003). Golden hour

78 FR 64523 - Agency Information Collection Activities: Vessel Entrance or Clearance Statement

Federal Register 2010, 2011, 2012, 2013, 2014

2013-10-29

... respondents or record keepers from the collection of information (a total capital/startup costs and operations... vessel data at time of formal entrance and clearance in U.S. ports. The form allows the master to attest... Responses per Respondent: 22. Estimated Total Annual Responses: 264,000. Estimated Time per Response: 30...

Arthroscopic lysis of adhesions improves knee range of motion after fixation of intra-articular fractures about the knee.

PubMed

Gittings, Daniel; Hesketh, Patrick; Dattilo, Jonathan; Zgonis, Miltiadis; Kelly, John; Mehta, Samir

2016-12-01

Post-traumatic stiffness after open reduction and internal fixation of fractures about the knee can have dramatic effects on function. Traditionally, open quadricepsplasty has been the treatment of choice, but is associated with significant morbidity. The purpose of this study is to examine the immediate and sustainable range of motion (ROM) changes after surgical arthroscopic lysis of knee adhesions (SALKA) for post-traumatic knee stiffness after open reduction internal fixation (ORIF). We retrospectively reviewed a consecutive series of patients at a single institution who underwent SALKA for knee stiffness after intra-articular fractures about the knee treated with ORIF from 2009 to 2015. Pre-operative and immediate post-operative total ROM was assessed while patients were sedated during the SALKA procedure. Total ROM was assessed in the office pre-operatively and compared to the latest post-operative follow-up visit. Immediate post-operative ROM was also compared to the latest post-operative follow-up visit. Two-tailed paired Student's t test was calculated for analysis. Of the 14 patients included in the study, 10 (71 %) had tibial plateau ORIF, 3 (21 %) had patella ORIF, and 1 (8 %) had intra-articular distal femur ORIF. The mean time between ORIF and SALKA was 244 days. The mean follow-up time after SALKA was 135 days. Under sedation during SALKA, the mean total ROM increased from 72° to 127° immediately post-operatively (p < 0.01). The mean pre-operative in-office total ROM was 73° and increased to 104° at the latest follow-up visit (p < 0.01). The mean immediate post-operative ROM was 127° and decreased to 104° at the latest follow-up visit (p = 0.01). Lysis of adhesions utilizing SALKA after ORIF about the knee improves knee ROM immediately post-operatively and in the short-term follow-up. However, there is a decrease in the gains in the range of motion over time. Patients should be counseled as such. Lysis of adhesions utilizing arthroscopic techniques may provide a favorable alternative to open quadricepsplasty.

77 FR 67026 - Proposed Extension of the Approval of Information Collection Requirements

Federal Register 2010, 2011, 2012, 2013, 2014

2012-11-08

.... Estimated Time per Response: 30-45 minutes. Frequency: On occasion. Total Burden Cost (capital/startup): $3996. Total Burden Costs (operation/maintenance): $54,732. Dated: October 31, 2012. Mary Ziegler...

76 FR 56213 - Agency Information Collection Activities: Crew's Effects Declaration

Federal Register 2010, 2011, 2012, 2013, 2014

2011-09-12

... keepers from the collection of information (a total capital/startup costs and operations and maintenance... Responses: 206,100. Estimated Time per Response: 60 minutes. Estimated Total Annual Burden Hours: 206,100...

75 FR 57284 - Agency Information Collection Activities: Cost Submission

Federal Register 2010, 2011, 2012, 2013, 2014

2010-09-20

... respondents or record keepers from the collection of information (a total capital/startup costs and operations... Respondent: 1. Estimated time per Response: 50 hours. Estimated Total Annual Burden Hours: 50,000. [[Page...

How Can School Funding Increase If Operating Budgets Are Declining? Get the Facts... #2

ERIC Educational Resources Information Center

Kansas Association of School Boards (NJ1), 2012

2012-01-01

State and local funding for general operating budgets for Kansas public schools will be at a five-year low this school year, yet total Kansas school district spending will reach an all-time high of $5.67 billion according to estimates released by the Kansas State Department of Education. Total per pupil spending is projected to reach $12,454 per…

Laparoscopic versus open incisional hernia repair: a retrospective cohort study with costs analysis on 269 patients.

PubMed

Soliani, G; De Troia, A; Portinari, M; Targa, S; Carcoforo, P; Vasquez, G; Fisichella, P M; Feo, C V

2017-08-01

To compare clinical outcomes and institutional costs of elective laparoscopic and open incisional hernia mesh repairs and to identify independent predictors of prolonged operative time and hospital length of stay (LOS). Retrospective observational cohort study on 269 consecutive patients who underwent elective incisional hernia mesh repair, laparoscopic group (N = 94) and open group (N = 175), between May 2004 and July 2014. Operative time was shorter in the laparoscopic versus open group (p < 0.0001). Perioperative morbidity and mortality were similar in the two groups. Patients in the laparoscopic group were discharged a median of 2 days earlier (p < 0.0001). At a median follow-up over 50 months, no difference in hernia recurrence was detected between the groups. In laparoscopic group total institutional costs were lower (p = 0.02). At Cox regression analysis adjusted for potential confounders, large wall defect (W3) and higher operative risk (ASA score 3-4) were associated with prolonged operative time, while midline hernia site was associated with increased hospital LOS. Open surgical approach was associated with prolongation of both operative time and LOS. Laparoscopic approach may be considered safely to all patients for incisional hernia repair, regardless of patients' characteristics (age, gender, BMI, ASA score, comorbidities) and size of the wall defect (W2-3), with the advantage of shorter operating time and hospital LOS that yields reduced total institutional costs. Patients with higher ASA score and large hernia defects are at risk of prolonged operative time, while an open approach is associated with longer duration of surgical operation and hospital LOS.

49 CFR 244.9 - Definitions.

Code of Federal Regulations, 2014 CFR

2014-10-01

... railroad operations, including, but not limited to, the allocation of resources affecting railroad... deflator formula) from time to time. Corporate culture means the totality of the commitments, written and...

49 CFR 244.9 - Definitions.

Code of Federal Regulations, 2012 CFR

2012-10-01

... railroad operations, including, but not limited to, the allocation of resources affecting railroad... deflator formula) from time to time. Corporate culture means the totality of the commitments, written and...

49 CFR 244.9 - Definitions.

Code of Federal Regulations, 2013 CFR

2013-10-01

... railroad operations, including, but not limited to, the allocation of resources affecting railroad... deflator formula) from time to time. Corporate culture means the totality of the commitments, written and...

49 CFR 244.9 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-10-01

... railroad operations, including, but not limited to, the allocation of resources affecting railroad... deflator formula) from time to time. Corporate culture means the totality of the commitments, written and...

[Meta analysis of three-dimensional printing patient-specific instrumentation versus conventional instrumentation in total knee arthroplasty].

PubMed

Ren, J T; Xu, C; Wang, J S; Liu, X L

2017-10-01

Objective: To evaluate the effects of three-dimensional printing patient-specific instrumentation(PSI) versus conventional instrumentation(CI) in the total knee arthroplasty. Methods: According to "patient-specific" , "patient-matched" , "custom" , "Instrumentation" , "Guide Instrumentation" , "cutting blocks" , "total knee arthroplasty" , "total knee replacement" , "TKA" and "TKR" , the literature on PubMed, EMbase, Cochrane library, CBM and WanFang were searched. According to the inclusion and exclusion criteria, the high quality randomized control trial (RCT) studies about three-dimensional (3D) printing patient-specific instrumentation versus conventional instrumentation in the total knee arthroplasty were collected. The post-operative limb mechanical axis outlier, the position of the components outlier, post-operative knee function, operative time, post-operative blood transfusion and complications were analyzed by RevMan 5.3 software. Results: A total of 13 high quality RCT studies were included. The results of Meta-analysis show that there were no statistical differences in the post-operative limb mechanical axis outlier( Z =0.55, P =0.58, 95% CI: 0.78 to 1.56), femoral coronal component outlier( Z =0.38, P =0.71, 95% CI: 0.69 to 1.72), tibia coronal component outlier( Z =1.95, P =0.05, 95% CI: 1.00 to 3.38), femoral rotation angle outlier( Z =0.36, P =0.72, 95% CI: 0.49 to 1.64), post-operative knee function( Z =1.18, P =0.24, 95% CI : -0.66 to 2.63), post-operative blood transfusions( Z =0.74, P =0.46, 95% CI: -0.10 to 0.05) and complications( Z =0.18, P =0.86, 95% CI: -0.07 to 0.05) between the PSI group and the CI group. But there are statistical differences in the operation time( Z =2.66, P =0.01, 95% CI: -15.97 to -2.41)and tibia sagittal component outlier ( Z =3.69, P =0.00, 95% CI: 1.43 to 3.18)between the PSI group and the CI group. Conclusions: In the primary total knee arthroplasty the PSI is not superior over the CI for the knee without severe knee varus or valgus deformity or contracture deformity, without the deformity around the knee and without the knee bone loss and obesity. The use of PSI in the primary total knee arthroplasty are not recommend.

An algorithm for fast elastic wave simulation using a vectorized finite difference operator

NASA Astrophysics Data System (ADS)

Malkoti, Ajay; Vedanti, Nimisha; Tiwari, Ram Krishna

2018-07-01

Modern geophysical imaging techniques exploit the full wavefield information which can be simulated numerically. These numerical simulations are computationally expensive due to several factors, such as a large number of time steps and nodes, big size of the derivative stencil and huge model size. Besides these constraints, it is also important to reformulate the numerical derivative operator for improved efficiency. In this paper, we have introduced a vectorized derivative operator over the staggered grid with shifted coordinate systems. The operator increases the efficiency of simulation by exploiting the fact that each variable can be represented in the form of a matrix. This operator allows updating all nodes of a variable defined on the staggered grid, in a manner similar to the collocated grid scheme and thereby reducing the computational run-time considerably. Here we demonstrate an application of this operator to simulate the seismic wave propagation in elastic media (Marmousi model), by discretizing the equations on a staggered grid. We have compared the performance of this operator on three programming languages, which reveals that it can increase the execution speed by a factor of at least 2-3 times for FORTRAN and MATLAB; and nearly 100 times for Python. We have further carried out various tests in MATLAB to analyze the effect of model size and the number of time steps on total simulation run-time. We find that there is an additional, though small, computational overhead for each step and it depends on total number of time steps used in the simulation. A MATLAB code package, 'FDwave', for the proposed simulation scheme is available upon request.

75 FR 57480 - Agency Information Collection Activities: Commercial Invoice

Federal Register 2010, 2011, 2012, 2013, 2014

2010-09-21

... respondents or record keepers from the collection of information (a total capital/startup costs and operations... Responses per Respondent: 1,208. Estimated Number of Total Annual Responses: 46,500,000. Estimated time per...

When is it safe to resume driving after total hip and total knee arthroplasty? a meta-analysis of literature on post-operative brake reaction times.

PubMed

van der Velden, C A; Tolk, J J; Janssen, R P A; Reijman, M

2017-05-01

The aim of this study was to assess the current available evidence about when patients might resume driving after elective, primary total hip (THA) or total knee arthroplasty (TKA) undertaken for osteoarthritis (OA). In February 2016, EMBASE, MEDLINE, Web of Science, Scopus, Cochrane, PubMed Publisher, CINAHL, EBSCO and Google Scholar were searched for clinical studies reporting on 'THA', 'TKA', 'car driving', 'reaction time' and 'brake response time'. Two researchers (CAV and JJT) independently screened the titles and abstracts for eligibility and assessed the risk of bias. Both fixed and random effects were used to pool data and calculate mean differences (MD) and 95% confidence intervals (CI) between pre- and post-operative total brake response time (TBRT). A total of 19 studies were included. The assessment of the risk of bias showed that one study was at high risk, six studies at moderate risk and 12 studies at low risk. Meta-analysis of TBRT showed a MD decrease of 25.54 ms (95% CI -32.02 to 83.09) two weeks after right-sided THA, and of 18.19 ms (95% CI -6.13 to 42.50) four weeks after a right-sided TKA, when compared with the pre-operative value. The TBRT returned to baseline two weeks after a right-sided THA and four weeks after a right-sided TKA. These results may serve as guidelines for orthopaedic surgeons when advising patients when to resume driving. However, the advice should be individualised. Cite this article: Bone Joint J 2017;99-B:566-76. ©2017 The British Editorial Society of Bone & Joint Surgery.

[Optimizing primary total hip replacement--a technique to effect saving of manpower].

PubMed

Huber, J F; Rink, M; Broger, I; Zumstein, M; Ruflin, G B

2003-01-01

Development of a standardized surgical technique for total hip replacement thereby saving manpower (one assistant) by using a retractor system. Total hip replacement is performed with the patient in a true lateral position on a tunnel cushion. By means of a direct lateral approach the pelvitrochanteric muscles are partially detached using an omega-shaped cut. The Bookwalter retractor is fixed dorsally on the operating table. The ring is centered keeping the greater trochanter in the middle. The Hohmann retractors are fixed to the ring to sufficiently expose the acetabulum. To insert the femoral stem the ring needs to be opened dorsally and the patient's leg is bent 90 degrees in the hip and the knee over the tunnel cushion. The muscles inserting at the greater trochanter are retracted by a separate Hohmann retractor with weight. In a case control study with matched pairs the patients treated with this technique were compared with those treated in supine position with the transgluteal approach. The number of assistants required and the operating time were assessed. All the hip replacements with the patient in side position were performed with one assistant, in supine position with two assistants. The operating time did not differ significantly (supine position 110 min/side position 112 min). The complication rate in both groups was comparable (one secondary wound healing, one transient ischalgia). The process of total hip replacement can be optimized. The described technique allows to spare one surgical assistant without prolonging the operating time.

Use of linear programming to estimate impact of changes in a hospital's operating room time allocation on perioperative variable costs.

PubMed

Dexter, Franklin; Blake, John T; Penning, Donald H; Sloan, Brian; Chung, Patricia; Lubarsky, David A

2002-03-01

Administrators at hospitals with a fixed annual budget may want to focus surgical services on priority areas to ensure its community receives the best health services possible. However, many hospitals lack the detailed managerial accounting data needed to ensure that such a change does not increase operating costs. The authors used a detailed hospital cost database to investigate by how much a change in allocations of operating room (OR) time among surgeons can increase perioperative variable costs. The authors obtained financial data for all patients who underwent outpatient or same-day admit surgery during a year. Linear programming was used to determine by how much changing the mix of surgeons can increase total variable costs while maintaining the same total hours of OR time for elective cases. Changing OR allocations among surgeons without changing total OR hours allocated will likely increase perioperative variable costs by less than 34%. If, in addition, intensive care unit hours for elective surgical cases are not increased, hospital ward occupancy is capped, and implant use is tracked and capped, perioperative costs will likely increase by less than 10%. These four variables predict 97% of the variance in total variable costs. The authors showed that changing OR allocations among surgeons without changing total OR hours allocated can increase hospital perioperative variable costs by up to approximately one third. Thus, at hospitals with fixed or nearly fixed annual budgets, allocating OR time based on an OR-based statistic such as utilization can adversely affect the hospital financially. The OR manager can reduce the potential increase in costs by considering not just OR time, but also the resulting use of hospital beds and implants.

40 CFR 60.676 - Reporting and recordkeeping.

Code of Federal Regulations, 2011 CFR

2011-07-01

... elevator, bagging operation, or enclosed truck or railcar loading station: (i) The rated capacity in... following such change. At the time of such change, this screening operation, bucket elevator, or belt... hour of the replacement equipment. (2) For a screening operation: (i) The total surface area of the top...

40 CFR 60.676 - Reporting and recordkeeping.

Code of Federal Regulations, 2012 CFR

2012-07-01

... elevator, bagging operation, or enclosed truck or railcar loading station: (i) The rated capacity in... following such change. At the time of such change, this screening operation, bucket elevator, or belt... hour of the replacement equipment. (2) For a screening operation: (i) The total surface area of the top...

40 CFR 60.676 - Reporting and recordkeeping.

Code of Federal Regulations, 2014 CFR

2014-07-01

... elevator, bagging operation, or enclosed truck or railcar loading station: (i) The rated capacity in... following such change. At the time of such change, this screening operation, bucket elevator, or belt... hour of the replacement equipment. (2) For a screening operation: (i) The total surface area of the top...

40 CFR 60.676 - Reporting and recordkeeping.

Code of Federal Regulations, 2013 CFR

2013-07-01

... elevator, bagging operation, or enclosed truck or railcar loading station: (i) The rated capacity in... following such change. At the time of such change, this screening operation, bucket elevator, or belt... hour of the replacement equipment. (2) For a screening operation: (i) The total surface area of the top...

14 CFR 331.7 - What losses will be reimbursed?

Code of Federal Regulations, 2010 CFR

2010-01-01

... the lost time value of money (i.e. interest on lost profits for the period of time the funds were not... income is calculated on a pretax basis. It is the total of Operating Profit or Loss (i.e., Total... in the ordinary course of business that were prepared for the eligible reimbursement period, such as...

[Total knee arthroplasty in 2014 : Results, expectations, and complications].

PubMed

Matziolis, G; Röhner, E

2015-04-01

Aseptic loosening seems to have become a minor problem in total knee arthroplasty. In contrast to that, new challenges are defined by changing patients' expectations. Beside reduction of pain and improving mobility, modern implants should not be noticed as such and should not limit sports activities. In this paper, a summary of the development and the current situation of total knee arthroplasty (e.g., implantation numbers, hospitality, operation time, and infection rates) are provided. The data are compared in an international context. In addition, current trends and developments from recent years are shown and rated according to the literature. The paper is based on a literature search (PubMed) and analyses of published official statistical data and expert recommendations. Implantation numbers have been declining gradually in Germany since 2009. In 2013, 127,077 total knee arthroplasties were implanted. In contrast, the number of revision operations has increased gradually during the last decade. In addition, hospital stay and operation time have declined. The development of implants, instruments, and operation techniques results from changing patients' expectations. All innovations must be compared against the results of well-proven techniques. The arthroplasty register may be an instrument to evaluate the results of new techniques and implants in a broad clinical application in terms of survival.

Integrated Data Fusion and Mining Techniques for Monitoring Total Organic Carbon Concentrations in a Lake

EPA Science Inventory

Total organic carbon (TOC) in surface waters, markedly of seasonal variations, is a known precursor of disinfection byproducts such as Total Trihalomethanes (TTHM) in drinking water treatment. Real-time knowledge of TOC distribution in source water can help treatment operation to...

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

PubMed

Lan, Roy H; Kamath, Atul F

2017-01-01

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

78 FR 57405 - Agency Information Collection Activities: Transportation Entry and Manifest of Goods Subject to...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-09-18

... keepers from the collection of information (a total capital/startup costs and operations and maintenance.... Estimated Time per Response: 10 minutes. Estimated Total Annual Burden Hours: 896,400 hours. Dated...

76 FR 34245 - Agency Information Collection Activities: Petition for Remission or Mitigation of Forfeitures and...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-06-13

... keepers from the collection of information (a total capital/startup costs and operations and maintenance... Number of Respondents: 28,000. Estimated Total Annual Responses: 28,000. Estimated Time per Respondent...

Comparison of surgical outcomes among infants in neonatal intensive care units treated by pediatric surgeons versus general surgeons: The need for pediatric surgery specialists.

PubMed

Boo, Yoon Jung; Lee, Eun Hee; Lee, Ji Sung

2017-11-01

This study compared the outcomes of infants who underwent surgery in neonatal intensive care units by pediatric surgeons and by general surgeons. This was a retrospective study of infants who underwent surgery in neonatal intensive care units between 2010 and 2014. A total of 227 patients were included. Of these patients, 116 were operated on by pediatric surgeons (PS) and 111 were operated on by general surgeons (GS). The outcome measures were the overall rate of operative complications, unplanned reoperation, mortality rate, length of stay, operative time, and number of total number of operative procedures. The overall operative complication rate was higher in the GS group compared with the PS group (18.7% vs. 7.0%, p=0.0091). The rate of unplanned reoperations was also higher in the GS group (10.8% vs. 3.5%, p=0.0331). The median operation time (90min vs. 75min, p=0.0474) and median length of stay (24days vs. 18days, p=0.0075) were significantly longer in the GS group. The adjusted odd ratios of postoperative complications for GS were 2.9 times higher than that of PS (OR 2.90, p=0.0352). The operative quality and patient outcomes of the PS group were superior to those of the GS group. III. Copyright © 2017 Elsevier Inc. All rights reserved.

Association between patient-centered medical home rating and operating cost at federally funded health centers.

PubMed

Nocon, Robert S; Sharma, Ravi; Birnberg, Jonathan M; Ngo-Metzger, Quyen; Lee, Sang Mee; Chin, Marshall H

2012-07-04

Little is known about the cost associated with a health center's rating as a patient-centered medical home (PCMH). To determine whether PCMH rating is associated with operating cost among health centers funded by the US Health Resources and Services Administration. Cross-sectional study of PCMH rating and operating cost in 2009. PCMH rating was assessed through surveys of health center administrators conducted by Harris Interactive of all 1009 Health Resources and Services Administration–funded community health centers. The survey provided scores from 0 (worst) to 100 (best) for total PCMH score and 6 subscales: access/communication, care management, external coordination, patient tracking, test/referral tracking, and quality improvement. Costs were obtained from the Uniform Data System reports submitted to the Health Resources and Services Administration. We used generalized linear models to determine the relationship between PCMH rating and operating cost. Operating cost per physician full-time equivalent, operating cost per patient per month, and medical cost per visit. Six hundred sixty-nine health centers (66%) were included in the study sample, with 340 excluded because of nonresponse or incomplete data. Mean total PCMH score was 60 (SD, 12; range, 21-90). For the average health center, a 10-point higher total PCMH score was associated with a $2.26 (4.6%) higher operating cost per patient per month (95% CI, $0.86-$4.12). Among PCMH subscales, a 10-point higher score for patient tracking was associated with higher operating cost per physician full-time equivalent ($27,300; 95% CI, $3047-$57,804) and higher operating cost per patient per month ($1.06; 95% CI, $0.29-$1.98). A 10-point higher score for quality improvement was also associated with higher operating cost per physician full-time equivalent ($32,731; 95% CI, $1571-$73,670) and higher operating cost per patient per month ($1.86; 95% CI, $0.54-$3.61). A 10-point higher PCMH subscale score for access/communication was associated with lower operating cost per physician full-time equivalent ($39,809; 95% CI, $1893-$63,169). According to a survey of health center administrators, higher scores on a scale that assessed 6 aspects of the PCMH were associated with higher health center operating costs. Two subscales of the medical home were associated with higher cost and 1 with lower cost.

Operative experience of surgery residents: trends and challenges.

PubMed

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

2013-01-01

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

Minimally invasive video-assisted thyroidectomy: Ascending the learning curve

PubMed Central

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

2015-01-01

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

Near-real-time TOMS, telecommunications and meteorological support for the 1987 Airborne Antarctic Ozone Experiment

NASA Technical Reports Server (NTRS)

Ardanuy, P.; Victorine, J.; Sechrist, F.; Feiner, A.; Penn, L.

1988-01-01

The goal of the 1987 Airborne Antarctic Ozone Experiment was to improve the understanding of the mechanisms involved in the formation of the Antarctic ozone hole. Total ozone data taken by the Nimbus-7 Total Ozone Mapping Spectrometer (TOMS) played a central role in the successful outcome of the experiment. During the experiment, the near-real-time TOMS total ozone observations were supplied within hours of real time to the operations center in Punta Arenas, Chile. The final report summarizes the role which Research and Data Systems (RDS) Corporation played in the support of the experiment. The RDS provided telecommunications to support the science and operations efforts for the Airborne Antarctic Ozone Experiment, and supplied near real-time weather information to ensure flight and crew safety; designed and installed the telecommunications network to link NASA-GSFC, the United Kingdom Meteorological Office (UKMO), Palmer Station, the European Center for Medium-Range Weather Forecasts (ECMWF) to the operation at Punta Arenas; engineered and installed stations and other stand-alone systems to collect data from designated low-orbiting polar satellites and beacons; provided analyses of Nimbus-7 TOMS data and backup data products to Punta Arenas; and provided synoptic meteorological data analysis and reduction.

Geostationary platform systems concepts definition study. Volume 2: Technical, book 1

NASA Technical Reports Server (NTRS)

1980-01-01

The initial selection and definition of operational geostationary platform concepts is discussed. Candidate geostationary platform missions and payloads were identified from COMSAT, Aerospace, and NASA studies. These missions and payloads were cataloged; classified with to communications, military, or scientific uses; screened for application and compatibility with geostationary platforms; and analyzed to identify platform requirements. Two platform locations were then selected (Western Hemisphere - 110 deg W, and Atlantic - 15 deg W), and payloads allocated based on nominal and high traffic models. Trade studies were performed leading to recommendation of selected concepts. Of 30 Orbit Transfer Vehicle (0TV) configuration and operating mode options identified, 18 viable candidates compatible with the operational geostationary platform missions were selected for analysis. Each was considered using four platform operational modes - 8 or 16 year life, and serviced or nonserviced, providing a total of 72 OTV/platform-mode options. For final trade study concept selection, a cost program was developed considering payload and platform costs and weight; transportation unit and total costs for the shuttle and OTV; and operational costs such as assembly or construction time, mating time, and loiter time. Servicing costs were added for final analysis and recommended selection.

Effectiveness of balance exercises in the acute post-operative phase following total hip and knee arthroplasty: A randomized clinical trial

PubMed Central

Overend, Tom J; Spaulding, Sandi J; Zecevic, Aleksandra; Kramer, John F

2015-01-01

Objectives: To determine the effectiveness of balance exercises in the acute post-operative phase following total hip arthroplasty or total knee arthroplasty. Methods: Patients who had total hip arthroplasty (n = 30) or total knee arthroplasty (n = 33) were seen in their residence 1–2 times per week for 5 weeks. At the first post-operative home visit, patients were randomly assigned to either typical (TE, n = 33) or typical plus balance (TE + B, n = 30) exercise groups. The TE group completed seven typical surgery-specific joint range-of-motion and muscle strengthening exercises, while the TE + B group completed the typical exercises plus three balance exercises. Patients were assessed before and 5 weeks after administering the rehabilitation program using four outcome measures: (1) the Berg Balance Scale, (2) the Timed Up and Go test, (3) the Western Ontario McMaster Universities Osteoarthritis Index, and (4) the Activities-specific Balance Confidence Scale. Results: Post-intervention scores for all four outcome measures were significantly improved (p < 0.01) over baseline scores. Patients who participated in the TE + B group demonstrated significantly greater improvement on the Berg Balance Scale and the Timed Up and Go tests (p < 0.01). Conclusion: Balance exercises added to a typical rehabilitation program resulted in significantly greater improvements in balance and functional mobility compared to typical exercises alone. PMID:26770765

DISE Summary Report (1992)

DTIC Science & Technology

1994-03-01

Specification and Network Time Protocol(NTP) over the Implementation. RFC-o 119, Network OSI Remote Operations Service. RFC- Working Group, September...approximately ISIS implements a powerful model of 94% of the total computation time. distributed computation known as modelo Timing results are

Bilateral laparoscopic totally extraperitoneal repair without mesh fixation.

PubMed

Dehal, Ahmed; Woodward, Brandon; Johna, Samir; Yamanishi, Frank

2014-01-01

Mesh fixation during laparoscopic totally extraperitoneal repair is thought to be necessary to prevent recurrence. However, mesh fixation may increase postoperative chronic pain. This study aimed to describe the experience of a single surgeon at our institution performing this operation. We performed a retrospective review of the medical records of all patients who underwent bilateral laparoscopic totally extraperitoneal repair without mesh fixation for inguinal hernia from January 2005 to December 2011. Demographic, operative, and postoperative data were obtained for analysis. A total of 343 patients underwent simultaneous bilateral laparoscopic totally extraperitoneal repair of 686 primary and recurrent inguinal hernias from January 2005 to December 2011. The mean operative time was 33 minutes. One patient was converted to an open approach (0.3%), and 1 patient had intraoperative bladder injury. Postoperative hematoma/seroma occurred in 5 patients (1.5%), wound infection in 1 (0.3%), hematuria in 2 (0.6%), and acute myocardial infarction in 1 (0.3%). Chronic pain developed postoperatively in 9 patients (2.6%); 3 of them underwent re-exploration. All patients were discharged home a few hours after surgery except for 3 patients. Among the 686 hernia repairs, there were a total of 20 recurrences (2.9%) in 18 patients (5.2%). Two patients had bilateral recurrences, whereas 16 had unilateral recurrences. Twelve of the recurrences occurred after 1 year (60%). Fourteen recurrences occurred among direct hernias (70%). Compared with the literature, our patients had fewer intraoperative and postoperative complications, less chronic pain, and no increase in operative time or length of hospital stay but had a slight increase in recurrence rate.

Arthroscopic treatment of patients with moderate arthrofibrosis after total knee replacement.

PubMed

Jerosch, Joerg; Aldawoudy, Akram M

2007-01-01

The purpose of this study was to document the effect of arthroscopic management in patients with knee stiffness after total knee replacement. We present a case series study, in which 32 patients have been treated for moderate arthrofibrosis of the knee after total knee replacement, with the same regimen. We have excluded all cases of stiffness, because of infection, mechanical mal-alignment, loosening of the implants and other obvious reasons of stiffness of the knee, rather than pure arthrofibrosis. All patients first underwent a trial of conservative treatment before going for arthroscopic management. A pain catheter for femoral nerve block was inserted just before anesthesia for post-operative pain management. Arthroscopic arthrolysis of the intra-articular pathology was performed in a standardized technique with release of all fibrous bands in the suprapatellar pouch, reestablishing the medial and lateral gutter, release of the patella, resection of the remaining meniscal tissue or an anterior cyclops, if needed. Intensive physiotherapy and continuous passive motion were to start immediately post-operatively. All the patients were available for the follow up and they were evaluated using the knee society rating system. A total of 25 of the 32 procedures resulted in an improvement of the patients knee score. All the knees operated upon had intra-articular fibrous bands, hypertrophic synovitis and peri-patellar adhesions. A total of eight patients suffered from an anterior cyclops lesion and six patients showed pseudomenicus. In 19 cases a medial and lateral relapse of the patella was performed; only 5 patients got an isolated lateral release. The mean knee flexion was 119 degrees (100-130) at the end of arthroscopy and was 97 degrees (75-115) at the last follow up. The eight patients with extension lags decreased from 27 degrees (10 degrees-35 degrees) pre-operatively to 4 degrees (0-10) at time of follow up. The average knee society ratings increased from 70 points prior to the arthroscopy to 86 at time of follow up, which was found to be statistically significant (P < 0.01, student's t test). The average function score also showed improvement from 68 points pre-operatively to 85 at the time of final follow up. The average pain scores improved from 30 points pre-operatively to 41 at the time of final follow up. Our results showed that arthroscopic management of knee stiffness following total knee replacement is a safe and efficient method of treatment. Pain and functional knee scores can improve markedly.

Nerve sparing sutureless total thyroidectomy. Preliminary study.

PubMed

Parmeggiani, Domenico; De Falco, Massimo; Avenia, Nicola; Sanguinetti, Alessandro; Fiore, Andrea; Docimo, Giovanni; Ambrosino, Pasquale; Madonna, Imma; Peltrini, Roberto; Parmeggiani, Umberto

2012-01-01

In the present study the authors assess the advantages of new technologies in thyroid surgery: to prevent nerve injury by using an intra-operative continuous nerve-monitoring techniques and to compare the real advantages of advanced coagulation devices. Among a series of 440 thyroidectomies (jan 2004-feb 2006) the Authors reviewed charts from two groups: (1) 240 total thyroidectomies performed using the traditional monopolar electrocautery, non-absorbable stitches for the principal vascular pedicles. (2) 140 total thyroidectomies performed using dedicated small bipolar electro thermal coagulator (ligasure-precise). (3) Since 2006 in a double blind group selection of 70, we've performed sutureless thyroidectomy with continuous intraoperative nerve monitoring using dedicated endotracheal tube. Mean operative time, post-operative bleeding, post-operative stay, incidence of transient or definitive laryngeal nerve lesions, incidence of permanent or transient hypocalcaemia, costs of the procedures were analyzed. Major complications in the first two groups compared with the data of the literature are absolutely over-imposable, except a reduction of incidence of transient hypocalcaemia in the Precise group, but if we compare data of the 3rd group (NIM), we find a significative reduction of transient and permanent laryngeal nerve palsy incidence. This new technology offers several advantages: (1) atraumatic; (2) easy to use; (3) continuous monitoring and audio feedback to the surgeon (4) works outside the operation field (5) high sensitiveness. Cost-analysis confirm that NIM + ligasure have same or less cost and time and probably less complications than traditional Total Thyroidectomy.

Displays mounted on cutting blocks reduce the learning curve in navigated total knee arthroplasty.

PubMed

Schnurr, Christoph; Eysel, Peer; König, Dietmar Pierre

2011-01-01

The use of computer navigation in total knee arthroplasty (TKA) improves the implant alignment but increases the operation time. Studies have shown that the operation time is further prolonged due to the surgeon's learning curve, and longer operation times have been associated with higher morbidity risks. It has been our hypothesis that an improvement in the human-machine interface might reduce the time required during the learning curve. Accordingly, we asked whether the use of navigation devices with a display fixed on the surgical instruments would reduce the operation time in navigated TKAs performed by navigation beginners. Thirty medical students were randomized and used two navigation devices in rotation: these were the Kolibri® device with an external display and the Dash® device with a display that was fixed on the cutting blocks. The time for adjustment of the tibial and femoral cutting blocks on knee models while using these devices was measured. A significant time reduction was demonstration when the Dash® device was used: The time reduction was 21% for the tibial block (p = 0.007), 40% for the femoral block (p < 0.001), and 32% for the whole procedure (p < 0.001). The integrated display, fixed on surgical instruments in a manner similar to a spirit level, seems to be more user-friendly for navigation beginners. Hence, unproductive time losses during the learning curve may be diminished.

High-frequency Total Focusing Method (TFM) imaging in strongly attenuating materials with the decomposition of the time reversal operator associated with orthogonal coded excitations

NASA Astrophysics Data System (ADS)

Villaverde, Eduardo Lopez; Robert, Sébastien; Prada, Claire

2017-02-01

In the present work, the Total Focusing Method (TFM) is used to image defects in a High Density Polyethylene (HDPE) pipe. The viscoelastic attenuation of this material corrupts the images with a high electronic noise. In order to improve the image quality, the Decomposition of the Time Reversal Operator (DORT) filtering is combined with spatial Walsh-Hadamard coded transmissions before calculating the images. Experiments on a complex HDPE joint demonstrate that this method improves the signal-to-noise ratio by more than 40 dB in comparison with the conventional TFM.

Initial Design and Construction of a Mobil Regenerative Fuel Cell System

NASA Technical Reports Server (NTRS)

Colozza, Anthony J.; Maloney, Thomas; Hoberecht, Mark (Technical Monitor)

2003-01-01

The design and initial construction of a mobile regenerative power system is described. The main components of the power system consists of a photovoltaic array, regenerative fuel cell and electrolyzer. The system is mounted on a modified landscape trailer and is completely self contained. An operational analysis is also presented that shows predicted performance for the system at various times of the year. The operational analysis consists of performing an energy balance on the system based on array output and total desired operational time.

Introduction of an operating room information management system improved overall operating room efficiency.

PubMed

De Deyne, Cathy; Heylen, René

2004-01-01

Operating Room (OR) information systems should manage the OR time, assigned to every surgeon, thereby minimizing the sum of costs of unused OR time and minimizing the costs of elective cases performed outside normal allocated OR time (excess OR-time). The aim of this paper is to illustrate how the introduction of an OR information system influenced daily OR activity performance. Since January 2001, we introduced an OR information system with a visual, airport-like, screen as central part, displaying all scheduled OR activity linked in real-time activity with all OR theatres. For the aim of this paper, we compared all data of OR activity for elective abdominal surgery (EAS) for the first half of 2000 compared to the first half of 2001, after the introduction of our information system. In 2000, 764 elective cases were performed, compared to 815 cases in 2001. For both periods, the total OR time allocated to EAS for this 6 months period was 805 h. For 2000, the total duration of OR activity for EAS was 1044 h 50 min (implicating 239 h 50 min over-time), compared to 1127 h 35 min (implicating 322 h 35 min overtime) for 2001. For 2000, we recorded 147 h 20 min excess time (=exceeding the time limits of OR activity and inducing extra costs) and 46h45min unused OR time. For 2001, we recorded 123 h 04 min excess time and 35 h 21 min unused time. In conclusion, in 2001 we recorded an increase in total OR activity for elective abdominal surgery by 7% in number of procedures and by 8% in total duration. However, in 2001 we recorded a decrease in excess time by 16% (123 h 04 min vs 147 h 20 min), which was for a large part due to a 23% decrease in unused OR time in 2001 compared to 2000 (35 h 21min vs 46 h 45 min). Therefore, the introduction of an OR information system, with a real-time visual display of ongoing OR activity, resulted in a increased performance of OR activity, with more OR procedures performed despite less excess time and less extra costs.

Real-time, interactive, visually updated simulator system for telepresence

NASA Technical Reports Server (NTRS)

Schebor, Frederick S.; Turney, Jerry L.; Marzwell, Neville I.

1991-01-01

Time delays and limited sensory feedback of remote telerobotic systems tend to disorient teleoperators and dramatically decrease the operator's performance. To remove the effects of time delays, key components were designed and developed of a prototype forward simulation subsystem, the Global-Local Environment Telerobotic Simulator (GLETS) that buffers the operator from the remote task. GLETS totally immerses an operator in a real-time, interactive, simulated, visually updated artificial environment of the remote telerobotic site. Using GLETS, the operator will, in effect, enter into a telerobotic virtual reality and can easily form a gestalt of the virtual 'local site' that matches the operator's normal interactions with the remote site. In addition to use in space based telerobotics, GLETS, due to its extendable architecture, can also be used in other teleoperational environments such as toxic material handling, construction, and undersea exploration.

Robotic single-site pelvic lymphadenectomy.

PubMed

Tateo, Saverio; Nozza, Arrigo; Del Pezzo, Chiara; Mereu, Liliana

2014-09-01

To examine the feasibility of performing pelvic lymphadenectomy with robotic single site approach. Recent papers described the feasibility of robotic-single site hysterectomy [1-3] for benign and malign pathologies but only with the development of new single site 5mm instruments as the bipolar forceps, robotic single site platform can be safely utilized also for lymphadenectomy. A 65 year-old, multiparous patient with a body mass index of 22.5 and diagnosed with well differentiated adenocarcinoma of the endometrium underwent a robotic single-site peritoneal washing, total hysterectomy, bilateral adnexectomy and pelvic lymphadenectomy. The procedure was performed using the da Vinci Si Surgical System (Intuitive Surgical, Sunnyvale, CA) through a single 2,5 cm umbilical incision, with a multi-channel system and two single site robotic 5mm instruments. A 3-dimensional, HD 8.5mm endoscope and a 5mm accessory instrument were also utilized. Type I lymphonodes dissection for external iliac and obturator regions was performed [4]. Total operative time was 210 min; incision, trocar placement and docking time occurring in 12 min. Total console time was 183 min, estimated blood loss was 50 ml, no intra-operative or post-operative complications occurred. Hospital discharge occurred on post operative day 2 and total number of lymphnodes removed was 33. Difficulties in term of instrument's clashing and awkward motions have been encountered. Robotic single-site pelvic lymphadenectomy using bipolar forceps and monopolar hook is feasible. New developments are needed to improve surgical ergonomics and additional studies should be performed to explore possible benefits of this procedure. Copyright © 2014 Elsevier Inc. All rights reserved.

Expanding the Operational Use of Total Lightning Ahead of GOES-R

NASA Technical Reports Server (NTRS)

Stano, Geoffrey T.; Wood, Lance; Garner, Tim; Nunez, Roland; Kann, Deirdre; Reynolds, James; Rydell, Nezette; Cox, Rob; Bobb, William R.

2015-01-01

NASA's Short-term Prediction Research and Transition Center (SPoRT) has been transitioning real-time total lightning observations from ground-based lightning mapping arrays since 2003. This initial effort was with the local Weather Forecast Offices (WFO) that could use the North Alabama Lightning Mapping Array (NALMA). These early collaborations established a strong interest in the use of total lightning for WFO operations. In particular the focus started with warning decision support, but has since expanded to include impact-based decision support and lightning safety. SPoRT has used its experience to establish connections with new lightning mapping arrays as they become available. The GOES-R / JPSS Visiting Scientist Program has enabled SPoRT to conduct visits to new partners and expand the number of operational users with access to total lightning observations. In early 2014, SPoRT conducted the most recent visiting scientist trips to meet with forecast offices that will used the Colorado, Houston, and Langmuir Lab (New Mexico) lightning mapping arrays. In addition, SPoRT met with the corresponding Center Weather Service Units (CWSUs) to expand collaborations with the aviation community. These visits were an opportunity to learn about the forecast needs of each office visited as well as to provide on-site training for the use of total lightning, setting the stage for a real-time assessment during May-July 2014. With five lightning mapping arrays covering multiple geographic locations, the 2014 assessment has demonstrated numerous uses of total lightning in varying situations. Several highlights include a much broader use of total lightning for impact-based decision support ranging from airport weather warnings, supporting fire crews, and protecting large outdoor events. The inclusion of the CWSUs has broadened the operational scope of total lightning, demonstrating how these data can support air traffic management, particularly in the Terminal Radar Approach Control Facilities (TRACON) region around an airport. These collaborations continue to demonstrate, from the operational perspective, the utility of total lightning and the importance of continued training and preparation in advance of the Geostationary Lightning Mapper.

75 FR 59733 - Agency Information Collection Activities: Arrival and Departure Record (Forms I-94 and I-94W) and...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-09-28

... of information (a total capital/startup costs and operations and maintenance costs). The comments... Number of Respondents: 100,000. Estimated Number of Total Annual Responses: 100,000. Estimated Time per...

Poor WOMAC scores in contralateral knee negatively impact TKA outcomes: data from the osteoarthritis initiative.

PubMed

Kahn, Timothy L; Soheili, Aydin C; Schwarzkopf, Ran

2014-08-01

While total knee arthroplasty (TKA) has been shown to have excellent outcomes, a significant proportion of patients experience relatively poor post-operative function. In this study, we test the hypothesis that the level of osteoarthritic symptoms in the contralateral knee at the time of TKA is associated with poorer post-operative outcomes in the operated knee. Using longitudinal cohort data from the Osteoarthritis Initiative (OAI), we included 171 patients who received a unilateral TKA. We compared pre-operative Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores in the contralateral knee to post-operative WOMAC scores in the index knee. Pre-operative contralateral knee WOMAC scores were associated with post-operative index knee WOMAC Total scores, indicating that the health of the pre-operative contralateral knee is a significant factor in TKA outcomes. Copyright © 2014 Elsevier Inc. All rights reserved.

Comparison of posterior retroperitoneal and transabdominal lateral approaches in robotic adrenalectomy: an analysis of 200 cases.

PubMed

Kahramangil, Bora; Berber, Eren

2018-04-01

Although numerous studies have been published on robotic adrenalectomy (RA) in the literature, none has done a comparison of posterior retroperitoneal (PR) and transabdominal lateral (TL) approaches. The aim of this study was to compare the outcomes of robotic PR and TL adrenalectomy. This is a retrospective analysis of a prospectively maintained database. Between September 2008 and January 2017, perioperative outcomes of patients undergoing RA through PR and TL approaches were recorded into an IRB-approved database. Clinical and perioperative parameters were compared using Student's t test, Wilcoxon rank-sum test, and χ 2 test. Multivariate regression analysis was performed to determine factors associated with total operative time. 188 patients underwent 200 RAs. 110 patients were operated through TL and 78 patients through PR approach. Overall, conversion rate to open was 2.5% and 90-day morbidity 4.8%. The perioperative outcomes of TL and PR approaches were similar regarding estimated blood loss, rate of conversion to open, length of hospital stay, and 90-day morbidity. PR approach resulted in a shorter mean ± SD total operative time (136.3 ± 38.7 vs. 154.6 ± 48.4 min; p = 0.005) and lower visual analog scale pain score on postoperative day #1 (4.3 ± 2.5 vs. 5.4 ± 2.4; p = 0.001). After excluding tumors larger than 6 cm operated through TL approach, the difference in operative times persisted (136.3 ± 38.7 vs. 153.7 ± 45.7 min; p = 0.009). On multivariate regression analysis, increasing BMI and TL approaches were associated with longer total operative time. This study shows that robotic PR and TL approaches are equally safe and efficacious. With experience, shorter operative time and less postoperative pain can be achieved with PR technique. This supports the preferential utilization of PR approach in high-volume centers with enough experience.

Higher cost of single incision laparoscopic cholecystectomy due to longer operating time. A study of opportunity cost based on meta-analysis

PubMed Central

GIRABENT-FARRÉS, M.

2018-01-01

Background We aimed to calculate the opportunity cost of the operating time to demonstrate that single incision laparoscopic cholecystectomy (SILC) is more expensive than classic laparoscopic cholecystectomy (CLC). Methods We identified studies comparing use of both techniques during the period 2008–2016, and to calculate the opportunity cost, we performed another search in the same period of time with an economic evaluation of classic laparoscopy. We performed a meta-analysis of the items selected in the first review considering the cost of surgery and surgical time, and we analyzed their differences. We subsequently calculated the opportunity cost of these time differences based on the design of a cost/time variable using the data from the second literature review. Results Twenty-seven articles were selected from the first review: 26 for operating time (3.138 patients) and 3 for the cost of surgery (831 patients), and 3 articles from the second review. Both techniques have similar operating costs. Single incision laparoscopy surgery takes longer (16.90min) to perform (p <0.00001) and this difference represents an opportunity cost of 755.97 € (cost/time unit factor of 44.73 €/min). Conclusions SILC costs the same as CLC, but the surgery takes longer to perform, and this difference involves an opportunity cost that increases the total cost of SILC. The value of the opportunity cost of the operating time can vary the total cost of a surgical technique and it should be included in the economic evaluation to support the decision to adopt a new surgical technique. PMID:29549678

Quantitative analysis of treatment process time and throughput capacity for spot scanning proton therapy.

PubMed

Suzuki, Kazumichi; Palmer, Matthew B; Sahoo, Narayan; Zhang, Xiaodong; Poenisch, Falk; Mackin, Dennis S; Liu, Amy Y; Wu, Richard; Zhu, X Ronald; Frank, Steven J; Gillin, Michael T; Lee, Andrew K

2016-07-01

To determine the patient throughput and the overall efficiency of the spot scanning system by analyzing treatment time, equipment availability, and maximum daily capacity for the current spot scanning port at Proton Therapy Center Houston and to assess the daily throughput capacity for a hypothetical spot scanning proton therapy center. At their proton therapy center, the authors have been recording in an electronic medical record system all treatment data, including disease site, number of fields, number of fractions, delivered dose, energy, range, number of spots, and number of layers for every treatment field. The authors analyzed delivery system downtimes that had been recorded for every equipment failure and associated incidents. These data were used to evaluate the patient census, patient distribution as a function of the number of fields and total target volume, and equipment clinical availability. The duration of each treatment session from patient walk-in to patient walk-out of the spot scanning treatment room was measured for 64 patients with head and neck, central nervous system, thoracic, and genitourinary cancers. The authors retrieved data for total target volume and the numbers of layers and spots for all fields from treatment plans for a total of 271 patients (including the above 64 patients). A sensitivity analysis of daily throughput capacity was performed by varying seven parameters in a throughput capacity model. The mean monthly equipment clinical availability for the spot scanning port in April 2012-March 2015 was 98.5%. Approximately 1500 patients had received spot scanning proton therapy as of March 2015. The major disease sites treated in September 2012-August 2014 were the genitourinary system (34%), head and neck (30%), central nervous system (21%), and thorax (14%), with other sites accounting for the remaining 1%. Spot scanning beam delivery time increased with total target volume and accounted for approximately 30%-40% of total treatment time for the total target volumes exceeding 200 cm(3), which was the case for more than 80% of the patients in this study. When total treatment time was modeled as a function of the number of fields and total target volume, the model overestimated total treatment time by 12% on average, with a standard deviation of 32%. A sensitivity analysis of throughput capacity for a hypothetical four-room spot scanning proton therapy center identified several priority items for improvements in throughput capacity, including operation time, beam delivery time, and patient immobilization and setup time. The spot scanning port at our proton therapy center has operated at a high performance level and has been used to treat a large number of complex cases. Further improvements in efficiency may be feasible in the areas of facility operation, beam delivery, patient immobilization and setup, and optimization of treatment scheduling.

An efficient compression scheme for bitmap indices

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

Wu, Kesheng; Otoo, Ekow J.; Shoshani, Arie

2004-04-13

When using an out-of-core indexing method to answer a query, it is generally assumed that the I/O cost dominates the overall query response time. Because of this, most research on indexing methods concentrate on reducing the sizes of indices. For bitmap indices, compression has been used for this purpose. However, in most cases, operations on these compressed bitmaps, mostly bitwise logical operations such as AND, OR, and NOT, spend more time in CPU than in I/O. To speedup these operations, a number of specialized bitmap compression schemes have been developed; the best known of which is the byte-aligned bitmap codemore » (BBC). They are usually faster in performing logical operations than the general purpose compression schemes, but, the time spent in CPU still dominates the total query response time. To reduce the query response time, we designed a CPU-friendly scheme named the word-aligned hybrid (WAH) code. In this paper, we prove that the sizes of WAH compressed bitmap indices are about two words per row for large range of attributes. This size is smaller than typical sizes of commonly used indices, such as a B-tree. Therefore, WAH compressed indices are not only appropriate for low cardinality attributes but also for high cardinality attributes.In the worst case, the time to operate on compressed bitmaps is proportional to the total size of the bitmaps involved. The total size of the bitmaps required to answer a query on one attribute is proportional to the number of hits. These indicate that WAH compressed bitmap indices are optimal. To verify their effectiveness, we generated bitmap indices for four different datasets and measured the response time of many range queries. Tests confirm that sizes of compressed bitmap indices are indeed smaller than B-tree indices, and query processing with WAH compressed indices is much faster than with BBC compressed indices, projection indices and B-tree indices. In addition, we also verified that the average query response time is proportional to the index size. This indicates that the compressed bitmap indices are efficient for very large datasets.« less

The lateral plane delivers higher dose than the frontal plane in biplane cardiac catheterization systems.

PubMed

Aldoss, Osamah; Patel, Sonali; Harris, Kyle; Divekar, Abhay

2015-06-01

The objective of the study is to compare radiation dose between the frontal and lateral planes in a biplane cardiac catheterization laboratory. Tube angulation progressively increases patient and operator radiation dose in single-plane cardiac catheterization laboratories. This retrospective study captured biplane radiation dose in a pediatric cardiac catheterization laboratory between April 2010 and January 2014. Raw and time-indexed fluoroscopic, cineangiographic and total (fluoroscopic + cineangiographic) air kerma (AK, mGy) and kerma area product (PKA, µGym(2)/Kg) for each plane were compared. Data for 716 patients were analyzed: 408 (56.98 %) were male, the median age was 4.86 years, and the median weight was 17.35 kg. Although median beam-on time (minutes) was 4.2 times greater in the frontal plane, there was no difference in raw median total PKA between the two planes. However, when indexed to beam-on time, the lateral plane had a higher median-indexed fluoroscopic (0.75 vs. 1.70), cineangiographic (16.03 vs. 24.92), and total (1.43 vs. 5.15) PKA (p < 0.0001). The median time-indexed total PKA in the lateral plane is 3.6 times the frontal plane. This is the first report showing that the lateral plane delivers a higher dose than the frontal plane per unit time. Operators should consciously reduce the lateral plane beam-on time and incorporate this practice in radiation reduction protocols.

Short-term outcomes of local infiltration anaesthetic in total knee arthroplasty: a randomized controlled double-blinded controlled trial.

PubMed

Mulford, Jonathan S; Watson, Anna; Broe, David; Solomon, Michael; Loefler, Andreas; Harris, Ian

2016-03-01

The primary objective of the study was to determine if local infiltration anaesthetic (LIA) reduced total length of hospital stay in total knee arthroplasty (TKA) patients. The study also examined whether LIA improves early pain management, patient satisfaction and range of motion in TKA patients. We conducted a randomized controlled double-blinded study. Fifty patients undergoing TKA were randomized to receive either placebo or LIA at the time of surgery and on the first day post-operatively. Pain scores, level of satisfaction and range of motion were recorded preoperatively and post-operatively. There was no statistical difference between the groups for length of stay, post-operative pain scores, satisfaction scores or range of motion 6 weeks post-operatively. This randomized double-blinded trial did not demonstrate a decrease in pain or reduction of length of stay due to local infiltration analgesia. © 2015 Royal Australasian College of Surgeons.

Predictors of short-term and long-term incontinence after robot-assisted radical prostatectomy.

PubMed

Shao, I-Hung; Chang, Ying-Hsu; Hou, Chun-Ming; Lin, Zheng-Feng; Wu, Chun-Te

2018-01-01

Purpose To determine retrospectively the prognostic factors for urinary incontinence following robot-assisted radical prostatectomy (RARP). Methods Altogether, 180 patients with localized prostate cancer underwent RARP (same surgeon). Preoperative physical status, disease characteristics, laboratory findings, and surgical technique were recorded and the patients checked 1, 6, 12, and 24 months after RARP regarding their contribution to predicting post-prostatectomy urinary incontinence (PPI). Results Overall, 114 (63.3%) patients had PPI 1 month after RARP and 19 patients (16.0%) at 24 months. Univariate analysis showed that age was a significant factor for predicting PPI at 1 month. PPI predictors at 24 months were age, body mass index, preoperative serum albumin level, previous transurethral resection of the prostate, total operative time, and bladder neck sparing. Multivariate analysis indicated that age and total operative time were significant predictors. Conclusion Older age and longer operative time were highly relevant to short- and long-term PPI occurrence after RARP.

Early Australian experience in robotic sleeve gastrectomy: a single site series.

PubMed

Silverman, Candice D; Ghusn, Michael A

2017-05-01

The use of robotic platforms in bariatric surgery has recently gained relevance. With an increased use of this technology come concerns regarding learning curve effects during the initial implementation phase. The sleeve gastrectomy though may represent an ideal training procedure for introducing the robot into bariatric surgical practice. The present review of the first 10 consecutive robotic sleeve gastrectomy procedures performed in an Australian bariatric programme by a single surgeon describes the evolution of the technique, learning curve and initial patient outcomes. Between 2014 and 2015, robotic sleeve gastrectomies were performed as primary and revisional procedures by a consistent surgeon-assistant team. Technique evolution and theatre set-up were documented. Patient demographics, operative time (robot docking and total operation time), additional operative procedures performed, operative and post-operative complications at 1, 3 and 6 months post-procedure and weight loss achieved at 6 months were retrospectively reviewed from a prospectively maintained database. Ten robotic sleeve gastrectomies were performed without significant operative complications. One patient was treated as an outpatient with oral antibiotics for a superficial wound infection. The median total operative time was 123 min (interquartile range (IQR) 108.8-142.5), with a median incision to docking time of 19 min (IQR 15.0-31.8). Length of stay in hospital was 2-3 days. Median excess weight loss achieved at 6 months was 50% (IQR 33.9-66.5). This study describes a method of safely introducing the da Vinci robot into bariatric surgical practice. © 2016 Royal Australasian College of Surgeons.

Feasibility of a nickel-metal hydride battery for totally implantable artificial hearts.

PubMed

Okamoto, E; Yoshida, T; Fujiyoshi, M; Shimanaka, M; Takeuchi, A; Mitamura, Y; Mikami, T

1996-01-01

An implantable rechargeable battery is one of the key technologies for totally implantable artificial hearts. The nickel-metal hydride (Ni-MH) battery is promising for its high energy density of 1.5-2.0 times that of a nickel-cadmium battery. In this study, the effects of pulsatile discharge loads on the operating time and cycle life of Ni-MH batteries at 39 degrees C were studied. Two battery cells (TH-3M, 1,200 mAh, phi 14.5 x 49 mm; Toshiba, Tokyo, Japan) in series were charge/discharge cycled at 39 degrees C using a charge current of 1CA (1,200 mA) and then were fully discharged to 1.0 V/cell under either pulsatile discharge loads, which mimicked a systole (1 A for 0.3 sec) and a diastole (0.4 A for 0.3 sec), or a non pulsatile discharge load equivalent to the average of the pulsatile loads (0.7 A). Each cycle life test was interrupted on the 482nd cycle under pulsatile load, and on the 423rd cycle under non pulsatile load, because of malfunction of each battery charger. The tests showed that the pulsatile discharge cells had significantly (p < 0.001) less operating time (74.0 +/- 7.15 min) throughout the test period (up to 482 days) compared to the cells under equivalent non pulsatile discharge loads (93.7 +/- 7.74 min). The pulsatile-discharged Ni-MH cells provide significantly less operating time than the constantly discharged cells; the Ni-MH battery has an operating time of over 78 min and a cycle life of almost 500 cycles at 39 degrees C. In conclusion, the Ni-MH battery is feasible as an implantable back-up battery for a totally implantable artificial heart system.

Minimally invasive hip arthroplasty: what role does patient preconditioning play?

PubMed

Pour, Aidin Eslam; Parvizi, Javad; Sharkey, Peter F; Hozack, William J; Rothman, Richard H

2007-09-01

The benefits of minimally invasive total hip arthroplasty continue to be debated. The objective of this study was to investigate the role of patient education, accelerated rehabilitation, and improved pain control on the outcome of total hip arthroplasty performed through a small incision. One hundred patients undergoing total hip arthroplasty at our institution were randomized into one of four groups on the basis of the size of the incision, preoperative counseling, the type of preoperative and postoperative rehabilitation, and the analgesia protocol. The operative parameters, complications, time to discharge to home, functional improvement, and patient satisfaction were assessed. The demographic distribution among the four groups was similar. The extent of functional improvement at the time of discharge to home, patient satisfaction, and walking ability at the time of discharge were better in patients who had received an accelerated preoperative and postoperative rehabilitation regimen regardless of the size of the incision. There was no difference in estimated blood loss, mean operative time, transfusion needs, or complications among the groups. This study highlights the importance of factors such as family education, patient preconditioning, preemptive analgesia, and accelerated preoperative and postoperative rehabilitation in influencing the outcome of total hip arthroplasty. The aforementioned factors, and not the surgical technique per se, may play a major role in imparting the better outcome after minimally invasive total hip arthroplasty that has been reported by various investigators.

Development of neurosurgery in Germany: comparison of data collected by polls for 1997, 2003, and 2008 among providers of neurosurgical care.

PubMed

Steiger, Hans J; Krämer, Michael; Reulen, Hans J

2012-01-01

To deduce structural trends in neurosurgery in Germany by comparison of data derived from polls conducted by the Deutsche Gesellschaft für Neurochirurgie (DGNC) in 1997, 2003 and 2008. The questionnaires of the different polls probed a comparable set of issues. The data from the responding sample were extrapolated to the nationwide average or sum and compared between the different time periods. The number of identified neurosurgical departments increased from 146 to 201 during the years 1997-2008 largely as a result of the new foundation of numerous private groups. Nationwide total neurosurgical bed capacity and intensive care unit bed capacity increased modestly over the time period. The extrapolated total number of neurosurgical operations increased from 196,341 to 319,295. Although cranial and spinal neurosurgery remain the dominant subspecialties, the number of functional neurosurgical procedures and operations for pain increased more than proportionally. Outpatient procedures were established during the time period and corresponded in 2008 to a substantial proportion of the surgical volume. The total number of residents and board-certified neurosurgeons increased during the period 1997-2008 from 1513 to 1961. The proportion of residents decreased during 1997-2003 and then increased again. The number of neurosurgical operations increased in Germany proportionally to the economic growth of other service branches over the time period. Private organizations developed more than neurosurgical departments at university and other general hospitals. Work density measured as operations per physician increased during the period 1997-2008. Copyright © 2012 Elsevier Inc. All rights reserved.

Bilateral Laparoscopic Totally Extraperitoneal Repair Without Mesh Fixation

PubMed Central

Woodward, Brandon; Johna, Samir; Yamanishi, Frank

2014-01-01

Background and Objectives: Mesh fixation during laparoscopic totally extraperitoneal repair is thought to be necessary to prevent recurrence. However, mesh fixation may increase postoperative chronic pain. This study aimed to describe the experience of a single surgeon at our institution performing this operation. Methods: We performed a retrospective review of the medical records of all patients who underwent bilateral laparoscopic totally extraperitoneal repair without mesh fixation for inguinal hernia from January 2005 to December 2011. Demographic, operative, and postoperative data were obtained for analysis. Results: A total of 343 patients underwent simultaneous bilateral laparoscopic totally extraperitoneal repair of 686 primary and recurrent inguinal hernias from January 2005 to December 2011. The mean operative time was 33 minutes. One patient was converted to an open approach (0.3%), and 1 patient had intraoperative bladder injury. Postoperative hematoma/seroma occurred in 5 patients (1.5%), wound infection in 1 (0.3%), hematuria in 2 (0.6%), and acute myocardial infarction in 1 (0.3%). Chronic pain developed postoperatively in 9 patients (2.6%); 3 of them underwent re-exploration. All patients were discharged home a few hours after surgery except for 3 patients. Among the 686 hernia repairs, there were a total of 20 recurrences (2.9%) in 18 patients (5.2%). Two patients had bilateral recurrences, whereas 16 had unilateral recurrences. Twelve of the recurrences occurred after 1 year (60%). Fourteen recurrences occurred among direct hernias (70%). Conclusion: Compared with the literature, our patients had fewer intraoperative and postoperative complications, less chronic pain, and no increase in operative time or length of hospital stay but had a slight increase in recurrence rate. PMID:25392633

Comparison of totally laparoscopic total gastrectomy using an endoscopic linear stapler with laparoscopic-assisted total gastrectomy using a circular stapler in patients with gastric cancer: A single-center experience.

PubMed

Gong, Chung Sik; Kim, Byung Sik; Kim, Hee Sung

2017-12-28

To evaluate the safety and efficacy of totally laparoscopic total gastrectomy (TLTG) with esophagojejunostomy using a linear stapler compared with laparoscopic-assisted total gastrectomy (LATG) using a circular stapler in gastric cancer patients. We retrospectively reviewed 687 patients who underwent laparoscopic total gastrectomy for gastric cancer at a single institution from August 2008 to August 2014. The patients were divided into two groups according to the type of operation: 421 patients underwent TLTG and 266 underwent LATG. Clinicopathologic characteristics and surgical outcomes in the two groups were compared and analyzed. The TLTG group had higher mean ages at the time of operation (57.78 ± 11.20 years and 55.69 ± 11.96 years, P = 0.020) and more histories of abdominal surgery (20.2% and 12.4%, P = 0.008) compared with the LATG group. Surgical outcomes such as intraoperative and postoperative transfusions, combined operations, pain scores and administration of analgesics, and complications were similar between the two groups. However, compared with the LATG group, the TLTG group required a shorter operation time (149 min vs 170 min, P < 0.001), had lower postoperative hematocrit change (3.49% vs 4.04%, P = 0.002), less intraoperative events (3.1% vs 10.2%, P < 0.001), less intraoperative anastomosis events (2.4% vs 7.1%, P = 0.003), faster postoperative recovery such as median time to first flatus (3.30 d vs 3.60 d, P < 0.001), faster median commencement of soft diet (4.30 d vs 4.60 d, P < 0.001) and shorter length of postoperative hospital stay (6.75 d vs 7.02 d, P = 0.005). The intracorporeal method for reconstruction of esophagojejunostomy using a linear stapler may be considered a feasible procedure comparing with extracorporeal anastomosis using circular stapler because TLTG is simpler and more straightforward than LATG. Therefore, TLTG can be recommended as an appropriate procedure for gastric cancer.

Comparison of totally laparoscopic total gastrectomy using an endoscopic linear stapler with laparoscopic-assisted total gastrectomy using a circular stapler in patients with gastric cancer: A single-center experience

PubMed Central

Gong, Chung Sik; Kim, Byung Sik; Kim, Hee Sung

2017-01-01

AIM To evaluate the safety and efficacy of totally laparoscopic total gastrectomy (TLTG) with esophagojejunostomy using a linear stapler compared with laparoscopic-assisted total gastrectomy (LATG) using a circular stapler in gastric cancer patients. METHODS We retrospectively reviewed 687 patients who underwent laparoscopic total gastrectomy for gastric cancer at a single institution from August 2008 to August 2014. The patients were divided into two groups according to the type of operation: 421 patients underwent TLTG and 266 underwent LATG. Clinicopathologic characteristics and surgical outcomes in the two groups were compared and analyzed. RESULTS The TLTG group had higher mean ages at the time of operation (57.78 ± 11.20 years and 55.69 ± 11.96 years, P = 0.020) and more histories of abdominal surgery (20.2% and 12.4%, P = 0.008) compared with the LATG group. Surgical outcomes such as intraoperative and postoperative transfusions, combined operations, pain scores and administration of analgesics, and complications were similar between the two groups. However, compared with the LATG group, the TLTG group required a shorter operation time (149 min vs 170 min, P < 0.001), had lower postoperative hematocrit change (3.49% vs 4.04%, P = 0.002), less intraoperative events (3.1% vs 10.2%, P < 0.001), less intraoperative anastomosis events (2.4% vs 7.1%, P = 0.003), faster postoperative recovery such as median time to first flatus (3.30 d vs 3.60 d, P < 0.001), faster median commencement of soft diet (4.30 d vs 4.60 d, P < 0.001) and shorter length of postoperative hospital stay (6.75 d vs 7.02 d, P = 0.005). CONCLUSION The intracorporeal method for reconstruction of esophagojejunostomy using a linear stapler may be considered a feasible procedure comparing with extracorporeal anastomosis using circular stapler because TLTG is simpler and more straightforward than LATG. Therefore, TLTG can be recommended as an appropriate procedure for gastric cancer. PMID:29358863

Short Operative Duration and Surgical Site Infection Risk in Hip and Knee Arthroplasty Procedures

PubMed Central

Dicks, Kristen V.; Baker, Arthur W.; Durkin, Michael J.; Anderson, Deverick J.; Moehring, Rebekah W.; Chen, Luke F.; Sexton, Daniel J.; Weber, David J.; Lewis, Sarah S.

2016-01-01

OBJECTIVE To determine the association (1) between shorter operative duration and surgical site infection (SSI) and (2) between surgeon median operative duration and SSI risk among first-time hip and knee arthroplasties. DESIGN Retrospective cohort study SETTING A total of 43 community hospitals located in the southeastern United States. PATIENTS Adults who developed SSIs according to National Healthcare Safety Network criteria within 365 days of first-time knee or hip arthroplasties performed between January 1, 2008 and December 31, 2012. METHODS Log-binomial regression models estimated the association (1) between operative duration and SSI outcome and (2) between surgeon median operative duration and SSI outcome. Hip and knee arthroplasties were evaluated in separate models. Each model was adjusted for American Society of Anesthesiology score and patient age. RESULTS A total of 25,531 hip arthroplasties and 42,187 knee arthroplasties were included in the study. The risk of SSI in knee arthroplasties with an operative duration shorter than the 25th percentile was 0.40 times the risk of SSI in knee arthroplasties with an operative duration between the 25th and 75th percentile (risk ratio [RR], 0.40; 95% confidence interval [CI], 0.38–0.56; P <.01). Short operative duration did not demonstrate significant association with SSI for hip arthroplasties (RR, 1.04; 95% CI, 0.79–1.37; P =.36). Knee arthroplasty surgeons with shorter median operative durations had a lower risk of SSI than surgeons with typical median operative durations (RR, 0.52; 95% CI, 0.43–0.64; P <.01). CONCLUSIONS Short operative durations were not associated with a higher SSI risk for knee or hip arthroplasty procedures in our analysis. PMID:26391277

Association Between Patient-Centered Medical Home Rating and Operating Cost at Federally Funded Health Centers

PubMed Central

Nocon, Robert S.; Sharma, Ravi; Birnberg, Jonathan M.; Ngo-Metzger, Quyen; Lee, Sang Mee; Chin, Marshall H.

2013-01-01

Context Little is known about the cost associated with a health center’s rating as a patient-centered medical home (PCMH). Objective To determine whether PCMH rating is associated with operating cost among health centers funded by the US Health Resources and Services Administration. Design, Setting, and Participants Cross-sectional study of PCMH rating and operating cost in 2009. PCMH rating was assessed through surveys of health center administrators conducted by Harris Interactive of all 1009 Health Resources and Services Administration–funded community health centers. The survey provided scores from 0 (worst) to 100 (best) for total PCMH score and 6 subscales: access/communication, care management, external coordination, patient tracking, test/referral tracking, and quality improvement. Costs were obtained from the Uniform Data System reports submitted to the Health Resources and Services Administration. We used generalized linear models to determine the relationship between PCMH rating and operating cost. Main Outcome Measures Operating cost per physician full-time equivalent, operating cost per patient per month, and medical cost per visit. Results Six hundred sixty-nine health centers (66%) were included in the study sample, with 340 excluded because of nonresponse or incomplete data. Mean total PCMH score was 60 (SD,12; range, 21–90). For the average health center, a 10-point higher total PCMH score was associated with a $2.26 (4.6%) higher operating cost per patient per month (95% CI, $0.86–$4.12). Among PCMH subscales, a 10-point higher score for patient tracking was associated with higher operating cost per physician full-time equivalent ($27 300; 95% CI,$3047–$57 804) and higher operating cost per patient per month ($1.06;95%CI,$0.29–$1.98). A 10-point higher score for quality improvement was also associated with higher operating cost per physician full-time equivalent ($32 731; 95% CI, $1571–$73 670) and higher operating cost per patient per month ($1.86; 95% CI, $0.54–$3.61). A 10-point higher PCMH subscale score for access/communication was associated with lower operating cost per physician full-time equivalent ($39 809; 95% CI, $1893–$63 169). Conclusions According to a survey of health center administrators, higher scores on a scale that assessed 6 aspects of the PCMH were associated with higher health center operating costs. Two subscales of the medical home were associated with higher cost and 1 with lower cost. PMID:22729481

Single-Use Energy Sources and Operating Room Time for Laparoscopic Hysterectomy: A Randomized Controlled Trial.

PubMed

Holloran-Schwartz, M Brigid; Gavard, Jeffrey A; Martin, Jared C; Blaskiewicz, Robert J; Yeung, Patrick P

2016-01-01

To compare the intraoperative direct costs of a single-use energy device with reusable energy devices during laparoscopic hysterectomy. A randomized controlled trial (Canadian Task Force Classification I). An academic hospital. Forty-six women who underwent laparoscopic hysterectomy from March 2013 to September 2013. Each patient served as her own control. One side of the uterine attachments was desiccated and transected with the single-use device (Ligasure 5-mm Blunt Tip LF1537 with the Force Triad generator). The other side was desiccated and transected with reusable bipolar forceps (RoBi 5 mm), and transected with monopolar scissors using the same Covidien Force Triad generator. The instrument approach used was randomized to the attending physician who was always on the patient's left side. Resident physicians always operated on the patient's right side and used the converse instruments of the attending physician. Start time was recorded at the utero-ovarian pedicle and end time was recorded after transection of the uterine artery on the same side. Costs included the single-use device; amortized costs of the generator, reusable instruments, and cords; cleaning and packaging of reusable instruments; and disposal of the single-use device. Operating room time was $94.14/min. We estimated that our single use-device cost $630.14 and had a total time savings of 6.7 min per case, or 3.35 min per side, which could justify the expense of the device. The single-use energy device had significant median time savings (-4.7 min per side, p < .001) and total intraoperative direct cost savings ($254.16 per case). A single-use energy device that both desiccates and cuts significantly reduced operating room time to justify its own cost, and it also reduced total intraoperative direct costs during laparoscopic hysterectomy in our institution. Operating room cost per minute varies between institutions and must be considered before generalizing our results. Copyright © 2016 AAGL. Published by Elsevier Inc. All rights reserved.

The effect of time until surgical intervention on survival in dogs with secondary septic peritonitis

PubMed Central

Bush, Maxwell; Carno, Margaret A.; St. Germaine, Lindsay; Hoffmann, Daniel E.

2016-01-01

This retrospective study examined the effect of time to intervention on outcome in cases of dogs with secondary septic peritonitis, and also searched for other potential prognostic factors. The medical records of 55 dogs were reviewed. No association was found between outcome and the time from hospital admission to surgical source control. However, several other factors were found to influence survival, including: age, needing vasopressors, lactate, pre-operative packed cell volume, serum alkaline phosphatase, serum total bilirubin, and post-operative serum albumin. These values were then used to create accurate pre- and post-operative survival prediction models. PMID:27928174

Solar Total Energy Project (STEP) Performance Analysis of High Temperature Energy Storage Subsystem

NASA Technical Reports Server (NTRS)

Moore, D. M.

1984-01-01

The 1982 milestones and lessons learned; performance in 1983; a typical day's operation; collector field performance and thermal losses; and formal testing are highlighted. An initial test that involves characterizing the high temperature storage (hts) subsystem is emphasized. The primary element is on 11,000 gallon storage tank that provides energy to the steam generator during transient solar conditions or extends operating time. Overnight, thermal losses were analyzed. The length of time the system is operated at various levels of cogeneration using stored energy is reviewed.

Operational summary of an electric propulsion long term test facility

NASA Technical Reports Server (NTRS)

Trump, G. E.; James, E. L.; Bechtel, R. T.

1982-01-01

An automated test facility capable of simultaneously operating three 2.5 kW, 30-cm mercury ion thrusters and their power processors is described, along with a test program conducted for the documentation of thruster characteristics as a function of time. Facility controls are analog, with full redundancy, so that in the event of malfunction the facility automaticcally activates a backup mode and notifies an operator. Test data are recorded by a central data collection system and processed as daily averages. The facility has operated continuously for a period of 37 months, over which nine mercury ion thrusters and four power processor units accumulated a total of over 14,500 hours of thruster operating time.

Evaluation of Operating Time and Patient Perception Using Conventional Impression Taking and Intraoral Scanning for Crown Manufacture: A Split-mouth, Randomized Clinical Study.

PubMed

Haddadi, Yasser; Bahrami, Golnosh; Isidor, Flemming

To compare operating time and patient perception of conventional impression (CI) taking and intraoral scanning (IOS) for manufacture of a tooth-supported crown. A total of 19 patients needing indirect full-coverage restorations fitting the requirements for a split-mouth design were recruited. Each patient received two lithium disilicate crowns, one manufactured from CI taking and one from IOS. Both teeth were prepared following the manufacturers' recommendations. For both impression techniques, two retraction cords soaked in 15% ferric sulphate were used for tissue management. CIs were taken in a full-arch metallic tray using one-step, two-viscosity technique with polyvinyl siloxane silicone. The operating time for each step of the two impression methods was registered. Patient perception associated with each method was scored using a 100-mm visual analog scale (VAS), with 100 indicating maximum discomfort. Median total operating time for CI taking was 15:47 minutes (interquartile range [IQR] 15:18 to 17:30), and for IOS was 5:05 minutes (IQR 4:35 to 5:23). The median VAS score for patient perception was 73 (IQR 16 to 89) for CI taking and 6 (IQR 2 to 9) for IOS. The differences between the two groups were statistically significant (P < .05) for both parameters. IOS was less time consuming than CI taking, and patient perception was in favor of IOS.

Time-driven activity based costing of total knee replacement surgery at a London teaching hospital.

PubMed

Chen, Alvin; Sabharwal, Sanjeeve; Akhtar, Kashif; Makaram, Navnit; Gupte, Chinmay M

2015-12-01

The aim of this study was to conduct a time-driven activity based costing (TDABC) analysis of the clinical pathway for total knee replacement (TKR) and to determine where the major cost drivers lay. The in-patient pathway was prospectively mapped utilising a TDABC model, following 20 TKRs. The mean age for these patients was 73.4 years. All patients were ASA grade I or II and their mean BMI was 30.4. The 14 varus knees had a mean deformity of 5.32° and the six valgus knee had a mean deformity of 10.83°. Timings were prospectively collected as each patient was followed through the TKR pathway. Pre-operative costs including pre-assessment and joint school were £ 163. Total staff costs for admission and the operating theatre were £ 658. Consumables cost for the operating theatre were £ 1862. The average length of stay was 5.25 days at a total cost of £ 910. Trust overheads contributed £ 1651. The overall institutional cost of a 'noncomplex' TKR in patients without substantial medical co-morbidities was estimated to be £ 5422, representing a profit of £ 1065 based on a best practice tariff of £ 6487. The major cost drivers in the TKR pathway were determined to be theatre consumables, corporate overheads, overall ward cost and operating theatre staffing costs. Appropriate discounting of implant costs, reduction in length of stay by adopting an enhanced recovery programme and control of corporate overheads through the use of elective orthopaedic treatment centres are proposed approaches for reducing the overall cost of treatment. Copyright © 2015 Elsevier B.V. All rights reserved.

Nutrients removal in hybrid fluidised bed bioreactors operated with aeration cycles.

PubMed

Martin, Martin; Enríquez, L López; Fernández-Polanco, M; Villaverde, S; Garcia-Encina, P A

2007-01-01

Abstract Two hybrid fluidised bed reactors filled with sepiolite and granular activated carbon (GAC) were operated with short cycled aeration for removing organic matter, total nitrogen and phosphorous, respectively. Both reactors were continuously operated with synthetic and/or industrial wastewater containing 350-500 mg COD/L, 110-130 mg NKT/L, 90-100 mg NH3-N/L and 12-15 mg P/L for 8 months. The reactor filled with sepiolite, treating only synthetic wastewater, removed COD, ammonia, total nitrogen and phosphorous up to 88, 91, 55 and 80% with a hydraulic retention time (HRT) of 10 h, respectively. These efficiencies correspond to removal rates of 0.95 kgCODm(-3)d(-1) and 0.16 kg total N m(-3)d(-1). The reactor filled with GAC was operated for 4 months with synthetic wastewater and 4 months with industrial wastewater, removing 98% of COD, 96% of ammonia, and 66% of total nitrogen, with an HRT of 13.6 h. No significant phosphorous removing activity was observed in this reactor. Microbial communities growing with both reactors were followed using polymerase chain reaction (PCR) and denaturing gradient gel electrophoresis (DGGE) techniques. The microbial fingerprints, i.e. DGGE profiles, indicated that biological communities in both reactors were stable along the operational period even when the operating conditions were changed.

[Use of a linear stapler device in total laryngectomy].

PubMed

Liu, Xue-kui; Li, Hao; Liu, Wei-wei; Li, Qiu-li; Li, Quan; Zhang, Xin-rui; Zhang, Xing; Guo, Zhu-ming; Zeng, Zong-yuan

2012-07-01

To evaluate the value of using a linear stapler device for the closure of the pharynx during total laryngectomy. Sixteen total laryngectomies were performed between August 2010 and December 2011, during the operation, the TA 60 linear stapler was used for pharyngeal closure. Among these patients, two patients had the history of pre-operative radiotherapy, four patients recurred after radiotherapy, ten patients were treated for the first time. 100 ml methylene blue was injected into the newly closed laryngopharyngeal cavity through the nasopharyngeal breather pipe for checking up whether it was watertight or not. Among the sixteen patients, methylene blue leakage from the mucosal joint of the gular cavity closed by the stapler were not found in fifteen patients, it was only found in one patient. The transudatory places were sutured with absorbable Vicryl sutures. This patient healed well without pharyngocutaneous fistula. Negative surgical margins were achieved in all patients. No patient needed to be transferred to open surgery. Using a linear stapler device in total laryngectomy, 45 minutes could be saved as compaired to manual suture. One patient developed a light pharyngocutaneous fistula. The incidence of pharyngocutaneous fistula was 6.25% (1/16). This stapled closed technique for pharyngoplasty is efficient, eliminates the risk of wound contamination, saves operation time and decreases the incidence of pharyngocutaneous fistula. This technique can be recommended as alternative for repairing the pharynx in patients undergoing total laryngectomy.

Scientific and Operational Requirements for TOMS Data

NASA Technical Reports Server (NTRS)

Krueger, Arlin J. (Editor)

1987-01-01

Global total ozone and sulfur dioxide data from the Nimbus 7 Total Ozone Mapping Spectrometer (TOMS) instrument have applications in a broad range of disciplines. The presentations of 29 speakers who are using the data in research or who have operational needs for the data are summarized. Five sessions addressed topics in stratospheric processes, tropospheric dynamics and chemistry, remote sensing, volcanology, and future instrument requirements. Stratospheric and some volcanology requirements can be met by a continuation of polar orbit satellites using a slightly modified TOMS but weather related research, tropospheric sulfur budget studies, and most operational needs require the time resolution of a geostationary instrument.

40 CFR 63.1446 - What alternative emission limitation may I meet for my combined gas streams?

Code of Federal Regulations, 2010 CFR

2010-07-01

... than a baghouse or venturi wet scrubber applied to meet any total particulate matter emission limit in... than 5 percent of the total operating time in any semiannual reporting period. (d) For each venturi wet scrubber applied to meet any total particulate matter emission limit in paragraph (b) of this section, you...

Fluvial sediment in Double Creek subwatershed No. 5, Washington County, Oklahoma

USGS Publications Warehouse

Bednar, Gene A.; Waldrep, Thomas E.

1973-01-01

A total of 21,370 tons of fluvial sediment was transported into reservoir No. 5 and a total of 19,930 tons was deposited. Seventy-eight percent of the total fluvial sediment was deposited during the first 9.2 years, or 63 percent of time of reservoir operation. The computed trap efficiency of reservoir No. 5 was 93 percent.

Selecting patients during the "learning curve" of endoscopic Totally Extraperitoneal (TEP) hernia repair.

PubMed

Schouten, N; Elshof, J W M; Simmermacher, R K J; van Dalen, T; de Meer, S G A; Clevers, G J; Davids, P H P; Verleisdonk, E J M M; Westers, P; Burgmans, J P J

2013-12-01

Totally Extraperitoneal (TEP) hernia surgery is associated with little postoperative pain and a fast recovery, but is a technically demanding operative procedure. Apart from the surgeon's expertise, patient characteristics and hernia-related variations may also affect the operative time and outcome. Patient-related factors predictive of perioperative complications, conversion to open anterior repair, and operative time were studied in a cohort of consecutive patients undergoing TEP hernia repair from 2005 to 2009. A total of 3,432 patients underwent TEP. The mean operative time was 26 min (SD ± 10.9), TEP was converted into an open anterior approach in 26 patients (0.8 %), and perioperative complications were observed in 55 (1.6 %) patients. Multivariable regression analysis showed that a history of abdominal surgery (OR 1.76, 95 per cent confidence interval 1.01-3.06; p = 0.05), and the presence of a scrotal (OR 5.31, 1.20-23.43; p = 0.03) or bilateral hernia (OR 2.25, 1.25-4.06; p = 0.01) were independent predictive factors of perioperative complications. Female gender (OR 5.30. 1.52-18.45; p = 0.01), a history of abdominal surgery (OR 3.96, 1.72- 9.12; p = 0.001), and the presence of a scrotal hernia (OR 34.84, 10.42-116.51, p < 0.001) were predictive factors for conversion. A BMI ≥ 25 (effect size (ES) 1.78, 95 % confidence interval 1.09-2.47; p < 0.001) and the presence of a scrotal (ES 5.81, 1.93-9.68; p = 0.003), indirect (ES 2.78, 2.05- 3.50, p < 0.001) or bilateral hernia (ES 10.19, 9.20-11.08; p < 0.001) were associated with a longer operative time. Certain patient characteristics are, even in experienced TEP surgeons, associated with an increased risk of conversion and complications and a longer operative time. For the surgeon gaining experience with TEP, it seems advisable to select relatively young and slender male patients with a unilateral (non-scrotal) hernia and no previous abdominal surgery to enhance patient safety and 'surgeon comfort'.

Improved operative efficiency using a real-time MRI-guided stereotactic platform for laser amygdalohippocampotomy.

PubMed

Ho, Allen L; Sussman, Eric S; Pendharkar, Arjun V; Le, Scheherazade; Mantovani, Alessandra; Keebaugh, Alaine C; Drover, David R; Grant, Gerald A; Wintermark, Max; Halpern, Casey H

2018-04-01

OBJECTIVE MR-guided laser interstitial thermal therapy (MRgLITT) is a minimally invasive method for thermal destruction of benign or malignant tissue that has been used for selective amygdalohippocampal ablation for the treatment of temporal lobe epilepsy. The authors report their initial experience adopting a real-time MRI-guided stereotactic platform that allows for completion of the entire procedure in the MRI suite. METHODS Between October 2014 and May 2016, 17 patients with mesial temporal sclerosis were selected by a multidisciplinary epilepsy board to undergo a selective amygdalohippocampal ablation for temporal lobe epilepsy using MRgLITT. The first 9 patients underwent standard laser ablation in 2 phases (operating room [OR] and MRI suite), whereas the next 8 patients underwent laser ablation entirely in the MRI suite with the ClearPoint platform. A checklist specific to the real-time MRI-guided laser amydalohippocampal ablation was developed and used for each case. For both cohorts, clinical and operative information, including average case times and accuracy data, was collected and analyzed. RESULTS There was a learning curve associated with using this real-time MRI-guided system. However, operative times decreased in a linear fashion, as did total anesthesia time. In fact, the total mean patient procedure time was less in the MRI cohort (362.8 ± 86.6 minutes) than in the OR cohort (456.9 ± 80.7 minutes). The mean anesthesia time was significantly shorter in the MRI cohort (327.2 ± 79.9 minutes) than in the OR cohort (435.8 ± 78.4 minutes, p = 0.02). CONCLUSIONS The real-time MRI platform for MRgLITT can be adopted in an expedient manner. Completion of MRgLITT entirely in the MRI suite may lead to significant advantages in procedural times.

Quantum Model of a Charged Black Hole

NASA Astrophysics Data System (ADS)

Gladush, V. D.

A canonical approach for constructing of the classical and quantum description spherically-symmetric con guration gravitational and electromagnetic elds is considered. According to the sign of the square of the Kodama vector, space-time is divided into R-and T-regions. By virtue of the generalized Birkho theorem, one can choose coordinate systems such that the desired metric functions in the T-region depend on the time, and in the R-domain on the space coordinate. Then, the initial action for the con guration breaks up into terms describing the elds in the T- and R-regions with the time and space evolutionary variable, respectively. For these regions, Lagrangians of the con guration are constructed, which contain dynamic and non-dynamic degrees of freedom, leading to constrains. We concentrate our attention on dynamic T-regions. There are two additional conserved physical quantities: the charge and the total mass of the system. The Poisson bracket of the total mass with the Hamiltonian function vanishes in the weak sense. A classical solution of the eld equations in the con guration space (minisuperspace) is constructed without xing non-dynamic variable. In the framework of the canonical approach to the quantum mechanics of the system under consideration, physical states are found by solving the Hamiltonian constraint in the operator form (the DeWitt equation) for the system wave function Ψ. It also requires that Ψ is an eigenfunction of the operators of charge and total mass. For the symmetric of the mass operator the corresponding ordering of operators is carried out. Since the total mass operator commutes with the Hamiltonian in the weak sense, its eigenfunctions must be constructed in conjunction with the solution of the DeWitt equation. The consistency condition leads to the ansatz, with the help of which the solution of the DeWitt equation for the state Ψem with a defined total mass and charge is constructed, taking into account the regularity condition on the horizon. The mass and charge spectra of the con guration in this approach turn out to be continuous. It is interesting that formal quantization in the R-region with a space evolutionary coordinate leads to a similar result.

Effective and efficient learning in the operating theater with intraoperative video-enhanced surgical procedure training.

PubMed

van Det, M J; Meijerink, W J H J; Hoff, C; Middel, B; Pierie, J P E N

2013-08-01

INtraoperative Video Enhanced Surgical procedure Training (INVEST) is a new training method designed to improve the transition from basic skills training in a skills lab to procedural training in the operating theater. Traditionally, the master-apprentice model (MAM) is used for procedural training in the operating theater, but this model lacks uniformity and efficiency at the beginning of the learning curve. This study was designed to investigate the effectiveness and efficiency of INVEST compared to MAM. Ten surgical residents with no laparoscopic experience were recruited for a laparoscopic cholecystectomy training curriculum either by the MAM or with INVEST. After a uniform course in basic laparoscopic skills, each trainee performed six cholecystectomies that were digitally recorded. For 14 steps of the procedure, an observer who was blinded for the type of training determined whether the step was performed entirely by the trainee (2 points), partially by the trainee (1 point), or by the supervisor (0 points). Time measurements revealed the total procedure time and the amount of effective procedure time during which the trainee acted as the operating surgeon. Results were compared between both groups. Trainees in the INVEST group were awarded statistically significant more points (115.8 vs. 70.2; p < 0.001) and performed more steps without the interference of the supervisor (46.6 vs. 18.8; p < 0.001). Total procedure time was not lengthened by INVEST, and the part performed by trainees was significantly larger (69.9 vs. 54.1 %; p = 0.004). INVEST enhances effectiveness and training efficiency for procedural training inside the operating theater without compromising operating theater time efficiency.

14 CFR 91.1053 - Crewmember experience.

Code of Federal Regulations, 2010 CFR

2010-01-01

...) AIR TRAFFIC AND GENERAL OPERATING RULES GENERAL OPERATING AND FLIGHT RULES Fractional Ownership... and ratings: (1) Total flight time for all pilots: (i) Pilot in command—A minimum of 1,500 hours. (ii) Second in command—A minimum of 500 hours. (2) For multi-engine turbine-powered fixed-wing and powered...

Environmental assessment of alternative pasteurization technologies for fluid milk production using process simulation

USDA-ARS?s Scientific Manuscript database

Fluid milk processing (FMP) has significant environmental impact because of its high energy use. High temperature short time (HTST) pasteurization is the third most energy intensive operation comprising about 16% of total energy use, after clean-in-place operations and packaging. Nonthermal processe...

77 FR 24990 - Marine Terminals and Longshoring Standards; Extension of the Office of Management and Budget's...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-04-26

.... Estimated Total Burden Hours: 47,398. Estimated Cost (Operation and Maintenance): $0. IV. Public..., reporting burden (time and costs) is minimal, collection instruments are clearly understood, and OSHA's... safety and health hazards associated with marine terminals and longshoring operations. OSHA uses the...

Patient profiling can identify patients with adult spinal deformity (ASD) at risk for conversion from nonoperative to surgical treatment: initial steps to reduce ineffective ASD management.

PubMed

Passias, Peter G; Jalai, Cyrus M; Line, Breton G; Poorman, Gregory W; Scheer, Justin K; Smith, Justin S; Shaffrey, Christopher I; Burton, Douglas C; Fu, Kai-Ming G; Klineberg, Eric O; Hart, Robert A; Schwab, Frank; Lafage, Virginie; Bess, Shay

2018-02-01

Non-operative management is a common initial treatment for patients with adult spinal deformity (ASD) despite reported superiority of surgery with regard to outcomes. Ineffective medical care is a large source of resource drain on the health system. Characterization of patients with ASD likely to elect for operative treatment from non-operative management may allow for more efficient patient counseling and cost savings. This study aimed to identify deformity and disability characteristics of patients with ASD who ultimately convert to operative treatment compared with those who remain non-operative and those who initially choose surgery. A retrospective review was carried out. A total of 510 patients with ASD (189 non-operative, 321 operative) with minimum 2-year follow-up comprised the patient sample. Oswestry Disability Index (ODI), Short-Form 36 Health Assessment (SF-36), Scoliosis Research Society questionnaire (SRS-22r), and spinopelvic radiographic alignment were the outcome measures. Demographic, radiographic, and patient-reported outcome measures (PROMs) from a cohort of patients with ASD prospectively enrolled into a multicenter database were evaluated. Patients were divided into three treatment cohorts: Non-operative (NON=initial non-operative treatment and remained non-operative), Operative (OP=initial operative treatment), and Crossover (CROSS=initial non-operative treatment with subsequent conversion to operative treatment). NON and OP groups were propensity score-matched (PSM) to CROSS for baseline demographics (age, body mass index, Charlson Comorbidity Index). Time to crossover was divided into early (<1 year) and late (>1 year). Outcome measures were compared across and within treatment groups at four time points (baseline, 6 weeks, 1 year, and 2 years). Following PSM, 118 patients were included (NON=39, OP=38, CROSS=41). Crossover rate was 21.7% (41/189). Mean time to crossover was 394 days. All groups had similar baseline sagittal alignment, but CROSS had larger pelvic incidence and lumbar lordosis (PI-LL) mismatch than NON (11.9° vs. 3.1°, p=.032). CROSS and OP had similar baseline PROM scores; however, CROSS had worse baseline ODI, PCS, SRS-22r (p<.05). At time of crossover, CROSS had worse ODI (35.7 vs. 27.8) and SRS Satisfaction (2.6 vs. 3.3) compared with NON (p<.05). Alignment remained similar for CROSS from baseline to conversion; however, PROMs (ODI, PCS, SRS Activity/Pain/Total) worsened (p<.05). Early and late crossover evaluation demonstrated CROSS-early (n=25) had worsening ODI, SRS Activity/Pain at time of crossover (p<.05). From time of crossover to 2-year follow-up, CROSS-early had less SRS Appearance/Mental improvement compared with OP. Both CROSS-early/late had worse baseline, but greater improvements, in ODI, PCS, SRS Pain/Total compared with NON (p<.05). Baseline alignment and disability parameters increased crossover odds-Non with Schwab T/L/D curves and ODI≥40 (odds ratio [OR]: 3.05, p=.031), and Non with high PI-LL modifier grades ("+"/'++') and ODI≥40 (OR: 5.57, p=.007) were at increased crossover risk. High baseline and increasing disability over time drives conversion from non-operative to operative ASD care. CROSS patients had similar spinal deformity but worse PROMs than NON. CROSS achieved similar 2-year outcome scores as OP. Profiling at first visit for patients at risk of crossover may optimize physician counseling and cost savings. Copyright © 2017. Published by Elsevier Inc.

Implementation of bipartite or remote unitary gates with repeater nodes

NASA Astrophysics Data System (ADS)

Yu, Li; Nemoto, Kae

2016-08-01

We propose some protocols to implement various classes of bipartite unitary operations on two remote parties with the help of repeater nodes in-between. We also present a protocol to implement a single-qubit unitary with parameters determined by a remote party with the help of up to three repeater nodes. It is assumed that the neighboring nodes are connected by noisy photonic channels, and the local gates can be performed quite accurately, while the decoherence of memories is significant. A unitary is often a part of a larger computation or communication task in a quantum network, and to reduce the amount of decoherence in other systems of the network, we focus on the goal of saving the total time for implementing a unitary including the time for entanglement preparation. We review some previously studied protocols that implement bipartite unitaries using local operations and classical communication and prior shared entanglement, and apply them to the situation with repeater nodes without prior entanglement. We find that the protocols using piecewise entanglement between neighboring nodes often require less total time compared to preparing entanglement between the two end nodes first and then performing the previously known protocols. For a generic bipartite unitary, as the number of repeater nodes increases, the total time could approach the time cost for direct signal transfer from one end node to the other. We also prove some lower bounds of the total time when there are a small number of repeater nodes. The application to position-based cryptography is discussed.

Quantitative analysis of treatment process time and throughput capacity for spot scanning proton therapy

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

Suzuki, Kazumichi, E-mail: kazumichisuzuki@gmail.c

Purpose: To determine the patient throughput and the overall efficiency of the spot scanning system by analyzing treatment time, equipment availability, and maximum daily capacity for the current spot scanning port at Proton Therapy Center Houston and to assess the daily throughput capacity for a hypothetical spot scanning proton therapy center. Methods: At their proton therapy center, the authors have been recording in an electronic medical record system all treatment data, including disease site, number of fields, number of fractions, delivered dose, energy, range, number of spots, and number of layers for every treatment field. The authors analyzed delivery systemmore » downtimes that had been recorded for every equipment failure and associated incidents. These data were used to evaluate the patient census, patient distribution as a function of the number of fields and total target volume, and equipment clinical availability. The duration of each treatment session from patient walk-in to patient walk-out of the spot scanning treatment room was measured for 64 patients with head and neck, central nervous system, thoracic, and genitourinary cancers. The authors retrieved data for total target volume and the numbers of layers and spots for all fields from treatment plans for a total of 271 patients (including the above 64 patients). A sensitivity analysis of daily throughput capacity was performed by varying seven parameters in a throughput capacity model. Results: The mean monthly equipment clinical availability for the spot scanning port in April 2012–March 2015 was 98.5%. Approximately 1500 patients had received spot scanning proton therapy as of March 2015. The major disease sites treated in September 2012–August 2014 were the genitourinary system (34%), head and neck (30%), central nervous system (21%), and thorax (14%), with other sites accounting for the remaining 1%. Spot scanning beam delivery time increased with total target volume and accounted for approximately 30%–40% of total treatment time for the total target volumes exceeding 200 cm{sup 3}, which was the case for more than 80% of the patients in this study. When total treatment time was modeled as a function of the number of fields and total target volume, the model overestimated total treatment time by 12% on average, with a standard deviation of 32%. A sensitivity analysis of throughput capacity for a hypothetical four-room spot scanning proton therapy center identified several priority items for improvements in throughput capacity, including operation time, beam delivery time, and patient immobilization and setup time. Conclusions: The spot scanning port at our proton therapy center has operated at a high performance level and has been used to treat a large number of complex cases. Further improvements in efficiency may be feasible in the areas of facility operation, beam delivery, patient immobilization and setup, and optimization of treatment scheduling.« less

Reducing sedation time for thyroplasty with arytenoid adduction with sequential anesthetic technique.

PubMed

Saadeh, Charles K; Rosero, Eric B; Joshi, Girish P; Ozayar, Esra; Mau, Ted

2017-12-01

To determine the extent to which a sequential anesthetic technique 1) shortens time under sedation for thyroplasty with arytenoid adduction (TP-AA), 2) affects the total operative time, and 3) changes the voice outcome compared to TP-AA performed entirely under sedation/analgesia. Case-control study. A new sequential anesthetic technique of performing most of the TP-AA surgery under general anesthesia (GA), followed by transition to sedation/analgesia (SA) for voice assessment, was developed to achieve smooth emergence from GA. Twenty-five TP-AA cases performed with the sequential GA-SA technique were compared with 25 TP-AA controls performed completely under sedation/analgesia. The primary outcome measure was the time under sedation. Voice improvement, as assessed by Consensus Auditory-Perceptual Evaluation of Voice, and total operative time were secondary outcome measures. With the conventional all-SA anesthetic, the duration of SA was 209 ± 26.3 minutes. With the sequential GA-SA technique, the duration of SA was 79.0 ± 18.9 minutes, a 62.3% reduction (P < 0.0001). There was no significant difference in the total operative time (209.5 vs. 200.9 minutes; P = 0.42) or in voice outcome. This sequential anesthetic technique has been easily adopted by multiple anesthesiologists and nurse anesthetists at our institution. TP-AA is effectively performed under sequential GA-SA technique with a significant reduction in the duration of time under sedation. This allows the surgeon to perform the technically more challenging part of the surgery under GA, without having to contend with variability in patient tolerance for laryngeal manipulation under sedation. 3b. Laryngoscope, 127:2813-2817, 2017. © 2017 The American Laryngological, Rhinological and Otological Society, Inc.

Ultrasonically activated scalpel versus monopolar electrocautery shovel in laparoscopic total mesorectal excision for rectal cancer.

PubMed

Zhou, Bao-Jun; Song, Wei-Qing; Yan, Qing-Hui; Cai, Jian-Hui; Wang, Feng-An; Liu, Jin; Zhang, Guo-Jian; Duan, Guo-Qiang; Zhang, Zhan-Xue

2008-07-07

To investigate the feasibility and safety of monopolar electrocautery shovel (ES) in laparoscopic total mesorectal excision (TME) with anal sphincter preservation for rectal cancer in order to reduce the cost of the laparoscopic operation, and to compare ES with the ultrasonically activated scalpel (US). Forty patients with rectal cancer, who underwent laparoscopic TME with anal sphincter preservation from June 2005 to June 2007, were randomly divided into ultrasonic scalpel group and monopolar ES group, prospectively. White blood cells (WBC) were measured before and after operation, operative time, blood loss, pelvic volume of drainage, time of anal exhaust, visual analogue scales (VAS) and surgery-related complications were recorded. All the operations were successful; no one was converted to open procedure. No significant differences were observed in terms of preoperative and postoperative d 1 and d 3 WBC counts (P=0.493, P=0.375, P=0.559), operation time (P=0.235), blood loss (P=0.296), anal exhaust time (P=0.431), pelvic drainage volume and VAS in postoperative d 1 (P=0.431, P=0.426) and d 3 (P=0.844, P=0.617) between ES group and US group. The occurrence of surgery-related complications such as anastomotic leakage and wound infection was the same in the two groups. ES is a safe and feasible tool as same as US used in laparoscopic TME with anal sphincter preservation for rectal cancer on the basis of the skillful laparoscopic technique and the complete understanding of laparoscopic pelvic anatomy. Application of ES can not only reduce the operation costs but also benefit the popularization of laparoscopic operation for rectal cancer patients.

Ultrasonically activated scalpel versus monopolar electrocautery shovel in laparoscopic total mesorectal excision for rectal cancer

PubMed Central

Zhou, Bao-Jun; Song, Wei-Qing; Yan, Qing-Hui; Cai, Jian-Hui; Wang, Feng-An; Liu, Jin; Zhang, Guo-Jian; Duan, Guo-Qiang; Zhang, Zhan-Xue

2008-01-01

AIM: To investigate the feasibility and safety of monopolar electrocautery shovel (ES) in laparoscopic total mesorectal excision (TME) with anal sphincter preservation for rectal cancer in order to reduce the cost of the laparoscopic operation, and to compare ES with the ultrasonically activated scalpel (US). METHODS: Forty patients with rectal cancer, who underwent laparoscopic TME with anal sphincter preservation from June 2005 to June 2007, were randomly divided into ultrasonic scalpel group and monopolar ES group, prospectively. White blood cells (WBC) were measured before and after operation, operative time, blood loss, pelvic volume of drainage, time of anal exhaust, visual analogue scales (VAS) and surgery-related complications were recorded. RESULTS: All the operations were successful; no one was converted to open procedure. No significant differences were observed in terms of preoperative and postoperative d 1 and d 3 WBC counts (P = 0.493, P = 0.375, P = 0.559), operation time (P = 0.235), blood loss (P = 0.296), anal exhaust time (P = 0.431), pelvic drainage volume and VAS in postoperative d 1 (P = 0.431, P = 0.426) and d 3 (P = 0.844, P = 0.617) between ES group and US group. The occurrence of surgery-related complications such as anastomotic leakage and wound infection was the same in the two groups. CONCLUSION: ES is a safe and feasible tool as same as US used in laparoscopic TME with anal sphincter preservation for rectal cancer on the basis of the skillful laparoscopic technique and the complete understanding of laparoscopic pelvic anatomy. Application of ES can not only reduce the operation costs but also benefit the popularization of laparoscopic operation for rectal cancer patients. PMID:18609692

7 CFR 226.7 - State agency responsibilities for financial management.

Code of Federal Regulations, 2011 CFR

2011-01-01

... provided does not exceed the product of the total enrollment times operating days times approved meal types... the final report is not submitted within this time limit unless FNS grants an exception. Upward... meal reimbursements estimated to be earned during the budget year. However, the State agency may waive...

7 CFR 226.7 - State agency responsibilities for financial management.

Code of Federal Regulations, 2010 CFR

2010-01-01

... provided does not exceed the product of the total enrollment times operating days times approved meal types... the final report is not submitted within this time limit unless FNS grants an exception. Upward... meal reimbursements estimated to be earned during the budget year. However, the State agency may waive...

40 CFR 60.7 - Notification and record keeping.

Code of Federal Regulations, 2010 CFR

2010-07-01

... control systems, productive capacity of the facility before and after the change, and the expected... submitted for each pollutant monitored at each affected facility. (1) If the total duration of excess emissions for the reporting period is less than 1 percent of the total operating time for the reporting...

40 CFR 60.7 - Notification and record keeping.

Code of Federal Regulations, 2013 CFR

2013-07-01

... control systems, productive capacity of the facility before and after the change, and the expected... submitted for each pollutant monitored at each affected facility. (1) If the total duration of excess emissions for the reporting period is less than 1 percent of the total operating time for the reporting...

40 CFR 60.7 - Notification and record keeping.

Code of Federal Regulations, 2011 CFR

2011-07-01

... control systems, productive capacity of the facility before and after the change, and the expected... submitted for each pollutant monitored at each affected facility. (1) If the total duration of excess emissions for the reporting period is less than 1 percent of the total operating time for the reporting...

40 CFR 60.7 - Notification and record keeping.

Code of Federal Regulations, 2014 CFR

2014-07-01

... control systems, productive capacity of the facility before and after the change, and the expected... submitted for each pollutant monitored at each affected facility. (1) If the total duration of excess emissions for the reporting period is less than 1 percent of the total operating time for the reporting...

40 CFR 60.7 - Notification and record keeping.

Code of Federal Regulations, 2012 CFR

2012-07-01

... control systems, productive capacity of the facility before and after the change, and the expected... submitted for each pollutant monitored at each affected facility. (1) If the total duration of excess emissions for the reporting period is less than 1 percent of the total operating time for the reporting...

Associations among pain catastrophizing, muscle strength, and physical performance after total knee and hip arthroplasty

PubMed Central

Hayashi, Kazuhiro; Kako, Masato; Suzuki, Kentaro; Hattori, Keiko; Fukuyasu, Saori; Sato, Koji; Kadono, Izumi; Sakai, Tadahiro; Hasegawa, Yukiharu; Nishida, Yoshihiro

2017-01-01

AIM To investigate whether reductions in pain catastrophizing associated with physical performance in the early period after total knee arthroplasty (TKA) or total hip arthroplasty (THA). METHODS The study group of 46 participants underwent TKA or THA. The participants were evaluated within 7 d before the operation and at 14 d afterwards. Physical performance was measured by the Timed Up and Go (TUG) test, and 10-m gait time was measured at comfortable and maximum speeds. They rated their knee or hip pain using a visual analog scale (VAS) for daily life activities. Psychological characteristics were measured by the Pain Catastrophizing Scale (PCS). Physical characteristics were measured by isometric muscle strength of knee extensors and hip abductors on the operated side. The variables of percent changes between pre- and post-operation were calculated by dividing post-operation score by pre-operation score. RESULTS Postoperative VAS and PCS were better than preoperative for both TKA and THA. Postoperative physical performance and muscle strength were poorer than preoperative for both TKA and THA. The percent change in physical performance showed no correlation with preoperative variables. In TKA patients, the percent change of PCS showed correlation with percent change of TUG (P = 0.016), 10-m gait time at comfortable speeds (P = 0.003), and 10-m gait time at maximum speeds (P = 0.042). The percent change of muscle strength showed partial correlation with physical performances. The percent change of VAS showed no correlation with physical performances. On the other hand, in THA patients, the percent change of hip abductor strength showed correlation with percent change of TUG (P = 0.047), 10-m gait time at comfortable speeds (P = 0.001), and 10-m gait time at maximum speeds (P = 0.021). The percent change of knee extensor strength showed partial correlation with physical performances. The percent change of VAS and PCS showed no correlation with physical performances. CONCLUSION Changes in pain catastrophizing significantly associated with changes in physical performance in the early period after TKA. It contributes to future postoperative rehabilitation of arthroplasty. PMID:28473962

Comparison of closed and open methods of pneumoperitonium in laparoscopic cholecystectomy.

PubMed

Akbar, Mohammad; Khan, Ishtiaq Ali; Naveed, Danish; Khattak, Irfanuddin; Zafar, Arshad; Wazir, Muhammad Salim; Khan, Asif Nawaz; Zia-ur-Rehman

2008-01-01

Pneumoperitonium is the first step in laparoscopic surgery including cholecystectomy. Two commonly used methods to create pneumoperitonium are closed and open technique. Both have advantages and disadvantages. The current study was designed to compare these two techniques in terms of safety and time required to complete the procedure. This was a randomized controlled prospective study conducted at Department of Surgery, Ayub Hospital Complex Abbottabad, from 1st June 2007 to 31st May 2008. Randomization was done into two groups randomly using sealed envelopes containing the questionnaire. Seventy envelopes were kept in the cupboard, containing 35 proformas for group A and 35 for group B. An envelope was randomly fetched and opened upon selection of the patient after taking the informed consent. Pneumoperitonium was created by closed technique in group A, and by open technique in group B. Time required for successful pneumoperitonium was calculated in each group. Failure to induce pneumoperitonium was determined for each technique. Time required to close the wounds at completion, total operating time and injuries sustained during induction of pneumoperitonium were compared in both techniques. Out of the total 70 patients included in study, 35 were in group A and 35 in group B. Mean time required for successful pneumoperitonium was 9.17 minutes in group A and 8.11 minutes in group B. Total operating time ranged from 55 minutes to 130 minutes in group A and from 45 minutes to 110 minutes in group B. Mean of total operating time was 78.34 and 67 minutes in group A and B respectively. Mean time needed to close the wound was 9.88 minutes in group A and 4.97 minutes in group B. Failure of technique was noted in three patients in group A while no failure was experienced in group B. In two cases in group A minor complications during creation of pneumoperitonium were observed while in group B no complication occurred. No patient died in the study. We concluded from this study that open technique of pneumoperitonium was, less time consuming and safer than the closed technique.

Impact of Operative and Postoperative Factors on Neurodevelopmental Outcomes After Cardiac Operations.

PubMed

2016-09-01

Neurodevelopmental disability is common after operations for congenital heart defects. We previously showed that patient and preoperative factors, center, and calendar year of birth explained less than 30% of the variance for the Psychomotor Development Index (PDI) and the Mental Development Index (MDI) of the Bayley Scales of Infant Development-Second Edition. Here we investigate how much additional variance in PDI and MDI is contributed by operative variables and postoperative events. We analyzed neurodevelopmental outcomes after operations with cardiopulmonary bypass at age 9 months or younger between 1996 and 2009. We used linear regression to investigate the effect of operative factors (age, weight, and cardiopulmonary bypass variables) and postoperative events on neurodevelopmental outcomes, adjusting for center, type of congenital heart defect, year of birth, and preoperative factors. We analyzed 1,770 children from 22 institutions with neurodevelopmental testing at age 13.3 months (range, 6 to 30 months). Among operative factors, longer total support time was associated with lower PDI and MDI (p < 0.05). When postoperative events were added, use of either extracorporeal membrane oxygenation or ventricular assist device support, and longer postoperative length of stay were associated with lower PDI and MDI (p < 0.05). Longer total support time was not a significant predictor in these models. After adjusting for patient, preoperative, intraoperative, and postoperative factors, measured intraoperative and postoperative factors accounted for 5% of the variances in PDI and MDI. Operative factors may be less important than innate patient and preoperative factors and postoperative events in predicting early neurodevelopmental outcomes after cardiac operations in infants. Neurodevelopmental outcomes improved over calendar time when adjusted for patient and medical variables. Copyright © 2016 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

The Earth Phenomena Observing System: Intelligent Autonomy for Satellite Operations

NASA Technical Reports Server (NTRS)

Ricard, Michael; Abramson, Mark; Carter, David; Kolitz, Stephan

2003-01-01

Earth monitoring systems of the future may include large numbers of inexpensive small satellites, tasked in a coordinated fashion to observe both long term and transient targets. For best performance, a tool which helps operators optimally assign targets to satellites will be required. We present the design of algorithms developed for real-time optimized autonomous planning of large numbers of small single-sensor Earth observation satellites. The algorithms will reduce requirements on the human operators of such a system of satellites, ensure good utilization of system resources, and provide the capability to dynamically respond to temporal terrestrial phenomena. Our initial real-time system model consists of approximately 100 satellites and large number of points of interest on Earth (e.g., hurricanes, volcanoes, and forest fires) with the objective to maximize the total science value of observations over time. Several options for calculating the science value of observations include the following: 1) total observation time, 2) number of observations, and the 3) quality (a function of e.g., sensor type, range, slant angle) of the observations. An integrated approach using integer programming, optimization and astrodynamics is used to calculate optimized observation and sensor tasking plans.

Intracorporeal esophagojejunostomy after totally laparoscopic total gastrectomy: A single-center 7-year experience

PubMed Central

Chen, Ke; Pan, Yu; Cai, Jia-Qin; Xu, Xiao-Wu; Wu, Di; Yan, Jia-Fei; Chen, Rong-Gao; He, Yang; Mou, Yi-Ping

2016-01-01

AIM: To assess the efficacy and safety of intracorporeal esophagojejunostomy in patients undergoing laparoscopic total gastrectomy (LTG) for gastric cancer. METHODS: A retrospective review of 81 consecutive patients who underwent LTG with the same surgical team between November 2007 and July 2014 was performed. Four types of intracorporeal esophagojejunostomy using staplers or hand-sewn suturing were performed after LTG. Data on clinicopatholgoical characteristics, occurrence of complications, postoperative recovery, anastomotic time, and operation time among the surgical groups were obtained through medical records. RESULTS: The average operation time was 288.7 min, the average anastomotic time was 54.3 min, and the average estimated blood loss was 82.7 mL. There were no cases of conversion to open surgery. The first flatus was observed around 3.7 d, while the liquid diet was started, on average, from 4.9 d. The average postoperative hospital stay was 10.1 d. Postoperative complications occurred in 14 patients, nearly 17.3%. However, there were no cases of postoperative death. CONCLUSION: LTG performed with intracorporeal esophagojejunostomy using laparoscopic staplers or hand-sewn suturing is feasible and safe. The surgical results were acceptable from the perspective of minimal invasiveness. PMID:27022225

Reduced Operating Time but Not Blood Loss With Cruciate Retaining Total Knee Arthroplasty

PubMed Central

Vermesan, Dinu; Trocan, Ilie; Prejbeanu, Radu; Poenaru, Dan V; Haragus, Horia; Gratian, Damian; Marrelli, Massimo; Inchingolo, Francesco; Caprio, Monica; Cagiano, Raffaele; Tatullo, Marco

2015-01-01

Background There is no consensus regarding the use of retaining or replacing cruciate implants for patients with limited deformity who undergo a total knee replacement. Scope of this paper is to evaluate whether a cruciate sparing total knee replacement could have a reduced operating time compared to a posterior stabilized implant. Methods For this purpose, we performed a randomized study on 50 subjects. All procedures were performed by a single surgeon in the same conditions to minimize bias and only knees with a less than 20 varus deviation and/or maximum 15° fixed flexion contracture were included. Results Surgery time was significantly shorter with the cruciate retaining implant (P = 0.0037). The mean duration for the Vanguard implant was 68.9 (14.7) and for the NexGen II Legacy was 80.2 (11.3). A higher range of motion, but no significant Knee Society Scores at 6 months follow-up, was used as controls. Conclusions In conclusion, both implants had the potential to assure great outcomes. However, if a decision has to be made, choosing a cruciate retaining procedure could significantly reduce the surgical time. When performed under tourniquet, this gain does not lead to reduced blood loss. PMID:25584102

Intracorporeal esophagojejunostomy after totally laparoscopic total gastrectomy: A single-center 7-year experience.

PubMed

Chen, Ke; Pan, Yu; Cai, Jia-Qin; Xu, Xiao-Wu; Wu, Di; Yan, Jia-Fei; Chen, Rong-Gao; He, Yang; Mou, Yi-Ping

2016-03-28

To assess the efficacy and safety of intracorporeal esophagojejunostomy in patients undergoing laparoscopic total gastrectomy (LTG) for gastric cancer. A retrospective review of 81 consecutive patients who underwent LTG with the same surgical team between November 2007 and July 2014 was performed. Four types of intracorporeal esophagojejunostomy using staplers or hand-sewn suturing were performed after LTG. Data on clinicopatholgoical characteristics, occurrence of complications, postoperative recovery, anastomotic time, and operation time among the surgical groups were obtained through medical records. The average operation time was 288.7 min, the average anastomotic time was 54.3 min, and the average estimated blood loss was 82.7 mL. There were no cases of conversion to open surgery. The first flatus was observed around 3.7 d, while the liquid diet was started, on average, from 4.9 d. The average postoperative hospital stay was 10.1 d. Postoperative complications occurred in 14 patients, nearly 17.3%. However, there were no cases of postoperative death. LTG performed with intracorporeal esophagojejunostomy using laparoscopic staplers or hand-sewn suturing is feasible and safe. The surgical results were acceptable from the perspective of minimal invasiveness.

The Cassini project: Lessons learned through operations

NASA Astrophysics Data System (ADS)

McCormick, Egan D.

1998-01-01

The Cassini space probe requires 180 238Pu Light-weight Radioisotopic Heater Units (LWRHU) and 216 238Pu General Purpose Heat Source (GPHS) pellets. Additional LWRHU and GPHS pellets required for non-destructive (NDA) and destructive assay purposes were fabricated bringing the original pellet requirement to 224 LWRHU and 252 GPHS. Due to rejection of pellets resulting from chemical impurities in the fuel and/or failure to meet dimensional specifications a total of 320 GPHS pellets were fabricated for the mission. Initial plans called for LANL to process a total of 30 kg of oxide powder for pressing into monolithic ceramic pellets. The original 30 kg commitment was processed within the time frame allotted; an additional 8 kg were required to replace fuel lost due to failure to meet Quality Assurance specifications for impurities and dimensions. During the time frame allotted for pellet production, operations were impacted by equipment failure, unacceptable fuel impurities levels, and periods of extended down time, >30 working days during which little or no processing occurred. Throughout the production process, the reality of operations requirements varied from the theory upon which production schedules were based.

The impact of a preloaded intraocular lens delivery system on operating room efficiency in routine cataract surgery.

PubMed

Jones, Jason J; Chu, Jeffrey; Graham, Jacob; Zaluski, Serge; Rocha, Guillermo

2016-01-01

The aim of this study was to evaluate the operational impact of using preloaded intraocular lens (IOL) delivery systems compared with manually loaded IOL delivery processes during routine cataract surgeries. Time and motion data, staff and surgery schedules, and cost accounting reports were collected across three sites located in the US, France, and Canada. Time and motion data were collected for manually loaded IOL processes and preloaded IOL delivery systems over four surgery days. Staff and surgery schedules and cost accounting reports were collected during the 2 months prior and after introduction of the preloaded IOL delivery system. The study included a total of 154 routine cataract surgeries across all three sites. Of these, 77 surgeries were performed using a preloaded IOL delivery system, and the remaining 77 surgeries were performed using a manual IOL delivery process. Across all three sites, use of the preloaded IOL delivery system significantly decreased mean total case time by 6.2%-12.0% (P<0.001 for data from Canada and the US and P<0.05 for data from France). Use of the preloaded delivery system also decreased surgeon lens time, surgeon delays, and eliminated lens touches during IOL preparation. Compared to a manual IOL delivery process, use of a preloaded IOL delivery system for cataract surgery reduced total case time, total surgeon lens time, surgeon delays, and eliminated IOL touches. The time savings provided by the preloaded IOL delivery system provide an opportunity for sites to improve routine cataract surgery throughput without impacting surgeon or staff capacity.

Neoplasms treatment by diode laser with and without real time temperature control on operation zone

NASA Astrophysics Data System (ADS)

Belikov, Andrey V.; Gelfond, Mark L.; Shatilova, Ksenia V.; Sosenkova, Svetlana A.; Lazareva, Anastasia A.; Semyashkina, Yulia V.

2016-04-01

Results of nevus, papilloma, dermatofibroma, and basal cell skin cancer in vivo removal by a 980+/-10 nm diode laser with "blackened" tip operating in continuous (CW) mode and automatic power control (APC) mode are presented. The collateral damage width and width of graze wound area around the collateral damage area were demonstrated. The total damage area width was calculated as sum of collateral damage width and graze wound area width. The mean width of total damage area reached 1.538+/-0.254 mm for patient group with nevus removing by 980 nm diode laser operating in CW mode, papilloma - 0.586+/-0.453 mm, dermatofibroma - 1.568+/-0.437 mm, and basal cell skin cancer - 1.603+/-0.613 mm. The mean width of total damage area reached 1.201+/-0.292 mm for patient group with nevus removing by 980 nm diode laser operating in APC mode, papilloma - 0.413+/-0.418 mm, dermatofibroma - 1.240+/-0.546 mm, and basal cell skin cancer - 1.204+/-0.517 mm. It was found that using APC mode decreases the total damage area width at removing of these nosological neoplasms of human skin, and decreases the width of graze wound area at removing of nevus and basal cell skin cancer. At the first time, the dynamic of output laser power and thermal signal during laser removal of nevus in CW and APC mode is presented. It was determined that output laser power during nevus removal for APC mode was 1.6+/-0.05 W and for CW mode - 14.0+/-0.1 W. This difference can explain the decrease of the total damage area width and width of graze wound area for APC mode in comparison with CW mode.

[Is the stapled suture in visceral surgery still justified? A prospective controlled, randomized study of cost effectiveness of manual and stapler suture].

PubMed

Izbicki, J R; Gawad, K A; Quirrenbach, S; Hosch, S B; Breid, V; Knoefel, W T; Küpper, H U; Broelsch, C E

1998-07-01

Hospitals are facing increasing economic pressure. It therefore seems necessary to evaluate the efficiency and effectiveness of medical or surgical interventions. In this study 324 anastomoses (167 stapled and 157 hand-sewn) were performed after randomization during 200 elective operations [20.5% gastrectomies, 14% gastric resections (Billroth II), 15% Whipple's procedures, 4% segmental colonic resections, 18% right-sided hemicolectomies, 4% left-sided hemicolectomies, 22% sigmoid- or anterior rectal resections, 2.5% total colectomies with pouch-anal anastomoses] in 200 patients. Postoperative motility (time to full oral diet, time with naso-gastric tube) and hospitalization were comparable in both groups. Anastomotic insufficiency was observed in 2.1% of all patients, five after stapled and two after hand-sewn anastomoses. Hospital mortality was 1.5%. All stapled anastomoses were performed significantly (P < 0.001) faster. However, the cost of material for these anastomoses was significantly (P < 0.001) higher, resulting in significantly higher total costs for reconstruction. The time saving for the reconstruction did not influence the total operative time (except for stapled gastrectomy). Therefore, all operations with stapled reconstruction were more expensive than those with sutured reconstruction. The difference was significant for the gastrectomy (P < 0.01), colonic resection (P < 0.01) and sigmoid and rectal resection (P < 0.001) groups. Stapled and sutured anastomoses are equally effective. Stapled anastomoses are not efficient, however, and should be reserved for individual indications.

Implementation and Analysis of a Lean Six Sigma Program in Microsurgery to Improve Operative Throughput in Perforator Flap Breast Reconstruction.

PubMed

Hultman, Charles Scott; Kim, Sendia; Lee, Clara N; Wu, Cindy; Dodge, Becky; Hultman, Chloe Elizabeth; Roach, S Tanner; Halvorson, Eric G

2016-06-01

Perforator flaps have become a preferred method of breast reconstruction but can consume considerable resources. We examined the impact of a Six Sigma program on microsurgical breast reconstruction at an academic medical center. Using methods developed by Motorola and General Electric, we applied critical pathway planning, workflow analysis, lean manufacturing, continuous quality improvement, and defect reduction to microsurgical breast reconstruction. Primary goals were to decrease preoperative-to-cut time and total operative time, through reduced variability and improved efficiency. Secondary goals were to reduce length of stay, complications, and reoperation. The project was divided into 3 phases: (1) Pre-Six Sigma (24 months), (2) Six Sigma (10 months), (3) and Post-Six Sigma (24 months). These periods (baseline, intervention, control) were compared by Student t test and χ analysis. Over a 5-year period, 112 patients underwent 168 perforator flaps for breast reconstructions, by experienced microsurgeons. Total operative time decreased from 714 to 607 minutes (P < 0.01), across the study period, with the greatest drop occurring in unilateral cases, from 672 to 498 minutes (P < 0.01). Length of stay decreased from 6.3 to 5.2 days (P = 0.01). Overall complication rates (35.9% vs 30%, not significant) and take-back rates (20.5% vs 23.9%, not significant) remained similar over the 5-year period. Physician revenue/minute increased from US $6.28 to US $7.59, whereas hospital revenue/minute increased from US $21.84 to US $25.11. A Six Sigma program in microsurgical breast reconstruction was associated with better operational and financial outcomes. These incremental gains were maintained over the course of the study, suggesting that these benefits were due, in part, to process improvements. However, continued reductions in total operative time and length of stay, well after the intervention period, support the possibility that "learning curve" phenomenon may have contributed to the improvement in these outcomes.

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

Pickerell, D.H.; Abkowitz, M.; Tozzi, J.

The 9 papers in the report deal with the following areas: Federal operating assistance for urban mass transit; a decade of experience; transit route characteristics and headway-based reliability control; day-of-week and part-of-month variation in bus ridership; job satisfaction and transit operator recognition programs; results of a survey of muni operators; bus marketing costs: the experience of 18 section 15 reporters from 1981 to 1983; prospects for differential transit pricing in the United States; an initial analysis of total factor productivity for public-transit coordination of transportation resources: the Georgia experience; absenteeism, accidents, and attrition: part-time versus full-time bus drivers.

The cost analysis of cemented versus cementless total hip replacement operations on the NHS.

PubMed

Kallala, R; Anderson, P; Morris, S; Haddad, F S

2013-07-01

In a time of limited resources, the debate continues over which types of hip prosthesis are clinically superior and more cost-effective. Orthopaedic surgeons increasingly need robust economic evidence to understand the full value of the operation, and to aid decision making on the 'package' of procedures that are available and to justify their practice beyond traditional clinical preference. In this paper we explore the current economic debate about the merits of cemented and cementless total hip replacement, an issue that continues to divide the orthopaedic community.

Determining the Cost-Savings Threshold and Alignment Accuracy of Patient-Specific Instrumentation in Total Ankle Replacements.

PubMed

Hamid, Kamran S; Matson, Andrew P; Nwachukwu, Benedict U; Scott, Daniel J; Mather, Richard C; DeOrio, James K

2017-01-01

Traditional intraoperative referencing for total ankle replacements (TARs) involves multiple steps and fluoroscopic guidance to determine mechanical alignment. Recent adoption of patient-specific instrumentation (PSI) allows for referencing to be determined preoperatively, resulting in less steps and potentially decreased operative time. We hypothesized that usage of PSI would result in decreased operating room time that would offset the additional cost of PSI compared with standard referencing (SR). In addition, we aimed to compare postoperative radiographic alignment between PSI and SR. Between August 2014 and September 2015, 87 patients undergoing TAR were enrolled in a prospectively collected TAR database. Patients were divided into cohorts based on PSI vs SR, and operative times were reviewed. Radiographic alignment parameters were retrospectively measured at 6 weeks postoperatively. Time-driven activity-based costing (TDABC) was used to derive direct costs. Cost vs operative time-savings were examined via 2-way sensitivity analysis to determine cost-saving thresholds for PSI applicable to a range of institution types. Cost-saving thresholds defined the price of PSI below which PSI would be cost-saving. A total of 35 PSI and 52 SR cases were evaluated with no significant differences identified in patient characteristics. Operative time from incision to completion of casting in cases without adjunct procedures was 127 minutes with PSI and 161 minutes with SR ( P < .05). PSI demonstrated similar postoperative accuracy to SR in coronal tibial-plafond alignment (1.1 vs 0.3 degrees varus, P = .06), tibial-plafond alignment (0.3 ± 2.1 vs 1.1 ± 2.1 degrees varus, P = .06), and tibial component sagittal alignment (0.7 vs 0.9 degrees plantarflexion, P = .14). The TDABC method estimated a PSI cost-savings threshold range at our institution of $863 below which PSI pricing would provide net cost-savings. Two-way sensitivity analysis generated a globally applicable cost-savings threshold model based on institution-specific costs and surgeon-specific time-savings. This study demonstrated equivalent postoperative TAR alignment with PSI and SR referencing systems but with a significant decrease in operative time with PSI. Based on TDABC and associated sensitivity analysis, a cost-savings threshold of $863 was identified for PSI pricing at our institution below which PSI was less costly than SR. Similar internal cost accounting may benefit health care systems for identifying cost drivers and obtaining leverage during price negotiations. Level III, therapeutic study.

Hydrogen production from formic acid in pH-stat fed-batch operation for direct supply to fuel cell.

PubMed

Shin, Jong-Hwan; Yoon, Jong Hyun; Lee, Seung Hoon; Park, Tai Hyun

2010-01-01

Enterobacter asburiae SNU-1 harvested after cultivation was used as a whole cell biocatalyst, for the production of hydrogen. Formic acid was efficiently converted to hydrogen using the harvested cells with an initial hydrogen production rate and total hydrogen production of 491 ml/l/h and 6668 ml/l, respectively, when 1 g/l of whole cell enzyme was used. Moreover, new pH-stat fed-batch operation was conducted, and total hydrogen production was 1.4 times higher than that of batch operation. For practical application, bio-hydrogen produced from formic acid using harvested cells was directly applied to PEMFC for power generation.

Improved alignment and operating room efficiency with patient-specific instrumentation for TKA.

PubMed

Renson, Luc; Poilvache, Pascal; Van den Wyngaert, Hans

2014-12-01

Achieving accurate alignment in total knee arthroplasty (TKA) remains a concern. Patient-specific instrumentation (PSI) produced using preoperative 3D models was developed to offer surgeons a simplified, reliable, efficient and customised TKA procedure. In this prospective study, 60 patients underwent TKA with conventional instrumentation and 71 patients were operated on using PSI. The primary endpoint was surgical time. Secondary endpoints included operating room (OR) time, the number of instrument trays used and postoperative radiographic limb alignment. Compared to conventional instrumentation, PSI significantly reduced total surgical time by 8.9 ± 3.3 min (p=0.038), OR time by 8.6 ± 4.2 min (p=0.043), and the number of instrument trays by six trays (p<0.001). Mechanical axis malalignment of the lower limb of >3° was observed in 13% of PSI patients versus 29% with conventional instrumentation (p=0.043). PSI predicted the size of the femoral and tibial components actually used in 85.9% and 78.9% of cases, respectively. PSI improves alignment, surgical and OR time, reduces the number of instruments trays used compared to conventional instrumentation in patients undergoing TKA and results in fewer outliers in overall mechanical alignment in the coronal plane. Prospective comparative therapeutic study. Copyright © 2014 Elsevier B.V. All rights reserved.

The school bus routing and scheduling problem with transfers

PubMed Central

Doerner, Karl F.; Parragh, Sophie N.

2015-01-01

In this article, we study the school bus routing and scheduling problem with transfers arising in the field of nonperiodic public transportation systems. It deals with the transportation of pupils from home to their school in the morning taking the possibility that pupils may change buses into account. Allowing transfers has several consequences. On the one hand, it allows more flexibility in the bus network structure and can, therefore, help to reduce operating costs. On the other hand, transfers have an impact on the service level: the perceived service quality is lower due to the existence of transfers; however, at the same time, user ride times may be reduced and, thus, transfers may also have a positive impact on service quality. The main objective is the minimization of the total operating costs. We develop a heuristic solution framework to solve this problem and compare it with two solution concepts that do not consider transfers. The impact of transfers on the service level in terms of time loss (or user ride time) and the number of transfers is analyzed. Our results show that allowing transfers reduces total operating costs significantly while average and maximum user ride times are comparable to solutions without transfers. © 2015 Wiley Periodicals, Inc. NETWORKS, Vol. 65(2), 180–203 2015 PMID:28163329

Hypocalcaemia and permanent hypoparathyroidism after total/bilateral thyroidectomy in the BAETS Registry

PubMed Central

2017-01-01

The UK Registry of Endocrine and Thyroid Surgeons (UKRETS) has been operated by the British Association of Endocrine and Thyroid Surgeons (BAETS) and Dendrite Clinical Systems Ltd. in a web-based electronic format since 2004. Data on over 90,000 endocrine procedures have been collected to date. Analysis of those cases undergoing bilateral thyroid resections in the interval July 2010 to June 2015 demonstrates that hypocalcaemia remains the commonest complication of thyroid surgery. After first-time total thyroidectomy, 23.6% of patients develop hypocalcaemia, defined as a serum calcium <2.10 mmol/L (or <1.20 mmol/L ionized calcium) on the first post-operative day. Most require treatment with calcium +/− vitamin D supplements, with around 38% of all patients being treated by the time of discharge from the index admission. By 6 months post-operative, 7.3% of patients remain on calcium/vitamin D supplements, reflecting persistent (though not necessarily permanent) hypoparathyroidism. Risk factors for persistent hypocalcaemia are principally concomitant level VI lymph node dissection [odds ratio (OR) =2.73]; re-operative surgery (OR =1.44); and inter-surgeon variation. PMID:29322024

[A study on the thermographic diagnosis of vibration disease of tie-tamper operators in the Japanese National Railways].

PubMed

Hirahata, H

1984-01-01

There have been many studies of thermographic diagnosis of vibration disease, but few of them seem to have discussed tie-tamping machines as a cause. This study focuses on thermographic diagnosis of vibration disease in tie-tamper operators of the Japanese National Railways. In the diagnosis the subject's both hands were immersed in water at 10 degrees C for 3 minutes before being examined. Variables such as season, age, type of vibration tool used and total operating time were considered. These were selected as outside variables and thermographic results as dependent variables, in Quantification Method II. Season and confirmation of vibration disease were found to have a relationship to thermographic scaling, but no such relationship was found for age, type of vibration tool used, or total operating time. A cross-analysis of variables confirmed the relationship with season, and revealed that there were fewer confirmed cases of vibration disease in spring and summer than in fall and winter. It was finally concluded that thermographic analysis is more reliable in colder weather.

A prospective case control comparison of the ZeroGravity system versus a standard lead apron as radiation protection strategy in neuroendovascular procedures.

PubMed

Haussen, Diogo C; Van Der Bom, Imramsjah Martijn John; Nogueira, Raul G

2016-10-01

We aimed to compare the performance of the ZeroGravity (ZG) system (radiation protection system composed by a suspended lead suit) against the use of standard protection (lead apron (LA), thyroid shield, lead eyeglasses, table skirts, and ceiling suspended shield) in neuroangiography procedures. Radiation exposure data were prospectively collected in consecutive neuroendovascular procedures between December 2014 and February 2015. Operator No 1 was assigned to the use of an LA (plus lead glasses, thyroid shield, and a 1 mm hanging shield at the groin) while operator No 2 utilized the ZG system. Dosimeters were used to measure peak skin dose for the head, thyroid, and left foot. The two operators performed a total of 122 procedures during the study period. The ZG operator was more commonly the primary operator compared with the LA operator (85% vs 71%; p=0.04). The mean anterior-posterior (AP), lateral, and cumulative dose area product (DAP) radiation exposure as well as the mean fluoroscopy time were not statistically different between the operators' cases. The peak skin dose to the head of the operator with LA was 2.1 times higher (3380 vs 1600 μSv), while the thyroid was 13.9 (4460 vs 320 μSv), the mediastinum infinitely (520 vs 0 μSv), and the foot 3.3 times higher (4870 vs 1470 μSv) compared with the ZG operator, leading to an overall accumulated dose 4 times higher. The ratio of cumulative operator received dose/total cumulative DAP was 2.5 higher on the LA operator. The ZG radiation protection system leads to substantially lower radiation exposure to the operator in neurointerventional procedures. However, substantial exposure may still occur at the level of the lens and thyroid to justify additional protection. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Development of a safe and pragmatic awake craniotomy program at Maine Medical Center.

PubMed

Rughani, Anand I; Rintel, Theodor; Desai, Rajiv; Cushing, Deborah A; Florman, Jeffrey E

2011-01-01

Awake craniotomy offers an excellent means of performing intraoperative mapping and optimizing surgical resection of brain tumors. Awake craniotomy relies on a strong collaboration between anesthesiologists, neurosurgeons, and operating room staff. The authors recently introduced awake craniotomy for tumor resection at the Maine Medical Center and propose that it can be performed safely, effectively, and efficiently in a high-volume community hospital. We describe a practical approach to performing awake craniotomy involving streamlined anesthetic protocols and simplified intraoperative testing parameters in a carefully selected group of patients. Our first 25 patients are retrospectively reviewed with particular attention to the anesthetic protocol, the extent of resection, the operative time, post-operative complications, the length of hospitalization, and their functional status at follow-up. The authors established an anesthetic protocol based primarily on midazolam, fentanyl, propofol, and local anesthetic. The authors note that all but one patient was able to tolerate the awake procedure. Gross total resection was achieved in nearly 80% of patients with a glial tumor. Operative time was short, averaging 159 minutes of entire anesthesia care. Length of stay averaged 3.7 days. Persistent new post-operative deficits were noted in 2 of 25 patients. There was no substantial difference in total hospital charges for patients undergoing awake craniotomy when compared to a matched historical control. With attention focused on patient selection and a streamlined anesthetic protocol, the authors were able to successfully implement an awake craniotomy protocol in a community setting with satisfying results, including low operative morbidity, short operative times, low anesthetic complications, and excellent patient tolerance.

Prospective Evaluation of Operating Room Inefficiency.

PubMed

Madni, Tarik D; Imran, Jonathan B; Clark, Audra T; Cunningham, Holly B; Taveras, Luis; Arnoldo, Brett D; Phelan, Herb A; Wolf, Steven E

2018-04-06

Previously, we identified that 60% of our facility's total operative time is nonoperative. We performed a review of our operating room to determine where inefficiencies exist in nonoperative time. Live video of operations performed in a burn operating room from 6/23/17 to 8/16/17 were prospectively reviewed. Preparation (end of induction to procedure start) and turnover (patient out of room to next patient in room) were divided into the following activities: 1) Preparation: remove dressing, position patient, clean patient, drape patient, and 2) Turnover: clean operating room, scrub tray set-up, anesthesia set-up. Ideal preparation time was calculated as the sum of time needed to perform preparation activities consecutively. Ideal turnover time was calculated as the sum of time needed to clean the operating room and to set up either the scrub tray or anesthesia (the larger of the two times as these can be done in parallel). We reviewed 101 consecutive operations. An average of 2.4±0.8 cases/day were performed. Ideal preparation and turnover time were 16.6 and 30.1 minutes, a 38.3% and 32.5% reduction compared to actual times. Attending surgeon presence in the operating room within 10 minutes of a patient's arrival was found to significantly decrease time to incision by 33% (52.7±14.3 minutes down to 35.7±20.4, p<0.0001). A reduction in preparation and turnover time could save $1.02 million and generate $1.76 million in additional revenue annually. Reducing preparation and turnover to ideal times could increase caseload to 4/day, leading to millions of dollars of savings annually.

PREMChlor: Probabilistic Remediation Evaluation Model for Chlorinated Solvents

DTIC Science & Technology

2010-03-01

Council O&M Operation & Management PAT pump-and-treat PCE tetrachloroethylene PDFs Probability density functions PRBs Permeable reactive barriers...includes a one-time capital cost and a total operation & management (O&M) cost in present net value (NPV) for a certain remediation period. The...Generally, the costs of plume treatment include the capital cost (treatment volume multiply by the unit cost) and the annual operation & Management (O&M

Induction graphitizing furnace acceptance test report

NASA Technical Reports Server (NTRS)

1972-01-01

The induction furnace was designed to provide the controlled temperature and environment required for the post-cure, carbonization and graphitization processes for the fabrication of a fibrous graphite NERVA nozzle extension. The acceptance testing required six tests and a total operating time of 298 hrs. Low temperature mode operations, 120 to 850 C, were completed in one test run. High temperature mode operations, 120 to 2750 C, were completed during five tests.

Staple Line Reinforcement During Laparoscopic Sleeve Gastrectomy: Absorbable Monofilament, Barbed Suture, Fibrin Glue, or Nothing? Results of a Prospective Randomized Study.

PubMed

Carandina, S; Tabbara, M; Bossi, M; Valenti, A; Polliand, C; Genser, L; Barrat, Christophe

2016-02-01

Laparoscopic sleeve gastrectomy (LSG) is associated with serious complications, such as staple line (SL) leaks and bleeding. In order to prevent the occurrence of these complications, surgeons have advocated the need to strengthen the staple line. The aim of this randomized controlled study was to compare the efficacy of three different ways of strengthening of the SL in LSG in preventing surgical post-operative complications. Between April 2012 and December 2014, 600 patients (pts) scheduled for LSG were prospectively randomized into groups without SL reinforcement (group A) or with SL reinforcement including fibrin glue coverage (group B), or oversewn SL with imbricating absorbable (Monocryl™; group C) or barbed (V lock®) running suture (group D). Primary endpoints were post-operative leaks, bleeding, and stenosis, while secondary outcomes consisted of the time to perform the staple line reinforcement (SLR) and total operative time. Mean SLR operative time was lower for group B (3.4 ± 1.3 min) compared with that for groups C (26.8 ± 8.5 min) and D (21.1 ± 8.4 min) (p < 0.0001). Mean total operative time was 100.7 ± 16.4 min (group A), 104.4 ± 22.1 min (group B), 126.2 ± 18.9 min (group C), and 124.6 ± 22.8 (group D) (p < 0.0001). Post-operative leaks, bleeding, and stenosis were recorded in 14 pts (2.3 %), 5 pts (0.8 %), and 7 pts (1.1 %), respectively, without statistical difference between the groups. Our study suggests that SLR during LSG, with an imbricating or non-imbricating running suture or with fibrin glue, is an unrewarding surgical act with the sole effect of prolonging the operative time.

Accurate Control of Josephson Phase Qubits

DTIC Science & Technology

2016-04-14

1 We begin by noting that g50 is a valid choice for a pulse . This corresponds to applying no electromagnetic radiation for some time. Working with...population during the pulse sequence. The total operation time is equal to n(2p/dv)1t ~where t is the total duration of the electromagnetic radiation... pulse . In the next section we show how transient populations in the third energy level can be highly undesirable in the presence of high tunneling rates

[Early total care pattern for intertrochanteric fracture of femur in the elderly].

PubMed

Gu, Jie; Kang, Xin-yong; Xu, Hong-wei; Li, Yong-fu; Zahng, Bin; Guo, Jian; He, Zhen-nian

2016-06-01

To evaluate clinical results of early total care (ETC) treatment for elderly patients with intertrochanteric femur fractures. Clinical data of 106 elderly patients with intertrochanteric fracture treated from January 2012 and February 2015 were retrospectively studied. According to whether receiving the early total care mode, the patients were divided into 2 groups, 34 cases were diagnosed and treated with early total care pattern (ETC group), including 14 males and 20 females with an average age of (74.88 ± 4.38) years old ranging from 70 to 86. According to Evans types, 4 cases were type I, 5 cases were type II, 13 cases were type III, 11 cases were type IV, 1 case was type V. Seventy-two patients were treated with conventional trauma method (conventional group), including 35 males and 37 females with an average age of (74.46 ± 3.63) years old ranging from 70 to 85. According to Evans type, 8 cases were type I ,13 cases were type II, 25 cases were type III, 25 cases were type IV, and 1 case was type V. All fractures were treated with proximal femoral nails anti-rotation (PFNA). Operative time, hospital stays, leaving bed time, complications, cases of death at 1 year after operation, postoperative Harris score at 12 months were observed and compared. All patients were followed up, the time of ETC group ranged from 9 to 18 months with an average of 13.29 ± 1.51, and the time in conventional group ranged from 12 to 16 months with an average 12.93 ± 1.15, while there was no significant difference between two groups in time of following-up (t = 1.368, P = 0.174). There was no significant meaning in cases of death between ETC group (2 cases) and conventional group (8 cases). Three cases occurred complications in ETC group, and 20 cases in conventional group,there was obvious meaning between two groups (χ² = 0.739, P = 0.318). Operative time,hospital stays,leaving bed time in ETC group respectively was (2.03 ± 0.67) d, (15.41 ± 2.87) d and (3.62 ± 0.74) d; while in conventional group respectively was (4.17 ± 1.59) d, (20.11 ± 4.24) d and (5.35 ± 1.22) d; there were significant differences between two groups in operative time, hospital stays, leaving bed time. Postoperative Harris scores at 12 months in ETC group was (82.32 ± 4.56), and (79.24 ± 5.52) in conventional group, there was obvious meaning between two groups (t = 2.833, P = 0.006). ETC pattern is a novel method for diagnosis and treatment of intertrochanteric femur fractures in elderly, it could shorten operative time, hospital stays, leaving bed time, decrease complications and promote recovery of function.

A prospective, randomised trial comparing closed intramedullary nailing with percutaneous plating in the treatment of distal metaphyseal fractures of the tibia.

PubMed

Guo, J J; Tang, N; Yang, H L; Tang, T S

2010-07-01

We compared the outcome of closed intramedullary nailing with minimally invasive plate osteosynthesis using a percutaneous locked compression plate in patients with a distal metaphyseal fracture in a prospective study. A total of 85 patients were randomised to operative stabilisation either by a closed intramedullary nail (44) or by minimally invasive osteosynthesis with a compression plate (41). Pre-operative variables included the patients' age and the side and pattern of the fracture. Peri-operative variables were the operating time and the radiation time. Postoperative variables were wound problems, the time to union of the fracture, the functional American Orthopaedic Foot and Ankle surgery score and removal of hardware. We found no significant difference in the pre-operative variables or in the time to union in the two groups. However, the mean radiation time and operating time were significantly longer in the locked compression plate group (3.0 vs 2.12 minutes, p < 0.001, and 97.9 vs 81.2 minutes, p < 0.001, respectively).After one year, all the fractures had united. Patients who had intramedullary nailing had a higher mean pain score (40 = no pain, 0 = severe pain), [corrected] but better function, alignment and total American Orthopaedic Foot and Ankle surgery scores, although the differences were not statistically significant (p = 0.234, p = 0.157, p = 0.897, p = 0.177 respectively). Three (6.8%) patients in the intramedullary nailing group and six (14.6%) in the locked compression plate group showed delayed wound healing, and 37 (84.1%) in the former group and 38 (92.7%) in the latter group expressed a wish to have the implant removed. We conclude that both closed intramedullary nailing and a percutaneous locked compression plate can be used safely to treat Orthopaedic Trauma Association type-43A distal metaphyseal fractures of the tibia. However, closed intramedullary nailing has the advantage of a shorter operating and radiation time and easier removal of the implant. We therefore prefer closed intramedullary nailing for patients with these fractures.

Effect of virtual reality training on laparoscopic surgery: randomised controlled trial

PubMed Central

Soerensen, Jette L; Grantcharov, Teodor P; Dalsgaard, Torur; Schouenborg, Lars; Ottosen, Christian; Schroeder, Torben V; Ottesen, Bent S

2009-01-01

Objective To assess the effect of virtual reality training on an actual laparoscopic operation. Design Prospective randomised controlled and blinded trial. Setting Seven gynaecological departments in the Zeeland region of Denmark. Participants 24 first and second year registrars specialising in gynaecology and obstetrics. Interventions Proficiency based virtual reality simulator training in laparoscopic salpingectomy and standard clinical education (controls). Main outcome measure The main outcome measure was technical performance assessed by two independent observers blinded to trainee and training status using a previously validated general and task specific rating scale. The secondary outcome measure was operation time in minutes. Results The simulator trained group (n=11) reached a median total score of 33 points (interquartile range 32-36 points), equivalent to the experience gained after 20-50 laparoscopic procedures, whereas the control group (n=10) reached a median total score of 23 (22-27) points, equivalent to the experience gained from fewer than five procedures (P<0.001). The median total operation time in the simulator trained group was 12 minutes (interquartile range 10-14 minutes) and in the control group was 24 (20-29) minutes (P<0.001). The observers’ inter-rater agreement was 0.79. Conclusion Skills in laparoscopic surgery can be increased in a clinically relevant manner using proficiency based virtual reality simulator training. The performance level of novices was increased to that of intermediately experienced laparoscopists and operation time was halved. Simulator training should be considered before trainees carry out laparoscopic procedures. Trial registration ClinicalTrials.gov NCT00311792. PMID:19443914

The effect of drainage tube on bleeding and prognosis after total knee arthroplasty: a prospective cohort study.

PubMed

Liu, Xiao-Han; Fu, Pei-Liang; Wang, Shi-Ying; Yang, Ya-Juan; Lu, Gen-Di

2014-04-23

To evaluate the effect of drainage tube on prognosis after total knee arthroplasty (TKA) and explore an effective treatment with favorable prognosis. In a prospective study, 18 patients with TKA for the first time were included and randomly divided into three groups, group A (no placement of drainage tube), group B (negative pressure drainage), and group C (4 h clamping drainage). Intraoperative and postoperative blood loss, operation time, and the drainage volume were recorded and analyzed. Arthrocele, ecchymosis, and range of motion (ROM) were examined postoperatively. The degree of pain was scored by Visual Analog Scale (VAS) after 6, 12, and 24 h of operation. The complications were examined and HSS (hospital for special surgery) knee score was taken during the follow-up period. There was no significant difference in operation time, total blood loss, intraoperative blood loss, and VAS score among three groups. Meanwhile, the hidden blood loss in group B was significantly decreased compared with group A (P = 0.0015). The postoperative drainage volume of group B was significantly increased compared with group C (P = 0.0002). No drainage increased the rate of arthrocele and ecchymosis. Compared with group A, ROM after 3 days of operation in groups B and C was significantly increased (P = 0.0357, P = 0.0372, respectively). During follow-up study, no deep infection or deep venous thrombosis was found. After TKA, early clamping of the drainage tube reduced the bleeding loss without adverse effect on prognosis, which might be useful for clinical application in future.

Direct cost comparison of totally endoscopic versus open ear surgery.

PubMed

Patel, N; Mohammadi, A; Jufas, N

2018-02-01

Totally endoscopic ear surgery is a relatively new method for managing chronic ear disease. This study aimed to test the null hypothesis that open and endoscopic approaches have similar direct costs for the management of attic cholesteatoma, from an Australian private hospital setting. A retrospective direct cost comparison of totally endoscopic ear surgery and traditional canal wall up mastoidectomy for the management of attic cholesteatoma in a private tertiary setting was undertaken. Indirect and future costs were excluded. A direct cost comparison of anaesthetic setup and resources, operative setup and resources, and surgical time was performed between the two techniques. Totally endoscopic ear surgery has a mean direct cost reduction of AUD$2978.89 per operation from the hospital perspective, when compared to canal wall up mastoidectomy. Totally endoscopic ear surgery is more cost-effective, from an Australian private hospital perspective, than canal wall up mastoidectomy for attic cholesteatoma.

Efficacy of Multimodal Pain Control Protocol in the Setting of Total Hip Arthroplasty

PubMed Central

Lee, Kyung-Jae; Bae, Ki-Cheor; Cho, Chul-Hyun; Kwon, Doo-Hyun

2009-01-01

Background This study evaluated the benefits and safety of a multimodal pain control protocol, which included a periarticular injection of local anesthetics, in patients undergoing total hip arthroplasty. Methods Between March 2006 and March 2007, 60 patients undergoing unilateral total hip arthroplasty were randomized to undergo either a multimodal pain control protocol or a conventional pain control protocol. The following parameters were compared: the preoperative and postoperative visual analogue scales (VAS), hospital stay, operative time, postoperative rehabilitation, additional painkiller consumption, and complication rates. Results There was no difference between the groups in terms of diagnosis, age, gender, and BMI. Although both groups had similar VAS scores in the preoperative period and on the fifth postoperative day, there was a significant difference between the groups over the four-day period after surgery. There were no differences in the hospital stay, operative time, additional painkiller consumption, or complication rate between the groups. The average time for comfortable crutch ambulation was 2.8 days in the multimodal pain control protocol group and 5.3 days in the control group. Conclusions The multimodal pain control protocol can significantly reduce the level of postoperative pain and improve patients' satisfaction, with no apparent risks, after total hip arthroplasty. PMID:19885051

Comparison of ultrasonic energy expenditures and corneal endothelial cell density reductions during modulated and non-modulated phacoemulsification.

PubMed

Davison, James A

2007-01-01

To compare the Legacy 20000 Advantec continuous and Infiniti hyperpulse modes (Alcon Laboratories, Fort Worth, TX) with respect to average power, machine-measured phacoemulsification time, total stopwatch real time spent within the phacoemulsification process, balanced salt solution (BSS) volume, and corneal endothelial cell density losses. A background study was done of consecutive patients operated on with the Legacy (n = 60) and Infiniti (n = 40) machines programmed with identical parameters and using the continuous mode only. A primary study of another set of consecutive cases was operated on using the Legacy (n = 87) and Infiniti (n = 94) with the same parameters, but using the hyperpulse mode during quadrant removal with the Infiniti. Measurements for each set included average power and phacoemulsification time with corneal endothelial cell densities, BSS volume, and time spent in the phacoemulsification process. Similarities were found in the background study for average power percent and average minutes of phacoemulsification time. In the primary study, similarities were found for total minutes in the phacoemulsification process, BSS usage, and ECD losses, and differences were found for average power percent (P< .001) and machine-measured phacoemulsification minutes (P< .001). The Legacy and Infiniti performed similarly in continuous mode. With the Infiniti hyperpulse mode, a total ultrasonic energy reduction of 66% was noted. The machines required the same amount of total stopwatch measured time to accomplish phacoemulsification and produced the same 5% corneal endothelial cell loss. Therefore, clinically, these two machines behave in a comparable manner relative to safety and effectiveness.

Elective laparoscopic recto-sigmoid resection for diverticular disease is suitable as a training operation.

PubMed

Bosker, Robbert; Hoogenboom, Froukje; Groen, Henk; Hoff, Christiaan; Ploeg, Rutger; Pierie, Jean-Pierre

2010-04-01

Some authors state that elective laparoscopic recto-sigmoid resection is more difficult for diverticular disease as compared with malignancy. For this reason, starting laparoscopic surgeons might avoid diverticulitis, making the implementation phase unnecessary long. The aim of this study was to determine whether laparoscopic resection for diverticular disease should be included during the implementation phase. All consecutive patients who underwent an elective laparoscopic recto-sigmoid resection in our hospital for diverticulitis or cancer from 2003 to 2007 were analysed. A total of 256 consecutive patients were included in this prospective cohort study. One hundred and fifty-one patients were operated on for diverticulitis and 105 for cancer. There was no significant difference in operation time (168 vs. 172 min), blood loss (189 vs. 208 ml), conversion rates (9.9% vs. 11.4%), hospital stay (8 vs. 8 days), total number of peroperative (2.3% vs. 1.6%) or postoperative complications (21.9% vs. 26.9%). The occurrence of anastomotic leakages was associated with higher American Society of Anesthesiologists (ASA) classification, which differed between the groups (86.8% vs. 64.8% ASA I-II, p < 0.001). Since there are no differences in operation time, blood loss, conversion rate and total complications, there is no need to avoid laparoscopic recto-sigmoid resection for diverticular disease early in the learning curve.

Evaluation of constructed wetland treatment performance for winery wastewater.

PubMed

Grismer, Mark E; Carr, Melanie A; Shepherd, Heather L

2003-01-01

Rapid expansion of wineries in rural California during the past three decades has created contamination problems related to winery wastewater treatment and disposal; however, little information is available about performance of on-site treatment systems. Here, the project objective was to determine full-scale, subsurface-flow constructed wetland retention times and treatment performance through assessment of water quality by daily sampling of total dissolved solids, pH, total suspended solids, chemical oxygen demand (COD), tannins, nitrate, ammonium, total Kjeldahl nitrogen, phosphate, sulfate, and sulfide across operating systems for winery wastewater treatment. Measurements were conducted during both the fall crush season of heavy loading and the spring following bottling and racking operations at the winery. Simple decay model coefficients for these constituents as well as COD and tannin removal efficiencies from winery wastewater in bench-scale reactors are also determined. The bench-scale study used upward-flow, inoculated attached-growth (pea-gravel substrate) reactors fed synthetic winery wastewater. Inlet and outlet tracer studies for determination of actual retention times were essential to analyses of treatment performance from an operational subsurface-flow constructed wetland that had been overloaded due to failure to install a pretreatment system for suspended solids removal. Less intensive sampling conducted at a smaller operational winery wastewater constructed wetland that had used pretreatment suspended solids removal and aeration indicated that the constructed wetlands were capable of complete organic load removal from the winery wastewater.

Robotic hysterectomy versus conventional laparoscopic hysterectomy: outcome and cost analyses of a matched case-control study.

PubMed

Sarlos, Dimitri; Kots, Lavonne; Stevanovic, Nebojsa; Schaer, Gabriel

2010-05-01

Robotic surgery, with its technical advances, promises to open a new window to minimally invasive surgery in gynaecology. Feasibility and safety of this surgical innovation have been demonstrated in several studies, and now a critical analysis of these new developments regarding outcome and costs is in place. So far only a few studies compare robotic with conventional laparoscopic surgery in gynaecology. Our objective was to evaluate our initial experience performing total robot-assisted hysterectomy with the da Vinci surgical system and compare peri-operative outcome and costs with total laparoscopic hysterectomy. For this prospective matched case-control study at our institution, peri-operative data from our first 40 consecutive total robot-assisted hysterectomies for benign indications were recorded and matched 1:1 with total laparoscopic hysterectomies according to age, BMI and uterus weight. Surgical costs were calculated for both procedures. Surgeons' subjective impressions of robotics were evaluated with a self-developed questionnaire. No conversions to laparotomy or severe peri-operative complications occurred. Mean operating time was 109 (113; 50-170) min for the robotic group and 83 (80; 55-165) min for the conventional laparoscopic group. Mean postoperative hospitalisation for robotic surgery was 3.3 (3; 2-6) days versus 3.9 (4; 2-7) days for the conventional laparoscopic group. Average surgical cost of a robot-assisted laparoscopic hysterectomy was 4067 euros compared to 2151 euros for the conventional laparoscopic procedure at our institution. For the robotic group wider range of motion of the instruments and better ergonomics were considered to be an advantage, and lack of direct access to the patient was stated as a disadvantage. Robot-assited hysterectomy is a feasible and interesting new technique with comparable outcome to total laparoscopic hysterectomy. Operating times of total laparoscopic hysterectomy seem to be achieved quickly especially for experienced laparoscopic surgeons. However, costs of robotic surgery are still higher than for conventional laparoscopy. Randomised clinical trials need to be conducted to further evaluate benefits of this new technology for patients and surgeons and analyse its cost-effectiveness in gynaecology. Copyright (c) 2010 Elsevier Ireland Ltd. All rights reserved.

Stable and verifiable state estimation methods and systems with spacecraft applications

NASA Technical Reports Server (NTRS)

Li, Rongsheng (Inventor); Wu, Yeong-Wei Andy (Inventor)

2001-01-01

The stability of a recursive estimator process (e.g., a Kalman filter is assured for long time periods by periodically resetting an error covariance P(t.sub.n) of the system to a predetermined reset value P.sub.r. The recursive process is thus repetitively forced to start from a selected covariance and continue for a time period that is short compared to the system's total operational time period. The time period in which the process must maintain its numerical stability is significantly reduced as is the demand on the system's numerical stability. The process stability for an extended operational time period T.sub.o is verified by performing the resetting step at the end of at least one reset time period T.sub.r whose duration is less than the operational time period T.sub.o and then confirming stability of the process over the reset time period T.sub.r. Because the recursive process starts from a selected covariance at the beginning of each reset time period T.sub.r, confirming stability of the process over at least one reset time period substantially confirms stability over the longer operational time period T.sub.o.

Variability in the skin exposure of machine operators exposed to cutting fluids.

PubMed

Wassenius, O; Järvholm, B; Engström, T; Lillienberg, L; Meding, B

1998-04-01

This study describes a new technique for measuring skin exposure to cutting fluids and evaluates the variability of skin exposure among machine operators performing cyclic (repetitive) work. The technique is based on video recording and subsequent analysis of the video tape by means of computer-synchronized video equipment. The time intervals at which the machine operator's hand was exposed to fluid were registered, and the total wet time of the skin was calculated by assuming different evaporation times for the fluid. The exposure of 12 operators with different work methods was analyzed in 6 different workshops, which included a range of machine types, from highly automated metal cutting machines (ie, actual cutting and chip removal machines) requiring operator supervision to conventional metal cutting machines, where the operator was required to maneuver the machine and manually exchange products. The relative wet time varied between 0% and 100%. A significant association between short cycle time and high relative wet time was noted. However, there was no relationship between the degree of automatization of the metal cutting machines and wet time. The study shows that skin exposure to cutting fluids can vary considerably between machine operators involved in manufacturing processes using different types of metal cutting machines. The machine type was not associated with dermal wetness. The technique appears to give objective information about dermal wetness.

Unsupervised laparoscopic appendicectomy by surgical trainees is safe and time-effective.

PubMed

Wong, Kenneth; Duncan, Tristram; Pearson, Andrew

2007-07-01

Open appendicectomy is the traditional standard treatment for appendicitis. Laparoscopic appendicectomy is perceived as a procedure with greater potential for complications and longer operative times. This paper examines the hypothesis that unsupervised laparoscopic appendicectomy by surgical trainees is a safe and time-effective valid alternative. Medical records, operating theatre records and histopathology reports of all patients undergoing laparoscopic and open appendicectomy over a 15-month period in two hospitals within an area health service were retrospectively reviewed. Data were analysed to compare patient features, pathology findings, operative times, complications, readmissions and mortality between laparoscopic and open groups and between unsupervised surgical trainee operators versus consultant surgeon operators. A total of 143 laparoscopic and 222 open appendicectomies were reviewed. Unsupervised trainees performed 64% of the laparoscopic appendicectomies and 55% of the open appendicectomies. There were no significant differences in complication rates, readmissions, mortality and length of stay between laparoscopic and open appendicectomy groups or between trainee and consultant surgeon operators. Conversion rates (laparoscopic to open approach) were similar for trainees and consultants. Unsupervised senior surgical trainees did not take significantly longer to perform laparoscopic appendicectomy when compared to unsupervised trainee-performed open appendicectomy. Unsupervised laparoscopic appendicectomy by surgical trainees is safe and time-effective.

The high prevalence of pathologic calcium crystals in pre-operative knees.

PubMed

Derfus, Beth A; Kurian, Jason B; Butler, Jeffrey J; Daft, Laureen J; Carrera, Guillermo F; Ryan, Lawrence M; Rosenthal, Ann K

2002-03-01

Calcium pyrophosphate dihydrate (CPPD) and basic calcium phosphate (BCP) crystals are important in the pathogenesis of osteoarthritis (OA) but are under recognized even in end stage disease. We determined the prevalence of these calcium crystals in synovial fluid (SF) of persons undergoing total knee arthroplasty for degenerative arthritis. SF samples were obtained from 53 knee joints undergoing total arthroplasty for a pre-operative diagnosis of OA. SF were analyzed via compensated light microscopy for CPPD crystals and a semiquantitative radiometric assay for BCP crystals. Fifty pre-operative radiographs were analyzed and graded according to the scale of Kellgren and Lawrence. Patients had an average age of 70 years at the time of surgery. CPPD and/or BCP crystals were identified in 60% of SF. Overall radiographic scores correlated with mean concentrations of BCP crystals. Higher mean radiographic scores correlated with the presence of calcium-containing crystals of either type in SF Radiographic chondrocalcinosis was identified in only 31% of those with SF CPPD. Pathologic calcium crystals were present in a majority of SF at the time of total knee arthroplasty. Intraoperative SF analysis could conveniently identify pathologic calcium crystals providing information that may be relevant to the future care of the patient's replaced joint and that of other joints. This information could also potentially aid in predicting the likelihood of the need for contralateral total knee arthroplasty.

Assessment of operative times of multiple surgical specialties in a public university hospital

PubMed Central

Costa, Altair da Silva

2017-01-01

ABSTRACT Objective To evaluate the indicators duration of anesthesia, operative time and time patients stay in the operating rooms of different surgical specialties at a public university hospital. Methods It was done by a descriptive cross-sectional study based on the operating room database. The following stages were measured: duration of anesthesia, procedure time and patient length of stay in the room of the various specialties. We included surgeries carried out in sequence in the same room, between 7:00 a.m. and 5 p.m., either elective or emergency. We calculated the 80th percentile of the stages, where 80% of procedures were below this value. Results The study measured 8,337 operations of 12 surgical specialties performed within one year. The overall mean duration of anesthesia of all specialties was 178.12±110.46 minutes, and the 80th percentile was 252 minutes. The mean operative time was 130.45±97.23 minutes, and the 80th percentile was 195 minutes. The mean total time of the patient in the operating room was 197.30±113.71 minutes, and the 80th percentile was 285 minutes. Thus, the variation of the overall mean compared to the 80th percentile was 41% for anesthesia, 49% for surgeries and 44% for operating room time. In average, anesthesia took up 88% of the operating room period, and surgery, 61%. Conclusion This study identified patterns in the duration of surgery stages. The mean values of the specialties can assist with operating room planning and reduce delays. PMID:28767919

Time between the first and second operations for staged total knee arthroplasties when the interval is determined by the patient.

PubMed

Ishii, Yoshinori; Noguchi, Hideo; Takeda, Mitsuhiro; Sato, Junko; Toyabe, Shin-Ichi

2014-01-01

The purpose of this study was to evaluate the interval between the first and second operations for staged total knee arthroplasties (TKAs) in patients with bilateral knee osteoarthritis. Depending on satisfactory preoperative health status, the patients determined the timing of the second operation. We also analysed correlations between the interval and patient characteristics. Eighty-six patients with bilateral knee osteoarthritis were analysed. The mean follow-up time from the first TKA was 96 months. The side of the first TKA was chosen by the patients. The timing of the second TKA was determined by the patients, depending on their perceived ability to tolerate the additional pain and limitations to activities of daily living. The median interval between the first and second operations was 12.5 months, with a range of 2 to 113 months. In 43 (50%) patients, the interval was <12 months. There was no difference in the interval between females and males (p=0.861), and no correlation between the interval and body mass index or age. There was weak correlation between the year of the first TKA and the interval (R=-0.251, p=0.020), with the interval getting significantly shorter as the years progressed (p=0.032). The median interval between the first and second operations in patients who underwent staged TKAs for bilateral knee osteoarthritis was about 1 year. The results of the current study may help patients and physicians to plan effective treatment strategies for staged TKAs. Level II. Copyright © 2013 Elsevier B.V. All rights reserved.

High performance discharges in the Lithium Tokamak eXperiment with liquid lithium walls

DOE PAGES

Schmitt, J. C.; Bell, R. E.; Boyle, D. P.; ...

2015-05-15

The first-ever successful operation of a tokamak with a large area (40% of the total plasma surface area) liquid lithium wall has been achieved in the Lithium Tokamak eXperiment (LTX). These results were obtained with a new, electron beam-based lithium evaporation system, which can deposit a lithium coating on the limiting wall of LTX in a five-minute period. Preliminary analyses of diamagnetic and other data for discharges operated with a liquid lithium wall indicate that confinement times increased by 10 x compared to discharges with helium-dispersed solid lithium coatings. Ohmic energy confinement times with fresh lithium walls, solid and liquid,more » exceed several relevant empirical scaling expressions. Spectroscopic analysis of the discharges indicates that oxygen levels in the discharges limited on liquid lithium walls were significantly reduced compared to discharges limited on solid lithium walls. Finally, Tokamak operations with a full liquid lithium wall (85% of the total plasma surface area) have recently started.« less

Rapid Oceanographic Data Gathering: Some Problems in Using Remote Sensing to Determine the Horizontal and Vertical Thermal Distributions in the Northeast Pacific Ocean.

DTIC Science & Technology

1981-09-01

Zulu time) GOES Geostationary Operational Environmental Satellite GOSSTCOMP Global Operational Sea Surface Temperature Computation HEPAD High Energy ...Manipulation System IFOV Instantaneous Field-of-View IMP Instrument Mounting Platofrm IR Infrared 12 K Kelvin km kilometer m meter MEPED Medium Energy ...Stratospheric Sounding Unit STREX Storm Transfer and Response Experiment TEP Total Energy Detector TIP TIROS Information Processor TOVS TIROS Operational

PROCEDURE FOR THE ESTABLISHMENT OF COMMUNITY JUNIOR COLLEGES IN ARKANSAS.

ERIC Educational Resources Information Center

Arkansas State Commission on Coordination of Higher Educational Finance, Little Rock.

CRITERIA FOR ESTABLISHMENT OF JUNIOR COLLEGE DISTRICTS IN ARKANSAS INCLUDE (1) A PROJECTED ENROLLMENT OF AT LEAST 300 FULL TIME EQUIVALENT STUDENTS IN THE THIRD YEAR OF OPERATION, (2) ASSESSED VALUATION ADEQUATE TO PROVIDE FROM LOCAL PROPERTY TAXES ONE-THIRD OF THE ANNUAL OPERATING COST AND THE TOTAL DEBT SERVICE REQUIREMENTS FOR CAPITAL OUTLAY,…

The indirect cost of Patient-Specific Instruments.

PubMed

Thienpont, Emmanuel; Paternostre, Frederic; Van Wymeersch, Charles

2015-09-01

To calculate the indirect costs of Patient Specific Instruments (PSI) based on an opportunity cost, cost of efforts and a supply chain cost model to compare PSI for value with conventional total knee arthroplasty (TKA). In 81 patients the total (direct+indirect) cost of PSI-assisted TKA was compared with conventional TKA. Surgical times and coronal mechanical alignment were measured to evaluate the effectiveness of the PSI system. Indirect costs (459 euro) make up 40% of the total cost that can run up to 1142 euro for a patient operated with PSI guides. No difference in surgical times or coronal alignment was observed in between both groups. Considering the total cost of PSI no value was found for the use of PSI in primary TKA as measured by surgical times or for obtaining a neutral mechanical axis in the coronal plane.

IMU-based Real-time Pose Measurement system for Anterior Pelvic Plane in Total Hip Replacement Surgeries.

PubMed

Zhe Cao; Shaojie Su; Hao Tang; Yixin Zhou; Zhihua Wang; Hong Chen

2017-07-01

With the aging of population, the number of Total Hip Replacement Surgeries (THR) increased year by year. In THR, inaccurate position of the implanted prosthesis may lead to the failure of the operation. In order to reduce the failure rate and acquire the real-time pose of Anterior Pelvic Plane (APP), we propose a measurement system in this paper. The measurement system includes two parts: Initial Pose Measurement Instrument (IPMI) and Real-time Pose Measurement Instrument (RPMI). IPMI is used to acquire the initial pose of the APP, and RPMI is used to estimate the real-time pose of the APP. Both are composed of an Inertial Measurement Unit (IMU) and magnetometer sensors. To estimate the attitude of the measurement system, the Extended Kalman Filter (EKF) is adopted in this paper. The real-time pose of the APP could be acquired together with the algorithm designed in the paper. The experiment results show that the Root Mean Square Error (RMSE) is within 1.6 degrees, which meets the requirement of THR operations.

A technical innovation for improving identification of the trackers by the LED cameras in navigation-assisted total knee arthroplasty.

PubMed

Darmanis, Spyridon; Toms, Andrew; Durman, Robert; Moore, Donna; Eyres, Keith

2007-07-01

To reduce the operating time in computer-assisted navigated total knee replacement (TKR), by improving communication between the infrared camera and the trackers placed on the patient. The innovation involves placing a routinely used laser pointer on top of the camera, so that the infrared cameras focus precisely on the trackers located on the knee to be operated on. A prospective randomized study was performed involving 40 patients divided into two groups, A and B. Both groups underwent navigated TKR, but for group B patients a laser pointer was used to improve the targeting capabilities of the cameras. Without the laser pointer, the camera had to move a mean 9.2 times in order to identify the trackers. With the introduction of the laser pointer, this was reduced to 0.9 times. Accordingly, the additional mean time required without the laser pointer was 11.6 minutes. Time delays are a major problem in computer-assisted surgery, and our technical suggestion can contribute towards reducing the delays associated with this particular application.

Operating room metrics score card-creating a prototype for individualized feedback.

PubMed

Gabriel, Rodney A; Gimlich, Robert; Ehrenfeld, Jesse M; Urman, Richard D

2014-11-01

The balance between reducing costs and inefficiencies with that of patient safety is a challenging problem faced in the operating room suite. An ongoing challenge is the creation of effective strategies that reduce these inefficiencies and provide real-time personalized metrics and electronic feedback to anesthesia practitioners. We created a sample report card structure, utilizing existing informatics systems. This system allows to gather and analyze operating room metrics for each anesthesia provider and offer personalized feedback. To accomplish this task, we identified key metrics that represented time and quality parameters. We collected these data for individual anesthesiologists and compared performance to the overall group average. Data were presented as an electronic score card and made available to individual clinicians on a real-time basis in an effort to provide effective feedback. These metrics included number of cancelled cases, average turnover time, average time to operating room ready and patient in room, number of delayed first case starts, average induction time, average extubation time, average time to recovery room arrival to discharge, performance feedback from other providers, compliance to various protocols, and total anesthetic costs. The concept we propose can easily be generalized to a variety of operating room settings, types of facilities and OR health care professionals. Such a scorecard can be created using content that is important for operating room efficiency, research, and practice improvement for anesthesia providers.

A prospective randomized cost billing comparison of local fasciocutaneous perforator versus free Gracilis flap reconstruction for lower limb in a developing economy.

PubMed

Abdelrahman, Islam; Moghazy, Amr; Abbas, Ashraf; Elmasry, Moustafa; Adly, Osama; Elbadawy, Mohamed; Steinvall, Ingrid; Sjoberg, Folke

2016-08-01

Distal half leg complex wounds are usually a formidable problem that necessitates either local or free flap coverage. The aim of this study was to compare cost billing charges in free Gracilis flap (fGF) and local fasciocutaneous perforator flap (lFPF) in reconstructing complex soft tissue leg and foot defects. Thirty consecutive adult (>15-year-old) patients with soft tissue defects in the leg and/or foot requiring tissue coverage with a flap in the period between 2012 and 2015 were randomly assigned (block randomization) to either an fGF or lFPF procedure. The outcome measures addressed were total billed charges costs, perioperative billed charges cost, partial or complete flap loss, length of hospital stay, inpatient postsurgical care duration, complications, operating time and number of operative scrub staff. One patient suffered from complete flap loss in each group. Reconstruction with lFPF showed total lower billed charges costs by 62% (2509 USD) (p < 0.001) and perioperative billed charges cost by 54% (779 USD) (p < 0.001), and shorter total hospital stay (36.5 days; p < 0.001), inpatient postsurgical care duration (6.4 days; p < 0.001), operating time (4.3 h; p < 0.001) and fewer scrub staff (2.2 persons; p < 0.001). These results suggest that neither flap is totally superior to the other; the choice should instead be based on the outcome sought and logistics. lFPF requires lower billed charges cost and resource use and saves operative time and personnel and reduces length of hospital stay. Our approach changed towards using perforator flaps in medium-sized defects, keeping the free flap option for larger defects. Copyright © 2016 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

[Therapy of adult-onset laryngeal papilloma: integrallty submucosal dissection of the tumor by CO2 laser].

PubMed

Lei, W B; Liu, Q H; Chai, L P; Zhu, X L; Wang, Z F; Li, Q M; Tang, H C; Jiang, A Y; Wen, Y H; Wen, W P

2016-10-07

Objective: To evaluate the feasibility and efficacy of the integrallty submucosal resection of adult-onset laryngeal papilloma by CO 2 laser. Methods: A group of 64 cases (36 males and 28 females, multipe lesions 54 cases and single lesion 10 cases, aged 18-75 years, mean age 43.13 years) with adult-onset laryngeal papilloma encountered in the first affliated hospital of Sun Yatsen university from 2009 to 2015 was retrospectively analyzed. All cases were treated with integrallty submucosal dissection of the tumor by CO 2 laser, and observed the changes of tumor integral scope, inter-operative, operative processes, postoperative voice quality, postoperative scarring, and the tracheotomy conditions, which were analysed and evaluated. Results: A total of 64 patients were followed up from 1 year to 5 years. Preoperative tumor integral scope of these patients averaged of 7.00. A total of 62 cases kept 0 score of the tumor integral scope for at least one year, which lead to a clinical cure rate of 96.9%. The inter-operative averaged of 25.7 months. The total operative processes of these patients were 87 times (mean time 1.36). Four cases resulted in postoperative scarring. However these was a good result in postoperative voice quality with a mean score 4.25. As to the changes of tumor integral scope, all cases got a declining score (mean score 6.72), which resulted in a remission rate of 100%. Conclusion: The integrallty submucosal dissection of adult-onset 1aryngeal papilloma by CO 2 laser was an effective way to reduce the tumor integral scope; lengthen their inter-operative; decrease the operative processes, avoid the occurrence of tracheotomy; and improve the postoperative voice quality. Most of the patients could even be cured ultimately.

Operating room efficiency improvement after implementation of a postoperative team assessment.

PubMed

Porta, Christopher R; Foster, Andrew; Causey, Marlin W; Cordier, Patricia; Ozbirn, Roger; Bolt, Stephen; Allison, Dennis; Rush, Robert

2013-03-01

Operating room time is highly resource intensive, and delays can be a source of lost revenue and surgeon frustration. Methods to decrease these delays are important not only for patient care, but to maximize operating room resource utilization. The purpose of this study was to determine the root cause of operating room delays in a standardized manner to help improve overall operating room efficiency. We performed a single-center prospective observational study analyzing operating room utilization and efficiency after implementing an executive-driven standardized postoperative team debriefing system from January 2010 to December 2010. A total of 11,342 procedures were performed over the 1-y study period (elective 86%, urgent 11%, and emergent 3%), with 1.3 million min of operating room time, 865,864 min of surgeon operative time (62.5%), and 162,958 min of anesthesia time (11.8%). Overall, the average operating room delay was 18 min and varied greatly based on the surgical specialty. The longest delays were due to need for radiology (40 min); other significant delays were due to supply issues (22.7 min), surgeon issues (18 min), nursing issues (14 min), and room turnover (14 min). Over the 1-y period, there was a decrease in mean delay duration, averaging a decrease in delay of 0.147 min/mo with an overall 9% decrease in the mean delay times. With regard to overall operating room utilization, there was a 39% decrease in overall un-utilized available OR time that was due to delays, improving efficiency by 2334 min (212 min/mo). During this study interval no sentinel events occurred in the operating room. A standardized postoperative debrief tracking system is highly beneficial in identifying and reducing overall operative delays and improving operating room utilization. Published by Elsevier Inc.

Comparison of the Operative Outcomes and Learning Curves between Laparoscopic and Robotic Gastrectomy for Gastric Cancer

PubMed Central

Huang, Kuo-Hung; Lan, Yuan-Tzu; Fang, Wen-Liang; Chen, Jen-Hao; Lo, Su-Shun; Li, Anna Fen-Yau; Chiou, Shih-Hwa; Wu, Chew-Wun; Shyr, Yi-Ming

2014-01-01

Background Minimally invasive surgery, including laparoscopic and robotic gastrectomy, has become more popular in the treatment of gastric cancer. However, few studies have compared the learning curves between laparoscopic and robotic gastrectomy for gastric cancer. Methods Data were prospectively collected between July 2008 and Aug 2014. A total of 145 patients underwent minimally invasive gastrectomy for gastric cancer by a single surgeon, including 73 laparoscopic and 72 robotic gastrectomies. The clinicopathologic characteristics, operative outcomes and learning curves were compared between the two groups. Results Compared with the laparoscopic group, the robotic group was associated with less blood loss and longer operative time. After the surgeon learning curves were overcome for each technique, the operative outcomes became similar between the two groups except longer operative time in the robotic group. After accumulating more cases of robotic gastrectomy, the operative time in the laparoscopic group decreased dramatically. Conclusions After overcoming the learning curves, the operative outcomes became similar between laparoscopic and robotic gastrectomy. The experience of robotic gastrectomy could affect the learning process of laparoscopic gastrectomy. PMID:25360767

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

PubMed

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

2017-03-01

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

Totally thoracoscopic surgery for the treatment of atrial septal defect without of the robotic Da Vinci surgical system

PubMed Central

2013-01-01

Background More and more surgeons and patients focus on the minimally invasive surgical techniques in the 21st century. Totally thoracoscopic operation provides another minimal invasive surgical option for patients with ASD (atrial septal defect). In this study, we reported our experience of 61 patients with atrial septal defect who underwent totally thoracoscopic operation and discussed the feasibility and safety of the new technique. Methods From January 2010 to October 2012, 61 patients with atrial septal defect underwent totally thoracoscopic closure but not traditional median sternotomy surgery. We divided the 61 patients into two groups based on the operation sequence. The data of group A (the first 30 cases) and group B (the last 31 cases). The mean age of the patients was 35.1 ± 12.8 years (range, 6.3 to 63.5 years), and mean weight was 52.7 ± 11.9 kg (range, 30.5 to 80 kg). Mean size of the atrial septal defect was 16.8 ± 11.3 mm (range, 13 to 39 mm) based on the description of the echocardiography. Results All patients underwent totally thoracoscopy successfully, 36 patients with pericardium patch and 25 patients were sutured directly. 7 patients underwent concomitant tricuspid valvuloplasty with Key technique. No death, reoperation or complete atrioventricular block occurred. The mean time of cardiopulmonary bypass was 68.5 ± 19.1 min (range, 31.0 to 153.0 min), the mean time of aortic cross-clamp was 27.2 ± 11.3 min (range, 0.0 to 80.0 min) and the mean time of operation was 149.8 ± 35.7 min (range, 63.0 to 300.0 min). Postoperative mechanical ventilation averaged 4.9 ± 2.5 hours (range, 3.5 to 12.6 hours), and the duration of intensive care unit stay 20.0 ± 4.8 hours (range, 15.5 to 25 hours). The mean volume of blood drainage was 158 ± 38 ml (range, 51 to 800 ml). No death, residual shunt, lung atelectasis or moderate tricuspid regurgitation was found at 3-month follow-up. Conclusion The totally thoracoscopic operation is feasible and safe for patients with ASD, even with or without tricuspid regurgitation. This technique provides another minimal invasive surgical option for patients with atrial septal defect. PMID:23634811

A cheap minimally painful and widely usable alternative for retrieving ureteral stents.

PubMed

Söylemez, Haluk; Sancaktutar, Ahmet Ali; Bozkurt, Yaşar; Atar, Murat; Penbegül, Necmettin; Yildirim, Kadir

2011-01-01

To describe a cheap, minimally painful and widely usable method for retrieving ureteral stents by using an ureteroscope. Sixty-seven patients with ureteral stents were enrolled in this study. The patients were randomized into a cystoscopic (35 patients) and a ureteroscopic (32 patients) group. All stents were retrieved by a flexible cystoscope in the first group and by a ureteroscope in the second group under local anesthesia. Patients in each group were assessed for stented time, stent side, cause of stent placement, operative time, peroperative pain, postoperative pain, irritative voiding symptoms and hematuria. Also costs of instruments were calculated. Stents were successfully retrieved in 67 patients. There were no statistical differences in the two groups regarding patient gender and age or stent side, operative time, stented time, mean operative pain score, irritative voiding symptom scores and hematuria. Total selling price was USD 20.399 for flexible instruments and USD 10.516 for rigid ones. Total maintenance price was higher in flexible instruments than in the rigid ones (USD 197.8 and 51.7 per use, respectively). Ureteroscopic stent retrieval is a minimally painful, safe and highly tolerable method under local anesthesia as well as flexible cystoscopic retrieval. Also, it is a cheap and widely usable method. Copyright © 2011 S. Karger AG, Basel.

The Magic Ear: Another Approach to Automated Classroom Control.

ERIC Educational Resources Information Center

George, James R., III; And Others

"Excessive" noise outburst behavior of 24 second graders was effectively controlled under automated stimulus conditions. A voice operated relay transmitted signals to an automated combination light display and outburst time/total running time meters; under 2 conditions, the light display functioned first as a primary, then as a secondary…

75 FR 52033 - Rigging Equipment for Material Handling; Extension of the Office of Management and Budget's (OMB...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-24

.... Estimated Total Burden Hours: 51,815. Estimated Cost (Operation and Maintenance): $0. IV. Public... desired format, reporting burden (time and costs) is minimal, collection instruments are clearly...; The accuracy of OSHA's estimate of the burden (time and costs) of the information collection...

Efficacy of the RADPAD protective drape during real world complex percutaneous coronary intervention procedures.

PubMed

Murphy, John C; Darragh, Karen; Walsh, Simon J; Hanratty, Colm G

2011-11-15

The RADPAD is a lead-free surgical drape containing bismuth and barium that has been demonstrated to reduce scatter radiation exposure to primary operators during fluoroscopic procedures. It is not known to what degree the RADPAD reduces radiation exposure in operators who perform highly complex percutaneous coronary intervention (PCI) requiring prolonged fluoroscopic screening times. Sixty consecutive patients due to undergo elective complex PCI involving rotational atherectomy, multivessel PCI, or chronic total occlusions were randomized in a 1:1 pattern to have their procedures performed with and without the RADPAD drape in situ. Dosimetry was performed on the left arm of the primary operator. There were 40 cases of chronic total occlusion, including 28 with contralateral injections; 15 cases involving rotational atherectomy; and 5 cases of multivessel PCI. There was no significant difference in screening times or dose-area products between the 2 patient groups. Primary operator radiation dose relative to screening time (RADPAD: slope = 1.44, R² = 0.25; no RADPAD: slope = 4.60, R² = 0.26; analysis of covariance F = 4.81, p = 0.032) and dose-area product (RADPAD: slope = 0.003, R² = 0.26; no RADPAD: slope = 0.011, R² = 0.52; analysis of covariance F = 12.54, p = 0.008) was significantly smaller in the RADPAD cohort compared to the no-RADPAD group. In conclusion, the RADPAD significantly reduces radiation exposure to primary operators during prolonged, complex PCI cases. Copyright © 2011 Elsevier Inc. All rights reserved.

Clinical use of a cordless laparoscopic ultrasonic device.

PubMed

Kim, Fernando J; Sehrt, David; Molina, Wilson R; Pompeo, Alexandre

2014-01-01

On April 25, 2012, the first laparoscopic cordless ultrasonic device (Sonicision, Covidien, Mansfield, Massachusetts) was used in a clinical setting. We describe our initial experience. The cordless device is assembled with a reusable battery and generator on a base hand-piece. It has a minimum and maximum power setting controlled by a single trigger for both coagulation and cutting. A laparoscopic radical nephrectomy was performed on a 56-year-old man with a 7-cm right renal mass. A laparoscopic pelvic lymphadenectomy was performed in a 51-year-old man with high-risk prostate cancer. Data on surgical team satisfaction, operative time, number of activations, and times the laparoscope was removed as a result of plume were collected. The surgical technician successfully assembled the device at the beginning of the cases with verbal instructions from the surgeon. Operative time for nephrectomy was 77 minutes, with 143 total activations (minimum = 86, maximum = 57). The operative time for the pelvic lymphadenectomy was 27 minutes, with 38 total activations (minimum = 27, maximum = 11). One battery was used in each case. The laparoscope was removed twice during the nephrectomy and once during the lymphadenectomy. Surgical staff satisfaction survey results revealed easier and faster assembly, more space in the operating room, ergonomic handle, and comparable cutting/coagulation, weight, and plume generation with other devices (Table 1). [Table: see text]. The first clinical application of the pioneering cordless dissector was successfully performed, resulting in surgeons' perceptions of comparable results with other devices of easier and safer use and faster assembly.

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

PubMed

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

2012-11-01

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

Harmonic focus versus electrocautery in axillary lymph node dissection for breast cancer: a randomized clinical study.

PubMed

He, Qingqing; Zhuang, Dayong; Zheng, Luming; Fan, Ziyi; Zhou, Peng; Zhu, Jian; Lv, Zhen; Chai, Jixin; Cao, Lei

2012-12-01

Electrocautery has been proven to be associated with prolonged serous drainage that might result in several complications in patients requiring axillary lymph node dissection for breast cancer. We proposed that the Harmonic Focus might outperform electrocautery in axillary lymph node dissection, resulting in shorter operative times and reduced postoperative complications. One hundred twenty-eight women with confirmed T1-3 N1-2 breast cancer were randomly assigned to undergo mastectomy or breast-conserving surgery with axillary dissection by using Harmonic Focus or electrocautery. Sixty-four has surgery with Harmonic Focus (group A) and 64 with electrocautery (group B) by the same surgical team. Operative time, blood loss, total drainage volume and days, incidence of seroma, hematoma, pain score, and flap necrosis were recorded. Using Harmonic Focus significantly diminished operative time, blood loss, total drainage volume, days of stay, and visual analogue scale as compared with traditional electrocautery. There was no statistical difference between the 2 groups regarding seroma, hematoma, and flap necrosis. Axillary lymph node dissection using Harmonic Focus is feasible, safe, and a more comfortable design for the surgeon. Copyright © 2012 Elsevier Inc. All rights reserved.

Gastrointestinal surgery in gynecologic oncology: evaluation of surgical techniques.

PubMed

Penalver, M; Averette, H; Sevin, B U; Lichtinger, M; Girtanner, R

1987-09-01

In recent years, the use of surgical staples has become popular in all subspecialties of surgery. The advantages proposed have been a decrease in operative time and morbidity. This paper reviews the University of Miami/Jackson Memorial Medical Center, Division of Gynecologic Oncology experience with the use of surgical staples in gastrointestinal surgery on patients with a diagnosis of a gynecologic malignancy. Between January 1, 1979 and July 1, 1985, a total of 152 procedures were done, 81 by stapler and 71 by suture anastomosis. Ninety-one patients had received previous radiation or chemotherapy. The average age of the patients was 52 years. The results show a decrease in operating time, blood loss, and postoperative hospital stay in those patients where the stapler anastomosis was used. The postoperative morbidity and mortality were not increased. Twenty-seven total pelvic exenterations were performed during the period of study and they were evaluated separately. The hospital stay and blood loss as well as the operative time were significantly less using staplers. This report includes a detailed evaluation of the results. From this study, we concluded that surgical staples are a safe alternative in gastrointestinal surgery in patients with a gynecologic malignancy.

Reduction of selenite to elemental selenium nanoparticles by activated sludge.

PubMed

Jain, Rohan; Matassa, Silvio; Singh, Satyendra; van Hullebusch, Eric D; Esposito, Giovanni; Lens, Piet N L

2016-01-01

Total selenium removal by the activated sludge process, where selenite is reduced to colloidal elemental selenium nanoparticles (BioSeNPs) that remain entrapped in the activated sludge flocs, was studied. Total selenium removal efficiencies with glucose as electron donor (2.0 g chemical oxygen demand (COD) L(-1)) at neutral pH and 30 °C gave 2.9 and 6.8 times higher removal efficiencies as compared to the electron donors lactate and acetate, respectively. Total selenium removal efficiencies of 79 (±3) and 86 (±1) % were achieved in shake flasks and fed batch reactors, respectively, at dissolved oxygen (DO) concentrations above 4.0 mg L(-1) and 30 °C when fed with 172 mg L(-1) (1 mM) Na2SeO3 and 2.0 g L(-1) COD of glucose. Continuously operated reactors operating at neutral pH, 30 °C and a DO >3 mg L(-1) removed 33.98 and 36.65 mg of total selenium per gram of total suspended solids (TSS) at TSS concentrations of 1.3 and 3.0 g L(-1), respectively. However, selenite toxicity to the activated sludge led to failure of a continuously operating activated sludge reactor at the applied loading rates. This suggests that a higher hydraulic retention time (HRT) or different reactor configurations need to be applied for selenium-removing activated sludge processes. Graphical Abstract Scheme representing the possible mechanisms of selenite reduction at high and low DO levels in the activated sludge process.

[Proposal of a costing method for the provision of sterilization in a public hospital].

PubMed

Bauler, S; Combe, C; Piallat, M; Laurencin, C; Hida, H

2011-07-01

To refine the billing to institutions whose operations of sterilization are outsourced, a sterilization cost approach was developed. The aim of the study is to determine the value of a sterilization unit (one point "S") evolving according to investments, quantities processed, types of instrumentation or packaging. The time of preparation has been selected from all sub-processes of sterilization to determine the value of one point S. The time of preparation of sterilized large and small containers and pouches were raised. The reference time corresponds to one bag (equal to one point S). Simultaneously, the annual operating cost of sterilization was defined and divided into several areas of expenditure: employees, equipments and building depreciation, supplies, and maintenance. A total of 136 crossing times of containers were measured. Time to prepare a pouch has been estimated at one minute (one S). A small container represents four S and a large container represents 10S. By dividing the operating cost of sterilization by the total number of points of sterilization over a given period, the cost of one S can be determined. This method differs from traditional costing method in sterilizing services, considering each item of expenditure. This point S will be the base for billing of subcontracts to other institutions. Copyright © 2011 Elsevier Masson SAS. All rights reserved.

Strategies to optimize the performance of Robotic-assisted ­laparoscopic hysterectomy

PubMed Central

Lambrou, N.; Diaz, R.E.; Hinoul, P.; Parris, D.; Shoemaker, K.; Yoo, A.; Schwiers, M.

2014-01-01

A hybrid technique of robot-assisted, laparoscopic hysterectomy using the ENSEAL® Tissue Sealing Device is described in a retrospective, consecutive, observational case series. Over a 45 month period, 590 robot-assisted total laparoscopic hysterectomies +/- oophorectomy for benign and malignant indications were performed by a single surgeon with a bedside assistant at a tertiary healthcare center. Patient demographics, indications for surgery, comorbidities, primary and secondary surgical procedures, total operative and surgical time, estimated blood loss (EBL), length of stay (LOS), complications, transfusions and subsequent readmissions were analyzed. The overall complication rate was 5.9% with 35 patients experiencing 69 complications. Mean (SD) surgery time, operating room (OR) time, EBL, and LOS for the entire cohort were 75.5 (39.42) minutes, 123.8 (41.15) minutes, 83.1 (71.29) millilitres, and 1.2 (0.93) days, respectively. Mean surgery time in the first year (2009) was 91.6 minutes, which declined significantly each year by 18.0, 19.0, and 24.3 minutes, respectively. EBL and LOS did not vary ­significantly across the entire series. Using the cumulative sum method, an optimization curve for surgery time was evaluated, with three distinct optimization phases observed. In summary, the use of an advanced laparoscopic tissue-sealing device by a bedside surgical assistant provided an improved operative efficiency and reliable vessel sealing during robotic hysterectomy. PMID:25374656

[Modified Misgav-Labach at a tertiary hospital].

PubMed

Martínez Ceccopieri, David Alejandro; Barrios Prieto, Ernesto; Martínez Ríos, David

2012-08-01

According to several studies from around the globe, the modified Misgav Ladach technique simplifies the surgical procedure for cesarean section, reduces operation time, costs, and complications, and optimizes obstetric and perinatal outcomes. Compare obstetric outcomes between patients operated on using traditional cesarean section technique and those operated on using modified Misgav Ladach technique. The study included 49 patients operated on using traditional cesarean section technique and 47 patients operated on using modified Misgav Ladach technique to compare the outcomes in both surgical techniques. The modified Misgav Ladach technique was associated with more benefits than those of the traditional technique: less surgical bleeding, less operation time, less analgesic total doses, less rescue analgesic doses and less need of more than one analgesic drug. The modified Misgav Ladach surgical technique was associated with better obstetric results than those of the traditional surgical technique; this concurs with the results reported by other national and international studies.

Flight evaluation of a simple total energy-rate system with potential wind-shear application

NASA Technical Reports Server (NTRS)

Ostroff, A. J.; Hueschen, R. M.; Hellbaum, R. F.; Creedon, J. F.

1981-01-01

Wind shears can create havoc during aircraft terminal area operations and have been cited as the primary cause of several major aircraft accidents. A simple sensor, potentially having application to the wind-shear problem, was developed to rapidly measure aircraft total energy relative to the air mass. Combining this sensor with either a variometer or a rate-of-climb indicator provides a total energy-rate system which was successfully applied in soaring flight. The measured rate of change of aircraft energy can potentially be used on display/control systems of powered aircraft to reduce glide-slope deviations caused by wind shear. The experimental flight configuration and evaluations of the energy-rate system are described. Two mathematical models are developed: the first describes operation of the energy probe in a linear design region and the second model is for the nonlinear region. The calculated total rate is compared with measured signals for many different flight tests. Time history plots show the tow curves to be almost the same for the linear operating region and very close for the nonlinear region.

Ligasure, Harmonic Scalpel versus conventional diathermy in excisional haemorrhoidectomy: a randomized controlled trial.

PubMed

Talha, Ahmed; Bessa, Samer; Abdel Wahab, Moataza

2017-04-01

This study was designed to compare the surgical outcomes of haemorrhoidectomy performed by the Ligasure, Harmonic Scalpel with that performed by the conventional diathermy. A total of 180 patients were randomized to Ligasure, Harmonic Scalpel and diathermy haemorrhoidectomy, 60 patients for each group. The operative time, post-operative pain scores, parenteral analgesic requirements in the first 24 h, post-operative complications and wound healing rates were documented. The median operative time was 8 min (range, 7-18) for the Ligasure and Harmonic Scalpel groups and 18 min (range, 15-21) for the diathermy group (P < 0.001). Throughout the first post-operative week, the daily median pain score was lower in the Ligasure and Harmonic Scalpel groups than in the diathermy group (P < 0.001). The median number of analgesic ampoules during the first 24 h post-operatively was lower in the Ligasure and Harmonic Scalpel groups (P < 0.001). There was no statistically significant difference in the incidence of post-operative complications. At 6 weeks post-operation, more patients in the Ligasure and Harmonic Scalpel groups had complete healing of wounds (P = 0 < 0.001). Ligasure and Harmonic Scalpel provide a superior alternative to conventional diathermy in haemorrhoidectomy with no difference between them in reducing the operative time, post-operative pain, analgesic requirements during the first 24 h and time to complete healing of wounds. © 2014 Royal Australasian College of Surgeons.

Operating room waste: disposable supply utilization in neurointerventional procedures.

PubMed

Rigante, Luigi; Moudrous, Walid; de Vries, Joost; Grotenhuis, André J; Boogaarts, Hieronymus D

2017-12-01

Operating rooms account for 70% of hospital waste, increasing healthcare costs and creating environmental hazards. Endovascular treatment of cerebrovascular pathologies has become prominent, and associated products highly impact the total cost of care. We investigated the costs of endovascular surgical waste at our institution. Data from 53 consecutive endovascular procedures at the Radboud UMC Nijmegen from May to December 2016 were collected. "Unused disposable supply" was defined as one-time use items opened but not used during the procedure. Two observers cataloged the unused disposable supply for each case. The cost of each item was determined from the center supply catalog, and these costs were summed to determine the total cost of unused supply per case. Thirteen diagnostic cerebral digital subtraction angiographies (DSA) (24.5%) and 40 endovascular procedures (75.5%) were analyzed. Total interventional waste was 27,299.53 € (mean 515.09 € per procedure). While total costs of unused disposable supply were almost irrelevant for DSAs, they were consistent for interventional procedures (mean 676.49 € per case). Aneurysm standard coiling had the highest impact on total interventional waste (mean 1061.55 €). Disposable interventional products had a very high impact on the surgical waste costs in the series of the neurointerventional procedures (95% of total waste). This study shows the impact of neurointerventional waste on the total care costs for cerebrovascular patients. This might reflect the tendency to anticipate needs and emergencies in neurointervention. Responsible use of disposable material can be achieved by educating operators and nurses and creating operator preference cards.

The effect of drainage tube on bleeding and prognosis after total knee arthroplasty: a prospective cohort study

PubMed Central

2014-01-01

Background To evaluate the effect of drainage tube on prognosis after total knee arthroplasty (TKA) and explore an effective treatment with favorable prognosis. Methods In a prospective study, 18 patients with TKA for the first time were included and randomly divided into three groups, group A (no placement of drainage tube), group B (negative pressure drainage), and group C (4 h clamping drainage). Intraoperative and postoperative blood loss, operation time, and the drainage volume were recorded and analyzed. Arthrocele, ecchymosis, and range of motion (ROM) were examined postoperatively. The degree of pain was scored by Visual Analog Scale (VAS) after 6, 12, and 24 h of operation. The complications were examined and HSS (hospital for special surgery) knee score was taken during the follow-up period. Results There was no significant difference in operation time, total blood loss, intraoperative blood loss, and VAS score among three groups. Meanwhile, the hidden blood loss in group B was significantly decreased compared with group A (P = 0.0015). The postoperative drainage volume of group B was significantly increased compared with group C (P = 0.0002). No drainage increased the rate of arthrocele and ecchymosis. Compared with group A, ROM after 3 days of operation in groups B and C was significantly increased (P = 0.0357, P = 0.0372, respectively). During follow-up study, no deep infection or deep venous thrombosis was found. Conclusion After TKA, early clamping of the drainage tube reduced the bleeding loss without adverse effect on prognosis, which might be useful for clinical application in future. PMID:24755244

Using operations research to plan improvement of the transport of critically ill patients.

PubMed

Chen, Jing; Awasthi, Anjali; Shechter, Steven; Atkins, Derek; Lemke, Linda; Fisher, Les; Dodek, Peter

2013-01-01

Operations research is the application of mathematical modeling, statistical analysis, and mathematical optimization to understand and improve processes in organizations. The objective of this study was to illustrate how the methods of operations research can be used to identify opportunities to reduce the absolute value and variability of interfacility transport intervals for critically ill patients. After linking data from two patient transport organizations in British Columbia, Canada, for all critical care transports during the calendar year 2006, the steps for transfer of critically ill patients were tabulated into a series of time intervals. Statistical modeling, root-cause analysis, Monte Carlo simulation, and sensitivity analysis were used to test the effect of changes in component intervals on overall duration and variation of transport times. Based on quality improvement principles, we focused on reducing the 75th percentile and standard deviation of these intervals. We analyzed a total of 3808 ground and air transports. Constraining time spent by transport personnel at sending and receiving hospitals was projected to reduce the total time taken by 33 minutes with as much as a 20% reduction in standard deviation of these transport intervals in 75% of ground transfers. Enforcing a policy of requiring acceptance of patients who have life- or limb-threatening conditions or organ failure was projected to reduce the standard deviation of air transport time by 63 minutes and the standard deviation of ground transport time by 68 minutes. Based on findings from our analyses, we developed recommendations for technology renovation, personnel training, system improvement, and policy enforcement. Use of the tools of operations research identifies opportunities for improvement in a complex system of critical care transport.

Simultaneous bilateral stereotactic procedure for deep brain stimulation implants: a significant step for reducing operation time.

PubMed

Fonoff, Erich Talamoni; Azevedo, Angelo; Angelos, Jairo Silva Dos; Martinez, Raquel Chacon Ruiz; Navarro, Jessie; Reis, Paul Rodrigo; Sepulveda, Miguel Ernesto San Martin; Cury, Rubens Gisbert; Ghilardi, Maria Gabriela Dos Santos; Teixeira, Manoel Jacobsen; Lopez, William Omar Contreras

2016-07-01

OBJECT Currently, bilateral procedures involve 2 sequential implants in each of the hemispheres. The present report demonstrates the feasibility of simultaneous bilateral procedures during the implantation of deep brain stimulation (DBS) leads. METHODS Fifty-seven patients with movement disorders underwent bilateral DBS implantation in the same study period. The authors compared the time required for the surgical implantation of deep brain electrodes in 2 randomly assigned groups. One group of 28 patients underwent traditional sequential electrode implantation, and the other 29 patients underwent simultaneous bilateral implantation. Clinical outcomes of the patients with Parkinson's disease (PD) who had undergone DBS implantation of the subthalamic nucleus using either of the 2 techniques were compared. RESULTS Overall, a reduction of 38.51% in total operating time for the simultaneous bilateral group (136.4 ± 20.93 minutes) as compared with that for the traditional consecutive approach (220.3 ± 27.58 minutes) was observed. Regarding clinical outcomes in the PD patients who underwent subthalamic nucleus DBS implantation, comparing the preoperative off-medication condition with the off-medication/on-stimulation condition 1 year after the surgery in both procedure groups, there was a mean 47.8% ± 9.5% improvement in the Unified Parkinson's Disease Rating Scale Part III (UPDRS-III) score in the simultaneous group, while the sequential group experienced 47.5% ± 15.8% improvement (p = 0.96). Moreover, a marked reduction in the levodopa-equivalent dose from preoperatively to postoperatively was similar in these 2 groups. The simultaneous bilateral procedure presented major advantages over the traditional sequential approach, with a shorter total operating time. CONCLUSIONS A simultaneous stereotactic approach significantly reduces the operation time in bilateral DBS procedures, resulting in decreased microrecording time, contributing to the optimization of functional stereotactic procedures.

The effect of surgeon and hospital volume on shoulder arthroplasty perioperative quality metrics.

PubMed

Singh, Anshu; Yian, Edward H; Dillon, Mark T; Takayanagi, Miwa; Burke, Mary F; Navarro, Ronald A

2014-08-01

There has been a significant increase in both the incidence of shoulder arthroplasty and the number of surgeons performing these procedures. Literature regarding the relationship between surgeon or hospital volume and the performance of modern shoulder arthroplasty is limited. This study examines the effect of surgeon or hospital shoulder arthroplasty volume on perioperative metrics related to shoulder hemiarthroplasty, total shoulder arthroplasty, and reverse shoulder arthroplasty. Blood loss, length of stay, and operative time were the main endpoints analyzed. Prospective data were analyzed from a multicenter shoulder arthroplasty registry; 1176 primary shoulder arthroplasty cases were analyzed. Correlation and analysis of covariance were used to examine the association between surgeon and hospital volume and perioperative metrics adjusting for age, sex, and body mass index. Surgeon volume is inversely correlated with length of stay for hemiarthroplasty and total shoulder arthroplasty and with blood loss and operative time for all 3 procedures. Hospital volume is inversely correlated with length of stay for hemiarthroplasty, with blood loss for total and reverse shoulder arthroplasty, and with operative time for all 3 procedures. High-volume surgeons performed shoulder arthroplasty 30 to 50 minutes faster than low-volume surgeons did. Higher surgeon and hospital case volumes led to improved perioperative metrics with all shoulder arthroplasty procedures, including reverse total shoulder arthroplasty, which has not been previously described in the literature. Surgeon volume had a larger effect on metrics than hospital volume did. This study supports the concept that complex shoulder procedures are, on average, performed more efficiently by higher volume surgeons in higher volume centers. Copyright © 2014 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

Effect of operational cycle time length on nitrogen removal in an alternating oxidation ditch system.

PubMed

Mantziaras, I D; Stamou, A; Katsiri, A

2011-06-01

This paper refers to nitrogen removal optimization of an alternating oxidation ditch system through the use of a mathematical model and pilot testing. The pilot system where measurements have been made has a total volume of 120 m(3) and consists of two ditches operating in four phases during one cycle and performs carbon oxidation, nitrification, denitrification and settling. The mathematical model consists of one-dimensional mass balance (convection-dispersion) equations based on the IAWPRC ASM 1 model. After the calibration and verification of the model, simulation system performance was made. Optimization is achieved by testing operational cycles and phases with different time lengths. The limits of EU directive 91/271 for nitrogen removal have been used for comparison. The findings show that operational cycles with smaller time lengths can achieve higher nitrogen removals and that an "equilibrium" between phase time percentages in the whole cycle, for a given inflow, must be achieved.

Spacelab Mission Implementation Cost Assessment (SMICA)

NASA Technical Reports Server (NTRS)

Guynes, B. V.

1984-01-01

A total savings of approximately 20 percent is attainable if: (1) mission management and ground processing schedules are compressed; (2) the equipping, staffing, and operating of the Payload Operations Control Center is revised, and (3) methods of working with experiment developers are changed. The development of a new mission implementation technique, which includes mission definition, experiment development, and mission integration/operations, is examined. The Payload Operations Control Center is to relocate and utilize new computer equipment to produce cost savings. Methods of reducing costs by minimizing the Spacelab and payload processing time during pre- and post-mission operation at KSC are analyzed. The changes required to reduce costs in the analytical integration process are studied. The influence of time, requirements accountability, and risk on costs is discussed. Recommendation for cost reductions developed by the Spacelab Mission Implementation Cost Assessment study are listed.

Army Efficiency Initiatives

DTIC Science & Technology

2011-04-28

provide, its customers with products and services that satisfy their needs. A total quality culture requires quality in all aspects of the company’s...operations, with things being done right the first time, with product defects and waste eradicated from operations. Many companies have...government, service, research and development, and education. Yet in today’s global economy of today, the quality of many American products and services

Extracapsular dissection for Warthin tumor in the tail of parotid gland.

PubMed

Lee, Dong Hoon; Yoon, Tae Mi; Lee, Joon Kyoo; Lim, Sang Chul

2017-09-01

Extracapsular dissection conferred the advantage of reduced operation time and morbidity without any recurrence, and it could be considered as the treatment of choice for Warthin tumors in the tail of the parotid gland. The purpose of this study is to confirm the appropriate surgical procedure for Warthin tumor in the tail of the parotid gland, by comparing the results of extracapsular dissection and superficial parotidectomy. The medical records of 72 patients with Warthin tumor in the tail of the parotid gland who underwent surgery between January 2006 and December 2016 were retrospectively reviewed. In the extracapsular dissection group, a total of 44 parotid gland operations were performed in 40 patients. In the superficial parotidectomy group, a total of 34 parotid gland operations were performed in 32 patients. The operation time was significantly shorter in the extracapsular dissection group than in the superficial parotidectomy group (p<.001, Table 1). One patient in the extracapsular dissection group and five patients in the superficial parotidectomy group had postoperative facial nerve palsy. Recurrence of Warthin tumor in the tail portion of the parotid gland was identified in one patient who underwent superficial parotidectomy.

A study on risk factors and diagnostic efficiency of posthepatectomy liver failure in the nonobstructive jaundice.

PubMed

Wang, He; Lu, Shi-Chun; He, Lei; Dong, Jia-Hong

2018-02-01

Liver failure remains as the most common complication and cause of death after hepatectomy, and continues to be a challenge for doctors.t test and χ test were used for single factor analysis of data-related variables, then results were introduced into the model to undergo the multiple factors logistic regression analysis. Pearson correlation analysis was performed for related postoperative indexes, and a diagnostic evaluation was performed using the receiver operating characteristic (ROC) of postoperative indexes.Differences in age, body mass index (BMI), portal vein hypertension, bile duct cancer, total bilirubin, alkaline phosphatase (ALP), gamma-glutamyl transpeptidase (GGT), operation time, cumulative portal vein occlusion time, intraoperative blood volume, residual liver volume (RLV)/entire live rvolume, ascites volume at postoperative day (POD)3, supplemental albumin amount at POD3, hospitalization time after operation, and the prothrombin activity (PTA) were statistically significant. Furthermore, there were significant differences in total bilirubin and the supplemental albumin amount at POD3. ROC analysis of the average PTA, albumin amounts, ascites volume at POD3, and their combined diagnosis were performed, which had diagnostic value for postoperative liver failure (area under the curve (AUC): 0.895, AUC: 0.798, AUC: 0.775, and AUC: 0.903).Preoperative total bilirubin level and the supplemental albumin amount at POD3 were independent risk factors. PTA can be used as the index of postoperative liver failure, and the combined diagnosis of the indexes can improve the early prediction of postoperative liver failure.

[Airborne particles in a multi-wall carbon nanotube production plant: observation of particle emission and personal exposure 1: Measurement in the packing process].

PubMed

Takaya, Mitsutoshi; Serita, Fumio; Ono-Ogasawara, Mariko; Shinohara, Yasushi; Saito, Hiroyuki; Koda, Shigeki

2010-01-01

In order to assess the exposure risks of multiwall carbon nanotubes (MWCNT) for packing workers, we carried out real-time monitoring in the two types of packing facilities of MWCNT, and exposure measurements for the packing workers. In the real-time monitoring, a scanning mobility particle sizer (SMPS) and an optical particle counter (OPC) were used to measure nanoscale particles and sub-micron/micron scale particles, respectively. A personal sampler with PM 4.0 was used to measure the personal exposures in the packing facilities. One of the packing facilities is manually operated and the other is automated. The concentrations of airborne dust in both facilities were almost the same as each other at 0.24 mg/m(3) (total dust). However, the results of personal exposure measurements were quite different between the two facilities. The exposure concentrations of workers in the manually and automated operations were 2.39/0.39 (total/respirable) mg/m(3) and 0.29/0.08 (total/respirable) mg/m(3), respectively. From the time series study, submicron scale particles were released into the workplace air when the CNT products were put into temporary container bags from a hopper and manually packed into shipping bags. However, the task-related nanoscale particle release was not observed. The manual packing operation is one of the "hot spots" in MWCNT production facilities, and automation brings much improvement to reduce MWCNT exposure.

Modelling the time at which overcrowding and feed interruption emerge on the swine premises under movement restrictions during a classical swine fever outbreak.

PubMed

Weng, H Y; Yadav, S; Olynk Widmar, N J; Croney, C; Ash, M; Cooper, M

2017-03-01

A stochastic risk model was developed to estimate the time elapsed before overcrowding (TOC) or feed interruption (TFI) emerged on the swine premises under movement restrictions during a classical swine fever (CSF) outbreak in Indiana, USA. Nursery (19 to 65 days of age) and grow-to-finish (40 to 165 days of age) pork production operations were modelled separately. Overcrowding was defined as the total weight of pigs on premises exceeding 100% to 115% of the maximum capacity of the premises, which was computed as the total weight of the pigs at harvest/transition age. Algorithms were developed to estimate age-specific weight of the pigs on premises and to compare the daily total weight of the pigs with the threshold weight defining overcrowding to flag the time when the total weight exceeded the threshold (i.e. when overcrowding occurred). To estimate TFI, an algorithm was constructed to model a swine producer's decision to discontinue feed supply by incorporating the assumptions that a longer estimated epidemic duration, a longer time interval between the age of pigs at the onset of the outbreak and the harvest/transition age, or a longer progression of an ongoing outbreak would increase the probability of a producer's decision to discontinue the feed supply. Adverse animal welfare conditions were modelled to emerge shortly after an interruption of feed supply. Simulations were run with 100 000 iterations each for a 365-day period. Overcrowding occurred in all simulated iterations, and feed interruption occurred in 30% of the iterations. The median (5th and 95th percentiles) TOC was 24 days (10, 43) in nursery operations and 78 days (26, 134) in grow-to-finish operations. Most feed interruptions, if they emerged, occurred within 15 days of an outbreak. The median (5th and 95th percentiles) time at which either overcrowding or feed interruption emerged was 19 days (4, 42) in nursery and 57 days (4, 130) in grow-to-finish operations. The study findings suggest that overcrowding and feed interruption could emerge early during a CSF outbreak among swine premises under movement restrictions. The outputs derived from the risk model could be used to estimate and evaluate associated mitigation strategies for alleviating adverse animal welfare conditions resulting from movement restrictions.

Analysis of Anterior Cervical Discectomy and Fusion Healthcare Costs via the Value-Driven Outcomes Tool.

PubMed

Reese, Jared C; Karsy, Michael; Twitchell, Spencer; Bisson, Erica F

2018-04-11

Examining the costs of single- and multilevel anterior cervical discectomy and fusion (ACDF) is important for the identification of cost drivers and potentially reducing patient costs. A novel tool at our institution provides direct costs for the identification of potential drivers. To assess perioperative healthcare costs for patients undergoing an ACDF. Patients who underwent an elective ACDF between July 2011 and January 2017 were identified retrospectively. Factors adding to total cost were placed into subcategories to identify the most significant contributors, and potential drivers of total cost were evaluated using a multivariable linear regression model. A total of 465 patients (mean, age 53 ± 12 yr, 54% male) met the inclusion criteria for this study. The distribution of total cost was broken down into supplies/implants (39%), facility utilization (37%), physician fees (14%), pharmacy (7%), imaging (2%), and laboratory studies (1%). A multivariable linear regression analysis showed that total cost was significantly affected by the number of levels operated on, operating room time, and length of stay. Costs also showed a narrow distribution with few outliers and did not vary significantly over time. These results suggest that facility utilization and supplies/implants are the predominant cost contributors, accounting for 76% of the total cost of ACDF procedures. Efforts at lowering costs within these categories should make the most impact on providing more cost-effective care.

[Sexual possibilities following total penis amputation].

PubMed

Hengeveld, M W; Boon, T A

1993-07-17

A male aged 45 was subjected to total penis amputation because of a penile carcinoma; a perineal urethral stoma was created. The postoperative course was uneventful. One month after the last operation the patient for the first time felt the need for sexual contact, but his wife hesitated. After medical-sexological counselling, the partners achieved satisfactory sexual functioning with the husband occasionally having an orgasm.

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

PubMed

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

2012-10-01

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

Are high penetrations of commercial cogeneration good for society?

NASA Astrophysics Data System (ADS)

Keen, Jeremy F.; Apt, Jay

2016-12-01

Low natural gas prices, market reports and evidence from New York State suggest that the number of commercial combined heat and power (CHP) installations in the United States will increase by 2%-9% annually over the next decade. We investigate how increasing commercial CHP penetrations may affect net emissions, the distribution network, and total system energy costs. We constructed an integrated planning and operations model that maximizes owner profit through sizing and operation of CHP on a realistic distribution feeder in New York. We find that a greater penetration of CHP reduces both total system energy costs and network congestion. Commercial buildings often have low and inconsistent heat loads, which can cause low fuel utilization efficiencies, low CHP rates-of-return and diminishing avoided emissions as CHP penetration increases. In the northeast, without policy intervention, a 5% penetration of small commercially owned CHP would increase CO2 emissions by 2% relative to the bulk power grid. Low emission CHP installations can be encouraged with incentives that promote CHP operation only during times of high heat loads. Time-varying rates, such as time-of-day and seasonal rates, are one option and were shown to reduce customer emissions without reducing profits. In contrast, natural gas rate discounts, a common incentive for industrial CHP in some states, can encourage CHP operation during low heat loads and thus increase emissions.

A financial analysis of operating room charges for robot-assisted gynaecologic surgery: Efficiency strategies in the operating room for reducing the costs

PubMed Central

Zeybek, Burak; Öge, Tufan; Kılıç, Cemil Hakan; Borahay, Mostafa A.; Kılıç, Gökhan Sami

2014-01-01

Objective To analyse the steps taking place in the operating room (OR) before the console time starts in robot-assisted gynaecologic surgery and to identify potential ways to decrease non-operative time in the OR. Material and Methods Thirteen consecutive robotic cases for benign gynaecologic disease at the Department of Obstetrics and Gynecology at University of Texas Medical Branch (UTMB) were retrospectively reviewed. The collected data included the specific terms ‘Anaesthesia Done’ (step 1), ‘Drape Done’ (step 2), and ‘Trocar In’ (step 3), all of which refer to the time before the actual surgery began and OR charges were evaluated as level 3, 4, and 5 for open abdominal/vaginal hysterectomy, laparoscopic hysterectomy, and robot-assisted hysterectomy, respectively. Results The cost of the OR for 0–30 minutes and each additional 30 minutes were $3,693 and $1,488, $4,961 and $2,426, $5,513 and $2,756 in level 3, 4, and 5 surgeries, respectively. The median time for step 1 was 12.1 min (5.25–23.3), for step 2 was 19 (4.59–44) min, and for step 3 was 25.3 (16.45–45) min. The total median time until the actual operation began was 54.58 min (40–100). The total cost was $6948.7 when the charge was calculated according to level 4 and $7771.1 when the charge was calculated according to level 5. Conclusion Robot-assisted surgery is already ‘cost-expensive’ in the preparation stage of a surgical procedure during anaesthesia induction and draping of the patient because of charging levels. Every effort should be made to shorten the time and reduce the number of instruments used without compromising care. (J Turk Ger Gynecol Assoc 2014; 15: 25–9) PMID:24790513

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.

Optimizing integrated airport surface and terminal airspace operations under uncertainty

NASA Astrophysics Data System (ADS)

Bosson, Christabelle S.

In airports and surrounding terminal airspaces, the integration of surface, arrival and departure scheduling and routing have the potential to improve the operations efficiency. Moreover, because both the airport surface and the terminal airspace are often altered by random perturbations, the consideration of uncertainty in flight schedules is crucial to improve the design of robust flight schedules. Previous research mainly focused on independently solving arrival scheduling problems, departure scheduling problems and surface management scheduling problems and most of the developed models are deterministic. This dissertation presents an alternate method to model the integrated operations by using a machine job-shop scheduling formulation. A multistage stochastic programming approach is chosen to formulate the problem in the presence of uncertainty and candidate solutions are obtained by solving sample average approximation problems with finite sample size. The developed mixed-integer-linear-programming algorithm-based scheduler is capable of computing optimal aircraft schedules and routings that reflect the integration of air and ground operations. The assembled methodology is applied to a Los Angeles case study. To show the benefits of integrated operations over First-Come-First-Served, a preliminary proof-of-concept is conducted for a set of fourteen aircraft evolving under deterministic conditions in a model of the Los Angeles International Airport surface and surrounding terminal areas. Using historical data, a representative 30-minute traffic schedule and aircraft mix scenario is constructed. The results of the Los Angeles application show that the integration of air and ground operations and the use of a time-based separation strategy enable both significant surface and air time savings. The solution computed by the optimization provides a more efficient routing and scheduling than the First-Come-First-Served solution. Additionally, a data driven analysis is performed for the Los Angeles environment and probabilistic distributions of pertinent uncertainty sources are obtained. A sensitivity analysis is then carried out to assess the methodology performance and find optimal sampling parameters. Finally, simulations of increasing traffic density in the presence of uncertainty are conducted first for integrated arrivals and departures, then for integrated surface and air operations. To compare the optimization results and show the benefits of integrated operations, two aircraft separation methods are implemented that offer different routing options. The simulations of integrated air operations and the simulations of integrated air and surface operations demonstrate that significant traveling time savings, both total and individual surface and air times, can be obtained when more direct routes are allowed to be traveled even in the presence of uncertainty. The resulting routings induce however extra take off delay for departing flights. As a consequence, some flights cannot meet their initial assigned runway slot which engenders runway position shifting when comparing resulting runway sequences computed under both deterministic and stochastic conditions. The optimization is able to compute an optimal runway schedule that represents an optimal balance between total schedule delays and total travel times.

Conversion to Reverse Total Shoulder Arthroplasty with and without Humeral Stem Retention: The Role of a Convertible-Platform Stem.

PubMed

Crosby, Lynn A; Wright, Thomas W; Yu, Stephen; Zuckerman, Joseph D

2017-05-03

Revision shoulder arthroplasty is a technically challenging procedure. It is associated with increased blood loss and operative time, and it frequently necessitates revision implants, augments, and bone-grafting. Shoulder arthroplasty systems with a convertible-platform humeral stem have been developed to reduce the complexity of revision procedures by eliminating the need for humeral component explantation when converting from anatomic shoulder arthroplasty (hemiarthroplasty or total shoulder arthroplasty) to reverse total shoulder arthroplasty (rTSA). A multicenter, retrospective analysis involving 102 consecutive shoulders (102 patients) that underwent revision of an anatomic shoulder arthroplasty to an rTSA was conducted. During the revision, 73 of the shoulders needed exchange of the humeral stem (the exchange group) and 29 had retention of a convertible-platform humeral component (the retention group). Patient demographics, operative time, blood management, range of motion, complications, and patient-reported outcomes were compared between the 2 groups. Patients with retention had significantly shorter operative time (mean and standard deviation, 130 ± 48 versus 195 ± 58 minutes; p < 0.001) and lower estimated blood loss (292 ± 118 versus 492 ± 334 mL; p = 0.034). The rate of intraoperative complications was lower in the retention group (0% versus 15%; p = 0.027). Patients with retention had slightly better postoperative range of motion (active external rotation, 26° ± 23° versus 11° ± 23° [p = 0.006]; active forward elevation, 112° ± 37° versus 96° ± 33° [p = 0.055]). Shoulder arthroplasty systems that utilize a convertible-platform humeral stem offer an advantage for rTSA conversion in that a well-fixed, well-positioned humeral stem can be retained. There were significantly fewer complications as well as significantly decreased blood loss and operative time when a convertible-platform stem was utilized (p < 0.050). Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

One-Joule-per-Pulse Q-Switched 2-micron Solid State Laser

NASA Technical Reports Server (NTRS)

Yu, Jirong; Trieu, Bo C.; Modlin, Ed A.; Singh, Upendra N.; Kavaya, Michael J.; Chen, Songsheng; Bai, Yingxin; Petzar, Pual J.; Petros, Mulugeta

2005-01-01

Q-switched output of 1.1 J per pulse at 2-micron wavelength has been achieved in a diode pumped Ho:Tm:LuLF laser using a side-pumped rod configuration in a Master-Oscillator-Power-Amplifier (MOPA) architecture. This is the first time that a 2-micron laser has broken the Joule per pulse barrier for Q-switched operation. The total system efficiency reaches 5% and 6.2% for single and double pulse operation, respectively. The system produces excellent 1.4 times of transform limited beam quality.

Total Probability of Collision as a Metric for Finite Conjunction Assessment and Collision Risk Management

NASA Technical Reports Server (NTRS)

Frigm, Ryan C.; Hejduk, Matthew D.; Johnson, Lauren C.; Plakalovic, Dragan

2015-01-01

On-orbit collision risk is becoming an increasing mission risk to all operational satellites in Earth orbit. Managing this risk can be disruptive to mission and operations, present challenges for decision-makers, and is time-consuming for all parties involved. With the planned capability improvements to detecting and tracking smaller orbital debris and capacity improvements to routinely predict on-orbit conjunctions, this mission risk will continue to grow in terms of likelihood and effort. It is very real possibility that the future space environment will not allow collision risk management and mission operations to be conducted in the same manner as it is today. This paper presents the concept of a finite conjunction assessment-one where each discrete conjunction is not treated separately but, rather, as a continuous event that must be managed concurrently. The paper also introduces the Total Probability of Collision as an analogous metric for finite conjunction assessment operations and provides several options for its usage in a Concept of Operations.

Dokan Hydropower Reservoir Operation under Stochastic Conditions as Regards the Inflows and the Energy Demands

NASA Astrophysics Data System (ADS)

Izat Rashed, Ghamgeen

2018-03-01

This paper presented a way of obtaining certain operating rules on time steps for the management of a large reservoir operation with a peak hydropower plant associated to it. The rules were allowed to have the form of non-linear regression equations which link a decision variable (here the water volume in the reservoir at the end of the time step) by several parameters influencing it. This paper considered the Dokan hydroelectric development KR-Iraq, which operation data are available for. It was showing that both the monthly average inflows and the monthly power demands are random variables. A model of deterministic dynamic programming intending the minimization of the total amount of the squares differences between the demanded energy and the generated energy is run with a multitude of annual scenarios of inflows and monthly required energies. The operating rules achieved allow the efficient and safe management of the operation and it is quietly and accurately known the forecast of the inflow and of the energy demand on the next time step.

Operation of Dokan Reservoir under Stochastic Conditions as Regards the Inflows and the Energy Demands

NASA Astrophysics Data System (ADS)

Rashed, G. I.

2018-02-01

This paper presented a way of obtaining certain operating rules on time steps for the management of a large reservoir operation with a peak hydropower plant associated to it. The rules were allowed to have the form of non-linear regression equations which link a decision variable (here the water volume in the reservoir at the end of the time step) by several parameters influencing it. This paper considered the Dokan hydroelectric development KR-Iraq, which operation data are available for. It was showing that both the monthly average inflows and the monthly power demands are random variables. A model of deterministic dynamic programming intending the minimization of the total amount of the squares differences between the demanded energy and the generated energy is run with a multitude of annual scenarios of inflows and monthly required energies. The operating rules achieved allow the efficient and safe management of the operation and it is quietly and accurately known the forecast of the inflow and of the energy demand on the next time step.

Modified totally tubeless percutaneous nephrolithotomy: Is it an effective and safe treatment option for renal and upper ureteral stones?

PubMed

Chung, Ho Seok; Jung, Seung Il; Yu, Ho Song; Hwang, Eu Chang; Oh, Kyung Jin; Kwon, Dong Deuk; Park, Kwangsung

2016-01-01

We hypothesized that modified totally tubeless percutaneous nephrolithotomy (PNL) without indwelling ureteral stent would minimize postoperative discomfort without complications. To evaluate the safety, efficacy, and morbidity of standard, tubeless, and modified totally tubeless PNL as well as the usefulness of modified totally tubeless PNL. From November 2011 to February 2015, 211 patients who underwent PNL consecutively were enrolled in this study and divided into 3 groups (group 1: standard, group 2: tubeless, group 3: modified totally tubeless PNL). Patient and stone characteristics, operation time, hemoglobin change, length of hospitalization, stone-free rate, analgesic requirement, and perioperative complications were analyzed and compared among the 3 groups. There were no significant differences in preoperative patient characteristics among the three groups. In the postoperative analysis, the three groups had similar operation time, stone-free rate, perioperative fever and transfusion rate, but group 2 showed superior results in terms of length of hospitalization (p = 0.001). Group 2 and group 3 had a lower analgesic requirement (p = 0.010). Immediate postoperative hemoglobin change (p = 0.001) and tube site complications (p = 0.001) were more common in group 1. Modified totally tubeless PNL was not inferior in terms of postoperative outcomes and safety compared with the standard and tubeless PNL, and avoided the postoperative stent-related symptoms and cystoscopy for double-J stent removal. Modified totally tubeless PNL could be an alternative treatment of choice for management of renal or upper ureteral stones in selected patients.

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

PubMed

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

2015-04-01

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

The Space Transportation System. [Space Shuttle-Spacelab-Space Tug system

NASA Technical Reports Server (NTRS)

Donlan, C. J.; Brazill, E. J.

1976-01-01

The Space Transportation System, consisting of the Space Shuttle, Spacelab, and the Space Tug, is discussed from the viewpoint of reductions in the cost of space operations. Each of the three vehicles is described along with its mission capabilities, and the time table for system development activities is outlined. Basic attributes of the Space Transportation System are reviewed, all operational modes are considered, and the total cost picture of the system is examined from the standpoint of a mission economic analysis. It is concluded that as the features of the Space Transportation System, especially the Shuttle and the Tug, are put to more efficient use during the maturing-operation phase, the total cost of conducting space missions should be about half of what it would be if any other system were employed.

Assessing Operational Total Lightning Visualization Products

NASA Technical Reports Server (NTRS)

Stano, Geoffrey T.; Darden, Christopher B.; Nadler, David J.

2010-01-01

In May 2003, NASA's Short-term Prediction Research and Transition (SPoRT) program successfully provided total lightning data from the North Alabama Lightning Mapping Array (NALMA) to the National Weather Service (NWS) office in Huntsville, Alabama. The major accomplishment was providing the observations in real-time to the NWS in the native Advanced Weather Interactive Processing System (AWIPS) decision support system. Within days, the NALMA data were used to issue a tornado warning initiating seven years of ongoing support to the NWS' severe weather and situational awareness operations. With this success, SPoRT now provides real-time NALMA data to five forecast offices as well as working to transition data from total lightning networks at Kennedy Space Center and the White Sands Missile Range to the surrounding NWS offices. The only NALMA product that has been transitioned to SPoRT's partner NWS offices is the source density product, available at a 2 km resolution in 2 min intervals. However, discussions with users of total lightning data from other networks have shown that other products are available, ranging from spatial and temporal variations of the source density product to the creation of a flash extent density. SPoRT and the Huntsville, Alabama NWS are evaluating the utility of these variations as this has not been addressed since the initial transition in 2003. This preliminary analysis will focus on what products will best support the operational warning decision process. Data from 19 April 2009 are analyzed. On this day, severe thunderstorms formed ahead of an approaching cold front. Widespread severe weather was observed, primarily south of the Tennessee River with multiple, weak tornadoes, numerous severe hail reports, and wind. This preliminary analysis is the first step in evaluation which product(s) are best suited for operations. The ultimate goal is selecting a single product for use with all total lightning networks to streamline training and science sharing.

Actual and estimated costs of disposable materials used during surgical procedures.

PubMed

Toyabe, Shin-Ichi; Cao, Pengyu; Kurashima, Sachiko; Nakayama, Yukiko; Ishii, Yuko; Hosoyama, Noriko; Akazawa, Kouhei

2005-07-01

It is difficult to estimate precisely the costs of disposable materials used during surgical operations. To evaluate the actual costs of disposable materials, we calculated the actual costs of disposable materials used in 59 operations by taking account of costs of all disposable materials used for each operation. The costs of the disposable materials varied significantly from operation to operation (US$ 38-4230 per operation), and the median [25-percentile and 75-percentile] of the sum total of disposable material costs of a single operation was found to be US$ 686 [205 and 993]. Multiple regression analysis with a stepwise regression method showed that costs of disposable materials significantly correlated only with operation time (p<0.001). Based on the results, we propose a simple method for estimating costs of disposable materials by measuring operation time, and we found that the method gives reliable results. Since costs of disposable materials used during surgical operations are considerable, precise estimation of the costs is essential for hospital cost accounting. Our method should be useful for planning hospital administration strategies.

40 CFR 63.2520 - What reports must I submit and when?

Code of Federal Regulations, 2014 CFR

2014-07-01

... report. (3) Date of report and beginning and ending dates of the reporting period. (4) For each SSM... SSM. (A) The total operating time of the affected source during the reporting period. (B) Information...) of this section. This includes periods of SSM. (A) The date and time that each CMS was inoperative...

75 FR 75500 - Material Hoists, Personnel Hoists, and Elevators Standard; Extension of the Office of Management...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-12-03

... worker to obtain and post information for hoists. Total Burden Hours: 20,957. Estimated Cost (Operation... information is in the desired format, reporting burden (time and costs) is minimal, collection instruments are... accuracy of OSHA's estimate of the burden (time and costs) of the information collection requirements...

75 FR 68381 - Gear Certification Standard; Extension of the Office of Management and Budget's (OMB) Approval of...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-11-05

... prospective accredited agency to complete the form. Total Burden Hours: 190. Estimated Cost (Operation and...)). This program ensures that information is in the desired format, reporting burden (time and costs) is...; The accuracy of OSHA's estimate of the burden (time and costs) of the information collection...

Robot-assisted total laparoscopic hysterectomy in obese and morbidly obese women.

PubMed

Rebeles, Sonia A; Muntz, Howard G; Wieneke-Broghammer, Carrie; Vason, Emily S; McGonigle, Kathryn F

2009-10-01

Total laparoscopic hysterectomy (TLH) in obese patients is challenging. We sought to evaluate whether total laparoscopic hysterectomies using the da Vinci robotic system in obese patients, in comparison with non-obese patients, is a reasonable surgical approach. One-hundred consecutive robot-assisted TLHs were performed over a 17-month period. Obesity was not a contraindication to robotic surgery, assuming adequate respiratory function to tolerate Trendelenburg position and, for cancer cases, a small enough uterus to allow vaginal extraction without morcellation. Data were prospectively collected on patient characteristics, total operative time, hysterectomy time, estimated blood loss, length of stay, and complications. Outcomes with non-obese and obese women were compared. The median age, weight, and BMI of the 100 patients who underwent robot-assisted TLH was 57.6 years (30.0-90.6), 82.1 kg (51.9-159.6), and 30.2 kg/m(2) (19.3-60.2), respectively. Fifty (50%) patients were obese (BMI ≥ 30); 22 patients were morbidly obese (BMI ≥ 40). There was no increase in complications (p = 0.56) or blood loss (p = 0.44) with increasing BMI. While increased BMI was associated with longer operative times (p = 0.05), median time increased by only 36 min when comparing non-obese and morbidly obese patients. Median length of stay was one day for all weight categories (p = 0.42). Robot-assisted TLH is feasible and can be safely performed in obese patients. More data are needed to compare robot-assisted TLH with other hysterectomy techniques in obese patients. Nonetheless, our results are encouraging. Robot-assisted total laparoscopic hysterectomy may be the preferred technique for appropriately selected obese patients.

Minimal invasive laparoscopic hysterectomy with ultrasonic scalpel.

PubMed

Gyr, T; Ghezzi, F; Arslanagic, S; Leidi, L; Pastorelli, G; Franchi, M

2001-06-01

The purpose of the study was to assess whether total laparoscopic hysterectomy with the ultrasonic scalpel offers advantages in term of intraoperative and postoperative outcomes over the conventional abdominal hysterectomy. A case-control study to compare patients undergoing total laparoscopic hysterectomy and women undergoing abdominal hysterectomy for benign conditions was designed. Matching criteria were the menopausal status, the need of adnexectomy, and the uterus weight. The laparoscopic procedure was carried out using an ultrasonically activated scalpel and the amputated uterus was removed transvaginally. Every part of the operation was carried out via laparoscopy, from the adnexal phase to the colpotomy. Abdominal hysterectomy was performed using a conventional laparotomic technique. Intraoperative and postoperative characteristics were analyzed. One hundred forty-four patients were enrolled, of whom 48 underwent total laparoscopic hysterectomy and 98 abdominal hysterectomy. No difference was found between groups in terms of operating time or intraoperative and postoperative infectious and noninfectious complications. The median (range) total consumption of morphine (0 mg [0 to 16] versus 15 mg [0 to 100], P <0.01) during the first 3 postoperative days was significantly lower in the laparoscopic group than in the laparotomic group. The median (range) time to regular diet (1[0 to 4] versus 2 [0 to 5], P <0.05) and the time to passage of stool (1[1 to 2] versus 2 [1 to 5], P <0.05) was shorter in the laparoscopic than in the laparotomic group. Total laparoscopic hysterectomy with the ultrasonic scalpel is feasible and safe, and offers not only cosmetic benefits but also reduces the need of analgesia and the time to return to a normal gastrointestinal function in comparison with the conventional abdominal hysterectomy.

Special features of total knee replacement in hemophilia.

PubMed

Rodriguez-Merchan, Emerito Carlos

2013-12-01

Total knee replacement is an operation frequently needed by hemophilia patients, which greatly improves their quality of life. This operation, however, carries a higher risk of bleeding and infection for hemophiliacs than it does for osteoarthritis sufferers. It is advisable to implant prosthetic components using antibiotic-loaded cement. It is essential to maintain a level of 100% of the replacement clotting factor for 2 weeks. Hematological treatment must be established, depending on the patient's factor levels and other pharmacokinetic parameters such as recovery and half-life, optimal doses and treatment time. It is preferable to use general anesthesia due to the risk of spinal bleeding. The lifespan of total knee replacement in hemophilic patients is shorter than in patients with osteoarthritis because of the increased risk of infection.

Early assessment of bilateral inguinal hernia repair: A comparison between the laparoscopic total extraperitoneal and Stoppa approaches.

PubMed

Utiyama, Edivaldo Massazo; Damous, S Rgio Henrique Bastos; Tanaka, Eduardo Yassushi; Yoo, Jin Hwan; de Miranda, Jocielle Santos; Ushinohama, Adriano Zuardi; Faro, Mario Paulo; Birolini, Claudio Augusto Vianna

2016-01-01

The present clinical trial was designed to compare the results of bilateral inguinal hernia repair between patients who underwent the conventional Stoppa technique and laparoscopic total extraperitoneal repair (LTE) with a single mesh and without staple fixation. This controlled, randomised clinical trial was conducted at General Surgery and Trauma of the Clinics Hospital, Medical School, the University of São Paulo between September 2010 and February 2011. Totally, 50 male patients, with a bilateral inguinal hernia, older than 25 years were considered eligible for the study. The following parameters were analysed during the early post-operative period: (1) The intensity of surgical trauma, operation time, C-reactive protein (CRP) levels, white blood cell count, bleeding and pain intensity; (2) quality of life assessment; and (3) post-operative complications. LTE procedure was longer than the Stoppa procedure (134.6 min ± 38.3 vs. 90.6 min ± 41.3; P < 0.05). The levels of CRP were higher in the Stoppa group (P < 0.05) but the number of leucocytes, haematocrit, and haemoglobin were similar between the groups (P > 0.05). There was no difference in pain during the 1st and 7th post-operative, physical functioning, physical limitation, the impact of pain on daily activities, and the Carolinas Comfort Scale during the 7th and 15th post-operative (P > 0.05). Complications occurred in 88% of Stoppa group (22 patients) and 64% in LTE group (16 patients) (P < 0.05). The comparative study between the Stoppa and LTE approaches for the bilateral inguinal hernia repair demonstrated that: (1) The LTE approach showed less surgical trauma despite the longer operation time; (2) Quality of life during the early post-operative period were similar; and (3) Complication rates were higher in the Stoppa group.

Early assessment of bilateral inguinal hernia repair: A comparison between the laparoscopic total extraperitoneal and Stoppa approaches

PubMed Central

Utiyama, Edivaldo Massazo; Damous, Sérgio Henrique Bastos; Tanaka, Eduardo Yassushi; Yoo, Jin Hwan; de Miranda, Jocielle Santos; Ushinohama, Adriano Zuardi; Faro, Mario Paulo; Birolini, Claudio Augusto Vianna

2016-01-01

BACKGROUND: The present clinical trial was designed to compare the results of bilateral inguinal hernia repair between patients who underwent the conventional Stoppa technique and laparoscopic total extraperitoneal repair (LTE) with a single mesh and without staple fixation. PATIENTS AND METHODS: This controlled, randomised clinical trial was conducted at General Surgery and Trauma of the Clinics Hospital, Medical School, the University of São Paulo between September 2010 and February 2011. Totally, 50 male patients, with a bilateral inguinal hernia, older than 25 years were considered eligible for the study. The following parameters were analysed during the early post-operative period: (1) The intensity of surgical trauma, operation time, C-reactive protein (CRP) levels, white blood cell count, bleeding and pain intensity; (2) quality of life assessment; and (3) post-operative complications. RESULTS: LTE procedure was longer than the Stoppa procedure (134.6 min ± 38.3 vs. 90.6 min ± 41.3; P < 0.05). The levels of CRP were higher in the Stoppa group (P < 0.05) but the number of leucocytes, haematocrit, and haemoglobin were similar between the groups (P > 0.05). There was no difference in pain during the 1st and 7th post-operative, physical functioning, physical limitation, the impact of pain on daily activities, and the Carolinas Comfort Scale during the 7th and 15th post-operative (P > 0.05). Complications occurred in 88% of Stoppa group (22 patients) and 64% in LTE group (16 patients) (P < 0.05). CONCLUSION: The comparative study between the Stoppa and LTE approaches for the bilateral inguinal hernia repair demonstrated that: (1) The LTE approach showed less surgical trauma despite the longer operation time; (2) Quality of life during the early post-operative period were similar; and (3) Complication rates were higher in the Stoppa group. PMID:27279401

Quantum gates by periodic driving

PubMed Central

Shi, Z. C.; Wang, W.; Yi, X. X.

2016-01-01

Topological quantum computation has been extensively studied in the past decades due to its robustness against decoherence. One way to realize the topological quantum computation is by adiabatic evolutions—it requires relatively long time to complete a gate, so the speed of quantum computation slows down. In this work, we present a method to realize single qubit quantum gates by periodic driving. Compared to adiabatic evolution, the single qubit gates can be realized at a fixed time much shorter than that by adiabatic evolution. The driving fields can be sinusoidal or square-well field. With the sinusoidal driving field, we derive an expression for the total operation time in the high-frequency limit, and an exact analytical expression for the evolution operator without any approximations is given for the square well driving. This study suggests that the period driving could provide us with a new direction in regulations of the operation time in topological quantum computation. PMID:26911900

Quantum gates by periodic driving.

PubMed

Shi, Z C; Wang, W; Yi, X X

2016-02-25

Topological quantum computation has been extensively studied in the past decades due to its robustness against decoherence. One way to realize the topological quantum computation is by adiabatic evolutions-it requires relatively long time to complete a gate, so the speed of quantum computation slows down. In this work, we present a method to realize single qubit quantum gates by periodic driving. Compared to adiabatic evolution, the single qubit gates can be realized at a fixed time much shorter than that by adiabatic evolution. The driving fields can be sinusoidal or square-well field. With the sinusoidal driving field, we derive an expression for the total operation time in the high-frequency limit, and an exact analytical expression for the evolution operator without any approximations is given for the square well driving. This study suggests that the period driving could provide us with a new direction in regulations of the operation time in topological quantum computation.

76 FR 22902 - Agency Forms Undergoing Paperwork Reduction Act Review

Federal Register 2010, 2011, 2012, 2013, 2014

2011-04-25

... `black lung'. Demographic and logistical information is gathered from coal mine operators and... and x-ray findings. There are no costs of the NCWAS to respondents other than their time. The total...

Statistical process control as a tool for controlling operating room performance: retrospective analysis and benchmarking.

PubMed

Chen, Tsung-Tai; Chang, Yun-Jau; Ku, Shei-Ling; Chung, Kuo-Piao

2010-10-01

There is much research using statistical process control (SPC) to monitor surgical performance, including comparisons among groups to detect small process shifts, but few of these studies have included a stabilization process. This study aimed to analyse the performance of surgeons in operating room (OR) and set a benchmark by SPC after stabilized process. The OR profile of 499 patients who underwent laparoscopic cholecystectomy performed by 16 surgeons at a tertiary hospital in Taiwan during 2005 and 2006 were recorded. SPC was applied to analyse operative and non-operative times using the following five steps: first, the times were divided into two segments; second, they were normalized; third, they were evaluated as individual processes; fourth, the ARL(0) was calculated;, and fifth, the different groups (surgeons) were compared. Outliers were excluded to ensure stability for each group and to facilitate inter-group comparison. The results showed that in the stabilized process, only one surgeon exhibited a significantly shorter total process time (including operative time and non-operative time). In this study, we use five steps to demonstrate how to control surgical and non-surgical time in phase I. There are some measures that can be taken to prevent skew and instability in the process. Also, using SPC, one surgeon can be shown to be a real benchmark. © 2010 Blackwell Publishing Ltd.

A two-stage method of quantitative flood risk analysis for reservoir real-time operation using ensemble-based hydrologic forecasts

NASA Astrophysics Data System (ADS)

Liu, P.

2013-12-01

Quantitative analysis of the risk for reservoir real-time operation is a hard task owing to the difficulty of accurate description of inflow uncertainties. The ensemble-based hydrologic forecasts directly depict the inflows not only the marginal distributions but also their persistence via scenarios. This motivates us to analyze the reservoir real-time operating risk with ensemble-based hydrologic forecasts as inputs. A method is developed by using the forecast horizon point to divide the future time into two stages, the forecast lead-time and the unpredicted time. The risk within the forecast lead-time is computed based on counting the failure number of forecast scenarios, and the risk in the unpredicted time is estimated using reservoir routing with the design floods and the reservoir water levels of forecast horizon point. As a result, a two-stage risk analysis method is set up to quantify the entire flood risks by defining the ratio of the number of scenarios that excessive the critical value to the total number of scenarios. The China's Three Gorges Reservoir (TGR) is selected as a case study, where the parameter and precipitation uncertainties are implemented to produce ensemble-based hydrologic forecasts. The Bayesian inference, Markov Chain Monte Carlo, is used to account for the parameter uncertainty. Two reservoir operation schemes, the real operated and scenario optimization, are evaluated for the flood risks and hydropower profits analysis. With the 2010 flood, it is found that the improvement of the hydrologic forecast accuracy is unnecessary to decrease the reservoir real-time operation risk, and most risks are from the forecast lead-time. It is therefore valuable to decrease the avarice of ensemble-based hydrologic forecasts with less bias for a reservoir operational purpose.

Transoral robotic-assisted laryngeal cleft repair in the pediatric patient.

PubMed

Leonardis, Rachel L; Duvvuri, Umamaheswar; Mehta, Deepak

2014-09-01

To assess the feasibility of performing robotic-assisted laryngeal cleft repair in the pediatric population. Retrospective chart review at a tertiary academic children's hospital. All patients underwent transoral robotic-assisted laryngeal cleft repair from March 2011 to June 2013. Demographics, robotic docking time, operative time, and postoperative course and swallowing function were collected and analyzed. Five children, three male and two female, underwent successful transoral robotic-assisted laryngeal cleft repair for closure of a type I laryngeal cleft. Mean age at time of surgery was 21.6 months (standard deviation 6.1 months; range, 15-29 months). From case 1 to case 5, robotic docking time (18-10 minutes), robotic operative time (102-36 minutes), and total operating room time (173-105 minutes) decreased. There were no complications with time until extubation (range, 2-3 days), length of intensive care unit stay (range, 3-4 days), and total hospital stay (range, 3-5 days) within acceptable range following laryngeal cleft repair. Modified barium swallow (two patients) or fiberoptic endoscopic evaluation of swallowing (three patients) was performed postoperatively, with all patients showing complete resolution of penetration and aspiration. In addition, all patients experienced subjective resolution of dysphagia and/or choking with feeds postoperatively. Transoral robotic-assisted laryngeal cleft repair may offer specific advantages over a traditional endoscopic approach. In our experience, the procedure was well tolerated and associated with definitive surgical cure in all patients. The scope of robotic technology continually expands and should be considered a feasible tool at an institution-based level. © 2014 The American Laryngological, Rhinological and Otological Society, Inc.

Computational Fluid Dynamics Modeling of the John Day Dam Tailrace

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

Rakowski, Cynthia L.; Perkins, William A.; Richmond, Marshall C.

US Army Corps of Engineers - Portland District required that a two-dimensional (2D) depth-averaged and a three-dimensional (3D) free-surface numerical models to be developed and validated for the John Day tailrace. These models were used to assess potential impact of a select group of structural and operational alternatives to tailrace flows aimed at improving fish survival at John Day Dam. The 2D model was used for the initial assessment of the alternatives in conjunction with a reduced-scale physical model of the John Day Project. A finer resolution 3D model was used to more accurately model the details of flow inmore » the stilling basin and near-project tailrace hydraulics. Three-dimensional model results were used as input to the Pacific Northwest National Laboratory particle tracking software, and particle paths and times to pass a downstream cross section were used to assess the relative differences in travel times resulting from project operations and structural scenarios for multiple total river flows. Streamlines and neutrally-buoyant particles were seeded in all turbine and spill bays with flows. For a Total River of 250 kcfs running with the Fish Passage Plan spill pattern and a spillwall, the mean residence times for all particles were little changed; however the tails of the distribution were truncated for both spillway and powerhouse release points, and, for the powerhouse releases, reduced the residence time for 75% of the particles to pass a downstream cross section from 45.5 minutes to 41.3 minutes. For a total river of 125 kcfs configured with the operations from the Fish Passage Plan for the temporary spillway weirs and for a proposed spillwall, the neutrally-buoyant particle tracking data showed that the river with a spillwall in place had the overall mean residence time increase; however, the residence time for 75% of the powerhouse-released particles to pass a downstream cross section was reduced from 102.4 min to 89 minutes.« less

The Causes of Logging Truck Delays on Two West Virginia Logging Operations

Treesearch

John E. Baumgras

1978-01-01

Logging truck downtime increases timber harvesting costs. To determine the extent and causes of truck delays, four logging trucks on two separate operations were monitored for a 7-month period by recording speedometers and with tallies of delay causes. The results show the number of truck delays per shift, their duration, and the total delay time per shift for eight...

The First 60 Days

DTIC Science & Technology

1987-03-23

solution . Using the battalion training NCO, senior guidance counselor, operations NCO, SGM, XO and operations officer as trainers will assist both the... towsrd justification of additional advertising funds, if needed. SProviding a workable Total Army Involvement in Recruiting (TAIR) plan on a quarterly... solution to this problem. 0 Have your CLT visit local reserve canters for assistance in gaining access to schools. Many times, members of the reserve units

The use of theatre time for paediatric dentistry under general anaesthesia.

PubMed

Foley, Jennifer; Soldani, Francesca

2007-01-01

The aim of this paper was to determine the use of theatre time for all procedures performed under general anaesthetic on a paediatric dental list. A prospective study of paediatric dental general anaesthetic procedures was undertaken at Ninewells Hospital and Medical School, NHS Tayside, Dundee, UK. Data were collected prospectively for 71 operating lists over a 3-year period from April 2003 to March 2006. Both operator status and the procedure being undertaken were recorded. In addition, pre-anaesthetic, anaesthetic, operating and disconnection times were recorded. Of the 71 lists examined, 61 either finished early or on time, with a median unused time of 32.50 min (interquartile range = 19.50, 50.00 min), whilst 10 lists finished late with a median overrun time of 30.50 min (interquartile range = 9.25, 45.50 min). Comparing lists which finished late with those which were completed within time, the median pre-anaesthetic time was significantly longer (Mann-Whitney U-test, W = 20.05, P = 0.048). Overall, the theatre was in use for 78.22% of time combining pre-anaesthetic, anaesthetic, operating and disconnection times; hence, there was poor time utilization of theatre for 21.78% of the total theatre time. Overall, 85.9% of theatre sessions for dental procedures under general anaesthetic in children finished early or on time. Where lists finished late, the duration of the pre-anaesthetic time appeared to be the significant factor.

Dynamic Performance of High Bypass Ratio Turbine Engines With Water Ingestion

NASA Technical Reports Server (NTRS)

Murthy, S. N. B.

1996-01-01

The research on dynamic performance of high bypass turbofan engines includes studies on inlets, turbomachinery and the total engine system operating with air-water mixture; the water may be in vapor, droplet, or film form, and their combinations. Prediction codes (WISGS, WINCOF, WINCOF-1, WINCLR, and Transient Engine Performance Code) for performance changes, as well as changes in blade-casing clearance, have been established and demonstrated in application to actual, generic engines. In view of the continuous changes in water distribution in turbomachinery, the performance of both components and the total engine system must be determined in a time-dependent mode; hence, the determination of clearance changes also requires a time-dependent approach. In general, the performance and clearances changes cannot be scaled either with respect to operating or ingestion conditions. Removal of water prior to phase change is the most effective means of avoiding ingestion effects. Sufficient background has been established to perform definitive, full scale tests on a set of components and a complete engine to establish engine control and operability with various air-water vapor-water mixtures.

Feasibility study of a real-time operating system for a multichannel MPEG-4 encoder

NASA Astrophysics Data System (ADS)

Lehtoranta, Olli; Hamalainen, Timo D.

2005-03-01

Feasibility of DSP/BIOS real-time operating system for a multi-channel MPEG-4 encoder is studied. Performances of two MPEG-4 encoder implementations with and without the operating system are compared in terms of encoding frame rate and memory requirements. The effects of task switching frequency and number of parallel video channels to the encoding frame rate are measured. The research is carried out on a 200 MHz TMS320C6201 fixed point DSP using QCIF (176x144 pixels) video format. Compared to a traditional DSP implementation without an operating system, inclusion of DSP/BIOS reduces total system throughput only by 1 QCIF frames/s. The operating system has 6 KB data memory overhead and program memory requirement of 15.7 KB. Hence, the overhead is considered low enough for resource critical mobile video applications.

40 CFR 63.1427 - Process vent requirements for processes using extended cookout as an epoxide emission reduction...

Code of Federal Regulations, 2010 CFR

2010-07-01

... obtaining the liquid sample, along with the test method used to determine the epoxide concentration. This... pressures, the owner or operator shall determine the time when the pressure has fallen to half its total pressure by using Equation 13: ER08MY00.008 Where: Phalf1 = Half the total pressure of the epoxide for...

Realizing improved patient care through human-centered operating room design: a human factors methodology for observing flow disruptions in the cardiothoracic operating room.

PubMed

Palmer, Gary; Abernathy, James H; Swinton, Greg; Allison, David; Greenstein, Joel; Shappell, Scott; Juang, Kevin; Reeves, Scott T

2013-11-01

Human factors engineering has allowed a systematic approach to the evaluation of adverse events in a multitude of high-stake industries. This study sought to develop an initial methodology for identifying and classifying flow disruptions in the cardiac operating room (OR). Two industrial engineers with expertise in human factors workflow disruptions observed 10 cardiac operations from the moment the patient entered the OR to the time they left for the intensive care unit. Each disruption was fully documented on an architectural layout of the OR suite and time-stamped during each phase of surgery (preoperative [before incision], operative [incision to skin closure], and postoperative [skin closure until the patient leaves the OR]) to synchronize flow disruptions between the two observers. These disruptions were then categorized. The two observers made a total of 1,158 observations. After the elimination of duplicate observations, a total of 1,080 observations remained to be analyzed. These disruptions were distributed into six categories such as communication, usability, physical layout, environmental hazards, general interruptions, and equipment failures. They were further organized into 33 subcategories. The most common disruptions were related to OR layout and design (33%). By using the detailed architectural diagrams, the authors were able to clearly demonstrate for the first time the unique role that OR design and equipment layout has on the generation of physical layout flow disruptions. Most importantly, the authors have developed a robust taxonomy to describe the flow disruptions encountered in a cardiac OR, which can be used for future research and patient safety improvements.

Nuclear powered Mars cargo transport mission utilizing advanced ion propulsion

NASA Technical Reports Server (NTRS)

Galecki, Diane L.; Patterson, Michael J.

1987-01-01

Nuclear-powered ion propulsion technology was combined with detailed trajectory analysis to determine propulsion system and trajectory options for an unmanned cargo mission to Mars in support of manned Mars missions. A total of 96 mission scenarios were identified by combining two power levels, two propellants, four values of specific impulse per propellant, three starting altitudes, and two starting velocities. Sixty of these scenarios were selected for a detailed trajectory analysis; a complete propulsion system study was then conducted for 20 of these trajectories. Trip times ranged from 344 days for a xenon propulsion system operating at 300 kW total power and starting from lunar orbit with escape velocity, to 770 days for an argon propulsion system operating at 300 kW total power and starting from nuclear start orbit with circular velocity. Trip times for the 3 MW cases studied ranged from 356 to 413 days. Payload masses ranged from 5700 to 12,300 kg for the 300 kW power level, and from 72,200 to 81,500 kg for the 3 MW power level.

The Mission Accessibility of Near-Earth Asteroids

NASA Technical Reports Server (NTRS)

Barbee, Brent W.; Abell, Paul A.; Adamo, Daniel R.; Mazanek, Daniel D.; Johnson, Lindley N.; Yeomans, Donald K.; Chodas, Paul W.; Chamberlin, Alan B.; Benner, Lance A. M.; Taylor, Patrick;

The efficiency of a dedicated staff on operating room turnover time in hand surgery.

PubMed

Avery, Daniel M; Matullo, Kristofer S

2014-01-01

To evaluate the effect of orthopedic and nonorthopedic operating room (OR) staff on the efficiency of turnover time in a hand surgery practice. A total of 621 sequential hand surgery cases were retrospectively reviewed. Turnover times for sequential cases were calculated and analyzed with regard to the characteristics of the OR staff being primarily orthopedic or nonorthopedic. A total of 227 turnover times were analyzed. The average turnover time with all nonorthopedic staff was 31 minutes, for having only an orthopedic surgical technician was 32 minutes, for having only an orthopedic circulator was 25 minutes, and for having both an orthopedic surgical technician and a circulator was 20 minutes. Statistical significance was seen when comparing only an orthopedic surgical technician versus both an orthopedic circulator and a surgical technician and when comparing both nonorthopedic staff versus both an orthopedic circulator and a surgical technician. OR efficiency is being increasingly evaluated for its effect on hospital revenue and OR staff costs. Reducing turnover time is one aspect of a multifaceted solution in increasing efficiency. Our study showed that, for hand surgery, orthopedic-specific staff can reduce turnover time. Economic/Decision Analysis III. Copyright © 2014 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

Patient-specific instrumentation does not improve radiographic alignment or clinical outcomes after total knee arthroplasty.

PubMed

Huijbregts, Henricus J T A M; Khan, Riaz J K; Sorensen, Emma; Fick, Daniel P; Haebich, Samantha

2016-08-01

Background and purpose - Patient-specific instrumentation (PSI) for total knee arthroplasty (TKA) has been introduced to improve alignment and reduce outliers, increase efficiency, and reduce operation time. In order to improve our understanding of the outcomes of patient-specific instrumentation, we conducted a meta-analysis. Patients and methods - We identified randomized and quasi-randomized controlled trials (RCTs) comparing patient-specific and conventional instrumentation in TKA. Weighted mean differences and risk ratios were determined for radiographic accuracy, operation time, hospital stay, blood loss, number of surgical trays required, and patient-reported outcome measures. Results - 21 RCTs involving 1,587 TKAs were included. Patient-specific instrumentation resulted in slightly more accurate hip-knee-ankle axis (0.3°), coronal femoral alignment (0.3°, femoral flexion (0.9°), tibial slope (0.7°), and femoral component rotation (0.5°). The risk ratio of a coronal plane outlier (> 3° deviation of chosen target) for the tibial component was statistically significantly increased in the PSI group (RR =1.64). No significance was found for other radiographic measures. Operation time, blood loss, and transfusion rate were similar. Hospital stay was significantly shortened, by approximately 8 h, and the number of surgical trays used decreased by 4 in the PSI group. Knee Society scores and Oxford knee scores were similar. Interpretation - Patient-specific instrumentation does not result in clinically meaningful improvement in alignment, fewer outliers, or better early patient-reported outcome measures. Efficiency is improved by reducing the number of trays used, but PSI does not reduce operation time.

Traffic in the operating room during joint replacement is a multidisciplinary problem

PubMed Central

Bédard, Martin; Pelletier-Roy, Rémi; Angers-Goulet, Mathieu; Leblanc, Pierre-Alexandre; Pelet, Stéphane

2015-01-01

Background Door openings disrupt the laminar air flow and increase the bacterial count in the operating room (OR). We aimed to define the incidence of door openings in the OR during primary total joint arthroplasty (TJA) surgeries and determine whether measures were needed and/or possible to reduce OR staff traffic. Methods We recorded the number of door openings during 100 primary elective TJA surgeries; the OR personnel were unaware of the observer’s intention. Operating time was divided into the preincision period, defined as the time from the opening of surgical trays to skin incision, and the postincision period, defined as time from incision to dressing application. Results The mean number of door openings during primary TJA was 71.1 (range 35–176) with a mean operative time of 111.9 (range 53–220) minutes, for an average of 0.64 (range 0.36–1.05) door openings/min. Nursing staff were responsible for 52.2% of total door openings, followed by anesthesia staff at 23.9% and orthopedic staff at 12.7%. In the preincision period, we observed an average of 0.84 door openings/min, with nursing and orthopedic personnel responsible for most of the door openings. The postincision period yielded an average of 0.54 door openings/min, with nursing and anesthesia personnel being responsible for most of the door openings. Conclusion There is a high incidence of door openings during TJA. Because we observed a range in the number of door openings per surgery, we believe it is possible to reduce this number during TJA. PMID:26022153

The use of augmented reality glasses in central line simulation: "see one, simulate many, do one competently, and teach everyone".

PubMed

Huang, Cynthia Y; Thomas, Jonathan B; Alismail, Abdullah; Cohen, Avi; Almutairi, Waleed; Daher, Noha S; Terry, Michael H; Tan, Laren D

2018-01-01

The aim of this study was to investigate the feasibility of using augmented reality (AR) glasses in central line simulation by novice operators and compare its efficacy to standard central line simulation/teaching. This was a prospective randomized controlled study enrolling 32 novice operators. Subjects were randomized on a 1:1 basis to either simulation using the augmented virtual reality glasses or simulation using conventional instruction. The study was conducted in tertiary-care urban teaching hospital. A total of 32 adult novice central line operators with no visual or auditory impairments were enrolled. Medical doctors, respiratory therapists, and sleep technicians were recruited from the medical field. The mean time for AR placement in the AR group was 71±43 s, and the time to internal jugular (IJ) cannulation was 316±112 s. There was no significant difference in median (minimum, maximum) time (seconds) to IJ cannulation for those who were in the AR group and those who were not (339 [130, 550] vs 287 [35, 475], p =0.09), respectively. There was also no significant difference between the two groups in median total procedure time (524 [329, 792] vs 469 [198, 781], p =0.29), respectively. There was a significant difference in the adherence level between the two groups favoring the AR group ( p =0.003). AR simulation of central venous catheters in manikins is feasible and efficacious in novice operators as an educational tool. Future studies are recommended in this area as it is a promising area of medical education.

Prognostic significance of the total number of harvested lymph nodes for lymph node-negative gastric cancer patients.

PubMed

Ji, Xin; Bu, Zhao-De; Li, Zi-Yu; Wu, Ai-Wen; Zhang, Lian-Hai; Zhang, Ji; Wu, Xiao-Jiang; Zong, Xiang-Long; Li, Shuang-Xi; Shan, Fei; Jia, Zi-Yu; Ji, Jia-Fu

2017-08-22

The relationship between the number of harvested lymph nodes (HLNs) and prognosis of gastric cancer patients without an involvement of lymph nodes has not been well-evaluated. The objective of this study is to further explore this issue. We collected data from 399 gastric cancer patients between November 2006 and October 2011. All of them were without metastatic lymph nodes. Survival analyses showed that statistically significant differences existed in the survival outcomes between the two groups allocated by the total number of HLNs ranging from 16 to 22. Therefore, we adopted 22 as the cut-off value of the total number of HLNs for grouping (group A: HLNs <22; group B: HLNs≥22). The intraoperative and postoperative characteristics, including operative blood loss (P=0.096), operation time (P=0.430), postoperative hospital stay (P=0.142), complications (P=0.552), rate of reoperation (P=0.966) and postoperative mortality (P=1.000), were comparable between the two groups. T-stage-stratified Kaplan-Meier analyses revealed that the 5-year survival rate of patients at the T4 stage was better in group B than in group A (76.9% vs. 58.5%; P=0.004). An analysis of multiple factors elucidated that the total number of HLNs, T stage, operation time and age were independently correlated factors of prognosis. Regarding gastric cancer patients without the involvement of lymph nodes, an HLN number ≥22 would be helpful in prolonging their overall survival, especially for those at T4 stage. The total number of HLNs was an independent prognostic factor for this population of patients.

Inheriting the Learner's View: A Google Glass-Based Wearable Computing Platform for Improving Surgical Trainee Performance.

PubMed

Brewer, Zachary E; Fann, Hutchinson C; Ogden, W David; Burdon, Thomas A; Sheikh, Ahmad Y

2016-01-01

It is speculated that, in operative environments, real-time visualization of the trainee's viewpoint by the instructor may improve performance and teaching efficacy. We hypothesized that introduction of a wearable surgical visualization system allowing the instructor to visualize otherwise "blind" areas in the operative field could improve trainee performance in a simulated operative setting. A total of 11 surgery residents (4 in general surgery training and 7 in an integrated 6-year cardiothoracic surgery program) participated in the study. Google (Mountain View, CA) Glass hardware running proprietary software from CrowdOptic (San Francisco, CA) was utilized for creation of the wearable surgical visualization system. Both the learner and trainer wore the system, and video was streamed from the learner's system in real time to the trainer, who directed the learner to place needles in a simulated operative field. Subjects placed a total of 5 needles in each of 4 quadrants. A composite error score was calculated based on the accuracy of needle placement in relation to the intended needle trajectories as described by the trainer. Time to task completion (TTC) was also measured and participants completed an exit questionnaire. All residents completed the protocol tasks and the survey. Introduction of the wearable surgical visualization system did not affect mean time to task completion (278 ± 50 vs. 282 ± 69 seconds, p = NS). However, mean composite error score fell significantly once the wearable system was deployed (18 ± 5 vs. 15 ± 4, p < 0.05), demonstrating improved accuracy of needle placement. Most of the participants deemed the device unobtrusive, easy to operate, and useful for communication and instruction. This study suggests that wearable surgical visualization systems allowing for adoption of the learner's perspective may be a useful educational adjunct in the training of surgeons. Further evaluations of the efficacy of wearable technology in the operating room environment are warranted. Copyright © 2016 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Single-Port Surgery: Laboratory Experience with the daVinci Single-Site Platform

PubMed Central

Haber, Georges-Pascal; Kaouk, Jihad; Kroh, Matthew; Chalikonda, Sricharan; Falcone, Tommaso

2011-01-01

Background and Objectives: The purpose of this study was to evaluate the feasibility and validity of a dedicated da Vinci single-port platform in the porcine model in the performance of gynecologic surgery. Methods: This pilot study was conducted in 4 female pigs. All pigs had a general anesthetic and were placed in the supine and flank position. A 2-cm umbilical incision was made, through which a robotic single-port device was placed and pneumoperitoneum obtained. A data set was collected for each procedure and included port placement time, docking time, operative time, blood loss, and complications. Operative times were compared between cases and procedures by use of the Student t test. Results: A total of 28 surgical procedures (8 oophorectomies, 4 hysterectomies, 8 pelvic lymph node dissections, 4 aorto-caval nodal dissections, 2 bladder repairs, 1 uterine horn anastomosis, and 1 radical cystectomy) were performed. There was no statistically significant difference in operating times for symmetrical procedures among animals (P=0.3215). Conclusions: This animal study demonstrates that single-port robotic surgery using a dedicated single-site platform allows performing technically challenging procedures within acceptable operative times and without complications or insertion of additional trocars. PMID:21902962

Current data do not support routine use of patient-specific instrumentation in total knee arthroplasty.

PubMed

Voleti, Pramod B; Hamula, Mathew J; Baldwin, Keith D; Lee, Gwo-Chin

2014-09-01

The purpose of this systematic review and meta-analysis is to compare patient-specific instrumentation (PSI) versus standard instrumentation for total knee arthroplasty (TKA) with regard to coronal and sagittal alignment, operative time, intraoperative blood loss, and cost. A systematic query in search of relevant studies was performed, and the data published in these studies were extracted and aggregated. In regard to coronal alignment, PSI demonstrated improved accuracy in femorotibial angle (FTA) (P=0.0003), while standard instrumentation demonstrated improved accuracy in hip-knee-ankle angle (HKA) (P=0.02). Importantly, there were no differences between treatment groups in the percentages of FTA or HKA outliers (>3 degrees from target alignment) (P=0.7). Sagittal alignment, operative time, intraoperative blood loss, and cost were also similar between groups (P>0.1 for all comparisons). Copyright © 2014 Elsevier Inc. All rights reserved.

Waardenburg syndrome with extended aganglionosis: report of 3 new cases.

PubMed

Karaca, Irfan; Turk, Erdal; Ortac, Ragip; Kandirici, Aliye

2009-06-01

The Waardenburg-Shah syndrome is an autosomal recessive disease with varied penetration where Hirschsprung's disease and the Waardenburg syndrome are seen together. Although the length of the involved intestinal segment varies in this syndrome, most patients had total colonic aganglionosis with or without small bowel involvement. We present in this study 2 siblings and one first-degree relative for a total of 3 male patients with Waardenburg syndrome and total colonic aganglionosis with or without small bowel involvement, together with their clinical characteristics and treatment methods. The patients who presented with intestinal obstruction findings within the first 48 hours after birth were operated on with 2 patients under elective conditions and 1 as an emergency. The ganglionic segment lengths were 6, 8, and 20 cm, respectively. Aganglionic enterostomy was performed, and the Ziegler operation was used for these patients. The enterostomies started to function on the third postoperative week, and they started to gain weight. However, all died because of sepsis on the 5th to 12th month. Waardenburg-Shah syndrome patients have a higher incidence of total colonic aganglionosis with or without small bowel involvement. The Ziegler operation may be used in patients with inadequate ganglionic bowel length to gain some time for the child to grow and to decrease total parenteral nutrition complications.

The pre-operative levels of haemoglobin in the blood can be used to predict the risk of allogenic blood transfusion after total knee arthroplasty.

PubMed

Maempel, J F; Wickramasinghe, N R; Clement, N D; Brenkel, I J; Walmsley, P J

2016-04-01

The pre-operative level of haemoglobin is the strongest predictor of the peri-operative requirement for blood transfusion after total knee arthroplasty (TKA). There are, however, no studies reporting a value that could be considered to be appropriate pre-operatively. This study aimed to identify threshold pre-operative levels of haemoglobin that would predict the requirement for blood transfusion in patients who undergo TKA. Analysis of receiver operator characteristic (ROC) curves of 2284 consecutive patients undergoing unilateral TKA was used to determine gender specific thresholds predicting peri-operative transfusion with the highest combined sensitivity and specificity (area under ROC curve 0.79 for males; 0.78 for females). Threshold levels of 13.75 g/dl for males and 12.75 g/dl for females were identified. The rates of transfusion in males and females, respectively above these levels were 3.37% and 7.11%, while below these levels, they were 16.13% and 28.17%. Pre-operative anaemia increased the rate of transfusion by 6.38 times in males and 6.27 times in females. Blood transfusion was associated with an increased incidence of early post-operative confusion (odds ratio (OR) = 3.44), cardiac arrhythmia (OR = 5.90), urinary catheterisation (OR = 1.60), the incidence of deep infection (OR = 4.03) and mortality (OR = 2.35) one year post-operatively, and increased length of stay (eight days vs six days, p < 0.001). Uncorrected low pre-operative levels of haemoglobin put patients at potentially modifiable risk and attempts should be made to correct this before TKA. Target thresholds for the levels of haemoglobin pre-operatively in males and females are proposed. Low pre-operative haemoglobin levels put patients at unnecessary risk and should be corrected prior to surgery. ©2016 The British Editorial Society of Bone & Joint Surgery.

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

PubMed

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

2014-03-01

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

Impact of the European Working Time Directive (EWTD) on the operative experience of surgery residents.

PubMed

Hopmans, Cornelis J; den Hoed, Pieter T; van der Laan, Lijckle; van der Harst, Erwin; van der Elst, Maarten; Mannaerts, Guido H H; Dawson, Imro; Timman, Reinier; Wijnhoven, Bas P L; IJzermans, Jan N M

2015-04-01

In Europe and the United States, work hour restrictions are considered to be particularly burdensome for residents in surgery specialties. The aim of this study was to examine whether reduction of the work week to 48 hours resulting from the implementation of the European Working Time Directive has affected the operative experience of surgery residents. This study was conducted in a general surgery training region in the Netherlands, consisting of 1 university hospital and 6 district training hospitals. Operating records summarizing the surgical procedures performed as "primary surgeon" in the operating theater for different grades of surgeons were retrospectively analyzed for the period 2005-2012 by the use of linear regression models. Operative procedures performed by residents were considered the main outcome measure. In total, 235,357 operative procedures were performed, including 47,458 (20.2%) in the university hospital and 187,899 (79.8%) in the district training hospitals (n = 5). For residents in the university hospital, the mean number of operative procedures performed per 1.0 full-time equivalent increased from 128 operations in 2005 to 204 operations in 2012 (P = .001), whereas for residents in district training hospitals, no substantial differences were found over time. The mean (±SD) operative caseload of 64 residents who completed the 6-year training program between 2005 and 2012 was 1,391 ± 226 (range, 768-1856). A comparison of the operative caseload according to year of board-certification showed no difference. Implementation of the European Working Time Directive has not affected adversely the number of surgical procedures performed by residents within a general surgical training region in the Netherlands. Copyright © 2015 Elsevier Inc. All rights reserved.

Application of robotics in general surgery: initial experience.

PubMed

Nguyen, Ninh T; Hinojosa, Marcelo W; Finley, David; Stevens, Melinda; Paya, Mahbod

2004-10-01

Robotic surgery was recently approved for clinical use in general abdominal surgery. The aim of this study was to review our experience with the da Vinci surgical system during laparoscopic general surgical procedures. Eighteen patients underwent robotically assisted laparoscopic abdominal surgery between June 2002 and March 2003. Main outcome measures were operative time, room setup time, robotic arm-positioning and surgical time, blood loss, conversion to laparoscopy, length of stay, and morbidity. The types of robotically assisted laparoscopic procedures were excision of gastric leiomyoma (n = 1), Heller myotomy (n = 1), cholecystectomy (n = 2), gastric banding (n = 2), Nissen fundoplication (n = 4), and gastric bypass (n = 8). The mean room setup time was 63 +/- 14 minutes, and the mean robotic arm-positioning time was 16 +/- 7 minutes. Conversion to laparoscopy occurred in two (11%) of 18 cases because of equipment difficulty (n = 1) and technical difficulty (n = 1). Estimated blood loss was 91 +/- 71 mL. The mean operative time was 156 +/- 42 minutes, and the robotic operative time was 27% of the total operative time. The mean length of hospital stay was 2.2 +/- 1.5 days. There was one postoperative wound infection and one anastomotic stricture. Robotically assisted laparoscopic abdominal surgery is feasible and safe; however, the theoretical advantages of the da Vinci surgical system were not clinically apparent.

Online total organic carbon (TOC) monitoring for water and wastewater treatment plants processes and operations optimization

NASA Astrophysics Data System (ADS)

Assmann, Céline; Scott, Amanda; Biller, Dondra

2017-08-01

Organic measurements, such as biological oxygen demand (BOD) and chemical oxygen demand (COD) were developed decades ago in order to measure organics in water. Today, these time-consuming measurements are still used as parameters to check the water treatment quality; however, the time required to generate a result, ranging from hours to days, does not allow COD or BOD to be useful process control parameters - see (1) Standard Method 5210 B; 5-day BOD Test, 1997, and (2) ASTM D1252; COD Test, 2012. Online organic carbon monitoring allows for effective process control because results are generated every few minutes. Though it does not replace BOD or COD measurements still required for compliance reporting, it allows for smart, data-driven and rapid decision-making to improve process control and optimization or meet compliances. Thanks to the smart interpretation of generated data and the capability to now take real-time actions, municipal drinking water and wastewater treatment facility operators can positively impact their OPEX (operational expenditure) efficiencies and their capabilities to meet regulatory requirements. This paper describes how three municipal wastewater and drinking water plants gained process insights, and determined optimization opportunities thanks to the implementation of online total organic carbon (TOC) monitoring.

Dynamic cooling during laser skin welding

NASA Astrophysics Data System (ADS)

Fried, Nathaniel M.; Walsh, Joseph T., Jr.

1999-06-01

Cryogen spray cooling of the tissue surface was investigated for laser welding applications. Benefits include reduced thermal damage to the papillary dermis and reduced operation time. Two-cm-long, full-thickness incisions were made on the backs of guinea pigs, in vivo. India ink was used as an absorber and clamps were used to appose the incision edges. Continuous-wave, 1.06-μm, Nd:YAG laser radiation was scanned over the incisions, producing ~100 ms pulses. A 4-mm-diameter laser spot was used with a constant power of 16 W. The total operation time was 60 or 120 s. Cryogen was delivered in spurt durations of 20, 60, or 100 ms, with 2 or 4 s between spurts. The working distance was approximately 12 cm, and the spray covered an area of about 5.0 x 5.0 cm. Control welds were irradiated for 20, 40, or 60 s. Total operation times were reduced from 10 min without dynamic cooling to 1 min with dynamic cooling. Optimal tensile strength was 1.7 +/- 0.7 kg/cm2, comparible to stengths of 2.1 +/- 0.7 kg/cm2 reported in previous studies without cryogen cooling (p>0.25). Thermal damage in the papillary dermis measured 320 +/- 80 μm.

Does speed matter? The impact of operative time on outcome in laparoscopic surgery

PubMed Central

Jackson, Timothy D.; Wannares, Jeffrey J.; Lancaster, R. Todd; Rattner, David W.

2012-01-01

Introduction Controversy exists concerning the importance of operative time on patient outcomes. It is unclear whether faster is better or haste makes waste or similarly whether slower procedures represent a safe, meticulous approach or inexperienced dawdling. The objective of the present study was to determine the effect of operative time on 30-day outcomes in laparoscopic surgery. Methods Patients who underwent laparoscopic general surgery procedures (colectomy, cholecystectomy, Nissen fundoplication, inguinal hernia, and gastric bypass) from the ACS-NSQIP 2005–2008 participant use file were identified. Exclusion criteria were defined a priori to identify same-day admission, elective procedures. Operative time was divided into deciles and summary statistics were analyzed. Univariate analyses using a Cochran-Armitage test for trend were completed. The effect of operative time on 30-day morbidity was further analyzed for each procedure type using multivariate regression controlling for case complexity and additional patient factors. Patients within the highest deciles were excluded to reduce outlier effect. Results A total of 76,748 elective general surgical patients who underwent laparoscopic procedures were analyzed. Univariate analyses of deciles of operative time demonstrated a statistically significant trend (p \\ 0.0001) toward increasing odds of complications with increasing operative time for laparoscopic colectomy (n = 10,135), cholecystectomy (n = 37,407), Nissen fundoplication (n = 4,934), and gastric bypass (n = 17,842). The trend was not found to be significant for laparoscopic inguinal hernia repair (n = 6,430; p = 0.14). Multivariate modeling revealed the effect of operative time to remain significant after controlling for additional patient factors. Conclusion Increasing operative time was associated with increased odds of complications and, therefore, it appears that speed may matter in laparoscopic surgery. These analyses are limited in their inability to adjust for all patient factors, potential confounders, and case complexities. Additional hierarchical multivariate analyses at the surgeon level would be important to examine this relationship further. PMID:21298533

Does speed matter? The impact of operative time on outcome in laparoscopic surgery.

PubMed

Jackson, Timothy D; Wannares, Jeffrey J; Lancaster, R Todd; Rattner, David W; Hutter, Matthew M

2011-07-01

Controversy exists concerning the importance of operative time on patient outcomes. It is unclear whether faster is better or haste makes waste or similarly whether slower procedures represent a safe, meticulous approach or inexperienced dawdling. The objective of the present study was to determine the effect of operative time on 30-day outcomes in laparoscopic surgery. Patients who underwent laparoscopic general surgery procedures (colectomy, cholecystectomy, Nissen fundoplication, inguinal hernia, and gastric bypass) from the ACS-NSQIP 2005-2008 participant use file were identified. Exclusion criteria were defined a priori to identify same-day admission, elective procedures. Operative time was divided into deciles and summary statistics were analyzed. Univariate analyses using a Cochran-Armitage test for trend were completed. The effect of operative time on 30-day morbidity was further analyzed for each procedure type using multivariate regression controlling for case complexity and additional patient factors. Patients within the highest deciles were excluded to reduce outlier effect. A total of 76,748 elective general surgical patients who underwent laparoscopic procedures were analyzed. Univariate analyses of deciles of operative time demonstrated a statistically significant trend (p<0.0001) toward increasing odds of complications with increasing operative time for laparoscopic colectomy (n=10,135), cholecystectomy (n=37,407), Nissen fundoplication (n=4,934), and gastric bypass (n=17,842). The trend was not found to be significant for laparoscopic inguinal hernia repair (n=6,430; p=0.14). Multivariate modeling revealed the effect of operative time to remain significant after controlling for additional patient factors. Increasing operative time was associated with increased odds of complications and, therefore, it appears that speed may matter in laparoscopic surgery. These analyses are limited in their inability to adjust for all patient factors, potential confounders, and case complexities. Additional hierarchical multivariate analyses at the surgeon level would be important to examine this relationship further.

GLM Post Launch Testing and Airborne Science Field Campaign

NASA Astrophysics Data System (ADS)

Goodman, S. J.; Padula, F.; Koshak, W. J.; Blakeslee, R. J.

2017-12-01

The Geostationary Operational Environmental Satellite (GOES-R) series provides the continuity for the existing GOES system currently operating over the Western Hemisphere. The Geostationary Lightning Mapper (GLM) is a wholly new instrument that provides a capability for total lightning detection (cloud and cloud-to-ground flashes). The first satellite in the GOES-R series, now GOES-16, was launched in November 2016 followed by in-orbit post launch testing for approximately 12 months before being placed into operations replacing the GOES-E satellite in December. The GLM will map total lightning continuously throughout day and night with near-uniform spatial resolution of 8 km with a product latency of less than 20 sec over the Americas and adjacent oceanic regions. The total lightning is very useful for identifying hazardous and severe thunderstorms, monitoring storm intensification and tracking evolution. Used in tandem with radar, satellite imagery, and surface observations, total lightning data has great potential to increase lead time for severe storm warnings, improve aviation safety and efficiency, and increase public safety. In this paper we present initial results from the post-launch in-orbit performance testing, airborne science field campaign conducted March-May, 2017 and assessments of the GLM instrument and science products.

[Handling modern imaging procedures in a high-tech operating room].

PubMed

Hüfner, T; Citak, M; Imrecke, J; Krettek, C; Stübig, T

2012-03-01

Operating rooms are the central unit in the hospital network in trauma centers. In this area, high costs but also high revenues are generated. Modern operating theater concepts as an integrated model have been offered by different companies since the early 2000s. Our hypothesis is that integrative concepts for operating rooms, in addition to improved operating room ergonomics, have the potential for measurable time and cost savings. In our clinic, an integrated operating room concept (I-Suite, Stryker, Duisburg) was implemented after analysis of the problems. In addition to the ceiling-mounted arrangement, the system includes an endoscopy unit, a navigation system, and a voice control system. In the first 6 months (9/2005 to 2/2006), 112 procedures were performed in the integrated operating room: 34 total knee arthroplasties, 12 endoscopic spine surgeries, and 66 inpatient arthroscopic procedures (28 shoulder and 38 knee reconstructions). The analysis showed a daily saving of 22-45 min, corresponding to 15-30% of the daily changeover times, calculated to account for potential savings in the internal cost allocation of 225-450 EUR. A commercial operating room concept was evaluated in a pilot phase in terms of hard data, including time and cost factors. Besides the described effects further savings might be achieved through the effective use of voice control and the benefit of the sterile handle on the navigation camera, since waiting times for an additional nurse are minimized. The time of the procedure of intraoperative imaging is also reduced due to the ceiling-mounted concept, as the C-arm can be moved freely in the operating theater without hindering cables. By these measures and ensuing improved efficiency, the initial high costs for the implementation of the system may be cushioned over time.

Proposed algorithm to improve job shop production scheduling using ant colony optimization method

NASA Astrophysics Data System (ADS)

Pakpahan, Eka KA; Kristina, Sonna; Setiawan, Ari

2017-12-01

This paper deals with the determination of job shop production schedule on an automatic environment. On this particular environment, machines and material handling system are integrated and controlled by a computer center where schedule were created and then used to dictate the movement of parts and the operations at each machine. This setting is usually designed to have an unmanned production process for a specified interval time. We consider here parts with various operations requirement. Each operation requires specific cutting tools. These parts are to be scheduled on machines each having identical capability, meaning that each machine is equipped with a similar set of cutting tools therefore is capable of processing any operation. The availability of a particular machine to process a particular operation is determined by the remaining life time of its cutting tools. We proposed an algorithm based on the ant colony optimization method and embedded them on matlab software to generate production schedule which minimize the total processing time of the parts (makespan). We test the algorithm on data provided by real industry and the process shows a very short computation time. This contributes a lot to the flexibility and timelines targeted on an automatic environment.

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

PubMed

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

2013-10-01

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

Transanal total mesorectal excision for rectal cancer: evaluation of the learning curve.

PubMed

Koedam, T W A; Veltcamp Helbach, M; van de Ven, P M; Kruyt, Ph M; van Heek, N T; Bonjer, H J; Tuynman, J B; Sietses, C

2018-04-01

Transanal total mesorectal excision (TaTME) provides an excellent view of the resection margins for rectal cancer from below, but is challenging due to few anatomical landmarks. During implementation of this technique, patient safety and optimal outcomes need to be ensured. The aim of this study was to evaluate the learning curve of TaTME in patients with rectal cancer in order to optimize future training programs. All consecutive patients after TaTME for rectal cancer between February 2012 and January 2017 were included in a single-center database. Influence of surgical experience on major postoperative complications, leakage rate and operating time was evaluated using cumulative sum charts and the splitting model. Correction for potential case-mix differences was performed. Over a period of 60 months, a total of 138 patients were included in this study. Adjusted for case-mix, improvement in postoperative outcomes was clearly seen after the first 40 patients, showing a decrease in major postoperative complications from 47.5 to 17.5% and leakage rate from 27.5 to 5%. Mean operating time (42 min) and conversion rate (from 10% to zero) was lower after transition to a two-team approach, but neither endpoint decreased with experience. Readmission and reoperation rates were not influenced by surgical experience. The learning curve of TaTME affected major (surgical) postoperative complications for the first 40 patients. A two-team approach decreased operative time and conversion rate. When implementing this new technique, a thorough teaching and supervisory program is recommended to shorten the learning curve and improve the clinical outcomes of the first patients.

Complete major amputation of the upper extremity: Early results and initial treatment algorithm.

PubMed

Märdian, Sven; Krapohl, Björn D; Roffeis, Jana; Disch, Alexander C; Schaser, Klaus-Dieter; Schwabe, Philipp

2015-03-01

Traumatic major amputations of the upper extremity are devastating injuries. These injuries have a profound impact on patient's quality of life and pose a burden on social economy. The aims of the current study were to report about the initial management of isolated traumatic major upper limb amputation from the time of admission to definitive soft tissue closure and to establish a distinct initial management algorithm. We recorded data concerning the initial management of the patient and the amputated body part in the emergency department (ED) (time from admission to the operation, Injury Severity Score [ISS], cold ischemia time from injury to ED, and total cold ischemia time). The duration, amount of surgical procedures, the time to definitive soft tissue coverage, and the choice of flap were part of the documentation. All intraoperative and postoperative complications were recorded. All patients were successfully replanted (time from injury to ED, 59 ± 4 minutes; ISS16; time from admission to operating room 57 ± 10 minutes; total cold ischemia time 203 ± 20 minutes; total number of procedures 7.3 ± 2.5); definitive soft tissue coverage could be achieved 23 ± 14 days after injury. Two thromboembolic complications occurred, which could be treated by embolectomy during revision surgery, and we saw one early infection, which could be successfully managed by serial debridements in our series. The management of complete major amputations of the upper extremity should be reserved for large trauma centers with enough resources concerning technical, structural, and personnel infrastructure to meet the demands of surgical reconstruction as well as the postoperative care. Following a distinct treatment algorithm is mandatory to increase the rate of successful major replantations, thus laying the foundation for promising secondary functional reconstructive efforts. Therapeutic study, level V.

Short term outcomes of long duration versus short duration tourniquet in primary total knee arthroplasty: A randomized controlled trial.

PubMed

Vaishya, Raju; Agarwal, Amit Kumar; Vijay, Vipul; Tiwari, Manish Kumar

2018-01-01

A tourniquet is used during the total knee replacement surgery to improve the visibility, to reduce the blood loss and for better cementation. Indirectly it decreases the duration of surgery and enhances the recovery of the patient. Their use however is controversial due to some side effects associated with the use of tourniquet. They may increase the risk of deep vein thrombosis and pulmonary embolism by causing venous stasis, endothelial damage and increased platelet adhesion secondary to distal limb ischemia. We conducted a randomized controlled trial (RCT) to examine the benefits and risks associated with the use of long duration over short duration tourniquets during TKA. The study was a prospective randomised control trial with a total of 80 knees (40 knees in each group) included in the study. The knees selected for surgery were randomly allocated to one of the two groups: Group A - long duration tourniquet (LT-group) or Group B - short duration tourniquet (ST-group). The average operating time in Group A (43.53±3.11 minutes) was statistically less significant than that of Group B (51.7±2.56 minutes). Intra-operative blood loss in Group B, was significantly more than that of Group A. Post-operative blood loss in the drain was more in long duration tourniquet group. Total blood loss (intra-operative + post-operative) was more in short duration tourniquet group. Pain score (using VAS scale) was comparable in both the groups at the end of the second and sixth week. At sixth weeks there was no significant difference in the range of motion in both the groups. The KSS score was not significantly different in both the groups in post operative period at first, second, and six weeks. There were no events of thrombo-embolism and deep vein thrombosis in either groups. In 11 patients (27.5%) of long duration tourniquet group, swelling, and redness of knee was seen post operatively as compared to three patients (7.5%) of short duration tourniquet group. The use of a short duration tourniquet during TKA gives better symptomatic pain relief in the early postoperative period as compared to long duration use of tourniquet. However, this is associated with increased blood loss, more operating time and not having a clear operative field. We suggest that a rational thinking and reconsidering the practice of routine use of long duration tourniquet in each and every case of TKA is required.

Advantages for passengers and cabin crew of operating a gas-phase adsorption air purifier in 11-h simulated flights.

PubMed

Strøm-Tejsen, P; Zukowska, D; Fang, L; Space, D R; Wyon, D P

2008-06-01

Experiments were carried out in a three-row, 21-seat section of a simulated aircraft cabin installed in a climate chamber to evaluate the extent to which passengers' perception of cabin air quality is affected by the operation of a gas-phase adsorption (GPA) purification unit. A total of 68 subjects, divided into four groups of 17 subjects took part in simulated 11-h flights. Each group experienced four conditions in balanced order, defined by two outside air supply rates (2.4 and 3.3 l/s per person), with and without the GPA purification unit installed in the recirculated air system, a total of 2992 subject-hours of exposure. During each flight the subjects completed questionnaires five times to provide subjective assessments of air quality, cabin environment, intensity of symptoms, and thermal comfort. Additionally, the subjects' visual acuity, finger temperature, skin dryness, and nasal peak flow were measured three times during each flight. Analysis of the subjective assessments showed that operating a GPA unit in the recirculated air provided consistent advantages with no apparent disadvantages. Operating a gas-phase adsorption (GPA) air purifier unit in the recirculated air in a simulated airplane cabin provided a clear and consistent advantage for passengers and crew that became increasingly apparent at longer flight times. This finding indicates that the expense of undertaking duly blinded field trials on revenue flights would be justified.

Agent Based Modeling and Simulation Framework for Supply Chain Risk Management

DTIC Science & Technology

2012-03-01

Christopher and Peck 2004) macroeconomic , policy, competition, and resource (Ghoshal 1987) value chain, operational, event, and recurring (Shi 2004...clustering algorithms in agent logic to protect company privacy ( da Silva et al. 2006), aggregation of domain context in agent data analysis logic (Xiang...Operational Availability ( OA ) for FMC and PMC. 75 Mission Capable (MICAP) Hours is the measure of total time (in a month) consumable or reparable

Acceleration of high-pressure-ratio single-spool turbojet engine as determined from component performance characteristics I : effect of air bleed at compressor outlet

NASA Technical Reports Server (NTRS)

Rebeske, John J , Jr; Rohlik, Harold E

1953-01-01

An analytical investigation was made to determine from component performance characteristics the effect of air bleed at the compressor outlet on the acceleration characteristics of a typical high-pressure-ratio single-spool turbojet engine. Consideration of several operating lines on the compressor performance map with two turbine-inlet temperatures showed that for a minimum acceleration time the turbine-inlet temperature should be the maximum allowable, and the operating line on the compressor map should be as close to the surge region as possible throughout the speed range. Operation along such a line would require a continuously varying bleed area. A relatively simple two-step area bleed gives only a small increase in acceleration time over a corresponding variable-area bleed. For the modes of operation considered, over 84 percent of the total acceleration time was required to accelerate through the low-speed range ; therefore, better low-speed compressor performance (higher pressure ratios and efficiencies) would give a significant reduction in acceleration time.

Comparison between two portal laparoscopy and open surgery for ovariectomy in dogs.

PubMed

Shariati, Elnaz; Bakhtiari, Jalal; Khalaj, Alireza; Niasari-Naslaji, Amir

2014-01-01

Ovariectomy (OVE) is a routine surgical procedure for neutering in small animal practice. Laparoscopy is a new surgical technique which contains advantages such as less trauma, smaller incision and excellent visualization than traditional open surgery. The present study was conducted to examine the feasibility and safety of laparoscopic procedure through two portal comparing with the conventional open surgery for OVE in healthy female bitches (n=16). Dogs were divided in two equal groups. In laparoscopic group, two 5 and 10 mm portals were inserted; First in the umbilicus for introducing the camera and the second, caudal to the umbilicus for inserting the forceps. Laparoscopic procedure involved grasping and tacking the ovary to the abdominal wall, followed by electrocautery, resection and removal of the ovary. In open surgery, routine OVE was conducted through an incision from umbilicus to caudal midline. Mean operative time, total length of scar, blood loss, clinical and blood parameters and all intra and post-operative complications were recorded in both groups. Mean operative time, total length of scar, blood loss and post-operative adhesions were significantly less in laparoscopic group compared with open surgery. In conclusion, laparoscopic OVE is an acceptable procedure due to more advantages in comparison with traditional OVE.

Orange Peel Excision of Gland: A Novel Surgical Technique for Treatment of Gynecomastia.

PubMed

S S, Shirol

2016-12-01

Gynecomastia is a common aesthetic problem faced by men with reported incidence as high as 65% with serious psychosocial impact. Although various techniques of liposculpture combined with glandular excision is the standard of treatment, many of the glandular excision techniques have inherent limitations and complications such as leaving a long scar, long operative time, contour abnormalities, and increased risk of hematoma. Here, we describe an innovative "the orange peel excision of gland (OPEG) technique" which overcomes these limitations with excellent cosmetic results. A total of 38 breasts were operated in 20 patients (18 bilateral and 2 unilateral). All the patients underwent suction-assisted liposuction and glandular excision under general anesthesia by our OPEG technique. The average operative time per breast was 60 minutes. One patient had a small hematoma which did not require evacuation. The patient satisfaction rate was 95%. The technique has reduced operative time and avoids residual gland and hematoma with excellent aesthetic outcome.

Advanced laparoscopic bariatric surgery Is safe in general surgery training.

PubMed

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

2017-05-01

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

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

PubMed

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

2016-01-01

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

Modified totally tubeless percutaneous nephrolithotomy: Is it an effective and safe treatment option for renal and upper ureteral stones?

PubMed Central

Chung, Ho Seok; Yu, Ho Song; Hwang, Eu Chang; Oh, Kyung Jin; Kwon, Dong Deuk; Park, Kwangsung

2016-01-01

Introduction We hypothesized that modified totally tubeless percutaneous nephrolithotomy (PNL) without indwelling ureteral stent would minimize postoperative discomfort without complications. Aim To evaluate the safety, efficacy, and morbidity of standard, tubeless, and modified totally tubeless PNL as well as the usefulness of modified totally tubeless PNL. Material and methods From November 2011 to February 2015, 211 patients who underwent PNL consecutively were enrolled in this study and divided into 3 groups (group 1: standard, group 2: tubeless, group 3: modified totally tubeless PNL). Patient and stone characteristics, operation time, hemoglobin change, length of hospitalization, stone-free rate, analgesic requirement, and perioperative complications were analyzed and compared among the 3 groups. Results There were no significant differences in preoperative patient characteristics among the three groups. In the postoperative analysis, the three groups had similar operation time, stone-free rate, perioperative fever and transfusion rate, but group 2 showed superior results in terms of length of hospitalization (p = 0.001). Group 2 and group 3 had a lower analgesic requirement (p = 0.010). Immediate postoperative hemoglobin change (p = 0.001) and tube site complications (p = 0.001) were more common in group 1. Conclusions Modified totally tubeless PNL was not inferior in terms of postoperative outcomes and safety compared with the standard and tubeless PNL, and avoided the postoperative stent-related symptoms and cystoscopy for double-J stent removal. Modified totally tubeless PNL could be an alternative treatment of choice for management of renal or upper ureteral stones in selected patients. PMID:28194243

Analysis of the United States Marine Corps Continuous Process Improvement Program Applied to the Contracting Process at Marine Corps Regional Contracting Office - Southwest

DTIC Science & Technology

2007-12-01

37 3. Poka - yoke ............................................................................................37 4. Systems for...Standard operating procedures • Visual displays for workflow and communication • Total productive maintenance • Poka - yoke techniques to prevent...process step or eliminating non-value-added steps, and reducing the seven common wastes, will decrease the total time of a process. 3. Poka - yoke

New fixation method for maxillary distraction osteogenesis using locking attachments.

PubMed

Suzuki, Eduardo Yugo; Buranastidporn, Boonsiva; Ishii, Masatoshi

2006-10-01

The external traction hooks of the intraoral splint used in the rigid external distraction (RED) system for maxillary distraction osteogenesis interfere with the surgical procedures. The purpose of this study is to introduce an innovative splint fixation method for maxillary distraction osteogenesis with Locking Attachments and evaluate their advantages, such as reduction of operating time compared with the traditional intraoral splint method. Retrospective comparison of operative times of maxillary Le Fort I osteotomy procedures was carried out with the traditional protocol using the intraoral splint cemented to the maxillary dentition (n = 14), and a removable intraoral splint that is inserted postsurgically (n = 14). Operative procedure times were compared and analyzed statistically using the data extracted from the surgical records. There were no complications inserting the removable splint postsurgically, including pain, discomfort, or time-consuming procedure. Stable and secure splint fixation was obtained before the distraction procedure and the desired treatment goals were obtained in all patients. The total operative procedure times were significantly reduced in the Locking Attachments group by 24% to 41% (approximately 65 minutes) compared with earlier operations involving the conventional splints (P < .05). Maxillary distraction osteogenesis with the Locking Attachments is a highly effective fixation approach to manage severe hypoplastic maxilla, eliminating lip constraints resulting from scarring and allowing for easier, more deliberate and careful dissection. The use of the Locking Attachments is reliable in craniofacial surgery and has proved to be advantageous in the reduction of the operating time and surgical risks.

Operation of a gated field emitter using an individual carbon nanofiber cathode

NASA Astrophysics Data System (ADS)

Guillorn, M. A.; Melechko, A. V.; Merkulov, V. I.; Ellis, E. D.; Britton, C. L.; Simpson, M. L.; Lowndes, D. H.; Baylor, L. R.

2001-11-01

We report on the operation of an integrated gated cathode device using a single vertically aligned carbon nanofiber as the field emission element. This device is capable of operation in a moderate vacuum for extended periods of time without experiencing a degradation of performance. Less than 1% of the total emitted current is collected by the gate electrode, indicating that the emitted electron beam is highly collimated. As a consequence, this device is ideal for applications that require well-focused electron emission from a microscale structure.

Knee, Shoulder, and Fundamentals of Arthroscopic Surgery Training: Validation of a Virtual Arthroscopy Simulator.

PubMed

Tofte, Josef N; Westerlind, Brian O; Martin, Kevin D; Guetschow, Brian L; Uribe-Echevarria, Bastián; Rungprai, Chamnanni; Phisitkul, Phinit

2017-03-01

To validate the knee, shoulder, and virtual Fundamentals of Arthroscopic Training (FAST) modules on a virtual arthroscopy simulator via correlations with arthroscopy case experience and postgraduate year. Orthopaedic residents and faculty from one institution performed a standardized sequence of knee, shoulder, and FAST modules to evaluate baseline arthroscopy skills. Total operation time, camera path length, and composite total score (metric derived from multiple simulator measurements) were compared with case experience and postgraduate level. Values reported are Pearson r; alpha = 0.05. 35 orthopaedic residents (6 per postgraduate year), 2 fellows, and 3 faculty members (2 sports, 1 foot and ankle), including 30 male and 5 female residents, were voluntarily enrolled March to June 2015. Knee: training year correlated significantly with year-averaged knee composite score, r = 0.92, P = .004, 95% confidence interval (CI) = 0.84, 0.96; operation time, r = -0.92, P = .004, 95% CI = -0.96, -0.84; and camera path length, r = -0.97, P = .0004, 95% CI = -0.98, -0.93. Knee arthroscopy case experience correlated significantly with composite score, r = 0.58, P = .0008, 95% CI = 0.27, 0.77; operation time, r = -0.54, P = .002, 95% CI = -0.75, -0.22; and camera path length, r = -0.62, P = .0003, 95% CI = -0.8, -0.33. Shoulder: training year correlated strongly with average shoulder composite score, r = 0.90, P = .006, 95% CI = 0.81, 0.95; operation time, r = -0.94, P = .001, 95% CI = -0.97, -0.89; and camera path length, r = -0.89, P = .007, 95% CI = -0.95, -0.80. Shoulder arthroscopy case experience correlated significantly with average composite score, r = 0.52, P = .003, 95% CI = 0.2, 0.74; strongly with operation time, r = -0.62, P = .0002, 95% CI = -0.8, -0.33; and camera path length, r = -0.37, P = .044, 95% CI = -0.64, -0.01, by training year. FAST: training year correlated significantly with 3 combined FAST activity average composite scores, r = 0.81, P = .0279, 95% CI = 0.65, 0.90; operation times, r = -0.86, P = .012, 95% CI = -0.93, -0.74; and camera path lengths, r = -0.85, P = .015, 95% CI = -0.92, -0.72. Total arthroscopy cases performed did not correlate significantly with overall FAST performance. We found significant correlations between both training year and knee and shoulder arthroscopy experience when compared with performance as measured by composite score, camera path length, and operation time during a simulated diagnostic knee and shoulder arthroscopy, respectively. Three FAST activities demonstrated significant correlations with training year but not arthroscopy case experience as measured by composite score, camera path length, and operation time. We attempt to validate an arthroscopy simulator that could be used to supplement arthroscopy skills training for orthopaedic residents. Copyright © 2016 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Ibuprofen timing for hand surgery in ambulatory care

PubMed Central

Giuliani, Enrico; Bianchi, Anna; Marcuzzi, Augusto; Landi, Antonio; Barbieri, Alberto

2015-01-01

OBJECTIVE: To evaluate the effect of pre-operative administration of ibuprofen on post-operative pain control vs. early post-operative administration for hand surgery procedures performed under local anaesthesia in ambulatory care. METHODS: Candidates to trigger finger release by De Quervain tenosynovitis and carpal tunnel operation under local anesthesia were enrolled in the study. Group A received 400 mg ibuprofen before the operation and placebo after the procedure; group B received placebo before the operation and ibuprofen 400 mg at the end of the procedure; both groups received ibuprofen 400 mg every 6h thereafter. Visual analogue scale (VAS) was measured at fixed times before and every 6h after surgery, for a total follow-up of 18h. RESULTS: Groups were similar according to age, gender and type of surgery. Median VAS values did not produce any statistical significance, while there was a statistically significant difference on pre-operative and early post-operative VAS values between groups (A -8.53 mm vs. B 3.36 mm, p=0.0085). CONCLUSION: Average pain levels were well controlled by local anesthesia and post-operative ibuprofen analgesia. Pre-operative ibuprofen administration can contribute to improve early pain management. Level of Evidence II, Therapeutic Studies. PMID:26327799

[Preliminary experience with laparoscopic repair of inguinal hernias].

PubMed

Freund, H R; Seror, D; Eimerl, D; Zamir, O

1997-12-01

During 1992-1996 we performed 163 laparoscopic hernia repairs in 100 men and 2 women. The mean age was 50.6; and in 61 the operation was bilateral, 66 were by transabdominal preperitoneal approach and 36 by total extra-peritoneal approach. There were only a few minor complications and total recurrence rate was only 4.3%, partly attributable to our learning curve. Laparoscopic inguinal herniorrhaphy reduces postoperative incisional and muscular pain and causes less disruption in the postoperative period than open repair. Return to normal activity and work is faster for laparoscopic than for open repair, but operating room costs are higher (time and equipment). However, economic advantages for the national economy should be considered.

Total number of longwall faces drops below 50

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

Fiscor, S.

2009-02-15

For the first time since Coal Age began its annual Longwall Census the number of faces has dropped below 50. A total of five mines operate two longwall faces. CONSOL Energy remains the leader with 12 faces. Arch Coal operates five longwall mines; Robert E. Murray owns five longwall mines. West Virginia has 13 longwalls, followed by Pennsylvania (8), Utah (6) and Alabama (6). A detailed table gives for each longwall installation, the ownership, seam height, cutting height, panel width and length, overburden, number of gate entries, depth of cut, model of equipment used (shearer, haulage system, roof support, facemore » conveyor, stage loader, crusher, electrical controls and voltage to face). 2 tabs., 1 photo.« less

From a single encapsulated detector to the spectrometer for INTEGRAL satellite: predicting the peak-to-total ratio at high γ-energies

NASA Astrophysics Data System (ADS)

Kshetri, R.

2012-12-01

In two recent papers (R. Kshetri, JINST 2012 7 P04008; ibid., P07006), a probabilistic formalism was introduced to predict the response of encapsulated type composite germanium detectors like the SPI (spectrometer for INTEGRAL satellite). Predictions for the peak-to-total and peak-to-background ratios are given at 1.3 MeV for the addback mode of operation. The application of the formalism to clover germanium detector is discussed in two separate papers (R. Kshetri, JINST 2012 7 P07008; ibid., P08015). Using the basic approach developed in those papers, for the first time we present a procedure for calculating the peak-to-total ratio of the cluster detector for γ-energies up to 8 MeV. Results are shown for both bare and suppressed detectors as well as for the single crystal and addback modes of operation. We have considered the experimental data of (i) peak-to-total ratio at 1.3 MeV, and (ii) single detector efficiency and addback factor for other energies up to 8 MeV. Using this data, an approximate method of calculating the peak-to-total ratio of other composite detectors, is shown. Experimental validation of our approach (for energies up to 8 MeV) has been confirmed considering the data of the SPI spectrometer. We have discussed about comparisons between various modes of operation and suppression cases. The present paper is the fifth in the series of papers on composite germanium detectors and for the first time discusses about the change in fold distribution and peak-to-total ratio for sophisticated detectors consisting of several modules of miniball, cluster and SPI detectors. Our work could provide a guidance in designing new composite detectors and in performing experimental studies with the existing detectors for high energy gamma-rays.

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

PubMed

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

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

Effect of screw fixation on acetabular component alignment change in total hip arthroplasty.

PubMed

Fujishiro, Takaaki; Hayashi, Shinya; Kanzaki, Noriyuki; Hashimoto, Shingo; Shibanuma, Nao; Kurosaka, Masahiro

2014-06-01

The use of screws can enhance immediate cup fixation, but the influence of screw insertion on cup position has not previously been measured. The purpose of this study was to quantitatively evaluate the effect of intra-operative screw fixation on acetabular component alignment that has been inserted with the use of a navigation system. We used a navigation system to measure cup alignment at the time of press-fit and after screw fixation in 144 hips undergoing total hip arthroplasty. We also compared those findings with factors measured from postoperative radiographs. The mean intra-operative change of cup position was 1.78° for inclination and 1.81° for anteversion. The intra-operative change of anteversion correlated with the number of screws. The intra-operative change of inclination also correlated with medial hip centre. The insertion of screws can induce changes in cup alignment, especially when multiple screws are used or if a more medial hip centre is required for rigid acetabular fixation.

Preliminary operational results from the Willard solar power system

NASA Technical Reports Server (NTRS)

Fenton, D. L.; Abernathy, G. H.; Krivokapich, G.; Ellibee, D. E.; Chilton, V.

1980-01-01

The solar powered system located near Willard, New Mexico, generates mechanical or electrical power at a capacity of 19 kW (25 HP). The solar collection system incorporates east/west tracking parabolic trough collectors with a total aperture area of 1275 sq m (13,720 sq ft). The hot oil type thermal energy storage is sufficient for approximately 20 hours of power system operation. The system utilizes a reaction type turbine in conjunction with an organic Rankine cycle engine. Total collector field efficiency reaches a maximum of 20 percent near the winter solstice and about 50 percent during the summer. During the month of July, 1979, the system pumped 60 percent of the 35,300 cu m (28.6 acre-feet) of water delivered. Operating efficiencies for the turbine component, organic Rankine cycle engine and the complete power system are respectively 65 to 75 percent, 12 to 15 percent and 5 to 6 percent. Significant maintenance time was expended on both the collector and power systems throughout the operational period.

Operating rules for multireservoir systems

NASA Astrophysics Data System (ADS)

Oliveira, Rodrigo; Loucks, Daniel P.

1997-04-01

Multireservoir operating policies are usually defined by rules that specify either individual reservoir desired (target) storage volumes or desired (target) releases based on the time of year and the existing total storage volume in all reservoirs. This paper focuses on the use of genetic search algorithms to derive these multireservoir operating policies. The genetic algorithms use real-valued vectors containing information needed to define both system release and individual reservoir storage volume targets as functions of total storage in each of multiple within-year periods. Elitism, arithmetic crossover, mutation, and "en bloc" replacement are used in the algorithms to generate successive sets of possible operating policies. Each policy is then evaluated using simulation to compute a performance index for a given flow series. The better performing policies are then used as a basis for generating new sets of possible policies. The process of improved policy generation and evaluation is repeated until no further improvement in performance is obtained. The proposed algorithm is applied to example reservoir systems used for water supply and hydropower.

Preliminary operational results from the Willard solar power system

NASA Astrophysics Data System (ADS)

Fenton, D. L.; Abernathy, G. H.; Krivokapich, G.; Ellibee, D. E.; Chilton, V.

1980-05-01

The solar powered system located near Willard, New Mexico, generates mechanical or electrical power at a capacity of 19 kW (25 HP). The solar collection system incorporates east/west tracking parabolic trough collectors with a total aperture area of 1275 sq m (13,720 sq ft). The hot oil type thermal energy storage is sufficient for approximately 20 hours of power system operation. The system utilizes a reaction type turbine in conjunction with an organic Rankine cycle engine. Total collector field efficiency reaches a maximum of 20 percent near the winter solstice and about 50 percent during the summer. During the month of July, 1979, the system pumped 60 percent of the 35,300 cu m (28.6 acre-feet) of water delivered. Operating efficiencies for the turbine component, organic Rankine cycle engine and the complete power system are respectively 65 to 75 percent, 12 to 15 percent and 5 to 6 percent. Significant maintenance time was expended on both the collector and power systems throughout the operational period.

A safety-based comparison of pure LigaSure use and LigaSure-tie technique in total thyroidectomy.

PubMed

Pergel, A; Yucel, A Fikret; Aydin, I; Sahin, D A; Aras, S; Kulacoglu, H

2014-01-01

Sutureless total thyroidectomy by using vessel sealing devices has been shown to be safe in some recent clinical studies. However, some surgeons are still concerned about the use of these energy devices in the vicinity of there current laryngeal nerve and parathyroid glands. The objective of this study was to investigate the effects of the use of pure LigaSure on postoperative complications and to discuss the pertinent literature. A total of 456 patients having undergone a total thyroidectomy operation between June 2009 and March 2011 were included in the study. Data were prospectively collected and retrospectively evaluated. Patients were separated into 2 groups. Group L comprised of 182 patients where onlyLigaSure was used, and group LT consisted of 274 patients where ligation was used in the vicinity of the recurrent laryngeal nerve and parathyroid glands, and LigaSure was used in all other parts of the surgery. Patient's blood calcium values were checked preoperatively and at postoperative 24, 48, and 72 hours. Groups were assessed in terms of demographic properties, thyroid pathology, duration of operation, and postoperative complications. Groups were similar in respect of demographic properties, operation duration, thyroid gland pathology. No mortality rate was recorded. Laboratory hypocalcemia rate was higher in group L (P 0.003), but no significant difference was identified between groups in terms of symptomatic hypocalcemia.No permanent hypocalcemia or recurrent laryngeal nerve injury developed in any of the patients in the two groups. Pure LigaSure for total thyroidectomy may increase laboratory hypocalcemia rate, but not symptomatic hypocalcemia. Hemorrhage related complications were similar and low in the two groups. Ligations in the places close to delicate anatomic structures did not cause longer operative times and may be a safer option in total thyroidectomy. Celsius.

[Robots in general surgery: present and future].

PubMed

Galvani, Carlos; Horgan, Santiago

2005-09-01

Robotic surgery is an emerging technology. We began to use this technique in 2000, after it was approved by the Food and Drug Administration. Our preliminary experience was satisfactory. We report 4 years' experience of using this technique in our institution. Between August 2000 and December 2004, 399 patients underwent robotic surgery using the Da Vinci system. We performed 110 gastric bypass procedures, 30 Lap band, 59 Heller myotomies, 12 Nissen fundoplications, 6 epiphrenic diverticula, 18 total esophagectomies, 3 esophageal leiomyoma resections, 1 pyloroplasty, 2 gastrojejunostomies, 2 transduodenal sphincteroplasties, 10 adrenalectomies and 145 living-related donor nephrectomies. Operating times for fundoplications and Lap band were longer. After the learning curve, the operating times and morbidity of the remaining procedures were considerably reduced. Robot-assisted surgery allows advanced laparoscopic procedures to be performed with enhanced results given that it reduces the learning curve as measured by operating time and morbidity.

The Effect of Time on Difficulty of Learning (The Case of Problem Solving with Natural Numbers)

ERIC Educational Resources Information Center

Kaya, Deniz; Kesan, Cenk

2017-01-01

The main purpose of this study is to determine the time-dependent learning difficulty of "solving problems that require making four operations with natural numbers" of the sixth grade students. The study, adopting the scanning model, consisted of a total of 140 students, including 69 female and 71 male students at the sixth grade. Data…

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

Radhi, Hassan

Developments in the design and manufacture of photovoltaic cells have recently been a growing concern in the UAE. At present, the embodied energy pay-back time (EPBT) is the criterion used for comparing the viability of such technology against other forms. However, the impact of PV technology on the thermal performance of buildings is not considered at the time of EPBT estimation. If additional energy savings gained over the PV system life are also included, the total EPBT could be shorter. This paper explores the variation of the total energy of building integrated photovoltaic systems (BiPV) as a wall cladding systemmore » applied to the UAE commercial sector and shows that the ratio between PV output and saving in energy due to PV panels is within the range of 1:3-1:4. The result indicates that for the southern and western facades in the UAE, the embodied energy pay-back time for photovoltaic system is within the range of 12-13 years. When reductions in operational energy are considered, the pay-back time is reduced to 3.0-3.2 years. This study comes to the conclusion that the reduction in operational energy due to PV panels represents an important factor in the estimation of EPBT. (author)« less

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

Brink, J.

Crude oil (c. 10,700 BOPD) was produced through temporary topside facilities in the Rolf Field offshore Denmark from January 7th to September 17th, 1986. These simple, unmanned and remote controlled facilities were a low cost solution to a problem caused by delays of the permanent topside facilities. Project execution time was two months from start of conceptual design until start-up of oil production. Installation works were performed from a jack-up drilling rig - in part simultaneously with drilling operations. Materials and equipment installed were obtained with very short delivery times. The facilties which were certified by a Certification Society andmore » approved by the Danish Authoritites included all necessary safety features. Total costs for the facilities amounted to c. 1 million US$ (excl. rig time for installation). Due to simplicity high reliability of the production system was obtained. Availability of the facilities for the entire period from start-up was 99.6 percent. The facilities were manned 3.2 percent of the total operating time mainly due to wireline work for reservoir monitoring. It is considered that the experience with the concept applied for the early production from the Rolf Field could form the basis for more simple and cost effective topside facilities for minor offshore fields.« less

Modeling municipal solid waste collection: A generalized vehicle routing model with multiple transfer stations, gather sites and inhomogeneous vehicles in time windows.

PubMed

Son, Le Hoang; Louati, Amal

2016-06-01

Municipal Solid Waste (MSW) collection is a necessary process in any municipality resulting in the quality-of-life, economic aspects and urban structuralization. The intrinsic nature of MSW collection relates to the development of effective vehicle routing models that optimize the total traveling distances of vehicles, the environmental emission and the investment costs. In this article, we propose a generalized vehicle routing model including multiple transfer stations, gather sites and inhomogeneous vehicles in time windows for MSW collection. It takes into account traveling in one-way routes, the number of vehicles per m(2) and waiting time at traffic stops for reduction of operational time. The proposed model could be used for scenarios having similar node structures and vehicles' characteristics. A case study at Danang city, Vietnam is given to illustrate the applicability of this model. The experimental results have clearly shown that the new model reduces both total traveling distances and operational hours of vehicles in comparison with those of practical scenarios. Optimal routes of vehicles on streets and markets at Danang are given. Those results are significant to practitioners and local policy makers. Copyright © 2016 Elsevier Ltd. All rights reserved.

Multi-ligament instability after early dislocation of a primary total knee replacement - case report.

PubMed

Sisak, Krisztian; Lloyd, John; Fiddian, Nick

2011-01-01

Peripheral nerve blocks have found increased popularity in providing prolonged post-operative analgesia following total knee replacement surgery. They generally provide effective analgesia with fewer complications than epidurals. This report describes an acute low-energy knee dislocation after a well balanced, fixed bearing, cruciate-retaining primary total knee replacement performed under a spinal anaesthetic with combined complimentary femoral and sciatic nerve blocks. The dislocation was not accompanied by neurovascular compromise. Due to the subsequent instability and injury to both collaterals, the posterior cruciate ligament and posterolateral corner structures, the knee was treated with a rotating-hinge revision total knee replacement. The dislocation occurred whilst the peripheral nerve blocks (PNB) were still working. We review our incidence of PNB related complications and conclude that PNB remain a safe and effective analgesia for total knee replacements. However, we advocate that ward staff and patients should be sufficiently educated to ensure that unaided post-operative mobilisation is prevented until such a time that patients have regained complete voluntary muscle control. Copyright © 2009 Elsevier B.V. All rights reserved.

[A therapeutic effect analysis of femur first principle and combined anteversion technique during total hip arthroplasty].

PubMed

Wang, X Q; Wu, C S; Sun, S; Wang, J; Li, W; Zhang, W

2018-04-01

Objective: To investigate the situation of hip dislocation with the application of "femur first" principle and "combined anteversion technique" during total hip arthroplasty. Methods: A retrospective analysis has been done on the clinical data about 104 patients(133 hips)who were diagnosed as hip disease and were treated with total hip arthroplasty by the doctors from the Department of Joint Orthorpaedics of Shandong Provincial Hospital Affiliated to Shandong University from June 2014 to June 2016, and all the prostheses applied in the operation were cementless ones.Among them, 65 patients were males, 39 females and their age was 46.6 years (ranging from 23 to 76 years) .And 29 of them underwent bilateral hip operations and 75 unilateral ones.Seventy-six cases of aseptic necrosis of the femoral head in the terminal stage, 28 cases of hip dysplasia and osteoarthritis.Surgical approach: of all the operations, 103 hips were operated on with hardinge approach, 30 with posterolateral approach.During the operation, first of all, the femoral medullary cavity was broached and then the anteversion of intramedullary broacher was measured.After that, the anteversion of the acetabular cup was calculated as 37° minus the anteversion of the broacher, and the acetabular cup was implanted at that angle.The patients' prosthesis combined anteversion, range of motion of the hip joint, operation time, hemorrhage amount, and complications had been kept record.One, three, and six months respectively after the operation, all the patients received outpatient review, and took anteroposterior and lateral position X-ray examination.Harris hip score had been applied to evaluate their hip function before the operation and six months after the operation. Results: All the patients had been operated on smoothly, with the operation time of(57.6±14.5)minutes(36-115 minutes)and hemorrhage amount of (336.5±50.8)ml(180-620 ml). The operation finding showed that the combined anteversion by employing"femur first"principle and combined anteversion techniqueis was (36.6±6.8)°. Also, range of motion of the patients' hip conforms to the D'Lima criterion and no patients had experienced dislocation and some other serious complications.The follow-up ended at August 2017, which lasted for 12.2 months(6-18 months), and 88 cases(119 hips) were interviewed. The Harris hip score for the affected sides of the hip joints 6 months after the surgery was 94.6(86-100). Compared with the score of 29.8(12-43) before surgery, the t -test had proven its statistical significance( t =12.82, P =0.003). Conclusion: Based upon the "femoral first" principle and "combined anteversion technique" during total hip arthroplasty, these operations has been carried out well enough to meet the patients' needs of performing normal daily activities.

The recovery of online drug markets following law enforcement and other disruptions.

PubMed

Van Buskirk, Joe; Bruno, Raimondo; Dobbins, Timothy; Breen, Courtney; Burns, Lucinda; Naicker, Sundresan; Roxburgh, Amanda

2017-04-01

Online drug markets operating on the 'darknet' ('cryptomarkets') facilitate the trade of illicit substances at an international level. The present study assessed the longitudinal impact on cryptomarket trading of two major disruptions: a large international law enforcement operation, 'Operation Onymous'; and the closure of the largest cryptomarket, Evolution. Almost 1150 weekly snapshots of a total of 39 cryptomarkets were collected between October 2013 and November 2015. Data were collapsed by month and the number of unique vendor aliases operating across markets was assessed using interrupted time series regression. Following both Operation Onymous and the closure of Evolution, significant drops of 627 (p=0.014) and 910 vendors (p<0.001) were observed, respectively. However, neither disruption significantly affected the rate at which vendor numbers increased overall. Operation Onymous and the closure of Evolution were associated with considerable, though temporary, reductions in the number of vendors operating across cryptomarkets. Vendor numbers, however, recovered at a constant rate. While these disruptions likely impacted cryptomarket trading at the time, these markets appear resilient to disruption long-term. Copyright © 2017 Elsevier B.V. All rights reserved.

A case report of idiopathic iliopsoas hematoma which occurred soon after transfer to the wheelchair after total hip arthroplasty.

PubMed

Okumura, Tomoo; Fujita, Hiroshi; Harada, Hideto; Nishimura, Ryuuichi; Tominaga, Tomohiro

2017-02-01

A 79-year-old woman was diagnosed with osteoarthritis of the left hip and scheduled for total hip arthroplasty. As two lesions were detected in branches of the coronary arteries, she was treated with catheter treatment. The patient was receiving anticoagulant treatment, which was suspended eight days before the operation; however, heparin was started at 6 days before the operation and was stopped 9 hours before the operation. On the 2nd postoperative day soon after transfer to the wheel chair, she was feeling unwell and was suffering from severe pain in her left buttock and left thigh. Her blood pressure had decreased to 70 mmHg. During abdominal contrast-enhanced CT, a hematoma was detected in the left iliopsoas muscle. Catheter therapy was started by the cardiovascular department and bleeding had stopped spontaneously. The patient was able to walk with a cane and was discharged on the 40th postoperative day. THA: total hip arthroplasty, CT: computed tomography, JOA score: Japanese Orthopaedic Association hip score, HA: hydroxyapatite, PMMA: polymethyl-methacrylate, APTT: activated partial thromboplastin time.

Timed Stair Climbing is the Single Strongest Predictor of Perioperative Complications in Patients Undergoing Abdominal Surgery

PubMed Central

Reddy, Sushanth; Contreras, Carlo M; Singletary, Brandon; Bradford, T Miller; Waldrop, Mary G; Mims, Andrew H; Smedley, W Andrew; Swords, Jacob A; Thomas N, Wang; Martin J, Heslin

2016-01-01

Background Current methods to predict patients' peri-operative morbidity utilize complex algorithms with multiple clinical variables focusing primarily on organ-specific compromise. The aim of the present study is to determine the value of a timed stair climb (SC) in predicting peri-operative complications for patients undergoing abdominal surgery. Study Design From March 2014 to July 2015, 362 patients attempted SC while being timed prior to undergoing elective abdominal surgery. Vital signs were measured before and after SC. Ninety day post-operative complications were assessed by the Accordion Severity Grading System. The prognostic value of SC was compared to the ACS NSQIP risk calculator. Results A total of 264 (97.4%) patients were able to complete SC. SC time directly correlated to changes in both mean arterial pressure and heart rate as an indicator of stress. An Accordion grade 2 or higher complication occurred in 84 (25%) patients. There were 8 mortalities (2.4%). Patients with slower SC times had an increased complication rate (P<0.0001). In multivariable analysis SC time was the single strongest predictor of complications (OR=1.029, P<0.0001), and no other clinical co-morbidity reached statistical significance. Receiver operative characteristic curves predicting post-operative morbidity by SC time was superior to that of the ACS risk calculator (AUC 0.81 vs. 0.62, P<0.0001). Additionally slower patients had a greater deviation from predicted length of hospital stay (P=0.034) Conclusions SC provides measurable stress, accurately predicts post-operative complications, and is easy to administer in patients undergoing abdominal surgery. Larger patient populations with a diverse group of operations will be needed to further validate the use of SC in risk prediction models. PMID:26920993

Integration of an Earth-Based Science Team During Human Exploration of Mars

NASA Technical Reports Server (NTRS)

Chappell, Steven P.; Beaton, Kara H.; Newton, Carolyn; Graff, Trevor G.; Young, Kelsey E.; Coan, David; Abercromby, Andrew F. J.; Gernhardt, Michael L.

2017-01-01

NASA Extreme Environment Mission Operations (NEEMO) is an underwater spaceflight analog that allows a true mission-like operational environment and uses buoyancy effects and added weight to simulate different gravity levels. A mission was undertaken in 2016, NEEMO 21, at the Aquarius undersea research habitat. During the mission, the effects of varied oper-ations concepts with representative communication latencies as-sociated with Mars missions were studied. Six subjects were weighed out to simulate partial gravity and evaluated different operations concepts for integration and management of a simulated Earth-based science team (ST) who provided input and direction during exploration activities. Exploration traverses were planned in advance based on precursor data collected. Subjects completed science-related tasks including presampling surveys and marine-science-based sampling during saturation dives up to 4 hours in duration that simulated extravehicular activity (EVA) on Mars. A communication latency of 15 minutes in each direction between space and ground was simulated throughout the EVAs. Objective data included task completion times, total EVA time, crew idle time, translation time, ST assimilation time (defined as time available for the science team to discuss, to review and act upon data/imagery after they have been collected and transmitted to the ground). Subjective data included acceptability, simulation quality, capability assessment ratings, and comments. In addition, comments from both the crew and the ST were captured during the post-mission debrief. Here, we focus on the acceptability of the operations concepts studied and the capabilities most enhancing or enabling in the operations concept. The importance and challenges of designing EVA time-lines to account for the length of the task, level of interaction with the ground that is required/desired, and communication latency, are discussed.

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

PubMed

Ho, David M; Huo, Michael H

2007-07-01

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

A comparison of electrothermal bipolar vessel sealing system and electrocautery in selective neck dissection.

PubMed

Ozturk, Kerem; Kaya, Isa; Turhal, Goksel; Ozturk, Arin; Gursan, Gulce; Akyildiz, Serdar

2016-11-01

The use of LigaSure™ vessel sealing system in head and neck surgery was reported to be reliable and safe, providing sufficient hemostasis and reducing operating time. The aim of this study was to evaluate efficacy of this technique in patients undergoing selective neck dissections. This study was carried out as a prospective controlled study at an otolaryngology department of a tertiary medical center between July 2013 and July 2015. Twenty-five patients older than 18 years who underwent unilateral selective neck dissection for head and neck cancer were included in the study. In the control group (group 2, 10 patients) only monopolar and bipolar diathermy was used; in the Ligasure group (group 1, 15 patients) Ligasure was used for hemostasis and dissection in addition to the conventional techniques. Cervical lymphadenectomy time, operation time, preoperative hemoglobin levels, preoperative hematocrit levels, postoperative hemoglobin levels, postoperative hematocrit levels, total neck drainage and drain removal time were analyzed and compared between the groups. Median operation time in group 1 and 2 were 95 min (IQR = 35) and 142.5 min (IQR = 63), respectively. Median cervical lymphadenectomy time in group 1 and 2 were 55 min (IQR = 23) and 102.5 min (IQR = 49), respectively. Median operation time and cervical operation time were significantly lower in group 1 (p < 0.05). In conclusion, LigaSure™ vessel sealing system is a safe, efficacious technique and significantly lowers cervical lymphadenectomy and operation time in selective neck dissections compared to controls. Given the superb hemostatic properties, this technique should be in the surgeon's armamentarium when possible.

Acute Perioperative Comparison of Patient-Specific Instrumentation versus Conventional Instrumentation Utilization during Bilateral Total Knee Arthroplasty.

PubMed

Steimle, Jerrod A; Groover, Michael T; Webb, Brad A; Ceccarelli, Brian J

2018-01-01

Utilizing patient-specific instrumentation during total knee arthroplasty has gained popularity in recent years with theoretical advantages in blood loss, intraoperative time, length of stay, postoperative alignment, and functional outcome, amongst others. No study has compared acute perioperative measures between patient-specific instrumentation and conventional instrumentation in the bilateral total knee arthroplasty setting. We compared patient-specific instrumentation versus conventional instrumentation in the setting of bilateral total knee arthroplasty to determine any benefits in the immediate perioperative period including surgical time, blood loss, pain medication use, length of stay, and discharge disposition. A total of 49 patients with standard instrumentation and 31 patients with patient-specific instrumentation were retrospectively reviewed in a two-year period at one facility. At baseline, the groups were comparable with respect to age, ASA, BMI, and comorbid conditions. We analyzed data on operative time, blood loss, hemoglobin change, need for transfusion, pain medication use, length of stay, and discharge disposition. There was no statistically significant difference between groups in regards to these parameters. Patient-specific instrumentation in the setting of bilateral total knee arthroplasty did not provide any immediate perioperative benefit compared to conventional instrumentation.

The use of augmented reality glasses in central line simulation: “see one, simulate many, do one competently, and teach everyone”

PubMed Central

Huang, Cynthia Y; Thomas, Jonathan B; Alismail, Abdullah; Cohen, Avi; Almutairi, Waleed; Daher, Noha S; Terry, Michael H; Tan, Laren D

2018-01-01

Objective The aim of this study was to investigate the feasibility of using augmented reality (AR) glasses in central line simulation by novice operators and compare its efficacy to standard central line simulation/teaching. Design This was a prospective randomized controlled study enrolling 32 novice operators. Subjects were randomized on a 1:1 basis to either simulation using the augmented virtual reality glasses or simulation using conventional instruction. Setting The study was conducted in tertiary-care urban teaching hospital. Subjects A total of 32 adult novice central line operators with no visual or auditory impairments were enrolled. Medical doctors, respiratory therapists, and sleep technicians were recruited from the medical field. Measurements and main results The mean time for AR placement in the AR group was 71±43 s, and the time to internal jugular (IJ) cannulation was 316±112 s. There was no significant difference in median (minimum, maximum) time (seconds) to IJ cannulation for those who were in the AR group and those who were not (339 [130, 550] vs 287 [35, 475], p=0.09), respectively. There was also no significant difference between the two groups in median total procedure time (524 [329, 792] vs 469 [198, 781], p=0.29), respectively. There was a significant difference in the adherence level between the two groups favoring the AR group (p=0.003). Conclusion AR simulation of central venous catheters in manikins is feasible and efficacious in novice operators as an educational tool. Future studies are recommended in this area as it is a promising area of medical education. PMID:29785148

Defense Finance and Accounting Service Needs to Improve Controls Over the Completeness and Accuracy of the Cash Management Report

DTIC Science & Technology

2011-08-15

resu lting from Navy subhead conversions and to timely address any new problems that may occur. Managemen t Comments: Stakeholder: Concur. DFAS...collection of information, including suggestions for reducing this burden, to Washington Headquarters Services, Directorate for Information Operations and...total disbursements reported on the CMR for the FY 2010, Operation and Maintenance (O&M) appropriation into agreement with the amount reported by the

Mission operations of the handicapped FORMOSAT-2

NASA Astrophysics Data System (ADS)

Lin, Shin-Fa; Chern, Jeng-Shing; Wu, An-Ming

2014-10-01

Since its launch on 20 May 2004, FORMOSAT-2 (FS2, Formosa satellite ♯2) has been operated on orbit for more than 9 years. It carries two payloads: the remote sensing instrument (RSI) for Earth observations and the imager of sprites and upper atmospheric lightning instrument (ISUAL) for the purpose of scientific observations. The RSI is operating at daytime while ISUAL is active at night-time. To meet both mission objectives simultaneously, the satellite operations planning has been more complicated. In order to maximize the usage of the on-board resources, the satellite attitude maneuver activities and power charge/discharge cycles have been scheduled cautiously in every detail. Under such fully engaged operations scenario and with a design life of 5 years, it is inevitable that the satellite encountered many anomalies, either permanent or temporary. In particular, one attitude gyro (totally four) and one reaction wheel (totally four) have been failed. This paper presents the major anomalies and resolutions in the past years. Many iterations and trade-offs have been made to minimize the effect on mission operations of the handicapped FORMOSAT-2. It still can provide about 80% of the designed functions and capabilities.

Real-time monitoring of a microbial electrolysis cell using an electrical equivalent circuit model.

PubMed

Hussain, S A; Perrier, M; Tartakovsky, B

2018-04-01

Efforts in developing microbial electrolysis cells (MECs) resulted in several novel approaches for wastewater treatment and bioelectrosynthesis. Practical implementation of these approaches necessitates the development of an adequate system for real-time (on-line) monitoring and diagnostics of MEC performance. This study describes a simple MEC equivalent electrical circuit (EEC) model and a parameter estimation procedure, which enable such real-time monitoring. The proposed approach involves MEC voltage and current measurements during its operation with periodic power supply connection/disconnection (on/off operation) followed by parameter estimation using either numerical or analytical solution of the model. The proposed monitoring approach is demonstrated using a membraneless MEC with flow-through porous electrodes. Laboratory tests showed that changes in the influent carbon source concentration and composition significantly affect MEC total internal resistance and capacitance estimated by the model. Fast response of these EEC model parameters to changes in operating conditions enables the development of a model-based approach for real-time monitoring and fault detection.

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

PubMed

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

2015-01-01

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

Costs of Robotic-Assisted Versus Traditional Laparoscopy in Endometrial Cancer.

PubMed

Vuorinen, Riikka-Liisa K; Mäenpää, Minna M; Nieminen, Kari; Tomás, Eija I; Luukkaala, Tiina H; Auvinen, Anssi; Mäenpää, Johanna U

2017-10-01

The purpose of this study was to compare the costs of traditional laparoscopy and robotic-assisted laparoscopy in the treatment of endometrial cancer. A total of 101 patients with endometrial cancer were randomized to the study and operated on starting from 2010 until 2013, at the Department of Obstetrics and Gynecology of Tampere University Hospital, Tampere, Finland. Costs were calculated based on internal accounting, hospital database, and purchase prices and were compared using intention-to-treat analysis. Main outcome measures were item costs and total costs related to the operation, including a 6-month postoperative follow-up. The total costs including late complications were 2160 &OV0556; higher in the robotic group (median for traditional 5823 &OV0556;, vs robot median 7983 &OV0556;, P < 0.001). The difference was due to higher costs for instruments and equipment as well as to more expensive operating room and postanesthesia care unit time. Traditional laparoscopy involved higher costs for operation personnel, general costs, medication used in the operation, and surgeon, although these costs were not substantial. There was no significant difference in in-patient stay, laboratory, radiology, blood products, or costs related to complications. According to this study, robotic-assisted laparoscopy is 37% more expensive than traditional laparoscopy in the treatment of endometrial cancer. The cost difference is mainly explained by amortization of the robot and its instrumentation.

Rapid detection of coliforms in drinking water of Arak city using multiplex PCR method in comparison with the standard method of culture (Most Probably Number)

PubMed Central

Fatemeh, Dehghan; Reza, Zolfaghari Mohammad; Mohammad, Arjomandzadegan; Salomeh, Kalantari; Reza, Ahmari Gholam; Hossein, Sarmadian; Maryam, Sadrnia; Azam, Ahmadi; Mana, Shojapoor; Negin, Najarian; Reza, Kasravi Alii; Saeed, Falahat

2014-01-01

Objective To analyse molecular detection of coliforms and shorten the time of PCR. Methods Rapid detection of coliforms by amplification of lacZ and uidA genes in a multiplex PCR reaction was designed and performed in comparison with most probably number (MPN) method for 16 artificial and 101 field samples. The molecular method was also conducted on isolated coliforms from positive MPN samples; standard sample for verification of microbial method certificated reference material; isolated strains from certificated reference material and standard bacteria. The PCR and electrophoresis parameters were changed for reducing the operation time. Results Results of PCR for lacZ and uidA genes were similar in all of standard, operational and artificial samples and showed the 876 bp and 147 bp bands of lacZ and uidA genes by multiplex PCR. PCR results were confirmed by MPN culture method by sensitivity 86% (95% CI: 0.71-0.93). Also the total execution time, with a successful change of factors, was reduced to less than two and a half hour. Conclusions Multiplex PCR method with shortened operation time was used for the simultaneous detection of total coliforms and Escherichia coli in distribution system of Arak city. It's recommended to be used at least as an initial screening test, and then the positive samples could be randomly tested by MPN. PMID:25182727

[Generalised Form of Synovial Chondromatosis of the Knee Joint].

PubMed

Vališ, P; Vyskočil, R

2016-01-01

This study describes a diagnostic and therapeutic algorithm in a 53-year-old male patient who was diagnosed with a synovial chondromatosis of the knee joint extending to the popliteal fossa and soft tissues around the knee. Because of the presence of massive nodules, the patient was indicated for total synovectomy, with removal of pathologically changed cartilaginous tissue, performed by combined anterior and posterior approaches to the knee joint. Despite complete removal of the synovium and loose cartilage bodies and the patient's pain relief in the post-operative time, three years after the operation new problems appeared. Magnetic resonance imaging (MRI) confirmed a relapse of synovial chondromatosis and the patient was indicated for revision surgery of the knee joint. The results of physical examination and MRI scans, and intra-operative findings in the patient are reported. synovial chondromatosis, total synovectomy, direct anterior and posterior approaches to the knee joint.

Early enteral nutrition and total parenteral nutrition on the nutritional status and blood glucose in patients with gastric cancer complicated with diabetes mellitus after radical gastrectomy.

PubMed

Wang, Junli; Zhao, Jiamin; Zhang, Yanling; Liu, Chong

2018-07-01

Effects of early enteral nutrition (EEN) or total parenteral nutrition (TPN) support on nutritional status and blood glucose in patients with gastric cancer complicated with diabetes mellitus after radical gastrectomy were investigated. One hundred and twenty-nine patients with gastric cancer complicated with diabetes mellitus type 2 admitted to the First People's Hospital of Jinan (Jinan, China), from June 2012 to June 2016 were selected into the study. According to different nutrition support pathways, these patients were randomly divided into the EEN group and the TPN group. The improvement of nutritional indexes, postoperative complications, gastrointestinal function recovery and perioperative blood glucose fluctuation were compared between the two groups. On the 4th day after operation, the improvement levels of total bilirubin (TBL), alanine aminotransferase (ALT), aspartate transaminase (AST), total protein (TP), prealbumin (PAB), hemoglobin (HGB) and weight (Wt) in the EEN group were significantly higher than those in the conventional group (P<0.05). There were no significant differences between the two groups on the 8th day after operation (P>0.05). No patients had complications in the EEN group, while a total of 29 patients in the TPN group suffered adverse reactions, indicating that the incidence rate of complications in the EEN group was significantly lower than that in the TPN group (P<0.05). The postoperative evacuation time was earlier, hospitalization time was shorter and cost of postoperative hospitalization was less in the EEN group than those in the TPN group, and the differences were statistically significant (P<0.05). The blood glucose fluctuation values at fasting and 2 h after a meal in the TPN group were higher than those in the EEN group within 8 days after operation, and the differences were statistically significant (χ 2 =13.219, P=0.002; χ 2 =20.527, P<0.001). EEN support provides nutrition for patients with gastric cancer complicated with diabetes mellitus after radical gastrectomy, which is worthy of clinical promotion as it maintains good nutritional status, produces few postoperative complications and keeps the blood glucose level stable, by which the postoperative evacuation time is early, the hospitalization time is short and the cost is low.

76 FR 28239 - Agency Information Collection Activities: Arrival and Departure Record (Forms I-94 and I-94W) and...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-05-16

.../startup costs and operations and maintenance costs). The comments that are submitted will be summarized... Number of Respondents: 100,000. Estimated Number of Total Annual Responses: 100,000. Estimated Time per...

Neutron Radiation Damage Estimation in the Core Structure Base Metal of RSG GAS

NASA Astrophysics Data System (ADS)

Santa, S. A.; Suwoto

2018-02-01

Radiation damage in core structure of the Indonesian RGS GAS multi purpose reactor resulting from the reaction of fast and thermal neutrons with core material structure was investigated for the first time after almost 30 years in operation. The aim is to analyze the degradation level of the critical components of the RSG GAS reactor so that the remaining life of its component can be estimated. Evaluation results of critical components remaining life will be used as data ccompleteness for submission of reactor operating permit extension. Material damage analysis due to neutron radiation is performed for the core structure components made of AlMg3 material and bolts reinforcement of core structure made of SUS304. Material damage evaluation was done on Al and Fe as base metal of AlMg3 and SUS304, respectively. Neutron fluences are evaluated based on the assumption that neutron flux calculations of U3Si8-Al equilibrium core which is operated on power rated of 15 MW. Calculation result using SRAC2006 code of CITATION module shows the maximum total neutron flux and flux >0.1 MeV are 2.537E+14 n/cm2/s and 3.376E+13 n/cm2/s, respectively. It was located at CIP core center close to the fuel element. After operating up to the end of #89 core formation, the total neutron fluence and fluence >0.1 MeV were achieved 9.063E+22 and 1.269E+22 n/cm2, respectively. Those are related to material damage of Al and Fe as much as 17.91 and 10.06 dpa, respectively. Referring to the life time of Al-1100 material irradiated in the neutron field with thermal flux/total flux=1.7 which capable of accepting material damage up to 250 dpa, it was concluded that RSG GAS reactor core structure underwent 7.16% of its operating life span. It means that core structure of RSG GAS reactor is still capable to receive the total neutron fluence of 9.637E+22 n/cm2 or fluence >0.1 MeV of 5.672E+22 n/cm2.

Total hip arthroplasty of dysplastic hip after previous Chiari pelvic osteotomy.

PubMed

Minoda, Yukihide; Kadowaki, Toru; Kim, Mitsunari

2006-08-01

Many reports have suggested that Chiari pelvic osteotomy would improve the results of acetabular component placement and fixation in subsequent total hip arthroplasty. However, little is known concerning the biomechanical, radiological, and clinical effects of Chiari pelvic osteotomy on subsequent total hip arthroplasty. Ten total hip arthroplasties for developmental dysplasia of the hip after previous Chiari pelvic osteotomy (Chiari group) were compared with 20 total hip arthroplasties for developmental dysplasia of the hip without previous surgery (control group). Preoperative patient demographic data and operative technique were well matched between the groups. The mean duration of follow-up was 3.0 years. Biomechanical, radiological, and clinical evaluations were performed. No acetabular or femoral components exhibited loosening. All patients had good or excellent clinical score according to the Merle d'Aubigne-Postel rating system at the most recent follow-up. Abductor force and joint force were smaller in the Chiari group, although long operative time, more blood loss, and verticalization of joint force were noted in this group. This limited study suggested that Chiari pelvic osteotomy changed the biomechanical features of the hip joint, and that this alteration might have compromised subsequent total hip arthroplasty.

Impact of the aspirated volume of fat tissue in the insulin resistance after liposuction.

PubMed

Oliveira, Sérgio de Souza; Cibantos, Jubert Sanches; Ripari, Wagner Targa; Aguilar-Nascimento, José Eduardo de

2013-01-01

To investigate insulin resistance imposed by liposuction, correlating its intensity with the extent of the operation. The sample consisted of 20 female patients without comorbidities, aged between 21 and 43 years, body mass index between 19 and 27 kg/m², undergoing liposuction alone or associated with breasts' prosthesis. We assessed insulin resistance at the beginning and end of the procedure by calculating the Homeostasis Model Assessment (HOMA-IR). The operative variables were length of liposuction, breast prosthesis time, body areas submitted to liposuction and total fat aspirated. The liposuction time was 94-278 min (mean = 174 min), duration of breast prosthesis 20-140 min (mean = 65 min) and total fat aspirated 680-4280 g (mean = 1778 g). Statistical analysis was performed by considering a division line of 1500 g of aspirated fat and there was a significantly increased insulin resistance by HOMA index greater in the group > 1500 g (123% increase) than in the group d" 1500 g (an increase of 53 %) from the baseline data (p = 0.02). Other operative variables showed no significant correlation. Insulin resistance shows significant increase in liposuction, and it is correlated to the volume of aspirated fat.

The VLA Low-band Ionosphere and Transient Experiment (VLITE)

NASA Astrophysics Data System (ADS)

Clarke, Tracy; Peters, Wendy; Brisken, Walter; Giacintucci, Simona; Kassim, Namir; Polisensky, Emil; Helmboldt, Joseph; Richards, Emily E.; Erickson, Alan; Ray, Paul S.; Kerr, Matthew T.; Deneva, Julia; Coburn, William; Huber, Robert; Long, Jeff

2018-01-01

The VLA Low-band Ionosphere and Transient Experiment (VLITE, http://vlite.nrao.edu/ ) is a commensal low-frequency observing system that has been operational on the National Radio Astronomy Observatory's Karl G. Jansky Very Large Array (VLA) since late 2014. The separate optical paths of the prime-focus sub-GHz dipole feeds and the Cassegrain-focus 1-50 GHz feeds allow both systems to operate simultaneously with independent correlators. The initial 2.5 years of VLITE operation provided real-time correlation of 10 antennas across the 320-384 MHz band with a total observing time approaching 12,000 hours. During the summer of 2017, VLITE was upgraded to a total of 16 antennas (more than doubling the number of baselines) with enhanced correlator capabilities to enable correlation of the on-the-fly observing mode being used for the new NRAO VLA Sky Survey (VLASS).We present an overview of the VLITE system, including highlights of the complexities of a commensal observing program, sparse-array challenges, and scientific capabilities from our science-ready data pipeline. In the longer term, we seek a path to broadband expansion across all VLA antennas to develop a powerful new LOw Band Observatory (LOBO).

Advanced Gas Turbine (AGT) Technology Project

NASA Technical Reports Server (NTRS)

1986-01-01

Engine testing, ceramic component fabrication and evaluation, component performance rig testing, and analytical studies comprised AGT 100 activities during the 1985 year. Ten experimental assemblies (builds) were evaluated using two engines. Accrued operating time was 120 hr of burning and 170 hr total, bringing cumulative total operating time to 395 hr, all devoid of major failures. Tests identified the generator seals as the primary working fluid leakage sources. Power transfer clutch operation was demonstrated. An alpha SiC gasifier rotor engine test resulted in blade tip failures. Recurring case vibration and shaft whip have limited gasifier shaft speeds to 84%. Ceramic components successfully engine tested now include the SiC scroll assembly, Si3N3 turbine rotor, combustor assembly, regenerator disk bulkhead, turbine vanes, piston rings, and couplings. A compressor shroud design change to reduce heat recirculation back to the inlet was executed. Ceramic components activity continues to focus on the development of state-of-the-art material strength characteristics in full-scale engine hardware. Fiber reinforced glass-ceramic composite turbine (inner) backplates were fabricated by Corning Glass Works. The BMAS/III material performed well in engine testing. Backplates of MAS material have not been engine tested.

A Time Tree Medium Access Control for Energy Efficiency and Collision Avoidance in Wireless Sensor Networks

PubMed Central

Lee, Kilhung

2010-01-01

This paper presents a medium access control and scheduling scheme for wireless sensor networks. It uses time trees for sending data from the sensor node to the base station. For an energy efficient operation of the sensor networks in a distributed manner, time trees are built in order to reduce the collision probability and to minimize the total energy required to send data to the base station. A time tree is a data gathering tree where the base station is the root and each sensor node is either a relaying or a leaf node of the tree. Each tree operates in a different time schedule with possibly different activation rates. Through the simulation, the proposed scheme that uses time trees shows better characteristics toward burst traffic than the previous energy and data arrival rate scheme. PMID:22319270

The use of LigaSure in patients with hyperthyroidism.

PubMed

Barbaros, Umut; Erbil, Yeşim; Bozbora, Alp; Deveci, Uğur; Aksakal, Nihat; Dinççağ, Ahmet; Ozarmağan, Selçuk

2006-11-01

Thyroidectomies of hyperthyroidic patients are known to be more blood-spattered than the operations performed for euthyroid nodular diseases and require careful hemostasis. Our purpose was to evaluate the efficacy of the use of LigaSure in patients with hyperthyroidism. Between January 2004 and October 2005, 100 patients underwent total or near-total thyroidectomy. Bipolar vessel ligation system (LigaSure) was the choice of modality for hemostasis in half of these patients, and the conventional suture ligation technique was used for the rest. The following data were evaluated non-randomized and prospectively in this study: patients demographics, thyroid pathology, operative duration, presence of complications, and the duration of the hospital stay. Comparisons of the data were evaluated by the Wilcoxon and chi-square tests. Among the patients of the LigaSure group, 14 patients were detected to have hyperthyroidism (seven patients with Graves' disease and another seven patients with multinodular toxic goiter), while 36 patients were found to be euthyroidic. The durations of the operation time and of the hospital stay of the patients in the LigaSure group were significantly lower than the conventional thyroidectomy group (p<0.05). The complication rates of the LigaSure and conventional thyroidectomy groups were 4 and 6%, respectively (p>0.05). The use of LigaSure as an operative technique in the treatment of Graves' disease and toxic goiter is a safe and effective modality that provides a shorter hospital stay and a shorter operation time as well.

No effect of the infiltration of local anaesthetic for total hip arthroplasty using an anterior approach: a randomised placebo controlled trial.

PubMed

den Hartog, Y M; Mathijssen, N M C; van Dasselaar, N T; Langendijk, P N J; Vehmeijer, S B W

2015-06-01

Only limited data are available regarding the infiltration of local anaesthetic for total hip arthroplasty (THA), and no studies were performed for THA using the anterior approach. In this prospective, randomised placebo-controlled study we investigated the effect of both standard and reverse infiltration of local anaesthetic in combination with the anterior approach for THA. The primary endpoint was the mean numeric rating score for pain four hours post-operatively. In addition, we recorded the length of hospital stay, the operating time, the destination of the patient at discharge, the use of pain medication, the occurrence of side effects and pain scores at various times post-operatively. Between November 2012 and January 2014, 75 patients were included in the study. They were randomised into three groups: standard infiltration of local anaesthetic, reversed infiltration of local anaesthetic, and placebo. There was no difference in mean numeric rating score for pain four hours post-operatively (p = 0.87). There were significantly more side effects at one and eight hours post-operatively in the placebo group (p = 0.02; p = 0.03), but this did not influence the mobilisation of the patients. There were no differences in all other outcomes between the groups. We found no clinically relevant effect when the infiltration of local anaesthetic with ropivacaine and epinephrine was used in a multimodal pain protocol for THA using the anterior approach. ©2015 The British Editorial Society of Bone & Joint Surgery.

Tennessee Valley Total and Cloud-to-Ground Lightning Climatology Comparison

NASA Technical Reports Server (NTRS)

Buechler, Dennis; Blakeslee, R. J.; Hall, J. M.; McCaul, E. W.

2008-01-01

The North Alabama Lightning Mapping Array (NALMA) has been in operation since 2001 and consists often VHF receivers deployed across northern Alabama. The NALMA locates sources of impulsive VHF radio signals from total lightning by accurately measuring the time that the signals arrive at the different receiving stations. The sources detected are then clustered into flashes by applying spatially and temporally constraints. This study examines the total lightning climatology of the region derived from NALMA and compares it to the cloud-to-ground (CG) climatology derived from the National Lightning Detection Network (NLDN) The presentation compares the total and CG lightning trends for monthly, daily, and hourly periods.

[The comparison of efficacy of female sterilization by modified Uchida technique and silver clips in China].

PubMed

Qiu, Hong-yan; Zou, Yan; Li, Li; Liang, Hong; Zhang, Hong-yan; Wu, Shang-chun

2011-02-01

To compare efficacy of female sterilization by modified Uchida technique and silver clips and to evaluate the influence on operation procedure and clinical effect with or without surgery training of service providers. A comparative, multicenter clinical trial was performed in 18 county and township-level service centers. Totally 2198 women underwent sterilization from these 18 study center were divided into 1116 women sterilized by modified Uchida technique and 1082 women by silver clips. Those 18 centers were classified into 9 training groups which provide surgical skills of sterilization and other contents and 9 non training groups. Clinical documents of sterilization were recorded. All women were follow-up at 3, 6 and 12 months after surgery. There were no complications during surgery by both sterilization. The failure rate was 2.03% (22/1082) in silver clip method and the mean operative time were (12.4 ± 6.4) minutes in training group and (14.4 ± 8.1) minutes in non training group. In modified Uchida method, the failure rate was 0.18% (2/1116) and the mean operative time were (16.2 ± 4.9) minutes in training group and (19.0 ± 8.6) minutes in non training group. The mean operative time between two groups reached statistical difference (all P < 0.05). Total ended rate in modified Uchida technique were 2.2/hundred women year in training group and 2.5/hundred women year in non training group, and the rate of silver slips were 3.9/hundred women year and 4.8/hundred women year, which did not show significant difference (all P > 0.05). There was no significant difference in acceptability and side effects of all women between two methods (P > 0.05). The training of service providers could influence acceptability of women (P < 0.05). Clinical efficacy was not influenced by those two methods. The operative time and acceptability were improved by training surgeons in silver clips method.

Ropivacaine for unilateral spinal anesthesia; hyperbaric or hypobaric?

PubMed

Cantürk, Mehmet; Kılcı, Oya; Ornek, Dilşen; Ozdogan, Levent; Pala, Yasar; Sen, Ozlem; Dikmen, Bayazit

2012-01-01

The aim of this study was to compare the unilaterality of subarachnoid block achieved with hyperbaric and hypobaric ropivacaine. The prospective, randomized trial was conducted in an orthopedics surgical suite. In all, 60 ASA I-III patients scheduled for elective total knee arthroplasty were included in the study. Group Hypo (n=30) received 11.25mg of ropivacaine (7.5mg.mL(-1)) + 2mL of distilled water (density at room temperature was 0.997) and group Hyper (n=30) received 11.25mg of ropivacaine (7.5mg.mL(-1)) + 2mL (5mg.mL(-1)) of dextrose (density at room temperature was 1,015). Patients in the hyperbaric group were positioned with the operated side down and in the 15° Fowler position, versus those in the hypobaric group with the operated side facing up and in the 15° Trendelenburg position. Combined spinal epidural anesthesia was performed midline at the L(3-4) lumbar interspace. Hemodynamic and spinal block parameters, regression time, success of unilateral spinal anesthesia, patient comfort, surgical comfort, surgeon comfort, first analgesic requirement time, and adverse effects were assessed. Time to reach the T10 dermatome level on the operated side was shorter in group Hyper (612.00±163.29s) than in group Hypo (763.63±208.35s) (p<0.05). Time to 2-segment regression of the sensory block level on both the operated and non-operated sides was shorter in group Hypo than in group Hyper. Both hyperbaric and hypobaric ropivacaine (11.25mg) provided adequate and dependable anesthesia for total knee replacement surgery, with a high level of patient and surgeon comfort. Hypobaric local anesthetic solutions provide a high level of unilateral anesthesia, with rapid recovery of both sensory and motor block, and therefore may be preferable in outpatient settings. Copyright © 2012 Elsevier Editora Ltda. All rights reserved.

The position of a standard optical computer mouse affects cardiorespiratory responses during the operation of a computer under time constraints.

PubMed

Sako, Shunji; Sugiura, Hiromichi; Tanoue, Hironori; Kojima, Makoto; Kono, Mitsunobu; Inaba, Ryoichi

2014-08-01

This study investigated the association between task-induced stress and fatigue by examining the cardiovascular responses of subjects using different mouse positions while operating a computer under time constraints. The study was participated by 16 young, healthy men and examined the use of optical mouse devices affixed to laptop computers. Two mouse positions were investigated: (1) the distal position (DP), in which the subjects place their forearms on the desk accompanied by the abduction and flexion of their shoulder joints, and (2) the proximal position (PP), in which the subjects place only their wrists on the desk without using an armrest. The subjects continued each task for 16 min. We assessed differences in several characteristics according to mouse position, including expired gas values, autonomic nerve activities (based on cardiorespiratory responses), operating efficiencies (based on word counts), and fatigue levels (based on the visual analog scale - VAS). Oxygen consumption (VO(2)), the ratio of inspiration time to respiration time (T(i)/T(total)), respiratory rate (RR), minute ventilation (VE), and the ratio of expiration to inspiration (Te/T(i)) were significantly lower when the participants were performing the task in the DP than those obtained in the PP. Tidal volume (VT), carbon dioxide output rates (VCO(2)/VE), and oxygen extraction fractions (VO(2)/VE) were significantly higher for the DP than they were for the PP. No significant difference in VAS was observed between the positions; however, as the task progressed, autonomic nerve activities were lower and operating efficiencies were significantly higher for the DP than they were for the PP. Our results suggest that the DP has fewer effects on cardiorespiratory functions, causes lower levels of sympathetic nerve activity and mental stress, and produces a higher total workload than the PP. This suggests that the DP is preferable to the PP when operating a computer.

Comparison of 3 Minimally Invasive Methods for Distal Tibia Fractures.

PubMed

Fang, Jun-Hao; Wu, Yao-Sen; Guo, Xiao-Shan; Sun, Liao-Jun

2016-07-01

This study compared the results of external fixation combined with limited open reduction and internal fixation (EF + LORIF), minimally invasive percutaneous plate osteosynthesis (MIPPO), and intramedullary nailing (IMN) for distal tibia fractures. A total of 84 patients with distal tibia shaft fractures were randomized to operative stabilization using EF + LORIF (28 cases), MIPPO (28 cases), or IMN (28 cases). The 3 groups were comparable with respect to patient demographics. Data were collected on operative time and radiation time, union time, complications, time of recovery to work, secondary operations, and measured joint function using the American Orthopaedic Foot and Ankle Society (AOFAS) score. There was no significant difference in time to union, incidence of union status, time of recovery to work, and AOFAS scores among the 3 groups (P>.05). Mean operative time and radiation time in the MIPPO group were longer than those in the IMN or EF + LORIF groups (P<.05). Wound complications after MIPPO were more common compared with IMN or EF + LORIF (P<.05). Anterior knee pain occurred frequently after IMN (32.1%), and irritation symptoms were encountered more frequently after MIPPO (46.4%). Although EF + LORIF was associated with fewer secondary procedures vs MIPPO or IMN, it was related with more pin-tract infections (14.3%). Findings indicated that EF + LORIF, MIPPO, and IMN all achieved similar good functional results. However, EF + LORIF had some advantages over MIPPO and IMN in reducing operative and radiation times, postoperative complications, and reoperation rate. [Orthopedics. 2016; 39(4):e627-e633.]. Copyright 2016, SLACK Incorporated.

How can we maximize the use of our operating lists? An analysis of factors influencing theatre efficiency in oculoplastic day surgery.

PubMed

Nagendran, Sonali T; Siah, We Fong; Litwin, Andre; Barbosa, Christine; Jayatilake, Jan; Malhotra, Raman

2016-12-01

Operating theatre utilization has become the principal measure of NHS operating theatre service performance. We analysed data from oculoplastic theatres in a tertiary centre to identify factors influencing theatre efficiency. We conducted three audits on operating theatre utilization in 2011, 2014 and 2015. Data was collected from real time information entered into the hospital database, including time of arrival, induction, first cut and close of operation. The primary outcome measure was the operating list utilization rate, a combined value of anaesthetic and surgical time as a proportion of the total planned session time. The initial 2011 audit recorded an operating list utilization rate of 81.2%. However, this dropped to 64.5% in 2014 following new management and a move to a new theatre suite. Analysis of the factors contributing to poor theatre efficiency led to changes that streamlined the patient pathway, including standardized case scheduling and reducing staggered patient arrival. A 2015 reaudit analyzing the effects of these changes demonstrated an increase in the operating list utilization rate to 78%. It was significantly higher (p < 0.01) for whole-day lists (85%) compared to half-day lists (75%), suggesting that whole-day lists were more efficient. Operating theatres are a valuable resource and the factors affecting theatre efficiency within our unit are common and will be relevant to units elsewhere. Correcting them can lead to significant improvements in patient care. Data from this study may provide a benchmark for other units in the United Kingdom.

Laparoscopic versus robotic-assisted Roux-en-Y gastric bypass: a retrospective, single-center study of early perioperative outcomes at a community hospital.

PubMed

Ahmad, Arif; Carleton, Jared D; Ahmad, Zoha F; Agarwala, Ashish

2016-09-01

The purpose of this study was to compare the operative and early perioperative outcomes of laparoscopic versus robotic-assisted Roux-en-Y gastric bypass procedures performed in a community hospital setting. The study was a chart review and analysis of the early perioperative outcomes of a total of 345 Roux-en-Y gastric bypass procedures performed by a single surgeon in a community hospital setting from January 2011 to October 2014. Of these, 173 procedures were performed laparoscopically and 172 were performed with robotic assistance utilizing the daVinci(®) surgical platform. Factors such as baseline patient characteristics, operative time, estimated blood loss (EBL), conversions to open procedure, complication rates, adverse events, length of stay (LOS), and return to the operating room for the two groups were retrospectively analyzed from a prospectively maintained database. Student's t test with unequal variances was used for statistical analysis, and a p value <0.05 was used for significance. There were no statistically significant differences in complication rates, EBL, or LOS between the two groups. There was a significant difference between the total operative times (135.30 ± 37.60 min for the laparoscopic procedure versus 154.84 ± 38.44 min for the robotic procedure, p < 0.05). There were no adverse intraoperative events, conversions to open procedures, leaks, strictures, returns to the operating room within 30 days, or mortalities in either group. Our study, which is the first of its kind to analyze the operative and early perioperative outcomes between laparoscopic and robotic-assisted Roux-en-Y gastric bypass procedures in the US community hospital setting, indicates that both are comparable in terms of safety, efficacy, and operative and early perioperative outcomes.

Investigating Electrostatic Precipitator Design Parameters for Efficient Control of Particulate Matter in Thermal Power Plant: A Case Study

NASA Astrophysics Data System (ADS)

Rai, P.; Gautam, N.; Chandra, H.

2018-06-01

This work deals with the analysis and modification of operational parameters for meeting the emission standards, set by Central Pollution Control Board (CPCB)/State Pollution Control Board (SPCB) from time to time of electrostatic precipitator (ESP). The analysis is carried out by using standard chemical analysis supplemented by the relevant data collected from Korba East Phase (Ph)-III thermal power plant, under Chhattisgarh State Electricity Board (CSEB) operating at Korba, Chhattisgarh. Chemical analysis is used to predict the emission level for different parameters of ESP. The results reveal that for a constant outlet PM concentration and fly ash percentage, the total collection area decreases with the increase in migration velocity. For constant migration velocity and outlet PM concentration, the total collection area increases with the increase in the fly ash percent. For constant migration velocity and outlet e PM concentration, the total collection area increases with the ash content in the coal. i.e. from minimum ash to maximum ash. As far as the efficiency is concerned, it increases with the fly ash percent, ash content and the inlet dust concentration but decreases with the outlet PM concentration at constant migration velocity, fly ash and ash content.

Investigating Electrostatic Precipitator Design Parameters for Efficient Control of Particulate Matter in Thermal Power Plant: A Case Study

NASA Astrophysics Data System (ADS)

Rai, P.; Gautam, N.; Chandra, H.

2018-02-01

This work deals with the analysis and modification of operational parameters for meeting the emission standards, set by Central Pollution Control Board (CPCB)/State Pollution Control Board (SPCB) from time to time of electrostatic precipitator (ESP). The analysis is carried out by using standard chemical analysis supplemented by the relevant data collected from Korba East Phase (Ph)-III thermal power plant, under Chhattisgarh State Electricity Board (CSEB) operating at Korba, Chhattisgarh. Chemical analysis is used to predict the emission level for different parameters of ESP. The results reveal that for a constant outlet PM concentration and fly ash percentage, the total collection area decreases with the increase in migration velocity. For constant migration velocity and outlet PM concentration, the total collection area increases with the increase in the fly ash percent. For constant migration velocity and outlet e PM concentration, the total collection area increases with the ash content in the coal. i.e. from minimum ash to maximum ash. As far as the efficiency is concerned, it increases with the fly ash percent, ash content and the inlet dust concentration but decreases with the outlet PM concentration at constant migration velocity, fly ash and ash content.

A new type industrial total station based on target automatic collimation

NASA Astrophysics Data System (ADS)

Lao, Dabao; Zhou, Weihu; Ji, Rongyi; Dong, Dengfeng; Xiong, Zhi; Wei, Jiang

2018-01-01

In the case of industrial field measurement, the present measuring instruments work with manual operation and collimation, which give rise to low efficiency for field measurement. In order to solve the problem, a new type industrial total station is presented in this paper. The new instrument can identify and trace cooperative target automatically, in the mean time, coordinate of the target is measured in real time. For realizing the system, key technology including high precision absolutely distance measurement, small high accuracy angle measurement, target automatic collimation with vision, and quick precise controlling should be worked out. After customized system assemblage and adjustment, the new type industrial total station will be established. As the experiments demonstrated, the coordinate accuracy of the instrument is under 15ppm in the distance of 60m, which proved that the measuring system is feasible. The result showed that the total station can satisfy most industrial field measurement requirements.

Effects of cemented versus press-fit primary humeral stem fixation in the setting of revision shoulder arthroplasty.

PubMed

Salesky, Madeleine A; Grace, Trevor R; Feeley, Brian T; Ma, C Benjamin; Zhang, Alan L

2018-05-01

The influence of primary humeral stem fixation method (cemented or press fit) on intraoperative or postoperative outcomes in the setting of revision shoulder arthroplasty is unknown. A retrospective analysis of a prospectively collected cohort of revision shoulder arthroplasty patients from a single tertiary center was performed. Demographic variables, intraoperative data, and 90-day complication rates were compared between cemented and press-fit primary stem fixation cohorts. Follow-up radiographs were graded and compared using a modified Gruen system for humeral lucencies. Eighty-six primary shoulder replacements (34 hemiarthroplasties, 39 anatomic total shoulder arthroplasties, 13 reverse total shoulder arthroplasties) underwent revision arthroplasty with humeral stem removal between 2004 and 2017. Forty-five patients had cemented primary humeral fixation and 41 had press-fit fixation. The cemented cohort was older than the cementless cohort (66.6 vs. 61.4 years; P = .03) but otherwise demonstrated no difference in gender, body mass index, type of primary prosthesis (hemi, total, or reverse), or time between primary and revision operations. The cemented and cementless cohorts showed similar rates of humeral osteotomy (28.9% vs. 29.3%; P = .97), operative time (133.5  vs. 121.3 minutes; P = .16), and 90-day complication rates (13.3% vs. 9.8%; P = .61). Cemented vs. press-fit primary stems also had similar rates of humeral lucencies seen on follow-up radiographs after revision (77.1% vs. 60.6%; P = .14). Humeral stem fixation with or without cement during primary shoulder arthroplasty demonstrated similar operative time, need for intraoperative humeral osteotomy, and postoperative complication rates in the setting of revision arthroplasty. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Outcomes of robotic, laparoscopic and open hysterectomy for benign conditions in obese patients.

PubMed

Borahay, Mostafa A; Tapısız, Ömer Lütfi; Alanbay, İbrahim; Kılıç, Gökhan Sami

2018-04-27

To compare outcomes of robotic assisted (RAH), total laparoscopic (LH) and total abdominal (TAH) hysterectomy for benign conditions in obese patients. Retrospective cohort (Class II-2) analysis. All obese patients who underwent RAH, LH or TAH for benign conditions by a single surgeon at the University of Texas Medical Branch between January 2009 and December 2011 were identified and their charts reviewed. Patients' characteristics, operative data and post-operative outcomes were collected and statistically analyzed. A total of 208 patients who underwent RAH ( n= 51 ), LH ( n=24 ) or TAH ( n=133 ) were analyzed. There were no significant differences among groups in demographic characteristics, indications for surgery or pathologic findings. RAH and LH were associated with less estimated blood loss (EBL) ( P < .001) and shorter length of hospital stay (LOS) ( P < .001) compared to TAH. In addition, RAH and LH had lower intraoperative and early postoperative (≤ 6 weeks) complications compared with TAH ( P = .002). However, the procedure time was longer in RAH and LH ( P < .001). No significant differences were noted among groups for late post-operative complications (after 6 weeks) or unscheduled post-operative visits. Minimally invasive hysterectomy appears to be safe in obese patients with the advantages of less EBL, fewer intraoperative complications and shorter LOS.

[Advantage investigation of totally laparoscopic modified Roux-en-Y reconstruction].

PubMed

Liu, Tianzhou; Ma, Zhiming; Sun, Pengda; Li, Jinlong; Fang, Xuedong; Tong, Ti; Zhu, Jiaming

2016-01-01

To investigate the clinical advantage of the application of modified Roux-en-Y reconstruction after totally laparoscopic total gastrectomy. Clinical data of 36 patients who underwent totally laparoscopic total gastrectomy with Roux-en-Y reconstruction by one medical team for gastric adenocarcinoma between January 2014 and December 2014 in the Second Hospital of Jilin University were retrospectively analyzed. Patients were divided into classic Roux-en-Y group (CRY, 16 cases) and modified Roux-en-Y group (MRY, 20 cases) according to reconstructive methods. The data concerning the intraoperative and postoperative situation in two groups were compared. Operation was successfully completed in all the cases without conversion to laparotomy. Compared to CRY group, MRY group had shorter mean operative time [(260.9 ± 21.2) min vs. (287.9 ± 19.0) min, P=0.000], shorter mean reconstruction duration [(32.4 ± 9.2] min vs. (45.4 ± 13.2) min, P=0.001] and less intraoperative bleeding [(50.9 ± 23.5) ml vs. (67.0 ± 20.5) ml, P=0.000]. Jejunum mesentery dissection and jejunum resection were not necessary in MRY group. However, there were no significant differences in lymph nodes harvested, time to flatus, hospital stay and postoperative complications between two groups. As compared to classic Roux-en-Y reconstruction, the modified Roux-en-Y reconstruction can simplify the surgical procedures and achieve similar efficacy. It is feasible and safe, and worth further promotion in clinical practice.

A randomised controlled trial of coblation, diode laser and cold dissection in paediatric tonsillectomy.

PubMed

Elbadawey, M R; Hegazy, H M; Eltahan, A E; Powell, J

2015-11-01

This study aimed to compare the efficacy of diode laser, coblation and cold dissection tonsillectomy in paediatric patients. A total of 120 patients aged 10-15 years with recurrent tonsillitis were recruited. Participants were prospectively randomised to diode laser, coblation or cold dissection tonsillectomy. Operative time and blood loss were recorded. Pain was recorded on a Wong-Baker FACES(®) pain scale. The operative time (10 ± 0.99 minutes), blood loss (20 ± 0.85 ml) and pain were significantly lower with coblation tonsillectomy than with cold dissection tonsillectomy (20 ± 1.0 minutes and 30 ± 1.0 ml; p = 0.0001) and diode laser tonsillectomy (15 ± 0.83 minutes and 25 ± 0.83 ml; p = 0.0001). Diode laser tonsillectomy had a shorter operative time (p = 0.0001) and less blood loss (p = 0.001) compared with cold dissection tonsillectomy. However, at post-operative day seven, the diode laser tonsillectomy group had significantly higher pain scores compared with the cold dissection (p = 0.042) and coblation (p = 0.04) tonsillectomy groups. Both coblation and diode laser tonsillectomy are associated with significantly reduced blood loss and shorter operative times compared with cold dissection tonsillectomy. However, we advocate coblation tonsillectomy because of the lower post-operative pain scores compared with diode laser and cold dissection tonsillectomy.

Planning for operating room efficiency and faster anesthesia wake-up time in open major upper abdominal surgery.

PubMed

Lai, Hou-Chuan; Chan, Shun-Ming; Lu, Chueng-He; Wong, Chih-Shung; Cherng, Chen-Hwan; Wu, Zhi-Fu

2017-02-01

Reducing anesthesia-controlled time (ACT) may improve operation room (OR) efficiency result from different anesthetic techniques. However, the information about the difference in ACT between desflurane (DES) anesthesia and propofol-based total intravenous anesthesia (TIVA) techniques for open major upper abdominal surgery under general anesthesia (GA) is not available in the literature.This retrospective study uses our hospital database to analyze the ACT of open major upper abdominal surgery without liver resection after either desflurane/fentanyl-based anesthesia or TIVA via target-controlled infusion with fentanyl/propofol from January 2010 to December 2011. The various time intervals including waiting for anesthesia time, anesthesia time, surgical time, extubation time, exit from OR after extubation, total OR time, and postanesthetic care unit (PACU) stay time and percentage of prolonged extubation (≥15 minutes) were compared between these 2 anesthetic techniques.We included data from 343 patients, with 159 patients receiving TIVA and 184 patients receiving DES. The only significant difference is extubation time, TIVA was faster than the DES group (8.5 ± 3.8 vs 9.4 ± 3.7 minutes; P = 0.04). The factors contributed to prolonged extubation were age, gender, body mass index, DES anesthesia, and anesthesia time.In our hospital, propofol-based TIVA by target-controlled infusion provides faster emergence compared with DES anesthesia; however, it did not improve OR efficiency in open major abdominal surgery. Older, male gender, higher body mass index, DES anesthesia, and lengthy anesthesia time were factors that contribute to extubation time.

Controversy of hand-assisted laparoscopic colorectal surgery

PubMed Central

Meshikhes, Abdul-Wahed Nasir

2010-01-01

Laparoscopically assisted colorectal procedures are time-consuming and technically demanding and hence have a long steep learning curve. In the technical demand, surgeons need to handle a long mobile organ, the colon, and have to operate on multiple abdominal quadrants, most of the time with the need to secure multiple mesenteric vessels. Therefore, a new surgical innovation called hand-assisted laparoscopic surgery (HALS) was introduced in the mid 1990s as a useful alternative to totally laparoscopic procedures. This hybrid operation allows the surgeon to introduce the non-dominant hand into the abdominal cavity through a special hand port while maintaining the pneumoperitoneum. A hand in the abdomen can restore the tactile sensation which is usually lacking in laparoscopic procedures. It also improves the eye-to-hand coordination, allows the hand to be used for blunt dissection or retraction and also permits rapid control of unexpected bleeding. All of those factors can contribute tremendously to reducing the operative time. Moreover, this procedure is also considered as a hybrid procedure that combines the advantages of both minimally invasive and conventional open surgery. Nevertheless, the exact role of HALS in colorectal surgery has not been well defined during the advanced totally laparoscopic procedures. This article reviews the current status of hand-assisted laparoscopic colorectal surgery as a minimally invasive procedure in the era of laparoscopic surgery. PMID:21128315

Validation of exposure assessment and assessment of recruitment methods for a prospective cohort study of mobile phone users (COSMOS) in Finland: a pilot study

PubMed Central

2011-01-01

Background The aim of the study was to evaluate the agreement between self-reported and operator-derived estimates of call time based on a three-month monitoring period, as well as the consistency of mobile phone use over time. Alternative approaches to improve participation in a cohort study of mobile phone users were also compared. Methods A total of 5,400 subjects were identified from network operators' subscriber databases for recruitment to the pilot study. Operator and questionnaire data were used to quantify mobile phone use. Operator data were available for a subset of the subjects for a three-month period in three consecutive years. We also evaluated the effect of the length of the questionnaire and one- or two-phase recruitment on participation. Results The average response rate for both questionnaires and recruitment procedures was 12%. The response rate was not affected by the length of the questionnaire or the recruitment method. Operator data were available for 83% of the participants for 2007, the first study year. The agreement between self-reported and operator-derived call times decreased with the level of use among intermediate and heavy mobile phone users. During 2007-2009, mobile phone use increased fairly constantly over time. Conclusions The agreement between self-reported mobile phone use and operator databases was moderate and overestimation of the call time by participants was common. A prospective cohort study would be feasible in Finland, although the potentially low participation rate would increase the resources required for recruitment. PMID:21385407

The learning curve in short-stem THA: influence of the surgeon's experience on intraoperative adjustments due to intraoperative radiography.

PubMed

Loweg, Lennard; Kutzner, Karl Philipp; Trost, Matthias; Hechtner, Marlene; Drees, Philipp; Pfeil, Joachim; Schneider, Michael

2018-02-01

Short-stem THA has become increasingly popular over the last decade. However, implantation technique differs from conventional THA and thus possibly involves a distinct learning curve. The purpose of this study was to evaluate the value of intraoperative radiography and the influence of the surgeon's experience on intraoperative adjustments in short-stem THA. A total of 287 consecutive short-stem THAs, operated by a total of 24 senior consultants, consultants and residents in training, were prospectively included. Intraoperative radiography was performed after trial reduction. Preoperative planning and intraoperative outcome with regard to positioning, sizing of components as well as resulting offset and leg length were compared. Frequency, reason and type of intraoperative adjustments were documented in relation to the surgeon's experience. Operation time was assessed. One hundred and fifty-six (54.4%) procedures were carried out by one of three senior consultants, and a total of nine consultants and 12 residents in training performed 105 (36.6%) and 26 (9.0%) operations, respectively. In 121 cases (42.2%), intraoperative adjustments were made following intraoperative radiography. Intraoperative adjustments of one or more components were made by senior consultants in 51 cases (32.7%), by consultants in 53 cases (50.5%) and by residents in 17 cases (65.4%), respectively. The most common cause was undersizing of the stem. Operation time varied markedly between groups of surgeons. Short-stem THA involves a learning curve. Intraoperative radiography is decisive for prevention of malpositioning and undersizing of components, as well as loss of offset and leg length discrepancies. Hence, it should be considered mandatory, especially for less experienced surgeons.

Totally tubeless percutaneous nephrolithotomy is feasible in morbidly obese patients.

PubMed

Aghamir, Seyed Mohammad Kazem; Mohseni, Mohammad Ghasem; Hosseini, Seyed Reza; Salavati, Alborz; Ganjali, Hossein; Fallah, Mohammad Ali; Rezaei, Hamed; Modaresi, Seyed Saeed

2017-06-01

Regarding technical difficulties that obese body habitus might impose to percutaneous nephrolithotomy (PNL) success and higher risk of peri-operative complications in this group of patients, we decided to retrospectively gather data from our patients during past 8 years to determine the stone free and complication rates. Between January 2007-December 2015, seventy-eight obese patients with body mass index over 35 who had indication for PNL including stones larger than 2 cm in pelvi-calyceal system or smaller extracorporeal shock wave lithotripsy (ESWL) resistant stones or who were not a fit candidate for ESWL due to increased skin to target distance, with no contraindication of PNL (including bleeding diathesis, inability to be positioned in prone) were enrolled. They were randomly assigned to group 1 (standard PNL with nephrostomy and ureteral stent) or group 2 (totally tubeless PNL with no ureteral stent and no nephrostomy). The outcomes were compared. The transfusion rate, operation time, and the hemoglobin drop were same across the groups (p>0.05). Total analgesic use was equivalent of 33.8 vs. 14.7 mgs of morphine sulfate (18-77 mg) and was significantly lower in total tubeless group (p=0.001). Return to normal activity was described as total number of in-patient and outpatient days from time of admission to the point which the patients returns to normal life activity such as going to job or school and was 19.4 vs. 9.3 days (6-30 days, p=0.001). Totally tubeless PNL in obese subjects would have lower analgesic use and return to normal activity versus standard PNL. Totally tubeless PNL is recommended for obese patients.

Total robotic radical rectal resection with da Vinci Xi system: single docking, single phase technique.

PubMed

Tamhankar, Anup Sunil; Jatal, Sudhir; Saklani, Avanish

2016-12-01

This study aims to assess the advantages of Da Vinci Xi system in rectal cancer surgery. It also assesses the initial oncological outcomes after rectal resection with this system from a tertiary cancer center in India. Robotic rectal surgery has distinct advantages over laparoscopy. Total robotic resection is increasing following the evolution of hybrid technology. The latest Da Vinci Xi system (Intuitive Surgical, Sunnyvale, USA) is enabled with newer features to make total robotic resection possible with single docking and single phase. Thirty-six patients underwent total robotic resection in a single phase and single docking. We used newer port positions in a straight line. Median distance from the anal verge was 4.5 cm. Median robotic docking time and robotic procedure time were 9 and 280 min, respectively. Median blood loss was 100 mL. One patient needed conversion to an open approach due to advanced disease. Circumferential resection margin and longitudinal resection margins were uninvolved in all other patients. Median lymph node yield was 10. Median post-operative stay was 7 days. There were no intra-operative adverse events. The latest Da Vinci Xi system has made total robotic rectal surgery feasible in single docking and single phase. With the new system, four arm total robotic rectal surgery may replace the hybrid technique of laparoscopic and robotic surgery for rectal malignancies. The learning curve for the new system appears to be shorter than anticipated. Early perioperative and oncological outcomes of total robotic rectal surgery with the new system are promising. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

Resource utilization and costs before and after total joint arthroplasty.

PubMed

Bozic, Kevin J; Stacey, Brett; Berger, Ariel; Sadosky, Alesia; Oster, Gerry

2012-03-23

The purpose of this study was to compare pre- and post-surgical healthcare costs in commercially insured total joint arthroplasty (TJA) patients with osteoarthritis (OA) in the United States (U.S.). Using a large healthcare claims database, we identified patients over age 39 with hip or knee OA who underwent unilateral primary TJA (hip or knee) between 1/1/2006 and 9/30/2007. Utilization of healthcare services and costs were aggregated into three periods: 12 months "pre-surgery," 91 days "peri-operative," and 3 to 15 month "follow-up," Mean total pre-surgery costs were compared with follow-up costs using Wilcoxon signed-rank test. 14,912 patients met inclusion criteria for the study. The mean total number of outpatient visits declined from pre-surgery to follow-up (18.0 visits vs 17.1), while the percentage of patients hospitalized increased (from 7.5% to 9.8%) (both p < 0.01). Mean total costs during the follow-up period were 18% higher than during pre-surgery ($11,043 vs. $9,632, p < 0.01), largely due to an increase in the costs of inpatient care associated with hospital readmissions ($3,300 vs. $1,817, p < 0.01). Pharmacotherapy costs were similar for both periods ($2013 [follow-up] vs. $1922 [pre-surgery], p = 0.33); outpatient care costs were slightly lower in the follow-up period ($4338 vs. $4571, p < 0.01). Mean total costs for the peri-operative period were $36,553. Mean total utilization of outpatient healthcare services declined slightly in the first year following TJA (exclusive of the peri-operative period), while mean total healthcare costs increased during the same time period, largely due to increased costs associated with hospital readmissions. Further study is necessary to determine whether healthcare costs decrease in subsequent years.

Laparoscopic reoperation with total fundoplication for failed Heller myotomy: is it a possible option? Personal experience and review of literature.

PubMed

Rossetti, Gianluca; del Genio, Gianmattia; Maffettone, Vincenzo; Fei, Landino; Brusciano, Luigi; Limongelli, Paolo; Pizza, Francesco; Tolone, Salvatore; Di Martino, Maria; del Genio, Federica; del Genio, Alberto

2009-01-01

Laparoscopic Heller myotomy with antireflux procedure seems the procedure of choice in the treatment of patients with esophageal achalasia. Persistent or recurrent symptoms occur in 10% to 20% of patients. Few reports on reoperation after failed Heller myotomy have been published. No author has reported the realization of a total fundoplication in these patient groups. The aim of this study is to evaluate the efficacy of laparoscopic reoperation with the realization of a total fundoplication after failed Heller myotomy for esophageal achalasia. From 1992 to December 2007, 5 out of a series of 242 patients (2.1%), along with 2 patients operated elsewhere, underwent laparoscopic reintervention for failed Heller myotomy. Symptoms leading to reoperation included persistent dysphagia in 3 patients, recurrent dysphagia in another 3, and heartburn in 1 patient. Mean time from the first to the second operation was 49.7 months (range, 4-180 months). Always, the intervention was completed via a laparoscopic approach and a Nissen-Rossetti fundoplication was realized or left in place after a complete Heller myotomy. Mean operative time was 160 minutes (range, 60-245 minutes). Mean postoperative hospital stay was 3.1 +/- 1.5 days. No major morbidity or mortality occurred. At a mean follow-up of 16.1 months, reoperation must be considered successful in 5 out of 7 patients (71.4%). The dysphagia DeMeester score fell from 2.71 +/- 0.22 to 0.91 +/- 0.38 postoperatively. The regurgitation score changed from 2.45 +/- 0.34 to 0.68 +/- 0.23. Laparoscopic reoperation for failed Heller myotomy with the realization of a total fundoplication is safe and is associated with good long-term results if performed by an experienced surgeon in a center with a long tradition of esophageal surgery.

Code Help: Can This Unique State Regulatory Intervention Improve Emergency Department Crowding?

PubMed

Michael, Sean S; Broach, John P; Kotkowski, Kevin A; Brush, D Eric; Volturo, Gregory A; Reznek, Martin A

2018-05-01

Emergency department (ED) crowding adversely affects multiple facets of high-quality care. The Commonwealth of Massachusetts mandates specific, hospital action plans to reduce ED boarding via a mechanism termed "Code Help." Because implementation appears inconsistent even when hospital conditions should have triggered its activation, we hypothesized that compliance with the Code Help policy would be associated with reduction in ED boarding time and total ED length of stay (LOS) for admitted patients, compared to patients seen when the Code Help policy was not followed. This was a retrospective analysis of data collected from electronic, patient-care, timestamp events and from a prospective Code Help registry for consecutive adult patients admitted from the ED at a single academic center during a 15-month period. For each patient, we determined whether the concurrent hospital status complied with the Code Help policy or violated it at the time of admission decision. We then compared ED boarding time and overall ED LOS for patients cared for during periods of Code Help policy compliance and during periods of Code Help policy violation, both with reference to patients cared for during normal operations. Of 89,587 adult patients who presented to the ED during the study period, 24,017 (26.8%) were admitted to an acute care or critical care bed. Boarding time ranged from zero to 67 hours 30 minutes (median 4 hours 31 minutes). Total ED LOS for admitted patients ranged from 11 minutes to 85 hours 25 minutes (median nine hours). Patients admitted during periods of Code Help policy violation experienced significantly longer boarding times (median 20 minutes longer) and total ED LOS (median 46 minutes longer), compared to patients admitted under normal operations. However, patients admitted during Code Help policy compliance did not experience a significant increase in either metric, compared to normal operations. In this single-center experience, implementation of the Massachusetts Code Help regulation was associated with reduced ED boarding time and ED LOS when the policy was consistently followed, but there were adverse effects on both metrics during violations of the policy.

Use of a surgical rehearsal platform and improvement in aneurysm clipping measures: results of a prospective, randomized trial.

PubMed

Chugh, A Jessey; Pace, Jonathan R; Singer, Justin; Tatsuoka, Curtis; Hoffer, Alan; Selman, Warren R; Bambakidis, Nicholas C

2017-03-01

OBJECTIVE The field of neurosurgery is constantly undergoing improvements and advances, both in technique and technology. Cerebrovascular neurosurgery is no exception, with endovascular treatments changing the treatment paradigm. Clipping of aneurysms is still necessary, however, and advances are still being made to improve patient outcomes within the microsurgical treatment of aneurysms. Surgical rehearsal platforms are surgical simulators that offer the opportunity to rehearse a procedure prior to entering the operative suite. This study is designed to determine whether use of a surgical rehearsal platform in aneurysm surgery is helpful in decreasing aneurysm dissection time and clip manipulation of the aneurysm. METHODS The authors conducted a blinded, prospective, randomized study comparing key effort and time variables in aneurysm clip ligation surgery with and without preoperative use of the SuRgical Planner (SRP) surgical rehearsal platform. Initially, 40 patients were randomly assigned to either of two groups: one in which surgery was performed after use of the SRP (SRP group) and one in which surgery was performed without use of the SRP (control group). All operations were videotaped. After exclusion of 6 patients from the SRP group and 9 from the control group, a total of 25 surgical cases were analyzed by a reviewer blinded to group assignment. The videos were analyzed for total microsurgical time, number of clips used, and number of clip placement attempts. Means and standard deviations (SDs) were calculated and compared between groups. RESULTS The mean (± SD) amount of operative time per clip used was 920 ± 770 seconds in the SRP group and 1294 ± 678 seconds in the control group (p = 0.05). In addition, the mean values for the number of clip attempts, total operative time, ratio of clip attempts to clips used, and time per clip attempt were all lower in the SRP group, although the between-group differences were not statistically significant. CONCLUSIONS Preoperative rehearsal with SRP increased efficiency and safety in aneurysm microsurgery as demonstrated by the statistically significant improvement in time per clip used. Although the rest of the outcomes did not demonstrate statistically significant between-group differences, the fact that the SRP group showed improvement in mean values for all measures studied suggests that preoperative rehearsal may increase the efficiency and safety of aneurysm microsurgery. Future studies aimed at improving patient outcome and safety during surgical clipping of aneurysms will be needed to keep pace with the quickly advancing endovascular field.

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

Valve Health Monitoring System Utilizing Smart Instrumentation

NASA Technical Reports Server (NTRS)

Jensen, Scott L.; Drouant, George J.

2006-01-01

The valve monitoring system is a stand alone unit with network capabilities for integration into a higher level health management system. The system is designed for aiding in failure predictions of high-geared ball valves and linearly actuated valves. It performs data tracking and archiving for identifying degraded performance. The data collection types are cryogenic cycles, total cycles, inlet temperature, body temperature torsional strain, linear bonnet strain, preload position, total travel and total directional changes. Events are recorded and time stamped in accordance with the IRIG B True Time. The monitoring system is designed for use in a Class 1 Division II explosive environment. The basic configuration consists of several instrumentation sensor units and a base station. The sensor units are self contained microprocessor controlled and remotely mountable in three by three by two inches. Each unit is potted in a fire retardant substance without any cavities and limited to low operating power for maintaining safe operation in a hydrogen environment. The units are temperature monitored to safeguard against operation outside temperature limitations. Each contains 902-928 MHz band digital transmitters which meet Federal Communication Commission's requirements and are limited to a 35 foot transmission radius for preserving data security. The base-station controller correlates data from the sensor units and generates data event logs on a compact flash memory module for database uploading. The entries are also broadcast over an Ethernet network. Nitrogen purged National Electrical Manufactures Association (NEMA) Class 4 enclosures are used to house the base-station

Valve health monitoring system utilizing smart instrumentation

NASA Astrophysics Data System (ADS)

Jensen, Scott L.; Drouant, George J.

2006-05-01

The valve monitoring system is a stand alone unit with network capabilities for integration into a higher level health management system. The system is designed for aiding in failure predictions of high-geared ball valves and linearly actuated valves. It performs data tracking and archiving for identifying degraded performance. The data collection types are: cryogenic cycles, total cycles, inlet temperature, outlet temperature, body temperature, torsional strain, linear bonnet strain, preload position, total travel, and total directional changes. Events are recorded and time stamped in accordance with the IRIG B True Time. The monitoring system is designed for use in a Class 1 Division II explosive environment. The basic configuration consists of several instrumentation sensor units and a base station. The sensor units are self contained microprocessor controlled and remotely mountable in three by three by two inches. Each unit is potted in a fire retardant substance without any cavities and limited to low operating power for maintaining safe operation in a hydrogen environment. The units are temperature monitored to safeguard against operation outside temperature limitations. Each contains 902-928 MHz band digital transmitters which meet Federal Communication Commissions requirements and are limited to a 35 foot transmission radius for preserving data security. The base-station controller correlates related data from the sensor units and generates data event logs on a compact flash memory module for database uploading. The entries are also broadcast over an Ethernet network. Nitrogen purged National Electrical Manufactures Association (NEMA) Class 4 Enclosures are used to house the base-station.

Second Generation International Space Station (ISS) Total Organic Carbon Analyzer (TOCA) Verification Testing and On-Orbit Performance Results

NASA Technical Reports Server (NTRS)

Bentley, Nicole L.; Thomas, Evan A.; VanWie, Michael; Morrison, Chad; Stinson, Richard G.

2010-01-01

The Total Organic Carbon Analyzer (TOGA) is designed to autonomously determine recovered water quality as a function of TOC. The current TOGA has been on the International Space Station since November 2008. Functional checkout and operations revealed complex operating considerations. Specifically, failure of the hydrogen catalyst resulted in the development of an innovative oxidation analysis method. This method reduces the activation time and limits the hydrogen produced during analysis, while retaining the ability to indicate TOC concentrations within 25% accuracy. Subsequent testing and comparison to archived samples returned from the Station and tested on the ground yield high confidence in this method, and in the quality of the recovered water.

[Operative treatment strategies for multiple trauma patients : early total care versus damage control].

PubMed

Klüter, T; Lippross, S; Oestern, S; Weuster, M; Seekamp, A

2013-09-01

The treatment of multiple trauma patients is a great challenge for an interdisciplinary team. After preclinical care and subsequent treatment in the emergency room the order of the interventions is prioritized depending of the individual risk stratification. For planning the surgery management it is essential to distinguish between absolutely essential operations to prevent life-threatening situations for the patient and interventions with shiftable indications, depending on the general condition of the patient. All interventions need to be done without causing significant secondary damage to prohibit hyperinflammation and systemic inflammatory response syndrome. The challenge consists in determination of the appropriate treatment at the right point in time. In general the early primary intervention, early total care, is differentiated from the damage control concept.

Analysis of various descent trajectories for a hypersonic-cruise, cold-wall research airplane

NASA Technical Reports Server (NTRS)

Lawing, P. L.

1975-01-01

The probable descent operating conditions for a hypersonic air-breathing research airplane were examined. Descents selected were cruise angle of attack, high dynamic pressure, high lift coefficient, turns, and descents with drag brakes. The descents were parametrically exercised and compared from the standpoint of cold-wall (367 K) aircraft heat load. The descent parameters compared were total heat load, peak heating rate, time to landing, time to end of heat pulse, and range. Trends in total heat load as a function of cruise Mach number, cruise dynamic pressure, angle-of-attack limitation, pull-up g-load, heading angle, and drag-brake size are presented.

Techniques for cash management in scheduling manufacturing operations

NASA Astrophysics Data System (ADS)

Morady Gohareh, Mehdy; Shams Gharneh, Naser; Ghasemy Yaghin, Reza

2017-06-01

The objective in traditional scheduling is usually time based. Minimizing the makespan, total flow times, total tardi costs, etc. are instances of these objectives. In manufacturing, processing each job entails a cost paying and price receiving. Thus, the objective should include some notion of managing the flow of cash. We have defined two new objectives: maximization of average and minimum available cash. For single machine scheduling, it is demonstrated that scheduling jobs in decreasing order of profit ratios maximizes the former and improves productivity. Moreover, scheduling jobs in increasing order of costs and breaking ties in decreasing order of prices maximizes the latter and creates protection against financial instability.

An Operational Perspective of Total Lightning Information

NASA Technical Reports Server (NTRS)

Nadler, David J.; Darden, Christopher B.; Stano, Geoffrey; Buechler, Dennis E.

2009-01-01

The close and productive collaborations between the NWS Warning and Forecast Office, the Short Term Prediction and Research Transition Center at NASA Marshall Space Flight Center and the University of Alabama in Huntsville have provided a unique opportunity for science sharing and technology transfer. One significant technology transfer that has provided immediate benefits to NWS forecast and warning operations is the use of data from the North Alabama Lightning Mapping Array. This network consists of ten VHF receivers deployed across northern Alabama and a base station located at the National Space Science and Technology Center. Preliminary investigations done at WFO Huntsville, along with other similar total lightning networks across the country, have shown distinct correlations between the time rate-of-change of total lightning and trends in intensity/severity of the parent convective cell. Since May 2003 when WFO HUN began receiving these data - in conjunction with other more traditional remotely sensed data (radar, satellite, and surface observations) -- have improved the situational awareness of the WFO staff. The use of total lightning information, either from current ground based systems or future space borne instrumentation, may substantially contribute to the NWS mission, by enhancing severe weather warning and decision-making processes. Operational use of the data has been maximized at WFO Huntsville through a process that includes forecaster training, product implementation, and post event analysis and assessments. Since receiving these data, over 50 surveys have been completed highlighting the use of total lightning information during significant events across the Tennessee Valley. In addition, around 150 specific cases of interest have been archived for collaborative post storm analysis. From these datasets, detailed trending information from radar and total lightning can be compared to corresponding damage reports. This presentation will emphasize the effective use of total lightning information in warning decision making along with best practices for implementation of new technologies into operations.

Operations Events Census Report: Volume III, 1975-1980. Sanitized Version.

DTIC Science & Technology

1985-04-01

DNA REPORT 6330F-3-SAN OPERATIONS EVENTS CENSUS REPORT Volume III 1975 through 1980 , SANITIZED VERSION CAUTIN: T~ DOCUM~ CTAJ INFOZRM ON PR TED UNDER...1975 through 1980 , SANITIZED VERSION 12. PERSONAL AUTHOR(S) William J. Brady, Karen K. Horton, and Bernard F. Eubank 13a. TYPE OF REPORT 13b. TIME...underground testing exposures from 1975 through 1980 . Personnel are listed alphabetically by year with their total gamma exposure for that year. 20

Cost accounting in a surgical unit in a teaching hospital--a pilot study.

PubMed

Malalasekera, A P; Ariyaratne, M H; Fernando, R; Perera, D; Deen, K I

2003-09-01

Economic constraints remain one of the major limitations on the quality of health care even in industrialised countries. Improvement of quality will require optimising facilities within available resources. Our objective was to determine costs of surgery and to identify areas where cost reduction is possible. 80 patients undergoing routine major and intermediate surgery during a period of 6 months were selected at random. All consumables used and procedures carried out were documented. A unit cost was assigned to each of these. Costing was based on 3 main categories: preoperative (investigations, blood product related costs), operative (anaesthetic charges, consumables and theatre charges) and post-operative (investigations, consumables, hospital stay). Theatre charges included two components: fixed (consumables) and variable (dependent on time per operation). The indirect costs (e.g. administration costs, 'hotel' costs), accounted for 30%, of the total and were lower than similar costs in industrialised nations. The largest contributory factors (median, range) towards total cost were, basic hospital charges (30%; 15 to 63%); theatre charges fixed (23%; 6 to 35%) and variable (14%; 8 to 27%); and anaesthetic charges (15%; 1 to 36%). Cost reduction in patients undergoing surgery should focus on decreasing hospital stay, operating theatre time and anaesthetic expenditure. Although definite measures can be suggested from the study, further studies on these variables are necessary to optimise cost effectiveness of surgical units.

Early rehabilitation after elective total knee arthroplasty.

PubMed

Lisi, Claudio; Caspani, Patrick; Bruggi, Marco; Carlisi, Ettore; Scolè, Donatella; Benazzo, Francesco; Dalla Toffola, Elena

2017-10-18

Outcomes after TKA surgery are supposed to be related to the intensity and type of post-operative rehabilitation. Aim of this paper is to describe our early rehabilitation protocol following TKA with mini-invasive surgery in the immediate post-operative period and analyze functional recovery and changes in pain scores in these patients. in this observational study, data were collected on 215 total knee arthroplasty patients referred to Orthopedics and Traumatology inpatient ward from July 2012 to January 2014, treated with the same early start rehabilitation protocol. We recorded times to reach functional goals (sitting, standing and assisted ambulation) and pain after the treatment. length of hospital stay in TKA was 4.6±1.8 days, with a rehabilitation treatment lenght of 3.3±1.3 days. The mean time needed to achieve the sitting position was 2.3±0.7 days, to reach the standing position was 2.6±1.0 days to reach the walking functional goal was 2.9±1.0 days.  Pain NRS scores remained below 4 in the first and second post-operative day and below 3 from the third post-operative day. Our study confirms that rehabilitation started as soon as 24 hours after surgery with mini-invasive approach, enables early verticalization of patients and early recovery of walking with a good control of pain.

[Effects of electroacupuncture preemptive intervention on postoperative pain of mixed hemorrhoids].

PubMed

Wu, Jing; Zhao, Yu; Yang, Chun-Mei; Xue, Qi-Ming; Li, Ning

2014-03-01

To evaluate clinical efficacy of electroacupuncture at Changqiang (GV 1) and Chengshan (BL 57) 30 min before surgery on postoperative pain and discomforts in patients with mixed hemorrhoids. One hundred and twenty cases of mixed hemorrhoids who received Milligan-Morgan operation were randomly divided into an electroacupuncture group, a sham electroacupuncture group and a blank group, 40 cases in each one. At the same time of basic treatment, the electroacupuncture was applied at Changqiang (GV 1) and Chengshan (BL 57) 30 min before surgery in the electroacupuncture group, while shallow needling without electrical stimulation at sham acupoint (1 cm next to acupoint) was applied 30 min before surgery in the sham electroacupuncture group, while no treatment was given before the surgery in the blank group. The total dose of painkillers in the first 24 h after operation, the number of cases who received additional anesthetic in the operation, the self-score of most severity pain in the first 24 h after operation and sleeping time in the night of surgery were observed. The differences of the numbers of cases who received additional anesthetic in the operation had no statistical significance among the three groups (all P > 0.05), but compared with the sham electroacupuncture group and blank group, the total dose of painkillers in the first 24 h after operation was reduced in the electroacupuncture group [(2.43 +/- 1.08) tablets vs (3.23 +/- 1.33) tablets, (3.10 +/- 1.22) tablets], and the score of most severity pain was also decreased (6.65 +/- 1.00 vs 7.48 +/- 0.96, 7.25 +/- 1.19), besides, the sleeping time in the night of surgery was increased [(220.63 +/- 85.50) min vs (162.00 +/- 92.69) min, (151.50 +/- 80.01) min, all P < 0.05]. The electroacupuncture at Changqiang (GV 1) and Chengshan (BL 57) 30 min before surgery has effects of preemptive analgesia on postoperative pain for patients with mixed hemorrhoids.

Influence of median surgeon operative duration on adverse outcomes in bariatric surgery.

PubMed

Reames, Bradley N; Bacal, Daniel; Krell, Robert W; Birkmeyer, John D; Birkmeyer, Nancy J O; Finks, Jonathan F

2015-01-01

Evidence suggests that prolonged operative time adversely affects surgical outcomes. However, whether faster surgeons have better outcomes is unclear, as a surgeon׳s speed could reflect skill and efficiency, but may alternatively reflect haste. This study evaluates whether median surgeon operative time is associated with adverse surgical outcomes after laparoscopic Roux-en-Y gastric bypass. We performed a retrospective cohort study using statewide clinical registry data from the years 2006 to 2012. Surgeons were ranked by their median operative time and grouped into terciles. Multivariable logistic regression with robust standard errors was used to evaluate the influence of median surgeon operative time on 30-day surgical outcomes, adjusting for patient and surgeon characteristics, trainee involvement, concurrent procedures, and the complex interaction between these variables. A total of 16,344 patients underwent surgery during the study period. Compared to surgeons in the fastest tercile, slow surgeons required 53 additional minutes to complete a gastric bypass procedure (median [interquartile range] 139 [133-150] versus 86 [69-91], P<.001). After adjustment for patient characteristic only, slow surgeons had significantly higher adjusted rates of any complication, prolonged length of stay, emergency department visits or readmissions, and venous thromboembolism (VTE). After further adjustment for surgeon characteristics, resident involvement, and the interaction between these variables, slow surgeons had higher rates of any complication (10.5% versus 7.1%, P=.039), prolonged length of stay (14.0% versus 4.4%, P=.002), and VTE (0.39% versus .22%, P<.001). Median surgeon operative duration is independently associated with adjusted rates of certain adverse outcomes after laparoscopic Roux-en-Y gastric bypass. Improving surgeon efficiency while operating may reduce operative time and improve the safety of bariatric surgery. Copyright © 2015 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

Kinetics of humoral responsiveness and antigenic distribution in operated rats.

PubMed Central

Kinnaert, P; Mahieu, A; van Geertruyden, N

1979-01-01

Wistar R/A rats were injected intravenously with 10(9) sheep red blood cells (SRBC) prior to, during or after a standard laparotomy. Stimulation of anti-SRBC antibody synthesis was already observed when the antigen was given 4 h prior to surgery and was maximal if SRBC were administered at the time of operation. The enhancing effect on the immune response lasted for 2 days after surgery. From the third post-operative day on, the injection of SRBC induced a normal humoral response. No subsequent depression was detected. Inter-organ distribution studies of 51Cr-labelled SRBC injected at various times prior, during or after the surgical procedure, showed a maximum decrease of liver uptake during operation; the depression was still present 2 h later but on the first post-operative day, no significant difference from the controls could be demonstrated. When the labelled antigen was given before surgery, organ distribution was normal. Consequently, there is no time relationship between the stimulation of antibody production and the alteration of total phagocytosis induced by surgery. Therefore, the enhanced humoral response cannot be explained only by spillover of the antigen from the liver into lymphoid organs. PMID:511217

Surgical planning and microvascular reconstruction of the mandible with a fibular flap using computer-aided design, rapid prototype modelling, and precontoured titanium reconstruction plates: a prospective study.

PubMed

Sieira Gil, R; Roig, A Marí; Obispo, C Arranz; Morla, A; Pagès, C Martí; Perez, J Llopis

2015-01-01

The standard of mandibular reconstruction has increased since the introduction of computer-assisted design (CAD) and rapid prototype modelling (RPM) for surgical planning. Between 2008 and 2013, a prospective pilot study of 20 patients was planned to compare the outcomes of patients treated by mandibular reconstruction who had CAD and RPM-guided operations using a precontoured titanium plate, with the outcomes of patients treated conventionally. We recorded the time taken for reconstruction, total operating time, and whether this type of planning could improve the results of mandibular reconstruction. We found significant differences in the incidence of dental malocclusion (p=0.03) and exposure of the titanium plate (p=0.009). The mean operating time for reconstruction in the preoperative planning group was 135 (37)min compared with 176 (58)min in the conventional group (p=0.04). Preoperative planning using CAD and RPM can increase the accuracy of microvascular mandibular reconstruction and reduce the operating time for reconstruction. Copyright © 2014 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Study of quiet turbofan STOL aircraft for short haul transportation

NASA Technical Reports Server (NTRS)

Higgins, T. P.; Stout, E. G.; Sweet, H. S.

1973-01-01

Conceptual designs of Quiet Turbofan STOL Short-Haul Transport Aircraft for the mid-1980 time period are developed and analyzed to determine their technical, operational, and economic feasibility. A matrix of aircraft using various high-lift systems and design parameters are considered. Variations in aircraft characteristics, airport geometry and location, and operational techniques are analyzed systematically to determine their effects on the market, operating economics, and community acceptance. In these studies, the total systems approach is considered to be critically important in analyzing the potential of STOL aircraft to reduce noise pollution and alleviate the increasing air corridor and airport congestion.

Study of quiet turbofan STOL aircraft for short-haul transportation. Volume 1: Summary

NASA Technical Reports Server (NTRS)

1974-01-01

Conceptual designs of Quiet Turbofan STOL Short-Haul Transport Aircraft for the mid-1980 time period are developed and analyzed to determine their technical, operational, and economic feasibility. A matrix of aircraft using various high-lift systems and design parameters are considered. Variations in aircraft characteristics, airport geometry and location, and operational techniques are analyzed systematically to determine their effects on the market, operating economics, and community acceptance. The total systems approach is considered to be critically important in analyzing the potential of STOL aircraft to reduce noise pollution and alleviate the increasing air corridor and airport congestion.

Reparable Inventory Reduction: Impacts on Air Force Fighter Aicraft Mission Capability.

DTIC Science & Technology

1999-09-01

operating just-in-time, there is less insurance (in the form of stocks) against these disruptions. Applying Lean Logistics approaches to all...impacts of initiatives such as these are isolated to the Air Force, and whether we can learn from the methods civilian companies use in handling...approx 84% service level Pipeline Stock (Q) 95.4 1.029555288 .3485+.5 Saftey Stock (SLQ) 16.92 Cost/Item Total Cost Rounding factor (K) 0.5 Total

Totally extraperitoneal inguinal hernia repair in patients previously having prostatectomy is feasible, safe, and effective.

PubMed

Le Page, Philip; Smialkowski, Ania; Morton, Jonathan; Fenton-Lee, Douglas

2013-12-01

The laparoscopic approach to repair of inguinal hernia has proven advantages over open repair. Repair of more technically challenging hernias, such as patients previously receiving prostatectomy, has been less studied and may not have these advantages. We aimed to compare safety, feasibility, and clinical outcomes for repairs in patients who previously underwent prostatectomy to control subjects. We undertook a case-control study using a prospectively collected database. From 2004, all patients were routinely offered totally extraperitoneal laparoscopic repair. All patients who had a history of previous prostatectomy were identified and compared to a matched control group. Both operative and follow-up data were analyzed. Of 987 patients undergoing surgery during this time period, 52 prostatectomy patients were identified (44% open, 44% robotic, 3% laparoscopic) and matched to 102 control subjects. Accounting for bilateral repairs, 203 hernia repairs had been performed. Patients were well matched for age and American Society of Anesthesiologists score. Operative time was longer for prostatectomy patients (mean, 70 vs. 52 min, p < 0.0001); however, this reduced over time when comparing the first and second half prostatectomy patients (77 vs. 63 min, p = 0.144). Overall, there were no intraoperative or major postoperative complications and only one conversion (prostatectomy group). No significant differences were found for rates of minor postoperative complications, length of stay, or recurrence (n = 1, control group). No difference was observed for chronic pain, and all patients in each group reported satisfaction with surgery at contemporary follow-up. In experienced hands, totally extraperitoneal inguinal hernia repair for patients previously having undergone prostatectomy is safe and has equivalent outcomes to patients not having undergone prostatectomy, and is an option to open repair. Understandably, slightly longer operative times may be justified, given the benefits of early discharge and less postoperative pain after laparoscopic surgery.

Prospective radionuclide renal function evaluation and its correlation with radiological findings in patients with Kock pouch urinary diversion

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

Chen, K.K.; Chang, L.S.; Chen, M.T.

1991-05-01

In an attempt to understand better the status of renal function after Kock pouch urinary diversion we conducted a prospective evaluation of renal function in 25 patients using the radionuclide 131iodine-hippurate. Studies were done before, and at 1 month and every 6 months for 30 months postoperatively. The radionuclide results were then compared to excretory urography and contrast study of the reservoir. Our renal function study included the determination of individual and total effective renal plasma flow (ml. per minute), the time to maximal radioactivity over the kidney (peak time in minutes) and a renogram. The mean total (both kidneys)more » effective renal plasma flow rates before (25 patients) and at month 1 (19), month 6 (14), month 12 (12), month 18 (6), month 24 (6) and month 30 (7) after operation were 385.5 +/- 112.2, 310.5 +/- 109.9, 362.7 +/- 69.2, 442.0 +/- 97.5, 468.2 +/- 82.5, 405.7 +/- 70.6 and 414.0 +/- 65.1, respectively. A comparison of individual and total effective renal plasma flow before and after operation revealed that only the change of the flow at each or both sides of the kidney before and at 1 month after the operation reached statistically significant differences, respectively (p less than 0.05, paired t test). Postoperatively 5 of 6 patients with hydronephrosis had abnormal peak time and a third segment on the renogram was performed on the corresponding side of the kidney. No reflux was noted on contrast study of the reservoir of any patient followed for up to 30 months. In conclusion, the radionuclide renal function evaluation showed a significant decrease of renal function 1 month after Kock pouch diversion, then it resumed and remained stable (neither improved nor deteriorated) for 30 months. Also the abnormal peak time and third segment on the renogram usually implicated a dilated upper urinary tract.« less

Introduction of laparoscopic sacral colpopexy to a fellowship training program.

PubMed

Kantartzis, Kelly; Sutkin, Gary; Winger, Dan; Wang, Li; Shepherd, Jonathan

2013-11-01

Minimally invasive sacral colpopexy has increased over the past decade, with many senior physicians adopting this new skill set. However, skill acquisition at an academic institution in the presence of postgraduate learners is not well described. This manuscript outlines the introduction of laparoscopic sacral colpopexy to an academic urogynecology service that was not performing minimally invasive sacral colpopexies, and it also defines a surgical learning curve. The first 180 laparoscopic sacral colpopexies done by four attending urogynecologists from January 2009 to December 2011 were retrospectively analyzed. The primary outcome was operative time. Secondary outcomes included conversion to laparotomy, estimated blood loss, and intra- and postoperative complications. Linear regression was used to analyze trends in operative times. Fisher's exact test compared surgical complications and counts of categorical variables. Mean total operative time was 250 ± 52 min (range 146-452) with hysterectomy and 222 ± 45 (range 146-353) for sacral colpopexy alone. When compared with the first ten cases performed by each surgeon, operative times in subsequent groups decreased significantly, with a 6-16.3% reduction in overall times. There was no significant difference in the rate of overall complications regardless of the number of prior procedures performed (p = 0.262). Introduction of laparoscopic sacral colpopexy in a training program is safe and efficient. Reduction in operative time is similar to published learning curves in teaching and nonteaching settings. Introducing this technique does not add additional surgical risk as these skills are acquired.

Minimally invasive neurosurgery within a 0.5 tesla intraoperative magnetic resonance scanner using an off-line neuro-navigation system.

PubMed

Mursch, K; Gotthardt, T; Kröger, R; Bublat, M; Behnke-Mursch, J

2005-08-01

We evaluated an advanced concept for patient-based navigation during minimally invasive neurosurgical procedures. An infrared-based, off-line neuro-navigation system (LOCALITE, Bonn, Germany) was applied during operations within a 0.5 T intraoperative MRI scanner (iMRI) (Signa SF, GE Medical Systems, Milwaukee, WI, USA) in addition to the conventional real-time system. The three-dimensional (3D) data set was acquired intraoperatively and up-dated when brain-shift was suspected. Twenty-three patients with subcortical lesions were operated upon with the aim to minimise the operative trauma. Small craniotomies (median diameter 30 mm, mean diameter 27 mm) could be placed exactly. In all cases, the primary goal of the operation (total resection or biopsy) was achieved in a straightforward procedure without permanent morbidity. The navigation system could be easily used without technical problems. In contrast to the real-time navigation mode of the MR system, the higher quality as well as the real-time display of the MR images reconstructed from the 3D reference data provided sufficient visual-manual coordination. The system combines the advantages of conventional neuro-navigation with the ability to adapt intraoperatively to the continuously changing anatomy. Thus, small and/or deep lesions can be operated upon in straightforward minimally invasive operations.

24 CFR 902.47 - Management operations portion of total PHAS points.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 24 Housing and Urban Development 4 2010-04-01 2010-04-01 false Management operations portion of... Operations § 902.47 Management operations portion of total PHAS points. Of the total 100 points available for a PHAS score, a PHA may receive up to 30 points based on the Management Operations Indicator. ...

Avalanche photodiode based time-of-flight mass spectrometry

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

Ogasawara, Keiichi, E-mail: kogasawara@swri.edu; Livi, Stefano A.; Desai, Mihir I.

2015-08-15

This study reports on the performance of Avalanche Photodiodes (APDs) as a timing detector for ion Time-of-Flight (TOF) mass spectroscopy. We found that the fast signal carrier speed in a reach-through type APD enables an extremely short timescale response with a mass or energy independent <2 ns rise time for <200 keV ions (1−40 AMU) under proper bias voltage operations. When combined with a microchannel plate to detect start electron signals from an ultra-thin carbon foil, the APD comprises a novel TOF system that successfully operates with a <0.8 ns intrinsic timing resolution even using commercial off-the-shelf constant-fraction discriminators. Bymore » replacing conventional total-energy detectors in the TOF-Energy system, APDs offer significant power and mass savings or an anti-coincidence background rejection capability in future space instrumentation.« less

The impact of operative time on complications after plastic surgery: a multivariate regression analysis of 1753 cases.

PubMed

Hardy, Krista L; Davis, Kathryn E; Constantine, Ryan S; Chen, Mo; Hein, Rachel; Jewell, James L; Dirisala, Karunakar; Lysikowski, Jerzy; Reed, Gary; Kenkel, Jeffrey M

2014-05-01

Little evidence within plastic surgery literature supports the precept that longer operative times lead to greater morbidity. The authors investigate surgery duration as a determinant of morbidity, with the goal of defining a clinically relevant time for increased risk. A retrospective chart review was conducted of patients who underwent a broad range of complex plastic surgical procedures (n = 1801 procedures) at UT Southwestern Medical Center in Dallas, Texas, from January 1, 2008 to January 31, 2012. Adjusting for possible confounders, multivariate logistic regression assessed surgery duration as an independent predictor of morbidity. To define a cutoff for increased risk, incidence of complications was compared among quintiles of surgery duration. Stratification by type of surgery controlled for procedural complexity. A total of 1753 cases were included in multivariate analyses with an overall complication rate of 27.8%. Most operations were combined (75.8%), averaging 4.9 concurrent procedures. Each hour increase in surgery duration was associated with a 21% rise in odds of morbidity (P < .0001). Compared with the first quintile of operative time (<2.0 hours), there was no change in complications until after 3.1 hours of surgery (odds ratio, 1.6; P = .017), with progressively greater odds increases of 3.1 times after 4.5 hours (P < .0001) and 4.7 times after 6.8 hours (P < .0001). When stratified by type of surgery, longer operations continued to be associated with greater morbidity. Surgery duration is an independent predictor of complications, with a significantly increased risk above 3 hours. Although procedural complexity undoubtedly affects morbidity, operative time should factor into surgical decision making.

Performance analysis and kernel size study of the Lynx real-time operating system

NASA Technical Reports Server (NTRS)

Liu, Yuan-Kwei; Gibson, James S.; Fernquist, Alan R.

1993-01-01

This paper analyzes the Lynx real-time operating system (LynxOS), which has been selected as the operating system for the Space Station Freedom Data Management System (DMS). The features of LynxOS are compared to other Unix-based operating system (OS). The tools for measuring the performance of LynxOS, which include a high-speed digital timer/counter board, a device driver program, and an application program, are analyzed. The timings for interrupt response, process creation and deletion, threads, semaphores, shared memory, and signals are measured. The memory size of the DMS Embedded Data Processor (EDP) is limited. Besides, virtual memory is not suitable for real-time applications because page swap timing may not be deterministic. Therefore, the DMS software, including LynxOS, has to fit in the main memory of an EDP. To reduce the LynxOS kernel size, the following steps are taken: analyzing the factors that influence the kernel size; identifying the modules of LynxOS that may not be needed in an EDP; adjusting the system parameters of LynxOS; reconfiguring the device drivers used in the LynxOS; and analyzing the symbol table. The reductions in kernel disk size, kernel memory size and total kernel size reduction from each step mentioned above are listed and analyzed.

Extending the maximum operation time of the MNSR reactor.

PubMed

Dawahra, S; Khattab, K; Saba, G

2016-09-01

An effective modification to extend the maximum operation time of the Miniature Neutron Source Reactor (MNSR) to enhance the utilization of the reactor has been tested using the MCNP4C code. This modification consisted of inserting manually in each of the reactor inner irradiation tube a chain of three polyethylene-connected containers filled of water. The total height of the chain was 11.5cm. The replacement of the actual cadmium absorber with B(10) absorber was needed as well. The rest of the core structure materials and dimensions remained unchanged. A 3-D neutronic model with the new modifications was developed to compare the neutronic parameters of the old and modified cores. The results of the old and modified core excess reactivities (ρex) were: 3.954, 6.241 mk respectively. The maximum reactor operation times were: 428, 1025min and the safety reactivity factors were: 1.654 and 1.595 respectively. Therefore, a 139% increase in the maximum reactor operation time was noticed for the modified core. This increase enhanced the utilization of the MNSR reactor to conduct a long time irradiation of the unknown samples using the NAA technique and increase the amount of radioisotope production in the reactor. Copyright © 2016 Elsevier Ltd. All rights reserved.

Management of Osseous and Soft-Tissue Ankle Equinus During Total Ankle Replacement.

PubMed

Roukis, Thomas S; Simonson, Devin C

2015-10-01

Obtaining functional alignment of a total ankle replacement, including physiologic sagittal plane range of motion, is paramount for a successful outcome. This article reviews the literature on techniques available for correction of osseous and soft-tissue equinus at the time of index total ankle replacement. These techniques include anterior tibiotalar joint cheilectomy, posterior superficial muscle compartment lengthening, posterior ankle capsule release, and release of the posterior portions of the medial and lateral collateral ligament complexes. The rationale for these procedures and the operative sequence of events for these procedures are presented. Copyright © 2015 Elsevier Inc. All rights reserved.

Early Experience of Robotic Hysterectomy for Treatment of Benign Uterine Disease.

PubMed

Gutierrez, Ana Luiza; Binda, Márcia Luisa Montalvão Appel; Ramos, José Geraldo Lopes

2016-09-01

Objectives  To demonstrate the initial experience of robotic hysterectomy to treat benign uterine disease at a university hospital in Brazil. Methods  A cross-sectional study was conducted to review data from the first twenty patients undergoing robotic hysterectomy at our hospital. The surgeries were performed from November 2013 to August 2014, all of them by the same surgeon. The patients were reviewed for preoperative characteristics, including age, body mass index (BMI), indications for the hysterectomy and previous surgeries. Data of operative times, complications, postoperative pain and length of hospital stay were also collected. Results  The total operating room time was 252.9 minutes, while the operative time was 180.7 minutes and the console time was 136.6 minutes. Docking time was 4.2 minutes, and the average undocking time was 1.9 minutes. There was a strong correlation between the operative time and the patient's BMI ( r  = 0.670; p  = 0.001). The console time had significant correlation with the uterine weight and the patient's BMI ( r  = 0.468; p  = 0.037). A learning curve was observed during docking and undocking times. Conclusion  Despite its high cost, the robotic surgery is gaining more space in gynecological surgery. By the results obtained in our hospital, this surgical proposal proved to be feasible and safe. Our initial experience demonstrated a learning curve in some ways. Thieme Publicações Ltda Rio de Janeiro, Brazil.

Pain control after primary total knee replacement. A prospective randomised controlled trial of local infiltration versus single shot femoral nerve block.

PubMed

Ashraf, Anam; Raut, Videsh V; Canty, Stephen J; McLauchlan, George J

2013-10-01

We report a prospective blinded randomised trial of local infiltration versus femoral nerve block in patients undergoing primary total knee replacement (TKR), in accordance with the CONSORT statement 2010. Fifty patients in a teaching hospital were consented for the study. The study arms were intraoperative local anaesthesia (150ml 0.2% ropivacaine/1ml 1:1000 adrenaline/30mg ketolorac) and femoral nerve block (30ml 0.2% ropivacaine) with a primary outcome of pain score at 4h post operatively. Secondary outcomes were pain at 2h, pain scores before and after physiotherapy on day one, total opiate administered, time to physiotherapy goals and length of stay. Randomisation was by sealed envelope. The assessor was blinded and the patients partially blinded to the intervention. Ten patients were excluded, eight before randomisation. The trial is complete. Forty patients were analysed for the primary outcome measure. The local infiltration group had significantly lower pain scores at 4h post-operatively; mean [SD] score 2.1 [2.6] versus 6.8 [3.2], p<0.00001 and on post-operative day one prior to physiotherapy; mean score 2.4 [2.3] versus 4.4 [2.3], p<0.05. Total opiate use was also significantly lower in the local infiltration group; mean total 115 [50.3]mg versus 176.5 [103.5]mg, p<0.01. There was no difference in any other outcome. There were no harms as a result of either intervention. Intraoperative local infiltration gives superior pain relief compared to single shot femoral nerve block over the first 24h following primary TKR and minimises post-operative opiate use. Copyright © 2013 Elsevier B.V. All rights reserved.

76 FR 30925 - Information Collection; Submission for OMB Review, Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2011-05-27

.../startup): None. Total Burden Cost (operating/maintenance): None. Instrument: Application and Budget.../startup): None. Total Burden Cost (operating/maintenance): None. AmeriCorps\\*\\VISTA Project Progress...,800 hours. Total Burden Cost (capital/startup): None. Total Burden Cost (operating/maintenance): None...

Locker-Room Talk.

ERIC Educational Resources Information Center

Lowe, Jason; Noyes, Brad

1999-01-01

Explains how proper athletic facility locker-room design can save time and money. Design factors that address who will be using the facility are discussed as are user requirements, such as preparation areas, total storage area per user, grooming area, and security areas. Final comments address maintenance and operations issues. (GR)

Phytochemical profiling of the ripening of Chinese mango (Mangifera indica L.) cultivars by real-time monitoring using UPLC-ESI-QTOF-MS and its potential benefits as prebiotic ingredients.

PubMed

Hu, Kai; Dars, Abdul Ghani; Liu, Qiudou; Xie, Bijun; Sun, Zhida

2018-08-01

Maturity has important effects on the phytochemical and biochemical characteristics of fruits. It affects the quality, nutritional value, harvest time and commercial operations. In this study, Keitt, Sensation and Xiangya mango cultivars in four distinct stages from southwest China were evaluated for their phytochemical profiling and antioxidant activities in real time. Furthermore, the biochemical characteristics indices polyphenol oxidase (PPO), peroxidase (POD), superoxide dismutase (SOD) and pectin methylesterase (PME) activities were determined. Antioxidant compounds such as vitamin C, total phenolic, total flavonoid and total carotenoid content were also analysed. A total of 34 phenolic compounds were identified and quantitatively monitored by UPLC-ESI-QTOF-MS. Consecutive degradation of phenolic acids and its derivatives were observed upon maturity. We found that in addition to carotenoids, phenolic acids could also be used as a measurement index of maturity in mango. Mango juices and its phenolic extracts may be used as potential prebiotics for modulating probiotic proliferation. Copyright © 2018. Published by Elsevier Ltd.

Physician Engagement in Improving Operative Supply Chain Efficiency Through Review of Surgeon Preference Cards.

PubMed

Harvey, Lara F B; Smith, Katherine A; Curlin, Howard

To reduce operative costs involved in the purchase, packing, and transport of unnecessary supplies by improving the accuracy of surgeon preference cards. Quality improvement study (Canadian Task Force classification II-3). Gynecologic surgery suite of an academic medical center. Twenty-one specialized and generalist gynecologic surgeons. The preference cards of up to the 5 most frequently performed procedures per surgeon were selected. A total of 81 cards were distributed to 21 surgeons for review. Changes to the cards were communicated to the operating room charge nurse and finalized. Fourteen surgeons returned a total of 48 reviewed cards, 39 of which had changes. A total of 109 disposable supplies were removed from these cards, at a total cost savings of $767.67. The cost per card was reduced by $16 on average for disposables alone. Three reusable instrument trays were also eliminated from the cards, resulting in savings of approximately $925 in processing costs over a 3-month period. Twenty-two items were requested by surgeons to be available on request but were not routinely placed in the room at the start of each case, at a total cost of $6,293.54. The rate of return of unused instruments to storage decreased after our intervention, from 10.1 to 9.6 instruments per case. Surgeon preference cards serve as the basis for economic decision making regarding the purchase, storing, packing, and transport of operative instruments and supplies. A one-time surgeon review of cards resulted in a decrease in the number of disposable and reusable instruments that must be stocked, transported, counted in the operating room, or returned, potentially translating into cost savings. Surgeon involvement in preference card management may reduce waste and provide ongoing cost savings. Copyright © 2017 American Association of Gynecologic Laparoscopists. Published by Elsevier Inc. All rights reserved.

[Transaxillary robot-assisted thyroidectomy: First experiences with a new operation technique].

PubMed

Eckhardt, S; Maurer, E; Fendrich, V; Bartsch, D K

2015-10-01

The main advantage of transaxillary robotic-assisted thyroid surgery (TRAT) is the avoidance of a scar on the neck. As TRAT is still rarely performed in Germany, there are not yet any German reports on acceptance, operation times and complications. In a pilot study all patients with an indication for hemithyroidectomy without preoperative evidence of malignancies or previous neck surgery and a lobe size < 30 ml, a body mass index (BMI) < 30 and age > 18 years were offered transaxillary robotic-assisted hemithyroidectomy (TRAHT) after a detailed explanation of this operation. The acceptance of this new technique, the operation time, complications and patient satisfaction were prospectively recorded and analyzed. Between January 2013 and October 2014 a total of 65 patients were offered the option of a TRAHT and 21 (32%) patients opted for this surgical technique. None of these 21 operations had to be converted and there were no intraoperative complications. The median operation time was 190 min (range 106-300 min) with a significant learning curve (first 5 TRAHT 219 min and last 5 TRAHT 163 min), 10 (48%) patients had a postoperative slight transient skin dysesthesia in the area of the access route, 4 (19%) patients had a transient recurrent laryngeal nerve palsy and 2 patients (9%) had a transient upper brachial plexus palsy. After the first 21 TRAHT operations, 2 Dunhill operations for Grave's disease were also performed via a single axillary incision. The operation times were 320 min and 260 min without complications and 21 out of the 23 patients (91%) were highly satisfied with the cosmetic result and would choose TRAT again. The TRAT procedure still has low acceptance by German patients but patient satisfaction after surgery is high due to the cosmetic result. The extended operation time, new complications (e.g. transient plexus palsy) and a potentially increased rate of transient recurrent laryngeal nerve palsy must be critically considered.

Bidding strategy for microgrid in day-ahead market based on hybrid stochastic/robust optimization

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

Liu, Guodong; Xu, Yan; Tomsovic, Kevin

In this paper, we propose an optimal bidding strategy in the day-ahead market of a microgrid consisting of intermittent distributed generation (DG), storage, dispatchable DG and price responsive loads. The microgrid coordinates the energy consumption or production of its components and trades electricity in both the day-ahead and real-time markets to minimize its operating cost as a single entity. The bidding problem is challenging due to a variety of uncertainties, including power output of intermittent DG, load variation, day-ahead and real-time market prices. A hybrid stochastic/robust optimization model is proposed to minimize the expected net cost, i.e., expected total costmore » of operation minus total benefit of demand. This formulation can be solved by mixed integer linear programming. The uncertain output of intermittent DG and day-ahead market price are modeled via scenarios based on forecast results, while a robust optimization is proposed to limit the unbalanced power in real-time market taking account of the uncertainty of real-time market price. Numerical simulations on a microgrid consisting of a wind turbine, a PV panel, a fuel cell, a micro-turbine, a diesel generator, a battery and a responsive load show the advantage of stochastic optimization in addition to robust optimization.« less

Bidding strategy for microgrid in day-ahead market based on hybrid stochastic/robust optimization

DOE PAGES

Liu, Guodong; Xu, Yan; Tomsovic, Kevin

2016-01-01

In this paper, we propose an optimal bidding strategy in the day-ahead market of a microgrid consisting of intermittent distributed generation (DG), storage, dispatchable DG and price responsive loads. The microgrid coordinates the energy consumption or production of its components and trades electricity in both the day-ahead and real-time markets to minimize its operating cost as a single entity. The bidding problem is challenging due to a variety of uncertainties, including power output of intermittent DG, load variation, day-ahead and real-time market prices. A hybrid stochastic/robust optimization model is proposed to minimize the expected net cost, i.e., expected total costmore » of operation minus total benefit of demand. This formulation can be solved by mixed integer linear programming. The uncertain output of intermittent DG and day-ahead market price are modeled via scenarios based on forecast results, while a robust optimization is proposed to limit the unbalanced power in real-time market taking account of the uncertainty of real-time market price. Numerical simulations on a microgrid consisting of a wind turbine, a PV panel, a fuel cell, a micro-turbine, a diesel generator, a battery and a responsive load show the advantage of stochastic optimization in addition to robust optimization.« less

Videolaparoscopic radical hysterectomy approach: a ten-year experience.

PubMed

Campos, Luciana Silveira; Limberger, Leo Francisco; Kalil, Antonio Nocchi; de Vargas, Gabriel Sebastião; Damiani, Paulo Agostinho; Haas, Fernanda Feltrin

2009-01-01

Because of the advancements in surgical techniques and laparoscopic instruments, total laparoscopic radical hysterectomy can now be performed for the treatment of uterine cervical carcinoma. We assessed the feasibility, complications, and survival rates of patients who underwent total laparoscopic radical hysterectomy with pelvic lymphadenectomy. We retrospectively collected data from the medical charts of 29 patients who had undergone surgery between 1998 and 2008. The following data were assessed: age, staging, histological type, number of lymph nodes retrieved, parametrial measures, operative time, length of hospital stay, surgical complications, and disease-free time. The mean patient age was 37.07+/-10.45 years. Forty percent of the patients had previously undergone abdominal or pelvic surgeries. Mean operative time was 228.96+/-60.41 minutes, and mean retrieved lymph nodes was 16.9+/-8.12. All patients had free margins. No conversions to laparotomy were necessary. Median time until hospital dismissal was 6.5 days (range 3-38 days). Four patients had intraoperative complications: 2 lacerations of the rectum, 1 laceration of the bladder, and 1 lesion of the ureter. Three patients developed bladder or ureteral fistulas postoperatively that were successfully corrected surgically. Laparoscopic radical hysterectomy is feasible and has acceptable complications. The radicalism of the surgery must be considered, bearing in mind the parametrial measures and the number of lymph nodes retrieved.

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

PubMed

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

2015-11-01

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

Real-time ultrasound-guided PCNL using a novel SonixGPS needle tracking system.

PubMed

Li, Xiang; Long, Qingzhi; Chen, Xingfa; He, Dalin; Dalin, He; He, Hui

2014-08-01

SonixGPS is a successful ultrasound guidance position system. It helps to improve accuracy in performing complex puncture operations. This study firstly used SonixGPS to perform kidney calyx access in PCNL to investigate its effectiveness and safety. This was a prospectively randomized controlled study performed from September 2011 to October 2012. A total of 97 patients were prospectively randomized into two groups using random number generated from SAS software. 47 Patients were enrolled in conventional ultrasound-guided (US-guided) group and 50 patients were classified into SonixGPS-guided group. Nine patients were lost during follow-up. Hence, a total of 88 patients were qualified and analyzed. Preoperative examinations included urine analysis, urine culture, kidney function, coagulation profile and routine analysis of blood. Ultrasonography was used to evaluate the degree of hydronephrosis. The intraoperative findings, including blood loss, operating time, time to successful puncture, the number of attempts for successful puncture and hospital stay were recorded. The stone clearance rate and complications were analyzed. The present study showed no significant difference between the two groups in terms of demographic data, preoperative markers, stone clearance rate and the stone composition. However, the time to successful puncture, the number of trials for successful puncture, operating time and hospital length of stay were significantly decreased in the SonixGPS-guided group. Furthermore, the hemoglobin decrease was also obviously lower in the SonixGPS group than that in conventional US-guided group. SonixGPS needle tacking system guided PCNL is safe and effective in treating upper urinary tract stones. This novel technology makes puncturing more accuracy and can significantly decrease the incidence of relative hemorrhage and accelerate recovery.

Catheter radiofrequency ablation for arrhythmias under the guidance of the Carto 3 three-dimensional mapping system in an operating room without digital subtraction angiography.

PubMed

Huang, Xingfu; Chen, Yanjia; Huang, Zheng; He, Liwei; Liu, Shenrong; Deng, Xiaojiang; Wang, Yongsheng; Li, Rucheng; Xu, Dingli; Peng, Jian

2018-06-01

Several studies have reported the efficacy of a zero-fluoroscopy approach for catheter radiofrequency ablation of arrhythmias in a digital subtraction angiography (DSA) room. However, no reports are available on the ablation of arrhythmias in the absence of DSA in the operating room. To investigate the efficacy and safety of catheter radiofrequency ablation for arrhythmias under the guidance of a Carto 3 three-dimensional (3D) mapping system in an operating room without DSA. Patients were enrolled according to the type of arrhythmia. The Carto 3 mapping system was used to reconstruct heart models and guide the electrophysiologic examination, mapping, and ablation. The total procedure, reconstruction, electrophysiologic examination, and mapping times were recorded. Furthermore, immediate success rates and complications were also recorded. A total of 20 patients were enrolled, including 12 males. The average age was 51.3 ± 17.2 (19-76) years. Nine cases of atrioventricular nodal re-entrant tachycardia, 7 cases of frequent ventricular premature contractions, 3 cases of Wolff-Parkinson-White syndrome, and 1 case of typical atrial flutter were included. All arrhythmias were successfully ablated. The procedure time was 127.0 ± 21.0 (99-177) minutes, the reconstruction time was 6.5 ± 2.9 (3-14) minutes, the electrophysiologic study time was 10.4 ± 3.4 (6-20) minutes, and the mapping time was 11.7 ± 8.3 (3-36) minutes. No complications occurred. Radiofrequency ablation of arrhythmias without DSA is effective and feasible under the guidance of the Carto 3 mapping system. However, the electrophysiology physician must have sufficient experience, and related emergency measures must be present to ensure safety.

Operating Room of the Future: Advanced Technologies in Safe and Efficient Operating Rooms

DTIC Science & Technology

2010-10-01

research, and treatment purposes. A laser optical mouse and a graphics tablet were used by radiologists to segment 12 simulated reference lesions per...radiologists seg- mented a total of 132 simulated lesions. Overall error in contour segmentation was less with the graphics tablet than with the mouse...PG0.0001). Error in area of segmentation was not significantly different between the tablet and the mouse (P=0.62). Time for segmen- tation was less with

Proceedings of the Integrated Logistics Support Symposium held at Fort Worth, Texas on 30 November-2 December 1983.

DTIC Science & Technology

1983-12-02

load of the vehicles. The vehicles will be recycled several times to the shore to provide round-the-clock, sustained operations. Phase III...delivery and storage systems will be installed and operated. The containers and breakbulk cargo will be recycled to the respective ships to permit a total...encouraged to submit to the manager everything, inclut ing trivia , with the winnowing of what is reported upward left to the manager’s discretion

Prescribing and formulating neonatal intravenous feeding solutions by microcomputer.

PubMed Central

MacMahon, P

1984-01-01

This paper describes a computer programme for a low cost microcomputer designed to assist in the task of administering total parenteral nutrition to neonates: no knowledge of computers is necessary to operate the system. The programme displays recommended values for each of the total parenteral nutrition constituents that must be prescribed, based on detailed analysis of all the pertinent variables. The recommended values may be rejected but they do provide a useful prompt, especially for the more junior doctors. The programme includes a number of safeguards that protect against entering potentially dangerous values. As soon as the operator has completed the procedure of entering total parenteral nutrition requirements the calculations necessary to formulate a solution containing these are automatically performed. The print out contains this data plus instructions on the infusion rate and an analysis of the formulation's calorific content. This system makes it easier to vary the quantity of individual total parenteral nutrition constituents and time has been saved which was previously wasted performing laborious calculations. One of the most important contributions has been the virtual elimination of errors in the complex task of prescribing and formulating total parenteral nutrition for sick neonates. PMID:6430246

The 274th Forward Surgical Team experience during Operation Enduring Freedom.

PubMed

Peoples, George E; Gerlinger, Tad; Craig, Robert; Burlingame, Brian

2005-06-01

The 274th Forward Surgical Team (FST) was deployed in support of Operation Enduring Freedom from October 14, 2001 to May 8, 2002. During this period, the FST was asked to perform many nondoctrinal missions. The FST was tasked with functioning as a mini-combat support hospital during the earlier phases of Operation Enduring Freedom, performing in-flight surgical procedures and resuscitation of combat wounded, conducting split operations with surgical coverage of both Karshi and Khanabad, Uzbekistan, and Bagram, Afghanistan, and leading the multinational medical coalition assembled for Operation Anaconda and other combat operations staged from Bagram. Overall, the 274th FST took care of approximately 90% of U.S. combat casualties during this period and treated a total of 221 combat casualties. The FST treated 103 total surgical cases, including 73 with combat wounds. At the time, this experience with combat casualties and the surgical care of combat wounds was the largest since the Persian Gulf War. More importantly, this account describes the flow, frequency, and type of combat casualties seen in a low-intensity conflict like that being waged currently in Afghanistan. It is hoped that this depiction will aid in the preparation, equipping, and overall utilization of surgical assets in similar future conflicts.

Acceptable short-term outcome of laparoscopic subtotal colectomy for inflammatory bowel disease.

PubMed

Frid, Natalie Lassen; Bulut, Orhan; Pachler, Jørn

2013-06-01

Laparoscopic colectomy for both benign and malignant disease, including inflammatory bowel disease (IBD), has recently been shown to have many advantages compared with open surgery. This study aimed to compare the effect of laparoscopic versus open subtotal colectomy (STC) for IBD on overall morbidity. A total of 99 patients undergoing STC for IBD at our institution from 2007 through 2011 were identified. Patients undergoing open STC were compared with patients undergoing laparoscopic STC. Outcomes included 30-day morbidity, conversion to laparotomy, intraoperative blood loss, operative time, admission time, late onset complications and 30-day mortality. Results are presented as median values. A total of 57 patients underwent open STC (Group 1) and 42 patients laparoscopic STC (Group 2). Group 1 comprised 26 males and 31 females, with a median age of 35 years and a body mass index (BMI) of 23.2 kg/m2. Group 2 comprised 18 males and 24 females, with a median age of 34 years and a BMI of 23.5 kg/m2. Group 2 had less morbidity (42.9% versus 75.4%, p < 0.002), reduced blood loss (100 ml versus 200 ml, p < 0.001), longer operative time (193.5 min. versus 128 min., p < 0.001), shorter length of hospital stay (six days versus 16 days, p < 0.001) than Group 1. One patient died (Group 1). There was no difference in late onset complications and no conversions to laparotomy in the laparoscopic group. Laparoscopic STC has a longer operative time, but improves short-term outcomes compared with open surgery. not relevant. not relevant.

Dispersion and Lifetime of the SO2 Cloud from the August 2008 Kasatochi Eruption

NASA Technical Reports Server (NTRS)

Krotkov, N. A.; Schoeberl, M. R.; Morris, G. A.; Carn, S.; Yang, K.

2010-01-01

Hemispherical dispersion of the SO2 cloud from the August 2008 Kasatochi eruption is analyzed using satellite data from the Ozone Monitoring Instrument (OMI) and the Goddard Trajectory Model (GTM). The operational OMI retrievals underestimate the total SO2 mass by 20-30% on 8-11 August, as compared with more accurate offline Extended Iterative Spectral Fit (EISF) retrievals, but the error decreases with time due to plume dispersion and a drop in peak SO2 column densities. The GTM runs were initialized with and compared to the operational OMI SO2 data during early plume dispersion to constrain SO2 plume heights and eruption times. The most probable SO2 heights during initial dispersion are estimated to be 10-12 km, in agreement with direct height retrievals using EISF algorithm and IR measurements. Using these height constraints a forward GTM run was initialized on 11 August to compare with the month-long Kasatochi SO2 cloud dispersion patterns. Predicted volcanic cloud locations generally agree with OMI observations, although some discrepancies were observed. Operational OMI SO2 burdens were refined using GTM-predicted mass-weighted probability density height distributions. The total refined SO2 mass was integrated over the Northern Hemisphere to place empirical constraints on the SO2 chemical decay rate. The resulting lower limit of the Kasatochi SO2 e-folding time is approx.8-9 days. Extrapolation of the exponential decay back in time yields an initial erupted SO2 mass of approx.2.2 Tg on 8 August, twice as much as the measured mass on that day.

Lost opportunity cost of surgical training in the Australian private sector.

PubMed

Aitken, R James

2012-03-01

To meet Australia's future demands, surgical training in the private sector will be required. The aim of this study was to estimate the time and lost opportunity cost of training in the private sector. A literature search identified studies that compared the operation time required by a supervised trainee with a consultant. This time was costed using a business model. In 22 studies (34 operations), the median operation duration of a supervised trainee was 34% longer than the consultant. To complete a private training list in the same time as a consultant list, one major case would have to be dropped. A consultant's average lost opportunity cost was $1186 per list ($106,698 per year). Training in rooms and administration requirements increased this to $155,618 per year. To train 400 trainees in the private sector to college standards would require 54,000 training lists per year. The consultants' national lost opportunity cost would be $137 million per year. The average lost hospital case payment was $5894 per list, or $330 million per year nationally. The total lost opportunity cost of surgical training in the private sector would be about $467 million per year. When trainee salaries, other specialties and indirect expenses are included, the total cost will be substantially greater. It is unlikely that surgeons or hospitals will be prepared to absorb these costs. There needs to be a public debate about the funding implications of surgical training in the private sector. © 2012 The Author. ANZ Journal of Surgery © 2012 Royal Australasian College of Surgeons.

A comparison of flame ionization and ozone chemiluminescence for the determination of atmospheric hydrocarbons.

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

Marley, N. A.; Gaffney, J. S.; Environmental Research

A reactive hydrocarbon analyzer has been constructed on the basis of chemiluminescence reaction with ozone. This detector is designed to operate at varying temperatures which take advantage of the different rates of reaction of the hydrocarbon classes with ozone to yield a measure of their atmospheric reactivity. When operated at high temperatures (170 C), all hydrocarbons will give a chemiluminescence signal. Reported here is a direct comparison of the ozone chemiluminescent detector (operated at a temperature of 170 C) with a flame ionization detector. This comparison was accomplished by connecting a capillary gas chromatograph to each of the two detectorsmore » by means of a switching valve. Twenty-seven compounds representing alkanes, alkenes, aromatics, and oxygenated hydrocarbons (aldehydes, ketones, alcohols, and ethers) were studied. For the compounds studied, analytical sensitivities were 10-1000 times better for the chemiluminescence detector. The results of this comparison indicate that the response of the chemiluminescent detector at 170 C correlates with a total carbon detector (flame ionization detection) and that total response is a measure of total carbon in the sample. The chemiluminescent system will be very useful for gas chromatographic detection of atmospheric hydrocarbons, particularly of oxygenates in complex mixtures.« less

Integration of the Total Lightning Jump Algorithm into Current Operational Warning Environment Conceptual Models

NASA Technical Reports Server (NTRS)

Schultz, C. J.; Carey, L. D.; Schultz, E. V.; Stano, G. T.; Blakeslee, R.; Goodman, S. J.

2014-01-01

The purpose of the total lightning jump algorithm (LJA) is to provide forecasters with an additional tool to identify potentially hazardous thunderstorms, yielding increased confidence in decisions within the operational warning environment. The LJA was first developed to objectively indentify rapid increases in total lightning (also termed "lightning jumps") that occur prior to the observance of severe and hazardous weather (Williams et al. 1999, Schultz et al. 2009, Gatlin and Goodman 2010, Schultz et al. 2011). However, a physical and framework leading up to and through the time of a lightning jump is still lacking within the literature. Many studies infer that there is a large increase in the updraft prior to or during the jump, but are not specific on what properties of the updraft are indeed increasing (e.g., maximum updraft speed vs volume or both) likely because these properties were not specifically observed. Therefore, the purpose of this work is to physically associate lightning jump occurrence to polarimetric and multi-Doppler radar measured thunderstorm intensity metrics and severe weather occurrence, thus providing a conceptual model that can be used to adapt the LJA to current operations.

The importance of ships and spare parts in LCAs of offshore wind power.

PubMed

Arvesen, Anders; Birkeland, Christine; Hertwich, Edgar G

2013-03-19

We develop and assess life cycle inventories of a conceptual offshore wind farm using a hybrid life cycle assessment (LCA) methodology. Special emphasis is placed on aspects of installation, operation, and maintenance, as these stages have been given only cursory consideration in previous LCAs. The results indicate that previous studies have underestimated the impacts caused by offshore operations and (though less important) exchange of parts. Offshore installation and maintenance activities cause 28% (10 g CO(2)-Eq/kWh) of total greenhouse gas emissions and 31-45% of total impact indicator values at the most (marine eutrophication, acidification, particulates, photochemical ozone). Transport and dumping of rock in installation phase and maintenance of wind turbines in use phase are major contributory activities. Manufacturing of spare parts is responsible for 6% (2 g CO2-Eq/kWh) of greenhouse gas emissions and up to 13% of total impact indicator values (freshwater ecotoxicity). Assumptions on lifetimes, work times for offshore activities and implementation of NOx abatement on vessels are shown to have a significant influence on results. Another source of uncertainty is assumed operating mode data for vessels determining fuel consumption rates.

Virtual Reality Simulation as a Tool to Monitor Surgical Performance Indicators: VIRESI Observational Study.

PubMed

Muralha, Nuno; Oliveira, Manuel; Ferreira, Maria Amélia; Costa-Maia, José

2017-05-31

Virtual reality simulation is a topic of discussion as a complementary tool to traditional laparoscopic surgical training in the operating room. However, it is unclear whether virtual reality training can have an impact on the surgical performance of advanced laparoscopic procedures. Our objective was to assess the ability of the virtual reality simulator LAP Mentor to identify and quantify changes in surgical performance indicators, after LAP Mentor training for digestive anastomosis. Twelve surgeons from Centro Hospitalar de São João in Porto (Portugal) performed two sessions of advanced task 5: anastomosis in LAP Mentor, before and after completing the tutorial, and were evaluated on 34 surgical performance indicators. The results show that six surgical performance indicators significantly changed after LAP Mentor training. The surgeons performed the task significantly faster as the median 'total time' significantly reduced (p < 0.05) from 759.5 to 523.5 seconds. Significant decreases (p < 0.05) were also found in median 'total needle loading time' (303.3 to 107.8 seconds), 'average needle loading time' (38.5 to 31.0 seconds), 'number of passages in which the needle passed precisely through the entrance dots' (2.5 to 1.0), 'time the needle was held outside the visible field' (20.9 to 2.4 seconds), and 'total time the needle-holders' ends are kept outside the predefined operative field' (88.2 to 49.6 seconds). This study raises the possibility of using virtual reality training simulation as a benchmark tool to assess the surgical performance of Portuguese surgeons. LAP Mentor is able to identify variations in surgical performance indicators of digestive anastomosis.

One-shot dilation in modified supine position for percutaneous nephrolithotomy: experience from over 300 cases.

PubMed

El Harrech, Youness; Abakka, Najib; El Anzaoui, Jihad; Goundale, Omar; Touiti, Driss

2014-07-08

To evaluate the feasibility, safety and efficacy of one-shot dilation (OSD) in modified supine position percutaneous nephrolithotomy (PCNL). A total of 320 PCNL in a total of 291 patients were performed between October 2008 and July 2011. There were no specific exclusion criteria. Patients with kidney anomalies or solitary kidney, with history of renal surgery or extracorporeal shockwave lithotripsy (SWL), those with staghorn calculi or needing more than one access, were eligible for inclusion. Data collected included patient demographics and stone characteristics, access time, radiation exposure, total operating time, preoperative and postoperative hemoglobin concentrations, tract dilatation failures, complications and transfusions. Mean stone size was 38 mm (16-110 mm). The mean time access was 2.1 min (range 0.7-6.2 min). Tract dilatation fluoroscopy time was 25 ± 17 sec. The targeted calix could be entered with a success rate of 97.81%. The mean hemoglobin decrease was -1.17 g/dL ± 0.84. There were no visceral, pleural, collecting systems or vascular injuries. Major complications included, transfusion in 4 (1.25%) patients, pseudoaneurysm with persistent bleeding necessitating nephrectomy in 1 (0.3%) patient and two deaths (0.62%) after surgery. There was no significant difference in successful access and complications between patients with and without previous open surgery and in those with or without staghorn stones (P > .05). The use of one shot and modified supine position combines the advantages of these both methods including less radiation exposure and shorter access and operative time. The one shot dilation is safe, easy to learn, cost effective and offers a potential alternative to the standard devices particularly in developing countries.

[The effect of arthroscopic debridement and conservative treatment in knee osteoarthritis: Results of a 5-year follow-up and literature review].

PubMed

Spahn, G; Klinger, H M; Hofmann, G O

2013-12-01

This study is aimed to compare the effects of arthroscopic joint debridement over a 5-year period in a clearly defined patient population (only grade III knee osteoarthritis, history < 2 years). A total of 96 patients (50 male and 46 female) underwent arthroscopic knee debridement for knee OA. The main criteria for inclusion were osteoarthritis grade III (Kellgren-Lawrence score) and a maximal history of 2 years. The subjective complaints and the knee-related quality of life were estimated by the KOOS (knee injury and osteoarthritis outcome score). The score increased significantly within the 1 to 3 rd year post operation. After this interval the mean points of the score declined. But after 5 years the KOOS was higher in comparison to the baseline dates. Patients who had undergone conservative treatment at baseline had a significantly different KOOS than patients in the arthroscopy group. Over time, patients in the arthroscopy group had fewer complaints than patients in the conservative treatment group. In both groups, the results decreased over time. A total of 17 patients (17.2 %) needed a conversion to total endoprothetic replacement. The mean time-interval between index operation and conversion was 56.6 (95 % CI 54.4 - 58.4) months. In middle stages of knee OA, arthroscopic joint debridement can effectively reduce subjective complaints. Because this treatment does not stop the process of OA, the improvements decrease over time. © Georg Thieme Verlag KG Stuttgart · New York.

Minimally invasive and computer-navigated total hip arthroplasty: a qualitative and systematic review of the literature

PubMed Central

2010-01-01

Background Both minimally invasive surgery (MIS) and computer-assisted surgery (CAS) for total hip arthroplasty (THA) have gained popularity in recent years. We conducted a qualitative and systematic review to assess the effectiveness of MIS, CAS and computer-assisted MIS for THA. Methods An extensive computerised literature search of PubMed, Medline, Embase and OVIDSP was conducted. Both randomised clinical trials and controlled clinical trials on the effectiveness of MIS, CAS and computer-assisted MIS for THA were included. Methodological quality was independently assessed by two reviewers. Effect estimates were calculated and a best-evidence synthesis was performed. Results Four high-quality and 14 medium-quality studies with MIS THA as study contrast, and three high-quality and four medium-quality studies with CAS THA as study contrast were included. No studies with computer-assisted MIS for THA as study contrast were identified. Strong evidence was found for a decrease in operative time and intraoperative blood loss for MIS THA, with no difference in complication rates and risk for acetabular outliers. Strong evidence exists that there is no difference in physical functioning, measured either by questionnaires or by gait analysis. Moderate evidence was found for a shorter length of hospital stay after MIS THA. Conflicting evidence was found for a positive effect of MIS THA on pain in the early postoperative period, but that effect diminished after three months postoperatively. Strong evidence was found for an increase in operative time for CAS THA, and limited evidence was found for a decrease in intraoperative blood loss. Furthermore, strong evidence was found for no difference in complication rates, as well as for a significantly lower risk for acetabular outliers. Conclusions The results indicate that MIS THA is a safe surgical procedure, without increases in operative time, blood loss, operative complication rates and component malposition rates. However, the beneficial effect of MIS THA on functional recovery has to be proven. The results also indicate that CAS THA, though resulting in an increase in operative time, may have a positive effect on operative blood loss and operative complication rates. More importantly, the use of CAS results in better positioning of acetabular component of the prosthesis. PMID:20470443

The Hand-Assisted Laparoscopic Approach to Resection of Pancreatic Mucinous Cystic Neoplasms: An Underused Technique?

PubMed

Postlewait, Lauren M; Ethun, Cecilia G; McInnis, Mia R; Merchant, Nipun; Parikh, Alexander; Idrees, Kamran; Isom, Chelsea A; Hawkins, William; Fields, Ryan C; Strand, Matthew; Weber, Sharon M; Cho, Clifford S; Salem, Ahmed; Martin, Robert C G; Scoggins, Charles; Bentrem, David; Kim, Hong J; Carr, Jacquelyn; Ahmad, Syed; Abbott, Daniel; Wilson, Gregory C; Kooby, David A; Maithel, Shishir K

2018-01-01

Pancreatic mucinous cystic neoplasms (MCNs) are rare tumors typically of the distal pancreas that harbor malignant potential. Although resection is recommended, data are limited on optimal operative approaches to distal pancreatectomy for MCN. MCN resections (2000-2014; eight institutions) were included. Outcomes of minimally invasive and open MCN resections were compared. A total of 289 patients underwent distal pancreatectomy for MCN: 136(47%) minimally invasive and 153(53%) open. Minimally invasive procedures were associated with smaller MCN size (3.9 vs 6.8 cm; P = 0.001), lower operative blood loss (192 vs 392 mL; P = 0.001), and shorter hospital stay(5 vs 7 days; P = 0.001) compared with open. Despite higher American Society of Anesthesiologists class, hand-assisted (n = 46) had similar advantages as laparoscopic/robotic (n = 76). When comparing hand-assisted to open, although MCN size was slightly smaller (4.1 vs 6.8 cm; P = 0.001), specimen length, operative time, and nodal yield were identical. Similar to laparoscopic/robotic, hand-assisted had lower operative blood loss (161 vs 392 mL; P = 0.001) and shorter hospital stay (5 vs 7 days; P = 0.03) compared with open, without increased complications. Hand-assisted laparoscopic technique is a useful approach for MCN resection because specimen length, lymph node yield, operative time, and complication profiles are similar to open procedures, but it still offers the advantages of a minimally invasive approach. Hand-assisted laparoscopy should be considered as an alternative to open technique or as a successive step before converting from total laparoscopic to open distal pancreatectomy for MCN.

Phasing of two amplifier channels for the coherent combining of laser beams with a total power of 60 W

NASA Astrophysics Data System (ADS)

Trikshev, A. I.; Pyrkov, Yu. N.; Tsvetkov, V. B.

2017-12-01

We have demonstrated stable operation of a system for maintaining a constant phase difference between two laser channels with a total output power of 60 W. The system is based on a two-channel fibre amplifier with phase modulators based on piezoceramic spools. At a main piezo element modulation frequency of 11 kHz, the phasing time after thermal and mechanical influences on the active medium is 100 ms.

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

PubMed

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

2014-08-01

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

Autonomy versus Affirmative Action: What Price Social Justice?

ERIC Educational Resources Information Center

Cavalier, Anne; Slaughter, Sheila

1982-01-01

A study measured costs of an affirmative action/equal employment opportunity program at one institution through cost analysis of personnel, operating expenses, and capital replacement value. Costs incurred in one budget cycle were 0.4 percent of the total institutional budget, most spent indirectly through faculty time, and were found…

75 FR 3765 - Proposed Collection; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2010-01-22

... time for the annual audit report is 100 hours per OTC derivatives dealer, for a total of 180 hours per... Financial and Operational Combined Uniform Single (``FOCUS'') Report, is the basic document for reporting...). Rule 17a-12 requires registered OTC derivatives dealers to file Part IIB of the FOCUS Report quarterly...

Environmental assessment of alternative pasteurization technologies for fluid milk production using process simulation

USDA-ARS?s Scientific Manuscript database

JUSTIFICATION Fluid milk processing (FMP) has significant environmental impact because of its high energy use and greenhouse gas (GHG) emissions. High temperature short time (HTST) pasteurization is the third most energy intense operation in FMP comprising about 16% of total energy use, after clean-...

College Sports Inc.: The Athletic Department vs. the University.

ERIC Educational Resources Information Center

Sperber, Murray

1990-01-01

Big-time intercollegiate athletics has become College Sports Inc., a huge entertainment conglomerate with operating methods and objectives totally separate from, and often opposed to, the educational aims of the schools housing its franchises. This article dispels prevailing myths and seeks a new role definition for intercollegiate athletics…

12 CFR 702.307 - Incentives for new credit unions.

Code of Federal Regulations, 2010 CFR

2010-01-01

... for new credit unions. (a) Assistance in revising business plans. Upon timely request by a credit union having total assets of less than $10 million (regardless how long it has been in operation), the NCUA Board shall provide assistance in preparing a revised business plan required to be filed under...

76 FR 36579 - Onsite Consultation Agreements; Extension of the Office of Management and Budget's (OMB) Approval...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-06-22

.... Estimated Total urden Hours: 222,924. Estimated Cost (Operation and Maintenance): $0. IV. Public... costs) is minimal, collection instruments are clearly understood, and OSHA's estimate of the information... of OSHA's estimate of the burden (time and costs) of the information collection requirements...

On-orbit operations and offline data processing of CALET onboard the ISS

NASA Astrophysics Data System (ADS)

Asaoka, Y.; Ozawa, S.; Torii, S.; Adriani, O.; Akaike, Y.; Asano, K.; Bagliesi, M. G.; Bigongiari, G.; Binns, W. R.; Bonechi, S.; Bongi, M.; Brogi, P.; Buckley, J. H.; Cannady, N.; Castellini, G.; Checchia, C.; Cherry, M. L.; Collazuol, G.; Di Felice, V.; Ebisawa, K.; Fuke, H.; Guzik, T. G.; Hams, T.; Hareyama, M.; Hasebe, N.; Hibino, K.; Ichimura, M.; Ioka, K.; Ishizaki, W.; Israel, M. H.; Javaid, A.; Kasahara, K.; Kataoka, J.; Kataoka, R.; Katayose, Y.; Kato, C.; Kawanaka, N.; Kawakubo, Y.; Krawczynski, H. S.; Krizmanic, J. F.; Kuramata, S.; Lomtadze, T.; Maestro, P.; Marrocchesi, P. S.; Messineo, A. M.; Mitchell, J. W.; Miyake, S.; Mizutani, K.; Moiseev, A. A.; Mori, K.; Mori, M.; Mori, N.; Motz, H. M.; Munakata, K.; Murakami, H.; Nakahira, S.; Nishimura, J.; de Nolfo, G. A.; Okuno, S.; Ormes, J. F.; Pacini, L.; Palma, F.; Papini, P.; Penacchioni, A. V.; Rauch, B. F.; Ricciarini, S. B.; Sakai, K.; Sakamoto, T.; Sasaki, M.; Shimizu, Y.; Shiomi, A.; Sparvoli, R.; Spillantini, P.; Stolzi, F.; Takahashi, I.; Takayanagi, M.; Takita, M.; Tamura, T.; Tateyama, N.; Terasawa, T.; Tomida, H.; Tsunesada, Y.; Uchihori, Y.; Ueno, S.; Vannuccini, E.; Wefel, J. P.; Yamaoka, K.; Yanagita, S.; Yoshida, A.; Yoshida, K.; Yuda, T.

2018-07-01

The CALorimetric Electron Telescope (CALET), launched for installation on the International Space Station (ISS) in August, 2015, has been accumulating scientific data since October, 2015. CALET is intended to perform long-duration observations of high-energy cosmic rays onboard the ISS. CALET directly measures the cosmic-ray electron spectrum in the energy range of 1 GeV to 20 TeV with a 2% energy resolution above 30 GeV. In addition, the instrument can measure the spectrum of gamma rays well into the TeV range, and the spectra of protons and nuclei up to a PeV. In order to operate the CALET onboard ISS, JAXA Ground Support Equipment (JAXA-GSE) and the Waseda CALET Operations Center (WCOC) have been established at JAXA and Waseda University, respectively. Scientific operations using CALET are planned at WCOC, taking into account orbital variations of geomagnetic rigidity cutoff. Scheduled command sequences are used to control the CALET observation modes on orbit. Calibration data acquisition by, for example, recording pedestal and penetrating particle events, a low-energy electron trigger mode operating at high geomagnetic latitude, a low-energy gamma-ray trigger mode operating at low geomagnetic latitude, and an ultra heavy trigger mode, are scheduled around the ISS orbit while maintaining maximum exposure to high-energy electrons and other high-energy shower events by always having the high-energy trigger mode active. The WCOC also prepares and distributes CALET flight data to collaborators in Italy and the United States. As of August 31, 2017, the total observation time is 689 days with a live time fraction of the total time of ∼ 84%. Nearly 450 million events are collected with a high-energy (E > 10 GeV) trigger. In addition, calibration data acquisition and low-energy trigger modes, as well as an ultra-heavy trigger mode, are consistently scheduled around the ISS orbit. By combining all operation modes with the excellent-quality on-orbit data collected thus far, it is expected that a five-year observation period will provide a wealth of new and interesting results.

Minimizing the Total Service Time of Discrete Dynamic Berth Allocation Problem by an Iterated Greedy Heuristic

PubMed Central

2014-01-01

Berth allocation is the forefront operation performed when ships arrive at a port and is a critical task in container port optimization. Minimizing the time ships spend at berths constitutes an important objective of berth allocation problems. This study focuses on the discrete dynamic berth allocation problem (discrete DBAP), which aims to minimize total service time, and proposes an iterated greedy (IG) algorithm to solve it. The proposed IG algorithm is tested on three benchmark problem sets. Experimental results show that the proposed IG algorithm can obtain optimal solutions for all test instances of the first and second problem sets and outperforms the best-known solutions for 35 out of 90 test instances of the third problem set. PMID:25295295

Biogeography-based combinatorial strategy for efficient autonomous underwater vehicle motion planning and task-time management

NASA Astrophysics Data System (ADS)

Zadeh, S. M.; Powers, D. M. W.; Sammut, K.; Yazdani, A. M.

2016-12-01

Autonomous Underwater Vehicles (AUVs) are capable of spending long periods of time for carrying out various underwater missions and marine tasks. In this paper, a novel conflict-free motion planning framework is introduced to enhance underwater vehicle's mission performance by completing maximum number of highest priority tasks in a limited time through a large scale waypoint cluttered operating field, and ensuring safe deployment during the mission. The proposed combinatorial route-path planner model takes the advantages of the Biogeography-Based Optimization (BBO) algorithm toward satisfying objectives of both higher-lower level motion planners and guarantees maximization of the mission productivity for a single vehicle operation. The performance of the model is investigated under different scenarios including the particular cost constraints in time-varying operating fields. To show the reliability of the proposed model, performance of each motion planner assessed separately and then statistical analysis is undertaken to evaluate the total performance of the entire model. The simulation results indicate the stability of the contributed model and its feasible application for real experiments.

[Surgery for benign goiter in Germany: fewer operations, changed resectional strategy, fewer complications].

PubMed

Dralle, H; Stang, A; Sekulla, C; Rusner, C; Lorenz, K; Machens, A

2014-03-01

The increase of certain operations in the wake of the introduction of the German Diagnosis-Related Groups (G-DRG) system rekindled debate on the risk-benefit profile of what is widely being perceived as a too high number of thyroidectomies for benign goiter in Germany. The numbers of thyroidectomy for benign goiter from 2005-2011 were obtained from the Federal Bureau of Statistics ("Statistisches Bundesamt"). For the purpose of the study, the following operation and procedure key (OPS) codes were selected: hemithyroidectomy (OPS code 5-061); partial thyroid resection (OPS code 5-062); total thyroidectomy (OPS code 5-063); and thyroid surgeries via sternotomy (OPS code 5-064). The rates of permanent hypoparathyroidism and vocal cord palsy were calculated based on two prospective multicenter evaluation studies conducted in 1998-2001 (PETS 1) and 2010-2013 (PETS 2) in Germany. Between 2005 and 2011, the number of thyroidectomies for benign thyroid goiter decreased by 8 %, and the age-standardized surgery rate decreased by 6 % in men (2005: 599 per 1 million; 2011: 565 per 1 million) and 11 % in women (2005: 1641 per 1 million; 2011: 1463 per 1 million). At the same time, the rates of partial and subtotal thyroidectomy decreased by 59 % in men and 64 % in women, whereas the rates of hemithyroidectomy and total thyroidectomy increased by 65 % (113 %) in men and 42 % (97 %) in women. Despite a greater proportion of thyroidectomies over time, the approximated rates for postoperative hypoparathyroidism were reduced from 2.98 to 0.83 % and for postoperative vocal cord palsy from 1.06 to 0.86 %. Irrespective of that decline, either complication was more frequent after total than after subtotal thyroidectomy. The total number of thyroid surgeries due to benign goiter has decreased substantially in Germany from 2005 through 2011. Despite changes in the resectional strategy with an increase in the total number thyroidectomies and a decrease of subtotal resections, the rates for postoperative hypoparathyroidism and vocal cord palsy have decreased. The complication rates for total thyroidectomy, however, are still higher compared to subtotal resection. An individualized risk-oriented surgical approach is warranted.

An Analysis of Operational Total Lightning Data During Long-Track Tornadoes

NASA Technical Reports Server (NTRS)

Carcione, Brian C.; Stano, Geoffrey T.

2012-01-01

The 27 April 2011 tornado outbreak brought three distinct waves of tornadic thunderstorms to portions of Mississippi, Alabama, Tennessee, and Georgia, striking the Tennessee Valley of north Alabama and southern Tennessee particularly hard. A total of 42 tornado paths were surveyed across the fourteen county area covered by the National Weather Service (NWS) forecast office in Huntsville, Alabama. Ten of these tornadoes were on the ground for at least 20 miles, two had total path lengths over 130 miles, and six tornadoes were classified as violent (EF-4 or EF-5 on the Enhanced Fujita Scale). Many of these tornadoes occurred within the domain of the North Alabama Lightning Mapping Array (NALMA), a ground-based total lightning detection network owned and operated by the NASA Marshall Space Flight Center. Since 2003, the NASA Short-term Prediction Research and Transition Center has supplied data from NALMA in real time to NWS forecast offices in Huntsville, Knoxville/Tri-Cities, Birmingham, and Nashville. Previous research has documented the utility of total lightning information in predicting tornadogenesis, particularly when combined with other remote sensing tools. Basic warning decision-making during events such as 27 April is not the most difficult part of the process; instead, the focus of warning meteorologists shifts to looking for changes in intensity or possible particularly dangerous situations, since doppler radar velocity data often cannot distinguish between weak and strong tornadoes. To that end, this research attempts to determine if any correlation exists between flash densities of the longest-tracked tornadoes over time, and the surveyed wind speeds of the tornadoes. The long-track EF-5 tornado which struck the Hackleburg, Phil Campbell, and Tanner communities in north Alabama was the primary focus of this research due to its intensity and extended life cycle. However, not all tornadoes were available for total lightning analysis due to widespread power outages which negatively affected the detection efficiency and operation of the NALMA. Therefore, additional storms from 2008-2010 with tracks of at least 20 miles were analyzed for comparison purposes.

Life-cycle environmental inventory of passenger transportation modes in the United States

NASA Astrophysics Data System (ADS)

Chester, Mikhail Vin

To appropriately mitigate environmental impacts from transportation, it is necessary for decision makers to consider the life-cycle energy consumption and emissions associated with each mode. A life-cycle energy, greenhouse gas, and criteria air pollutant emissions inventory is created for the passenger transportation modes of automobiles, urban buses, heavy rail transit, light rail transit, and aircraft in the U.S. Each mode's inventory includes an assessment of vehicles, infrastructure, and fuel components. For each component, analysis is performed for material extraction through use and maintenance in both direct and indirect (supply chain) processes. For each mode's life-cycle components, energy inputs and emission outputs are determined. Energy inputs include electricity and petroleum-based fuels. Emission outputs include greenhouse gases (CO2, CH4, and N2O) and criteria pollutants (CO, SO2, NOx , VOCs, and PM). The inputs and outputs are normalized by vehicle lifetime, vehicle mile traveled, and passenger mile traveled. A consistent system boundary is applied to all modal inventories which captures the entire life-cycle, except for end-of-life. For each modal life-cycle component, both direct and indirect processes are included if possible. A hybrid life-cycle assessment approach is used to estimate the components in the inventories. We find that life-cycle energy inputs and emission outputs increase significantly compared to the vehicle operational phase. Life-cycle energy consumption is 39-56% larger than vehicle operation for autos, 38% for buses, 93-160% for rail, and 19-24% for air systems per passenger mile traveled. Life-cycle greenhouse gas emissions are 47-65% larger than vehicle operation for autos, 43% for buses, 39-150% for rail, and 24-31% for air systems per passenger mile traveled. The energy and greenhouse gas increases are primarily due to vehicle manufacturing and maintenance, infrastructure construction, and fuel production. For criteria air pollutants, life-cycle components often dominate total emissions and can be a magnitude larger than operational counterparts. Per passenger mile traveled, total SO2 emissions (between 350 and 460 mg) are 19-27 times larger than operational emissions as a result of electricity generation in vehicle manufacturing, infrastructure construction, and fuel production. NOx emissions increase 50-73% for automobiles, 24% for buses, 13-1300% for rail, and 19-24% for aircraft. Non-tailpipe VOCs are 27-40% of total automobile, 71-95% of rail, and 51-81% of air total emissions. Infrastructure and parking construction are major components of total PM10 emissions resulting in total emissions over three times larger than operational emissions for autos and even larger for many rail systems and aircraft (the major contributor being emissions from hot-mix asphalt plants and concrete production). Infrastructure construction and operation as well as vehicle manufacturing increase total CO emissions by 5-17 times from tailpipe performance for rail and 3-9 times for air. A case study comparing the environmental performance of metropolitan regions is presented as an application of the inventory results. The San Francisco Bay Area, Chicago, and New York City are evaluated capturing passenger transportation life-cycle energy inputs and greenhouse gas and criteria air pollutant emissions. The regions are compared between off-peak and peak travel as well as personal and public transit. Additionally, healthcare externalities are computed from vehicle emissions. It is estimated that life-cycle energy varies from 6.3 MJ/PMT in the Bay Area to 5.7 MJ/PMT in Chicago and 5.3 MJ/PMT in New York for an average trip. Life-cycle GHG emissions range from 480 g CO2e/PMT in the Bay Area to 440 g CO2e/PMT for Chicago and 410 g CO 2e/PMT in New York. CAP emissions vary depending on the pollutant with differences as large as 25% between regions. Life-cycle CAP emissions are between 11% and 380% larger than their operational counterparts. Peak travel, with typical higher riderships, does not necessarily environmentally outperform off-peak travel due to the large share of auto PMT and less than ideal operating conditions during congestion. The social costs of travel range from ¢51 (in ¢2007) per auto passenger per trip during peak in New York to ¢6 per public transit passenger per trip during peak hours in the Bay Area and New York. Average personal transit costs are around ¢30 while public transit ranges from ¢28 to ¢41. (Abstract shortened by UMI.)

Crew Factors in Flight Operations. 8; A Survey of Fatigue Factors in Corporate/Executive A Viation Operations

NASA Technical Reports Server (NTRS)

Rosekind, Mark R.; Co, Elizabeth L.; Gregory, Kevin B.; Miller, Donna L.

2000-01-01

Corporate flight crews face unique challenges including unscheduled flights, quickly changing schedules, extended duty days, long waits, time zone changes, and peripheral tasks. Most corporate operations are regulated by Part 91 FARs which set no flight or duty time limits. The objective of this study was to identify operationally significant factors that may influence fatigue, alertness, and performance in corporate operations. In collaboration with the National Business Aircraft Association and the Flight Safety Foundation, NASA developed and distributed a retrospective survey comprising 107 questions addressing demographics, home sleep habits, flight experience, duty schedules, fatigue during operations, and work environment. Corporate crewmembers returned 1,488 surveys. Respondents averaged 45.2 years of age, had 14.9 years of corporate flying experience, and 9,750 total flight hours. The majority (89%) rated themselves as 'good' or 'very good' sleepers at home. Most (82%) indicated they are subject to call for duty and described an average duty day of 9.9 h. About two-thirds reported having a daily duty time limit and over half (57%) reported a daily flight time limit. Nearly three-quarters (71%) acknowledged having 'nodded off' during a flight. Only 21% reported that their flight departments offer training on fatigue issues. Almost three-quarters (74%) described fatigue as a 'moderate' or 'serious' concern, and a majority (61%) characterized it as a common occurrence. Most (85%) identified fatigue as a 'moderate' or 'serious' safety issue.

Ipsilateral renal function preservation after robot-assisted partial nephrectomy (RAPN): an objective analysis using mercapto-acetyltriglycine (MAG3) renal scan data and volumetric assessment.

PubMed

Zargar, Homayoun; Akca, Oktay; Autorino, Riccardo; Brandao, Luis Felipe; Laydner, Humberto; Krishnan, Jayram; Samarasekera, Dinesh; Stein, Robert J; Kaouk, Jihad H

2015-05-01

To objectively assess ipsilateral renal function (IRF) preservation and factors influencing it after robot-assisted partial nephrectomy (RAPN). Our database was queried to identify patients who had undergone RAPN from 2007 to 2013 and had complete pre- and postoperative mercapto-acetyltriglycine (MAG3) renal scan assessment. The estimated glomerular filtration rate (eGFR) for the operated kidney was calculated by multiplying the percentage of contribution from the renal scan by the total eGFR. IRF preservation was defined as a ratio of the postoperative eGFR for the operated kidney to the preoperative eGFR for the operated kidney. The percentage of total eGFR preservation was calculated in the same manner (postoperative eGFR/preoperative eGFR × 100). The amount of healthy rim of renal parenchyma removed was assessed by deducting the volume of tumour from the volume of the PN specimen assessed on pathology. Multivariable linear regression was used for analysis. In all, 99 patients were included in the analysis. The overall median (interquartile range) total eGFR preservation and IRF preservation for the operated kidney was 83.83 (75.2-94.1)% and 72 (60.3-81)%, respectively (P < 0.01). On multivariable analysis, volume of healthy rim of renal parenchyma removed, warm ischaemia time (WIT) > 30 min, body mass index (BMI) and operated kidney preoperative eGFR were predictive of IRF preservation. Using total eGFR tends to overestimate the degree of renal function preservation after RAPN. This is particularly relevant when studying factors affecting functional outcomes after nephron-sparing surgery. IRF may be a more precise assessment method in this setting. Operated kidney baseline renal function, BMI, WIT >30 min, and amount of resected healthy renal parenchyma represent the factors with a significant impact on the IRF preservation. RAPN provides significant preservation of renal function as shown by objective assessment criteria. © 2014 The Authors. BJU International © 2014 BJU International.

Studies on the oil spillage near shorline

NASA Astrophysics Data System (ADS)

Voicu, I.; Dumitrescu, L. G.; Panaitescu, V. F.; Panaitescu, M.

2017-08-01

This paper presents a simulation of an oil spillage near shoreline in real conditions. The purpose of the paper is to determine the evolution of oil spill on sea water surface and in the same time to determine the total costs of depolluting operations organized by the authorities. The simulation is made on the PISCES II Simulator (Potential Incident Simulator Control and Evaluation System) which is designed to handle on real situations such as oil pollutions of the sea. The mathematical model used by the simulator is the dispersion oil-water model, taking account all external conditions such as air/sea water temperature, current/wind speed and direction, sea water density, petroleum physical properties. In the conclusions chapter is presented oil spill details with a financial report for total costs of depolluting operation.

A Model for the Stop Planning and Timetables of Customized Buses

PubMed Central

Yang, Yang

2017-01-01

Customized buses (CBs) are a new mode of public transportation and an important part of diversified public transportation, providing advanced, attractive and user-led service. The operational activity of a CB is planned by aggregating space–time demand and similar passenger travel demands. Based on an analysis of domestic and international research and the current development of CBs in China and considering passenger travel data, this paper studies the problems associated with the operation of CBs, such as stop selection, line planning and timetables, and establishes a model for the stop planning and timetables of CBs. The improved immune genetic algorithm (IIGA) is used to solve the model with regard to the following: 1) multiple population design and transport operator design, 2) memory library design, 3) mutation probability design and crossover probability design, and 4) the fitness calculation of the gene segment. Finally, a real-world example in Beijing is calculated, and the model and solution results are verified and analyzed. The results illustrate that the IIGA solves the model and is superior to the basic genetic algorithm in terms of the number of passengers, travel time, average passenger travel time, average passenger arrival time ahead of schedule and total line revenue. This study covers the key issues involving operational systems of CBs, combines theoretical research and empirical analysis, and provides a theoretical foundation for the planning and operation of CBs. PMID:28056041

A Model for the Stop Planning and Timetables of Customized Buses.

PubMed

Ma, Jihui; Zhao, Yanqing; Yang, Yang; Liu, Tao; Guan, Wei; Wang, Jiao; Song, Cuiying

2017-01-01

Customized buses (CBs) are a new mode of public transportation and an important part of diversified public transportation, providing advanced, attractive and user-led service. The operational activity of a CB is planned by aggregating space-time demand and similar passenger travel demands. Based on an analysis of domestic and international research and the current development of CBs in China and considering passenger travel data, this paper studies the problems associated with the operation of CBs, such as stop selection, line planning and timetables, and establishes a model for the stop planning and timetables of CBs. The improved immune genetic algorithm (IIGA) is used to solve the model with regard to the following: 1) multiple population design and transport operator design, 2) memory library design, 3) mutation probability design and crossover probability design, and 4) the fitness calculation of the gene segment. Finally, a real-world example in Beijing is calculated, and the model and solution results are verified and analyzed. The results illustrate that the IIGA solves the model and is superior to the basic genetic algorithm in terms of the number of passengers, travel time, average passenger travel time, average passenger arrival time ahead of schedule and total line revenue. This study covers the key issues involving operational systems of CBs, combines theoretical research and empirical analysis, and provides a theoretical foundation for the planning and operation of CBs.

High speed clinical data retrieval system with event time sequence feature: with 10 years of clinical data of Hamamatsu University Hospital CPOE.

PubMed

Kimura, M; Tani, S; Watanabe, H; Naito, Y; Sakusabe, T; Watanabe, H; Nakaya, J; Sasaki, F; Numano, T; Furuta, T; Furuta, T

2008-01-01

This paper illustrates a high speed clinical data retrieving system, from 10 years of data of operating hospital information system for the purposes of research, evidence creation, patient safety, etc., even incorporating time sequence of causal relations. Total of 73,709,298 records of 10 years at Hamamatsu University Hospital (as of June 2008) are sent from HIS to retrieval system in HL7 v2.5 format. Hierarchical variable length database is used to install them. A search for "listing patients who were prescribed Pravastatin (Mevalotin and generic drugs, any titer)" took 1.92 seconds. "Pravastatin (any) prescribed and recorded AST >150 within two weeks" took 112.22 seconds. Searching conditions can be set to be more complex, connected by Boolean operator and/or. This system called D*D is in operation at Hamamatsu University Hospital since August 2002. It is used for 48,518 times (monthly average of 703 searches). Neither searching, nor background export of data from HIS caused delay of routine operating CPOE. Search database outside of routine operating CPOE, with daily export of order data in HL7 v2.5 format, is proved to provide excellent search environment without causing trouble. Hierarchical representation gives high-speed search response, especially with time sequence of events.

Assessment of the SonixGPS system for its application in real-time ultrasonography navigation-guided percutaneous nephrolithotomy for the treatment of complex kidney stones.

PubMed

Li, Xiang; Long, Qingzhi; Chen, Xingfa; He, Dalin; He, Hui

2017-04-01

SonixGPS is a novel real-time ultrasonography navigation technology, which has been demonstrated to promote accuracy of puncture in surgical operations. The aim of this study is to evaluate its application in guiding the puncture during percutaneous nephrolithotomy (PCNL). We retrospectively reviewed our experience in treating a total of 74 patients with complex kidney stones with PCNL, in which puncture in 37 cases were guided by SonixGPS system, while the other 37 by conventional ultrasound. The effectiveness of operation was evaluated in terms of stone clearance rate, operation time, time to successful puncture, number of attempts for successful puncture and hospital stay. The safety of operation was examined by evaluating postoperative complications. Our retrospective review showed that although there were no significant differences in stone clearance rates between the groups, SonixGPS guidance resulted in more puncture accuracy with shorter puncture time and higher successful puncture rate. Under the help of SonixGPS, most patients (92 %) had no or just mild complications, compared to that (73 %) in conventional ultrasound group. Post-operative decrease of hemoglobin in SonixGPS group was 13.79 (7-33) mg/dl, significantly lower than that 20.97 (8-41) mg/dl in conventional ultrasound group. Our experience demonstrates that SonixGPS is superior to conventional ultrasound in guiding the puncture in PCNL for the treatment of complex kidney stone.

Amniotic Constriction Bands: Secondary Deformities and Their Treatments.

PubMed

Drury, Benjamin T; Rayan, Ghazi M

2018-01-01

The purpose of this study was to report the surgical treatment experience of patients with amniotic constriction bands (ACB) over a 35-year interval and detail consequential limb deformities with emphasis on hands and upper extremities, along with the nature and frequency of their surgical treatment methods. Fifty-one patients were identified; 26 were males and 25 females. The total number of deformities was listed. The total number of operations, individual procedures, and operations plus procedures that were done for each patient and their frequency were recorded. The total number of operations was 117, and total number of procedures was 341. More procedures were performed on the upper extremity (85%) than the lower extremity (15%). Including the primary deformity ACB, 16 different hand deformities secondary to ACB were encountered. Sixteen different surgical methods for the upper extremity were utilized; a primary procedure for ACB and secondary reconstructions for all secondary deformities. Average age at the time of the first procedure was 9.3 months. The most common procedures performed, in order of frequency, were excision of ACB plus Z-plasty, release of partial syndactyly, release of fenestrated syndactyly, full-thickness skin grafts, resection of digital bony overgrowth from amputation stumps, and deepening of first and other digital web spaces. Many hand and upper extremity deformities secondary to ACB are encountered. Children with ACB may require more than one operation including multiple procedures. Numerous surgical methods of reconstruction for these children's secondary deformities are necessary in addition to the customary primary procedure of excision of ACB and Z-plasty.

Total robotic pancreaticoduodenectomy: a systematic review of the literature.

PubMed

Kornaropoulos, Michail; Moris, Demetrios; Beal, Eliza W; Makris, Marinos C; Mitrousias, Apostolos; Petrou, Athanasios; Felekouras, Evangelos; Michalinos, Adamantios; Vailas, Michail; Schizas, Dimitrios; Papalampros, Alexandros

2017-11-01

Pancreaticoduodenectomy (PD) is a complex operation with high perioperative morbidity and mortality, even in the highest volume centers. Since the development of the robotic platform, the number of reports on robotic-assisted pancreatic surgery has been on the rise. This article reviews the current state of completely robotic PD. A systematic literature search was performed including studies published between January 2000 and July 2016 reporting PDs in which all procedural steps (dissection, resection and reconstruction) were performed robotically. Thirteen studies met the inclusion criteria, including a total of 738 patients. Data regarding perioperative outcomes such as operative time, blood loss, mortality, morbidity, conversion and oncologic outcomes were analyzed. No major differences were observed in mortality, morbidity and oncologic parameters, between robotic and non-robotic approaches. However, operative time was longer in robotic PD, whereas the estimated blood loss was lower. The conversion rate to laparotomy was 6.5-7.8%. Robotic PD is feasible and safe in high-volume institutions, where surgeons are experienced and medical staff are appropriately trained. Randomized controlled trials are required to further investigate outcomes of robotic PD. Additionally, cost analysis and data on long-term oncologic outcomes are needed to evaluate cost-effectiveness of the robotic approach in comparison with the open technique.

Current topics in surgery for isolated total anomalous pulmonary venous connection.

PubMed

Yoshimura, Naoki; Fukahara, Kazuaki; Yamashita, Akio; Doki, Yoshinori; Takeuchi, Katsunori; Higuma, Tomonori; Senda, Kazutaka; Toge, Masayoshi; Matsuo, Tatsuro; Nagura, Saori; Aoki, Masaya; Sakata, Kimimasa; Obi, Hayato

2014-12-01

Surgical correction of total anomalous pulmonary venous connection (TAPVC) remains a challenge, with reported early mortality rates of up to 20%. In this review article, we describe several topics, including surgery for neonates, diagnoses with multidetector computed tomography (MDCT), and primary sutureless repair. Several studies have reported mortality rates of around 10%, and demonstrated unchanged hospital mortality in neonates, despite improvement of the overall mortality of cohorts including older patients. Previous reports identified a low body weight at the time of the operation, preoperative pulmonary venous obstruction (PVO), and a prolonged cardiopulmonary bypass time as risk factors for hospital mortality. With the development of new technologies, MDCT has become a good diagnostic modality for use in the pre- and post-operative evaluation. MDCT delineates the drainage site of the vertical vein and the atypical vessel into the systemic vein, and it can also evaluate the existence of obstruction in the vertical vein. Following favorable experiences with post-repair PVO, the indications for sutureless repair as a primary operation have been expanded for infants, including those at risk of developing PVO after the repair of TAPVC. Primary sutureless repair has proven especially useful for difficult patient groups, such as those with congenital PVO, infracardiac TAPVC with small pulmonary veins, or mixed-type TAPVC.

Antegrade versus retrograde cerebral perfusion for hemiarch replacement with deep hypothermic circulatory arrest: Does it matter? A propensity-matched analysis

PubMed Central

Ganapathi, Asvin M.; Hanna, Jennifer M.; Schechter, Matthew A.; Englum, Brian R.; Castleberry, Anthony W.; Gaca, Jeffrey G.; Hughes, G. Chad

2015-01-01

Objective The choice of cerebral perfusion strategy for aortic arch surgery has been debated, and the superiority of antegrade (ACP) or retrograde (RCP) cerebral perfusion has not been shown. We examined the early and late outcomes for ACP versus RCP in proximal (hemi-) arch replacement using deep hypothermic circulatory arrest (DHCA). Methods A retrospective analysis of a prospectively maintained database was performed for all patients undergoing elective and nonelective hemiarch replacement at a single referral institution from June 2005 to February 2013. Total arch cases were excluded to limit the analysis to shorter DHCA times and a more uniform patient population for whom clinical equipoise regarding ACP versus RCP exists. A total of 440 procedures were identified, with 360 (82%) using ACP and 80 (18%) using RCP. The endpoints included 30-day/in-hospital and late outcomes. A propensity score with 1:1 matching of 40 pre- and intraoperative variables was used to adjust for differences between the 2 groups. Results All 80 RCP patients were propensity matched to a cohort of 80 similar ACP patients. The pre- and intra-operative characteristics were not significantly different between the 2 groups after matching. No differences were found in 30-day/in-hospital mortality or morbidity outcomes. The only significant difference between the 2 groups was a shorter mean operative time in the RCP cohort (P = .01). No significant differences were noted in late survival (P = .90). Conclusions In proximal arch operations using DHCA, equivalent early and late outcomes can be achieved with RCP and ACP, although the mean operative time is significantly less with RCP, likely owing to avoidance of axillary cannulation. Questions remain regarding comparative outcomes with straight DHCA and lesser degrees of hypothermia. PMID:24908350

A real-time control framework for urban water reservoirs operation

NASA Astrophysics Data System (ADS)

Galelli, S.; Goedbloed, A.; Schwanenberg, D.

2012-04-01

Drinking water demand in urban areas is growing parallel to the worldwide urban population, and it is acquiring an increasing part of the total water consumption. Since the delivery of sufficient water volumes in urban areas represents a difficult logistic and economical problem, different metropolitan areas are evaluating the opportunity of constructing relatively small reservoirs within urban areas. Singapore, for example, is developing the so-called 'Four National Taps Strategies', which detects the maximization of water yields from local, urban catchments as one of the most important water sources. However, the peculiar location of these reservoirs can provide a certain advantage from the logistical point of view, but it can pose serious difficulties in their daily management. Urban catchments are indeed characterized by large impervious areas: this results in a change of the hydrological cycle, with decreased infiltration and groundwater recharge, and increased patterns of surface and river discharges, with higher peak flows, volumes and concentration time. Moreover, the high concentrations of nutrients and sediments characterizing urban discharges can cause further water quality problems. In this critical hydrological context, the effective operation of urban water reservoirs must rely on real-time control techniques, which can exploit hydro-meteorological information available in real-time from hydrological and nowcasting models. This work proposes a novel framework for the real-time control of combined water quality and quantity objectives in urban reservoirs. The core of this framework is a non-linear Model Predictive Control (MPC) scheme, which employs the current state of the system, the future discharges furnished by a predictive model and a further model describing the internal dynamics of the controlled sub-system to determine an optimal control sequence over a finite prediction horizon. The main advantage of this scheme stands in its reduced computational requests and the capability of exploiting real-time hydro-meteorological information, which are crucial for an effective operation of these fast-varying hydrological systems. The framework is here demonstrated on the operation of Marina Reservoir (Singapore), whose recent construction in late 2008 increased the effective catchment area to about 50% of the total available. Its operation, which accounts for drinking water supply, flash floods control and water quality standards, is here designed by combining the MPC scheme with the process-based hydrological model SOBEK. Extensive simulation experiments show the validity of the proposed framework.

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

PubMed

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

2011-03-01

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

Advanced solar irradiances applied to satellite and ionospheric operational systems

NASA Astrophysics Data System (ADS)

Tobiska, W. Kent; Schunk, Robert; Eccles, Vince; Bouwer, Dave

Satellite and ionospheric operational systems require solar irradiances in a variety of time scales and spectral formats. We describe the development of a system using operational grade solar irradiances that are applied to empirical thermospheric density models and physics-based ionospheric models used by operational systems that require a space weather characterization. The SOLAR2000 (S2K) and SOLARFLARE (SFLR) models developed by Space Environment Technologies (SET) provide solar irradiances from the soft X-rays (XUV) through the Far Ultraviolet (FUV) spectrum. The irradiances are provided as integrated indices for the JB2006 empirical atmosphere density models and as line/band spectral irradiances for the physics-based Ionosphere Forecast Model (IFM) developed by the Space Environment Corporation (SEC). We describe the integration of these irradiances in historical, current epoch, and forecast modes through the Communication Alert and Prediction System (CAPS). CAPS provides real-time and forecast HF radio availability for global and regional users and global total electron content (TEC) conditions.

[Malignant ovarian tumors and second look operations].

PubMed

Yasuda, M

1983-08-01

There are many problems that, the timing of S.L.O. the range of reduction, and side effects etc., we studied retrospectively for the S.L.O. The number of subjects were 302 of common epithelial and 251 of germinal cell tumors, totalling 553 cases. Among them, 41 cases were common epithelial and 49 cases germ cell origine respectively, totalling 90 cases of S.L.O. were carried out. Conclusion The 5 year survival rate of S.L.O. was observed to a significant extent. The mean survival time of S.L.O. group: were significantly prolonged. Complete surgery at the S.L.O. of the patient with epithelial and germinal affected the survival rate significantly.

Energy Security Threats

DTIC Science & Technology

2011-06-01

continued  although  there  were  equally  ambitious  programs  to  develop nuclear powered submarines at the same time. The first  reactor  capable  of...new plants.13 The  construction  of  new  reactors  has continued periodically since  that  time such  that at  the end of  2009  total  global  nuclear...electrical  generation  capacity  totalled  370  giga watts  (electric)  (GW(e))  spread  amongst  437  operational  reactors .14  According  to

OUTCOME OF LAPAROSCOPIC TOTALLY EXTRAPERITONEAL HERNIOPLASTY FOR INGUINAL HERNIA.

PubMed

Hanif, Hammad; Memon, Sohail Ahmed

2015-01-01

Hernioplasty for Inguinal hernia is one of the commonest operations performed in general surgical wards. More recently, interest has waxed and waned regarding the minimally invasive approach to hernioplasty. This study was carried out to assess the management outcome of minimally invasive hernioplasty (Totally extra-peritoneal approach) as the treatment of choice for uncomplicated (incomplete and reducible) inguinal hernia. In this quasi experimental study patients aged between 14-83 years who were otherwise fit and willing for total extra-peritoneal laparoscopic repair were recruited prospectively over a 10 month period. Thirty-seven such patients were operated and followed up in the hernia clinics. Six cases were later excluded for lack of proper follow-up. The typical patient was middle-aged male with right-sided inguinal hernia. Mean operating time was 53.3 minutes. No conversion was undertaken; however, there was one case of small bowel injury that went unrecognized on-table but necessitated subsequent laparotomy. Overall morbidity was 13.5%. Mean length of hospitalization was 2.89 days. Mean duration to normal routine life was 9.25 days. Overall, 70.9% of patients expressed satisfaction with the surgery. Totally extra-peritoneal mesh repair is a new and safe technique for hernioplasty with acceptable rates of morbidity and it is procedure of choice for recurrent and bilateral inguinal hernias and also used as alternate to open hernioplasty for uncomplicated (incomplete and reducible) inguinal herma.

Total body photography for skin cancer screening.

PubMed

Dengel, Lynn T; Petroni, Gina R; Judge, Joshua; Chen, David; Acton, Scott T; Schroen, Anneke T; Slingluff, Craig L

2015-11-01

Total body photography may aid in melanoma screening but is not widely applied due to time and cost. We hypothesized that a near-simultaneous automated skin photo-acquisition system would be acceptable to patients and could rapidly obtain total body images that enable visualization of pigmented skin lesions. From February to May 2009, a study of 20 volunteers was performed at the University of Virginia to test a prototype 16-camera imaging booth built by the research team and to guide development of special purpose software. For each participant, images were obtained before and after marking 10 lesions (five "easy" and five "difficult"), and images were evaluated to estimate visualization rates. Imaging logistical challenges were scored by the operator, and participant opinion was assessed by questionnaire. Average time for image capture was three minutes (range 2-5). All 55 "easy" lesions were visualized (sensitivity 100%, 90% CI 95-100%), and 54/55 "difficult" lesions were visualized (sensitivity 98%, 90% CI 92-100%). Operators and patients graded the imaging process favorably, with challenges identified regarding lighting and positioning. Rapid-acquisition automated skin photography is feasible with a low-cost system, with excellent lesion visualization and participant acceptance. These data provide a basis for employing this method in clinical melanoma screening. © 2014 The International Society of Dermatology.

Intraoperative and postoperative feasibility and safety of total tubeless, tubeless, small-bore tube, and standard percutaneous nephrolithotomy: a systematic review and network meta-analysis of 16 randomized controlled trials.

PubMed

Lee, Joo Yong; Jeh, Seong Uk; Kim, Man Deuk; Kang, Dong Hyuk; Kwon, Jong Kyou; Ham, Won Sik; Choi, Young Deuk; Cho, Kang Su

2017-06-27

Percutaneous nephrolithotomy (PCNL) is performed to treat relatively large renal stones. Recent publications indicate that tubeless and total tubeless (stentless) PCNL is safe in selected patients. We performed a systematic review and network meta-analysis to evaluate the feasibility and safety of different PCNL procedures, including total tubeless, tubeless with stent, small-bore tube, and large-bore tube PCNLs. PubMed, Cochrane Central Register of Controlled Trials, and EMBASE™ databases were searched to identify randomized controlled trials published before December 30, 2013. One researcher examined all titles and abstracts found by the searches. Two investigators independently evaluated the full-text articles to determine whether those met the inclusion criteria. Qualities of included studies were rated with Cochrane's risk-of-bias assessment tool. Sixteen studies were included in the final syntheses including pairwise and network meta-analyses. Operation time, pain scores, and transfusion rates were not significantly different between PCNL procedures. Network meta-analyses demonstrated that for hemoglobin changes, total tubeless PCNL may be superior to standard PCNL (mean difference [MD] 0.65, 95% CI 0.14-1.13) and tubeless PCNLs with stent (MD -1.14, 95% CI -1.65--0.62), and small-bore PCNL may be superior to tubeless PCNL with stent (MD 1.30, 95% CI 0.27-2.26). Network meta-analyses also showed that for length of hospital stay, total tubeless (MD 1.33, 95% CI 0.23-2.43) and tubeless PCNLs with stent (MD 0.99, 95% CI 0.19-1.79) may be superior to standard PCNL. In rank probability tests, small-bore tube and total tubeless PCNLs were superior for operation time, pain scores, and hemoglobin changes. For hemoglobin changes, total tubeless and small-bore PCNLs may be superior to other methods. For hospital stay, total tubeless and tubeless PCNLs with stent may be superior to other procedures.

Impact of pharmacist intervention on antibiotic use and prophylactic antibiotic use in urology clean operations.

PubMed

Zhou, Y; Ma, L-Y; Zhao, X; Tian, S-H; Sun, L-Y; Cui, Y-M

2015-08-01

The use of prophylactic antibiotics in clean operations was routine in China before 2011. Along with the appeal for using antibiotics rationally by WHO in 2011, China launched a national special rectification scheme on clinical use of antibiotics from April that year. The scheme, aimed at achieving rational use of antibiotics, made pharmacists part of the responsible medical team. Our objective was to describe the impacts of pharmacist intervention on the use of antibiotics, particularly in urology clean operations. Pharmacists participated in antibiotic stewardship programmes of the hospital and urological clinical work and conducted real-time interventions at the same time from 2011 to 2013. Data on the use of antibiotics between 2010 and 2013 in urology were collected. Comparison of the 2013 data with those of 2010 showed that antibiotic use density [AUD= DDDs*100/(The number of patients who were treated the same period*Average days in hospital). DDDs = Total drug consumption (g)/DDD. DDD is the Defined Daily Dose] decreased by 57·8(58·8%); average antibiotic cost decreased by 246·94 dollars; the cost of antibiotics as a percentage of total drug cost decreased by 27·7%; the rate of use of antibiotics decreased from 100% to 7·3%. The study illustrates how an antibiotic stewardship programme with pharmacist participation including real-time interventions can promote improved antibiotic-prescribing and significantly decrease costs. © 2015 John Wiley & Sons Ltd.

Monitoring Space Radiation Hazards with the Responsive Environmental Assessment Commercially Hosted (REACH) Project

NASA Astrophysics Data System (ADS)

Mazur, J. E.; Guild, T. B.; Crain, W.; Crain, S.; Holker, D.; Quintana, S.; O'Brien, T. P., III; Kelly, M. A.; Barnes, R. J.; Sotirelis, T.

2017-12-01

The Responsive Environmental Assessment Commercial Hosting (REACH) project uses radiation dosimeters on a commercial satellite constellation in low Earth orbit to provide unprecedented spatial and time sampling of space weather radiation hazards. The spatial and time scales of natural space radiation environments coupled with constraints for the hosting accommodation drove the instrumentation requirements and the plan for the final orbital constellation. The project has delivered a total of thirty two radiation dosimeter instruments for launch with each instrument containing two dosimeters with different passive shielding and electronic thresholds to address proton-induced single-event effects, vehicle charging, and total ionizing dose. There are two REACH instruments currently operating with four more planned for launch by the time of the 2017 meeting. Our aim is to field a long-lived system of highly-capable radiation detectors to monitor the hazards of single-event effects, total ionizing dose, and spacecraft charging with maximized spatial coverage and with minimal time latency. We combined a robust detection technology with a commercial satellite hosting to produce a new demonstration for satellite situational awareness and for other engineering and science applications.

Impact of nowcasting on the production and processing of agricultural crops. [in the US

NASA Technical Reports Server (NTRS)

Dancer, W. S.; Tibbitts, T. W.

1973-01-01

The value was studied of improved weather information and weather forecasting to farmers, growers, and agricultural processing industries in the United States. The study was undertaken to identify the production and processing operations that could be improved with accurate and timely information on changing weather patterns. Estimates were then made of the potential savings that could be realized with accurate information about the prevailing weather and short term forecasts for up to 12 hours. This weather information has been termed nowcasting. The growing, marketing, and processing operations of the twenty most valuable crops in the United States were studied to determine those operations that are sensitive to short-term weather forecasting. Agricultural extension specialists, research scientists, growers, and representatives of processing industries were consulted and interviewed. The value of the crops included in this survey and their production levels are given. The total value for crops surveyed exceeds 24 billion dollars and represents more than 92 percent of total U.S. crop value.

Reducing Operating Room Costs Through Real-Time Cost Information Feedback: A Pilot Study.

PubMed

Tabib, Christian H; Bahler, Clinton D; Hardacker, Thomas J; Ball, Kevin M; Sundaram, Chandru P

2015-08-01

To create a protocol for providing real-time operating room (OR) cost feedback to surgeons. We hypothesize that this protocol will reduce costs in a responsible way without sacrificing quality of care. All OR costs were obtained and recorded for robot-assisted partial nephrectomy and laparoscopic donor nephrectomy. Before the beginning of this project, costs pertaining to the 20 most recent cases were analyzed. Items were identified from previous cases as modifiable for replacement or omission. Timely feedback of total OR costs and cost of each item used was provided to the surgeon after each case, and costs were analyzed. A cost analysis of the robot-assisted partial nephrectomy before the washout period indicates expenditures of $5243.04 per case. Ten recommended modifiable items were found to have an average per case cost of $1229.33 representing 23.4% of the total cost. A postwashout period cost analysis found the total OR cost decreased by $899.67 (17.2%) because of changes directly related to the modifiable items. Therefore, 73.2% of the possible identified savings was realized. The same stepwise approach was applied to laparoscopic donor nephrectomies. The average total cost per case before the washout period was $3530.05 with $457.54 attributed to modifiable items. After the washout period, modifiable items costs were reduced by $289.73 (8.0%). No complications occurred in the donor nephrectomy cases while one postoperative complication occurred in the partial nephrectomy group. Providing surgeons with feedback related to OR costs may lead to a change in surgeon behavior and decreased overall costs. Further studies are needed to show equivalence in patient outcomes.

Accurate low-dose iterative CT reconstruction from few projections by Generalized Anisotropic Total Variation minimization for industrial CT.

PubMed

Debatin, Maurice; Hesser, Jürgen

2015-01-01

Reducing the amount of time for data acquisition and reconstruction in industrial CT decreases the operation time of the X-ray machine and therefore increases the sales. This can be achieved by reducing both, the dose and the pulse length of the CT system and the number of projections for the reconstruction, respectively. In this paper, a novel generalized Anisotropic Total Variation regularization for under-sampled, low-dose iterative CT reconstruction is discussed and compared to the standard methods, Total Variation, Adaptive weighted Total Variation and Filtered Backprojection. The novel regularization function uses a priori information about the Gradient Magnitude Distribution of the scanned object for the reconstruction. We provide a general parameterization scheme and evaluate the efficiency of our new algorithm for different noise levels and different number of projection views. When noise is not present, error-free reconstructions are achievable for AwTV and GATV from 40 projections. In cases where noise is simulated, our strategy achieves a Relative Root Mean Square Error that is up to 11 times lower than Total Variation-based and up to 4 times lower than AwTV-based iterative statistical reconstruction (e.g. for a SNR of 223 and 40 projections). To obtain the same reconstruction quality as achieved by Total Variation, the projection number and the pulse length, and the acquisition time and the dose respectively can be reduced by a factor of approximately 3.5, when AwTV is used and a factor of approximately 6.7, when our proposed algorithm is used.

Surgeon and hospital cost variability for septoplasty and inferior turbinate reduction.

PubMed

Thomas, Andrew; Alt, Jeremiah; Gale, Craig; Vijayakumar, Sathya; Padia, Reema; Peters, Matthew; Champagne, Trevor; Meier, Jeremy D

2016-10-01

Septoplasty and turbinate reduction (STR) is a common procedure for which cost reduction efforts may improve value. The purpose of this study was to identify sources of variation in medical facility and surgeon costs associated with STR, and whether these costs correlated with short-term complications. An observational cohort study was performed in a multifacility network using a standardized cost-accounting system to determine costs associated with adult STR from January 1, 2008 to July 31, 2015. A total of 4007 cases, performed at 21 facilities, by 72 different surgeons were included in the study. Total costs, variable costs, operating room (OR) time, and 30-day complications (eg, epistaxis) were compared among surgeons, facilities, and specialties. Total procedure cost: (mean ± standard deviation [SD]) $2503 ± $790 (range, $852 to $10,559). Mean total variable cost: $1147 ± $423 (range, $400 to $5,081). Intersurgeon and interfacility variability was significant for total cost (p < 0.0001) and OR time (p < 0.0001). Intersurgeon OR supply cost variability was also significant (p < 0.0001). Otolaryngologists had less total cost (p < 0.0001), OR time/cost (p < 0.0001), and complications (p = 0.0164), but greater supply cost (p < 0.0001), than other specialties. There is wide variation in cost associated with STR. Significant variance in OR time and supply cost between surgeons suggests these are potential areas for cost reduction. Although no increased 30-day complications were seen with faster and less costly surgeries, further research is needed to evaluate how time and cost relate to quality of care. © 2016 ARS-AAOA, LLC.

Does circumpatellar electrocautery improve the outcome after total knee replacement?: a prospective, randomised, blinded controlled trial.

PubMed

Baliga, S; McNair, C J; Barnett, K J; MacLeod, J; Humphry, R W; Finlayson, D

2012-09-01

The incidence of anterior knee pain following total knee replacement (TKR) is reported to be as high as 49%. The source of the pain is poorly understood but the soft tissues around the patella have been implicated. In theory circumferential electrocautery denervates the patella thereby reducing efferent pain signals. However, there is mixed evidence that this practice translates into improved outcomes. We aimed to investigate the clinical effect of intra-operative circumpatellar electrocautery in patients undergoing TKR using the LCS mobile bearing or Kinemax fixed bearing TKR. A total of 200 patients were randomised to receive either circumpatellar electrocautery (diathermy) or not (control). Patients were assessed by visual analogue scale (VAS) for anterior knee pain and Oxford knee score (OKS) pre-operatively and three months, six months and one year post-operatively. Patients and assessors were blinded. There were 91 patients in the diathermy group and 94 in the control. The mean VAS improvement at one year was 3.9 in both groups (control; -10 to 6, diathermy; -9 to 8, p < 0.001 in both cases, paired, two-tailed t-test). There was no significant difference in VAS between the groups at any other time. The mean OKS improvement was 17.7 points (0 to 34) in the intervention group and 16.6 (0 to 42) points in the control (p = 0.36). There was no significant difference between the two groups in OKS at any other time. We found no relevant effect of patellar electrocautery on either VAS anterior knee pain or OKS for patients undergoing LCS and Kinemax TKR.

Infection and Rerupture After Surgical Repair of Achilles Tendons

PubMed Central

Jildeh, Toufic R.; Okoroha, Kelechi R.; Marshall, Nathan E.; Abdul-Hak, Abraham; Zeni, Ferras; Moutzouros, Vasilios

2018-01-01

Background: Surgical repair of an Achilles tendon rupture has been shown to decrease rerupture rates. However, surgery also increases the risk of complications, including infection. Purpose: To determine the risk factors for infection and rerupture after primary repair of Achilles tendon ruptures. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective review was performed on 423 patients who underwent operative treatment of Achilles tendon ruptures between the years 2008 and 2014. The primary outcome of interest was the total rate of infection, and the secondary outcome of interest was the incidence of rerupture within 2 years of operation. Results: A total of 423 patients were analyzed, with a mean age of 46 years (range, 16-83 years) and a mean body mass index of 31.4 kg/m2 (range, 17-55 kg/m2). The overall infection rate was 2.8%, and the rerupture rate was 1%. The median time between surgery and superficial surgical site infection was 30 days, and the median time between surgery and rerupture was 38 days. Longer tourniquet times (100.3 ± 34.7 minutes vs 69.9 ± 21.4 minutes; P = .04) and greater estimated blood loss (15.0 ± 9.1 mL vs 5.1 ± 12.0 mL; P = .01) were associated with an increased rate of deep surgical site infections. Patients who had longer operation and tourniquet times trended toward higher rerupture rates (P = .06 and .08, respectively). When compared with nonsmokers, current and previous smokers had an increased incidence of superficial or deep surgical site infections (6.25% vs 1.42%; P = .02). Age, sex, race, body mass index, alcohol use, diabetes, past steroid injections, and mechanism of injury did not contribute to complication rates. Conclusion: Achilles tendon repairs were associated with a low risk of infection and rerupture. Patients with longer tourniquet times, higher estimated blood loss, and a history of smoking were at increased risk for surgical site infections. Patients with longer operative times had increased rates of rerupture. PMID:29854862

A Prospective Comparison of Robotic and Laparoscopic Pyeloplasty

PubMed Central

Link, Richard E.; Bhayani, Sam B.; Kavoussi, Louis R.

2006-01-01

Objective: To determine whether robotic-assisted pyeloplasty (RLP) has any significant clinical or cost advantages over laparoscopic pyeloplasty (LP) for surgeons already facile with intracorporeal suturing. Summary Background Data: LP has become an established management approach for primary ureteropelvic junction obstruction. More recently, the da Vinci robot has been applied to this procedure (RLP) in an attempt to shorten the learning curve. Whether RLP provides any significant advantage over LP for the experienced laparoscopist remains unclear. Methods: Ten consecutive cases each of transperitoneal RLP and LP performed by a single surgeon were compared prospectively with respect to surgical times and perioperative outcomes. Cost assessment was performed by sensitivity analysis using a mathematical cost model incorporating operative time, anesthesia fees, consumables, and capital equipment depreciation. Results: The RLP and LP groups had statistically indistinguishable demographics, pathology, and similar perioperative outcomes. Mean operative and total room time for RLP was significantly longer than LP by 19.5 and 39.0 minutes, respectively. RLP was much more costly than LP (2.7 times), due to longer operative time, increased consumables costs, and depreciation of the costly da Vinci system. However, even if depreciation was eliminated, RLP was still 1.7 times as costly as LP. One-way sensitivity analysis showed that LP operative time must increase to almost 6.5 hours for it to become cost equivalent to RLP. Conclusions: For the experienced laparoscopist, application of the da Vinci robot resulted in no significant clinical advantage and added substantial cost to transperitoneal laparoscopic dismembered pyeloplasty. PMID:16552199

A prospective comparison of robotic and laparoscopic pyeloplasty.

PubMed

Link, Richard E; Bhayani, Sam B; Kavoussi, Louis R

2006-04-01

To determine whether robotic-assisted pyeloplasty (RLP) has any significant clinical or cost advantages over laparoscopic pyeloplasty (LP) for surgeons already facile with intracorporeal suturing. LP has become an established management approach for primary ureteropelvic junction obstruction. More recently, the da Vinci robot has been applied to this procedure (RLP) in an attempt to shorten the learning curve. Whether RLP provides any significant advantage over LP for the experienced laparoscopist remains unclear. Ten consecutive cases each of transperitoneal RLP and LP performed by a single surgeon were compared prospectively with respect to surgical times and perioperative outcomes. Cost assessment was performed by sensitivity analysis using a mathematical cost model incorporating operative time, anesthesia fees, consumables, and capital equipment depreciation. The RLP and LP groups had statistically indistinguishable demographics, pathology, and similar perioperative outcomes. Mean operative and total room time for RLP was significantly longer than LP by 19.5 and 39.0 minutes, respectively. RLP was much more costly than LP (2.7 times), due to longer operative time, increased consumables costs, and depreciation of the costly da Vinci system. However, even if depreciation was eliminated, RLP was still 1.7 times as costly as LP. One-way sensitivity analysis showed that LP operative time must increase to almost 6.5 hours for it to become cost equivalent to RLP. For the experienced laparoscopist, application of the da Vinci robot resulted in no significant clinical advantage and added substantial cost to transperitoneal laparoscopic dismembered pyeloplasty.

The 1987 Airborne Antarctic Ozone Experiment: the Nimbus-7 TOMS Data Atlas

NASA Technical Reports Server (NTRS)

Krueger, Arlin J.; Ardanuy, Philip E.; Sechrist, Frank S.; Penn, Lanning M.; Larko, David E.; Doiron, Scott D.; Galimore, Reginald N.

1988-01-01

Total ozone data taken by the Nimbus-7 Total Ozone Mapping Spectrometer (TOMS) played a central role in the successful outcome of the 1987 Airborne Antarctic Ozone Experiment. The near-real-time TOMS total ozone observations were suppled within hours of real time to the operations center in Punta Arenas, Chile, over a telecommunications network designed specifically for this purpose. The TOMS data preparation and method of transfer over the telecommunications links are reviewed. This atlas includes a complete set of the near-real-time TOMS orbital overpass data over regions around the Palmer Peninsula of Antarctica for the period of August 8 through September 29, 1987. Also provided are daily polar orthographic projections of TOMS total ozone measurements over the Southern Hemisphere from August through November 1987. In addition, a chronology of the salient points of the experiment, along with some latitudinal cross sections and time series at locations of interest of the TOMS total ozone observations are presented. The TOMS total ozone measurements are evaluated along the flight tracks of each of the ER-2 and DC-8 missions during the experiment. The ozone hole is shown here to develop in a monotonic progression throughout late August and September. The minimum total ozone amount was found on 5 October, when its all-time lowest value of 109 DU is recorded. The hole remains well defined, but fills gradually from mid-October through mid-November. The hole's dissolution is observed here to begin in mid-November, when it elongates and begins to rotate. By the end of November, the south pole is no longer located within the ozone hole.

Application of modified R.E.N.A.L. nephrometry score system in evaluating the retroperitoneal partial nephrectomy for T1 renal cell carcinoma.

PubMed

Wang, Qinzhang; Qian, Biao; Li, Qiang; Ni, Zhao; Li, Yinglong; Wang, Xinmin

2015-01-01

This study aims to investigate the application of the modified R.E.N.A.L. nephrometry score system in evaluating the operation difficulty of retroperitoneal partial nephrectomy in T1 renal cell carcinoma patients. A total of 52 patients with T1 renal cell carcinoma were enrolled. They all had retroperitoneal partial nephrectomy. Their clinical data was retrospectively analyzed. R.E.N.A.L. nephrometry score system was modified based on the features of retroperitoneal partial nephrectomy. The specificity, sensitivity and Youden index were compared between R.E.N.A.L. nephrometry score system and the modified R.E.N.A.L. nephrometry score system. The effect of the modified R.E.N.A.L. nephrometry score system on perioperative outcomes was analyzed. Three degrees of operation difficulty were defined by the modified R.E.N.A.L. nephrometry score system, which included the low, medium and high degree of operation difficulty. The specificity, sensitivity and Youden index of the modified R.E.N.A.L. nephrometry score system were better than those of the original R.E.N.A.L. nephrometry score system. Compared with low degree of operation difficulty, patients with medium and high degree of operation difficulty had significantly higher levels of operative time, warm ischemia time, and intraoperative blood loss (P < 0.05). And, the levels of operative time, warm ischemia time, and intraoperative blood loss in patients with high degree were significantly higher than those in patients with medium degree (P < 0.05). The modified R.E.N.A.L. nephrometry score system has a good effect in evaluating the operation difficulty of retroperitoneal partial nephrectomy.

Infiltration with lidocaine and adrenaline instead of normal saline does not improve the septoplasty procedure.

PubMed

Gungor, Volkan; Baklaci, Deniz; Kum, Rauf Oguzhan; Yilmaz, Yavuz Fuat; Ozcan, Muge; Unal, Adnan

2016-08-01

The aim of this study was to determine whether infiltration of local anesthetics with adrenaline improved septoplasty procedure when compared to normal saline. Eight-two patients undergoing septoplasty were randomized into two groups. In group 1, septal mucoperichondrium was infiltrated with lidocaine with adrenaline, and normal saline was used in group 2. Presence of intra-operative septal mucosal injuries, the amount of bleeding, arterial blood pressure, operation time as well as the quality of the surgical field and the convenience of finding the correct surgical plane as determined by the surgeon using a 5-point scale were compared between two groups. There were no significant differences for the amount of blood loss, mean arterial pressure, operation time, or scores for convenience of finding the correct surgical plane between the two groups. There was no significant difference for intra-operative simple (P = 0.631) and total (simple+severe) (P = 0.649) septal mucoperichondrial injuries between groups 1 and 2, either. However, severe mucoperichondrial injury rate was higher in the patients infiltrated with lidocaine and adrenaline (P = 0.026), and the quality of the surgical field was worse in the patients injected with normal saline (P = 0.0179). Infiltration of septal mucoperichondrium with lidocaine and adrenaline instead of normal saline was not advantageous in terms of objective parameters tested, including bleeding amount and duration of surgery as well as the of the total mucosal injury rate in septoplasty procedure.

A robust and non-obtrusive automatic event tracking system for operating room management to improve patient care.

PubMed

Huang, Albert Y; Joerger, Guillaume; Salmon, Remi; Dunkin, Brian; Sherman, Vadim; Bass, Barbara L; Garbey, Marc

2016-08-01

Optimization of OR management is a complex problem as each OR has different procedures throughout the day inevitably resulting in scheduling delays, variations in time durations and overall suboptimal performance. There exists a need for a system that automatically tracks procedural progress in real time in the OR. This would allow for efficient monitoring of operating room states and target sources of inefficiency and points of improvement. We placed three wireless sensors (floor-mounted pressure sensor, ventilator-mounted bellows motion sensor and ambient light detector, and a general room motion detector) in two ORs at our institution and tracked cases 24 h a day for over 4 months. We collected data on 238 total cases (107 laparoscopic cases). A total of 176 turnover times were also captured, and we found that the average turnover time between cases was 35 min while the institutional goal was 30 min. Deeper examination showed that 38 % of laparoscopic cases had some aspect of suboptimal activity with the time between extubation and patient exiting the OR being the biggest contributor (16 %). Our automated system allows for robust, wireless real-time OR monitoring as well as data collection and retrospective data analyses. We plan to continue expanding our system and to project the data in real time for all OR personnel to see. At the same time, we plan on adding key pieces of technology such as RFID and other radio-frequency systems to track patients and physicians to further increase efficiency and patient safety.

Outcome of total knee replacement following explantation and cemented spacer therapy.

PubMed

Ghanem, Mohamed; Zajonz, Dirk; Bollmann, Juliane; Geissler, Vanessa; Prietzel, Torsten; Moche, Michael; Roth, Andreas; Heyde, Christoph-E; Josten, Christoph

2016-01-01

Infection after total knee replacement (TKR) is one of the serious complications which must be pursued with a very effective therapeutic concept. In most cases this means revision arthroplasty, in which one-setting and two-setting procedures are distinguished. Healing of infection is the conditio sine qua non for re-implantation. This retrospective work presents an assessment of the success rate after a two-setting revision arthroplasty of the knee following periprosthetic infection. It further considers drawing conclusions concerning the optimal timing of re-implantation. A total of 34 patients have been enclosed in this study from September 2005 to December 2013. 35 re-implantations were carried out following explantation of total knee and implantation of cemented spacer. The patient's group comprised of 53% (18) males and 47% (16) females. The average age at re-implantation time was 72.2 years (ranging from 54 to 85 years). We particularly evaluated the microbial spectrum, the interval between explantation and re-implantation, the number of surgeries that were necessary prior to re-implantation as well as the postoperative course. We reported 31.4% (11) reinfections following re-implantation surgeries. The number of the reinfections declined with increasing time interval between explantation and re-implantation. Patients who developed reinfections were operated on (re-implantation) after an average of 4.47 months. Those patients with uncomplicated course were operated on (re-implantation) after an average of 6.79 months. Nevertheless, we noticed no essential differences in outcome with regard to the number of surgeries carried out prior to re-implantation. Mobile spacers proved better outcome than temporary arthrodesis with intramedullary fixation. No uniform strategy of treatment exists after peri-prosthetic infections. In particular, no optimal timing can be stated concerning re-implantation. Our data point out to the fact that a longer time interval between explantation and re-implantation reduces the rate of reinfection. From our point of view, the optimal timing for re-implantation depends on various specific factors and therefore it should be defined individually.

Outcome of total knee replacement following explantation and cemented spacer therapy

PubMed Central

Ghanem, Mohamed; Zajonz, Dirk; Bollmann, Juliane; Geissler, Vanessa; Prietzel, Torsten; Moche, Michael; Roth, Andreas; Heyde, Christoph-E.; Josten, Christoph

2016-01-01

Background: Infection after total knee replacement (TKR) is one of the serious complications which must be pursued with a very effective therapeutic concept. In most cases this means revision arthroplasty, in which one-setting and two-setting procedures are distinguished. Healing of infection is the conditio sine qua non for re-implantation. This retrospective work presents an assessment of the success rate after a two-setting revision arthroplasty of the knee following periprosthetic infection. It further considers drawing conclusions concerning the optimal timing of re-implantation. Patients and methods: A total of 34 patients have been enclosed in this study from September 2005 to December 2013. 35 re-implantations were carried out following explantation of total knee and implantation of cemented spacer. The patient’s group comprised of 53% (18) males and 47% (16) females. The average age at re-implantation time was 72.2 years (ranging from 54 to 85 years). We particularly evaluated the microbial spectrum, the interval between explantation and re-implantation, the number of surgeries that were necessary prior to re-implantation as well as the postoperative course. Results: We reported 31.4% (11) reinfections following re-implantation surgeries. The number of the reinfections declined with increasing time interval between explantation and re-implantation. Patients who developed reinfections were operated on (re-implantation) after an average of 4.47 months. Those patients with uncomplicated course were operated on (re-implantation) after an average of 6.79 months. Nevertheless, we noticed no essential differences in outcome with regard to the number of surgeries carried out prior to re-implantation. Mobile spacers proved better outcome than temporary arthrodesis with intramedullary fixation. Conclusion: No uniform strategy of treatment exists after peri-prosthetic infections. In particular, no optimal timing can be stated concerning re-implantation. Our data point out to the fact that a longer time interval between explantation and re-implantation reduces the rate of reinfection. From our point of view, the optimal timing for re-implantation depends on various specific factors and therefore it should be defined individually. PMID:27066391

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

PubMed

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

2002-09-01

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

Computer-designed surgical guide template compared with free-hand operation for mesiodens extraction in premaxilla using “trapdoor” method

PubMed Central

Hu, Ying Kai; Xie, Qian Yang; Yang, Chi; Xu, Guang Zhou

2017-01-01

Abstract The aim of this study was to introduce a novel method of mesiodens extraction using a vascularized pedicled bone flap by piezosurgery and to compare the differences between a computer-aided design surgical guide template and free-hand operation. A total of 8 patients with mesiodens, 4 with a surgical guide (group I), and 4 without it (group II) were included in the study. The surgical design was to construct a trapdoor pedicle on the superior mucoperiosteal attachment with application of piezosurgery. The bone lid was repositioned after mesiodens extraction. Group I patients underwent surgeries based on the preoperative planning with surgical guide templates, while group II patients underwent free-hand operation. The outcome variables were success rate, intraoperative time, anterior nasal spine (ANS) position, changes of nasolabial angle (NLA), and major complications. Data from the 2 groups were compared by SPSS 17.0, using Wilcoxon test. The operative time was significantly shorter in group I patients. All the mesiodentes were extracted successfully and no obvious differences of preoperative and postoperative ANS position and NLA value were found in both groups. The patients were all recovered uneventfully. Surgical guide templates can enhance clinical accuracy and reduce operative time by facilitating accurate osteotomies. PMID:28658139

[Comparative study of three bonding methods in attaching removable thermoplastic appliances].

PubMed

Chu, Kejia; Wang, Haihui; Zheng, Zhijun; Li, Qi

2015-10-01

To evaluate the operation time and clinical effect of three types of materials (i.e., total-etching adhesive, self-etching adhesive, resin-modified glass ionomer cement) that are used to bond removable thermoplastic appliances. Thirty malocclusion patients (156 attachments) with removable thermoplastic appliances were randomly divided into three groups, with 10 individuals each. Attachments of groups A and B were bonded using 3M Adper Single Bond 2 and 3M Adper Easy One, respectively; both adhesives utilized 3M Z350 nano composite resin. Attachments of group C was directly bonded using GC Fuji Ortho LC. The operation time of each attachment was recorded. Failure rates of adhesion were evaluated during adhesion, 1 month after treatment, and 6 months after treatment. The operation time of group C was shorter than those of groups A and B (P<0.01). Significant difference of adhesion failure rates was not found among the three groups (P>0.05). No significant difference of adhesion failure rates was also observed in different times of the same group (P>0.05). The attachment stability of the three types of materials achieved satisfactory effects. However, the operation method of resin-modified glass ionomer cement is more concise and suitable for clinical promotion.

Translating evidence-based protocol of wound drain management for total joint arthroplasty into practice: A quasi-experimental study.

PubMed

Tsang, Lap Fung; Cheng, Hang Cheong; Ho, Hon Shuen; Hsu, Yung Chak; Chow, Chiu Man; Law, Heung Wah; Fong, Lup Chau; Leung, Lok Ming; Kong, Ivy Ching Yan; Chan, Chi Wai; Sham, Alice So Yuen

2016-05-01

Although various drains have long been used in total joint replacement, evidence suggests inconsistent practice exists in the use of drainage systems including intermittently applying suction or free of drainage suction, and variations in the optimal timing for wound drain removal. A comprehensive systematic review of available evidence up to 2013 was conducted in a previous study and a protocol was adapted for clinical application according to the summary of the retrieved information (Tsang, 2015). To determine if the protocol could reduce blood loss and blood transfusion after operation and to develop a record form so as to enhance communication of drainage record amongst surgeons and nurses. A quasi-experimental time-series design was undertaken. In the conventional group, surgeons ordered free drainage if the drain output was more than 300 ml. The time of removal of the drain was based on their professional judgement. In the protocol group the method of drainage was dependant of the drainage output as was the timing of the removal of the drain. A standardized record form was developed to guide operating room and orthopaedic ward nurses to manage the drainage system. The drain was removed significantly earlier in the protocol group. Blood loss rate at the first hour of post-operation was extremely low in the protocol group due to clamping effect. Blood loss in volume during the first three hours in the protocol group was significantly lower than that in the conventional group. Only in 11.1% and 4% of cases was it necessary to clamp at the three and four hour post-operative hours. No clamping was required at the two and eight hour postoperative period. There was no significant difference in blood loss during the removal of the drain and during blood transfusion, which was required for patients upon removal of the drain in the two groups. This is the first clinical study to develop an evidence-based protocol to manage wound drain effectively in Hong Kong. Total blood loss and blood transfusions were not significantly different between the conventional and protocol groups. A standard documentation document is beneficial to enhance communication between doctors and nurses as well as to monitor and observe drainage effectively. Copyright © 2016 Elsevier Ltd. All rights reserved.

Outcomes and cost analysis of laparoscopic versus open appendectomy for treatment of acute appendicitis: 4-years experience in a district hospital

PubMed Central

2014-01-01

Background Laparoscopic appendectomy is not yet unanimously considered the “gold standard” in the treatment of acute appendicitis because of its higher operative time, intra-abdominal abscess risk, and costs compared to open appendectomy. This study aimed to compare outcomes and cost of laparoscopic and open appendectomy in a district hospital. Methods A retrospective analysis of 230 patients who underwent appendectomy at the Division of General Surgery of the Civil Hospital of Ragusa, Italy, from May 2008 to May 2012 was performed. The variables analyzed included patients data (age, gender, previous abdominal surgery, preoperative WBC count, duration of symptoms, ASA risk score), rate of uncomplicated or complicated appendicitis, operative time, postoperative complications, length of hospital stay, and total costs. The patients were divided in two groups according to the surgical approach and compared for each variable. The results were analyzed using the t Student test for quantitative variables, and the Chi-square test with Yates correction and Fisher exact test for categorical. Results Laparoscopic appendectomy was performed in 139 patients, open appendectomy in 91. Two cases (1.4%) were converted to open procedure and included in the laparoscopic group data. Patient data and rate of complicated appendicitis were similar in the two study groups. There was no statistical difference (p = 0.476) in the mean operative time between the laparoscopic (52.2 min; range, 20–155) and open appendectomy (49.3 min; range, 20–110) groups. The overall incidence of minor and major complications was significantly lower (p = 0.006) after laparoscopic appendectomy (2.9%, 4 cases) than after open appendectomy (13.2%, 12 cases); rate of intra-abdominal abscess were similar. The length of hospital stay was significantly shorter (p = 0.001) in laparoscopic group (2.75 days; range, 1–8) than in open group (3.87 days; range, 1–19). The mean total cost was 2282 Euro in laparoscopic group and 2337 Euro in open group, with a no significant difference of 55 Euro (p = 0.812). Conclusion Laparoscopic appendectomy is associated with fewer complications, shorter hospital stay, and similar operative time, intra-abdominal abscess rate, and total costs, compared with open appendectomy. Therefore, laparoscopic appendectomy can be recommended as preferred approach in acute appendicitis. PMID:24646120

Cost analysis in the toxicology laboratory.

PubMed

Travers, E M

1990-09-01

The process of determining laboratory sectional and departmental costs and test costs for instrument-generated and manually generated reportable results for toxicology laboratories has been outlined in this article. It is hoped that the basic principles outlined in the preceding text will clarify and elucidate one of the most important areas needed for laboratory fiscal integrity and its survival in these difficult times for health care providers. The following general principles derived from this article are helpful aids for managers of toxicology laboratories. 1. To manage a cost-effective, efficient toxicology laboratory, several factors must be considered: the laboratory's instrument configuration, test turnaround time needs, the test menu offered, the analytic methods used, the cost of labor based on time expended and the experience and educational level of the staff, and logistics that determine specimen delivery time and costs. 2. There is a wide variation in costs for toxicologic methods, which requires that an analysis of capital (equipment) purchase and operational (test performance) costs be performed to avoid waste, purchase wisely, and determine which tests consume the majority of the laboratory's resources. 3. Toxicologic analysis is composed of many complex steps. Each step must be individually cost-accounted. Screening test results must be confirmed, and the cost for both steps must be included in the cost per reportable result. 4. Total costs will vary in the same laboratory and between laboratories based on differences in salaries paid to technical staff, differences in reagent/supply costs, the number of technical staff needed to operate the analyzer or perform the method, and the inefficient use of highly paid staff to operate the analyzer or perform the method. 5. Since direct test costs vary directly with the type and number of analyzers or methods and are dependent on the operational mode designed by the manufacturer, laboratory managers should construct an actual test-cost data base for instrument or method in use to accurately compare costs using the "bottom-up" approach. 6. Laboratory expenses can be examined from three perspectives: total laboratory, laboratory section, and subsection workstation. The objective is to track all laboratory expenses through each of these levels. 7. In the final analysis, a portion of total laboratory expenses must be allocated to each unit of laboratory output--the billable procedure or, in laboratories where tests are not billed, the tests produced.(ABSTRACT TRUNCATED AT 400 WORDS)

Preparations for Integrating Space-Based Total Lightning Observations into Forecast Operations

NASA Technical Reports Server (NTRS)

Stano, Geoffrey T.; Fuell, Kevin K.; Molthan, Andrew L.

2016-01-01

NASA's Short-term Prediction Research and Transition (SPoRT) Center has been a leader in collaborating with the United States National Weather Service (NWS) offices to integrate ground-based total lightning (intra-cloud and cloud-to-ground) observations into the real-time operational environment. For much of these collaborations, the emphasis has been on training, dissemination of data to the NWS AWIPS system, and focusing on the utility of these data in the warning decision support process. A shift away from this paradigm has occurred more recently for several reasons. For one, SPoRT's collaborations have expanded to new partners, including emergency managers and the aviation community. Additionally, and most importantly, is the impending launch of the GOES-R Geostationary Lightning Mapper (GLM). This has led to collaborative efforts to focus on additional forecast needs, new data displays, develop training for GLM uses based on the lessons learned from ground-based lightning mapping arrays, and ways to better relate total lightning data to other meteorological parameters. This presentation will focus on these efforts to prepare the operational end user community for GLM with an eye towards sharing lessons learned as EUMETSAT prepares for the Meteosat Third Generation Lightning Imager. This will focus on both software and training needs. In particular, SPoRT has worked closely with the Meteorological Development Laboratory to create the total lightning tracking tool. This software allows for NWS forecasters to manually track storms of interest and display a time series trend of observations. This tool also has been expanded to work on any gridded data set allowing for easy visual comparisons of multiple parameters in addition to total lightning. A new web display has been developed for the ground-based observations that can be easily extended to satellite observations. This paves the way for new collaborations outside of the NWS, both domestically and internationally, as the web display will be functional on PCs and mobile devices. Furthermore, SPoRT has helped developed the software plug-in to visualize GLM data. Examples using the official GLM proxy product will be used to provide a glimpse as to what real-time GLM and likely MTG-LI data will be in the near future.

How to unlock the benefits of MRP (materiel requirements planning) II and Just-in-Time.

PubMed

Jacobi, M A

1994-05-01

Manufacturing companies need to use the best and most applicable parts of MRP II and JIT to run their businesses effectively. MRP II provides the methodology to plan and control the total resources of the company and focuses on the processes that add value to their customers' products. It is the cornerstone of total quality management, as it reduces the variability and costly activities in the communication and subsequent execution of the required steps from customer order to shipment. JIT focuses on simplifying the total business operation and execution of business processes. MRP II and JIT are the foundations for successful manufacturing businesses.

Assessing performance of an Electronic Health Record (EHR) using Cognitive Task Analysis.

PubMed

Saitwal, Himali; Feng, Xuan; Walji, Muhammad; Patel, Vimla; Zhang, Jiajie

2010-07-01

Many Electronic Health Record (EHR) systems fail to provide user-friendly interfaces due to the lack of systematic consideration of human-centered computing issues. Such interfaces can be improved to provide easy to use, easy to learn, and error-resistant EHR systems to the users. To evaluate the usability of an EHR system and suggest areas of improvement in the user interface. The user interface of the AHLTA (Armed Forces Health Longitudinal Technology Application) was analyzed using the Cognitive Task Analysis (CTA) method called GOMS (Goals, Operators, Methods, and Selection rules) and an associated technique called KLM (Keystroke Level Model). The GOMS method was used to evaluate the AHLTA user interface by classifying each step of a given task into Mental (Internal) or Physical (External) operators. This analysis was performed by two analysts independently and the inter-rater reliability was computed to verify the reliability of the GOMS method. Further evaluation was performed using KLM to estimate the execution time required to perform the given task through application of its standard set of operators. The results are based on the analysis of 14 prototypical tasks performed by AHLTA users. The results show that on average a user needs to go through 106 steps to complete a task. To perform all 14 tasks, they would spend about 22 min (independent of system response time) for data entry, of which 11 min are spent on more effortful mental operators. The inter-rater reliability analysis performed for all 14 tasks was 0.8 (kappa), indicating good reliability of the method. This paper empirically reveals and identifies the following finding related to the performance of AHLTA: (1) large number of average total steps to complete common tasks, (2) high average execution time and (3) large percentage of mental operators. The user interface can be improved by reducing (a) the total number of steps and (b) the percentage of mental effort, required for the tasks. 2010 Elsevier Ireland Ltd. All rights reserved.