Patent foramen ovale closure following cryptogenic stroke or transient ischaemic attack: Long-term follow-up of 301 cases.

PubMed

Mirzaali, Mikaeil; Dooley, Maureen; Wynne, Dylan; Cooter, Nina; Lee, Lorraine; Haworth, Peter; Saha, Romi; Gainsborough, Nicola; Hildick-Smith, David

2015-11-15

Patent foramen ovale has been identified as a conduit for paradoxical embolism resulting in cryptogenic stroke or transient ischemic attack (TIA). We aimed to establish rates of death, recurrent stroke or TIA among patients undergoing PFO closure for stroke or TIA at our unit. A retrospective analysis of all PFO closure patients was performed between May 2004 and January 2013. Follow up was performed by mortality tracing using the Medical Research Information Service of the Office of National Statistics. With regard to stroke or TIA recurrence, written consent forms and questionnaires were mailed with follow up telephone calls. Medical notes and imaging records were consulted where adverse events were noted. 301 patients aged 48.6 ± 11.0 years, 54.4% male, with ≥1 thromboembolic neurovascular event had percutaneous PFO closure with one of eight devices, with successful implantation in 99% of cases. Follow-up duration was 40.2 ± 26.2 months (range 1.3-105.3); complete in 301 patients for mortality (100%) and 283 patients (94.0%) for neurovascular events. Two patients died during follow-up (respiratory failure n = 1; road traffic accident n = 1). Recurrent stroke (MRI or CT confirmed) was observed in five patients (0.5%; 0.55 per 100 person-years) and TIA in 9 (1.1%; 0.98 per 100 person-years). Atrial fibrillation requiring treatment was documented in 14 patients (1.7%). Percutaneous PFO closure in patients with cryptogenic stroke or TIA is a safe treatment with a low incidence of procedural complications and recurrent neurovascular events. Registry data like these may help to demonstrate the utility of PFO closure in stroke. © 2015 Wiley Periodicals, Inc.

State Environmental Policy Act (SEPA) environmental checklist forms for 304 Concretion Facility Closure Plan. Revision 2

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

Not Available

The 300 Area of the Hanford Site contains reactor fuel manufacturing facilities and several research and development laboratories. Recyclable scrap uranium with zircaloy-2 and copper silicon alloy, uranium-titanium alloy, beryllium/zircaloy-2 alloy, and zircaloy-2 chips and fines were secured in concrete billets (7.5-gallon containers) in the 304 Facility, located in the 300 Area. The beryllium/zircaloy-2 alloy and zircaloy-2 chips and fines are designated as mixed waste with the characteristic of ignitability. The concretion process reduced the ignitability of the fines and chips for safe storage and shipment. This process has been discontinued and the 304 Facility is now undergoing closure asmore » defined in the Resource Conservation and Recovery Act (RCRA) of 1976 and the Washington Administrative Code (WAC) Dangerous Waste Regulations, WAC 173-303-040. This closure plan presents a description of the 304 Facility, the history of materials and waste managed, and the procedures that will be followed to close the 304 Facility. The 304 Facility is located within the 300-FF-3 (source) and 300-FF-5 (groundwater) operable units, as designated in the Hanford Federal Facility Agreement and Consent Order (Tri-Party Agreement) (Ecology et al. 1992). Contamination in the operable units 300-FF-3 and 300-FF-5 is scheduled to be addressed through the Comprehensive Environmental Response, Compensation, and Liability Act (CERCLA) of 1980 remedial action process. Therefore, all soil remedial action at the 304 Facility will be conducted as part of the CERCLA remedial action of operable units 300-FF-3 and 300-FF-5.« less

Does omphalocele major undergo spontaneous closure?

PubMed Central

Emordi, Victor C.; Osifo, David O.

2017-01-01

Abstract The early surgical management of omphalocele major in Africa predisposes neonates to surgical complications which are often worsened by the presence of associated anomalies. Conservative management using available escharotics results in early skin cover by secondary wound healing. This delays the need for fascial closure and avoids neonatal surgical risks thus improving survival. We present a case of omphalocele major that underwent spontaneous closure during conservative management with honey dressing without surgical intervention. PMID:28928917

40 CFR 265.117 - Post-closure care and use of property.

Code of Federal Regulations, 2010 CFR

2010-07-01

.... 265.117 Section 265.117 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID.... (a)(1) Post-closure care for each hazardous waste management unit subject to the requirements of... this part. (2) Any time preceding closure of a hazardous waste management unit subject to post-closure...

40 CFR 264.1202 - Closure and post-closure care.

Code of Federal Regulations, 2010 CFR

2010-07-01

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

40 CFR 258.16 - Closure of existing municipal solid waste landfill units.

Code of Federal Regulations, 2011 CFR

2011-07-01

... (CONTINUED) SOLID WASTES CRITERIA FOR MUNICIPAL SOLID WASTE LANDFILLS Location Restrictions § 258.16 Closure of existing municipal solid waste landfill units. (a) Existing MSWLF units that cannot make the... 40 Protection of Environment 25 2011-07-01 2011-07-01 false Closure of existing municipal solid...

40 CFR 258.16 - Closure of existing municipal solid waste landfill units.

Code of Federal Regulations, 2010 CFR

2010-07-01

... (CONTINUED) SOLID WASTES CRITERIA FOR MUNICIPAL SOLID WASTE LANDFILLS Location Restrictions § 258.16 Closure of existing municipal solid waste landfill units. (a) Existing MSWLF units that cannot make the... 40 Protection of Environment 24 2010-07-01 2010-07-01 false Closure of existing municipal solid...

100-D Ponds closure plan. Revision 1

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

Petersen, S.W.

1997-09-01

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

CRP - VD Tube & Closure -  Unit Non-Reclosable Packaging Rigid

EPA Pesticide Factsheets

This is a unit-dose non-reclosable rigid package. The package consists of a tube and a closure that is permanently attached to the tube neck. The package is opened by pushing down on the closure and simultaneously turning it counterclockwise.

Resource Conservation and Recovery Act closure report: Area 2 Bitcutter and Postshot Containment Shops Injection Wells, Correction Action Unit 90

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

NONE

This Closure Report provides documentation of the activities conducted during the Resource Conservation and Recovery Act (RCRA) closure of the Bitcutter and Postshot Containment Shops Injection Wells located in Area 2 of the Nevada Test Site (NTS), Oak Spring Quadrangle (USGS, 1986), Township 10 South, Range 53 East, Nye County, Nevada. This report discusses the Bitcutter Shop Inside Injection Well (CAU 90-A) closure-in-place and the Bitcutter Shop Outside Injection Well (CAU 90-B) and Postshot Containment Shop Injection Well (CAU 90-C) clean closures. This Closure Report provides background information about the unit, the results of the characterization activities and actions conductedmore » to determine the closure design. It also provides a discussion of the drainage analysis, preliminary closure activities, final closure activities, waste management activities, and the Post-Closure Care requirements.« less

40 CFR 264.117 - Post-closure care and use of property.

Code of Federal Regulations, 2010 CFR

2010-07-01

.... 264.117 Section 264.117 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID... for each hazardous waste management unit subject to the requirements of §§ 264.117 through 264.120... preceding partial closure of a hazardous waste management unit subject to post-closure care requirements or...

A comparison of 2-octyl cyanoacrylate with nylon for wound closure of knee arthroscopy portals.

PubMed

Imbuldeniya, A M; Rashid, A; Murphy, J P

2014-09-01

To compare the cosmetic results, complications and patient satisfaction of 2-octyl cyanoacrylate (Dermabond, Ethicon Inc. Somerville, NJ, USA), a liquid bonding agent, with 3-0 nylon sutures (Ethilon, Ethicon Inc) skin closure in two groups of patients undergoing elective knee arthroscopy at 6 weeks. The retrospective clinical audit recruited patients undergoing knee surgery for the first time between October 2010 and August 2011. The patients were either treated with the liquid bonding agent or nylon sutures. The patients in the bonding agent group were allowed to shower as normal on postoperative day one, while patients in the suture group kept their wounds dry for 2 weeks. Between the two groups (40 patients per group) there was no difference in the cosmetic outcome (p=0.285), patient satisfaction (p=0.29), pain scores (p=0.44) or wound complication rate (p<0.05). Patient satisfaction was high in both groups. Furthermore, 83.75% of all patients indicated they would prefer the liquid bonding closure over nylon sutures if undergoing the same procedure in the future as they could shower the next day and avoid suture removal. 2-octyl cyanoacrylate is safe to use in the short term in knee arthroscopy providing comparable results to nylon suture closure. Allowing patients to shower the next day appears to cause no adverse effects. The authors would like to state that they do not have any economic or social interest in any of the products used or mentioned. No grant or finance was received for this study, nor any input from other sources.

40 CFR 264.1202 - Closure and post-closure care.

Code of Federal Regulations, 2014 CFR

2014-07-01

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

40 CFR 264.1202 - Closure and post-closure care.

Code of Federal Regulations, 2011 CFR

2011-07-01

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

40 CFR 264.1202 - Closure and post-closure care.

Code of Federal Regulations, 2013 CFR

2013-07-01

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

40 CFR 264.1202 - Closure and post-closure care.

Code of Federal Regulations, 2012 CFR

2012-07-01

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

Comparison of W-Plasty vs Traditional Straight-Line Techniques for Primary Paramedian Forehead Flap Donor Site Closure.

PubMed

Jáuregui, Emmanuel J; Tummala, Neelima; Seth, Rahul; Arron, Sarah; Neuhaus, Isaac; Yu, Siegrid; Grekin, Roy; Knott, P Daniel

2016-07-01

The paramedian forehead flap (PMFF) donor site scar is hard to disguise and may be a source of patient dissatisfaction. To evaluate the aesthetic outcome of W-plasty vs traditional straight-line (SL) closure techniques of the PMFF donor site. A retrospective cohort study was conducted at the University of California, San Francisco Medical Center. Clinical history and operative reports were reviewed for 31 patients who underwent a PMFF procedure performed between November 1, 2011, and May 29, 2014. Blinded photographic analysis of postoperative photographs was performed. The pedicled component of the PMFF was raised primarily with either a W-plasty or traditional SL design. Standard photographs of the donor site, obtained at least 90 days after surgery, were reviewed and scored in a blinded fashion by 4 dermatologic surgeons using a 100-point visual analog scale (from 0 [worst possible outcome] to 100 [best possible outcome]) and a 5-point Likert scale (from very poor to excellent). Interrater reliability was assessed via Cronbach α testing. All 31 forehead flaps survived during this study period; 16 PMFFs were raised with the W-plasty technique and 15 were raised with the SL technique. The W-plasty and SL groups were similar in terms of age, sex, and race/ethnicity (mean [SD] age, 68.4 [12.4] vs 61.8 [11.6] years; 13 [84%] vs 9 [60%] men; and 15 [94%] vs 13 [87%] white). Patients undergoing W-plasty closure had significantly higher mean visual analog scale scores compared with those undergoing SL closure (72.8 [18.3] vs 65.6 [18.1]; P = .03). Mean Likert scale scores for W-plasty were higher than those for SL closure, but the difference was not significant (3.77 [1.02] vs 3.43 [0.98]; P = .08). Overall interrater reliability for the visual analog scale and Likert scale scores were 0.67 and 0.58, respectively. Patients undergoing PMFF donor site closure using a primary W-plasty technique demonstrated better mean scar appearance of the forehead donor site compared with SL closure. The primary W-plasty technique did not result in any PMFF losses and should be considered for appropriate patients. 3.

Corrective Action Decision Document/Closure Report for Corrective Action Unit 105: Area 2 Yucca Flat Atmospheric Test Sites, Nevada National Security Site, Nevada, Revision 0

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

Matthews, Patrick

2013-09-01

This Corrective Action Decision Document/Closure Report presents information supporting the closure of Corrective Action Unit (CAU) 105: Area 2 Yucca Flat Atmospheric Test Sites, Nevada National Security Site, Nevada. CAU 105 comprises the following five corrective action sites (CASs): -02-23-04 Atmospheric Test Site - Whitney Closure In Place -02-23-05 Atmospheric Test Site T-2A Closure In Place -02-23-06 Atmospheric Test Site T-2B Clean Closure -02-23-08 Atmospheric Test Site T-2 Closure In Place -02-23-09 Atmospheric Test Site - Turk Closure In Place The purpose of this Corrective Action Decision Document/Closure Report is to provide justification and documentation supporting the recommendation that nomore » further corrective action is needed for CAU 105 based on the implementation of the corrective actions. Corrective action investigation (CAI) activities were performed from October 22, 2012, through May 23, 2013, as set forth in the Corrective Action Investigation Plan for Corrective Action Unit 105: Area 2 Yucca Flat Atmospheric Test Sites; and in accordance with the Soils Activity Quality Assurance Plan, which establishes requirements, technical planning, and general quality practices.« less

Closure report for Corrective Action Unit 211, Area 15 EPA Farm waste sites, Nevada Test Site, Nevada

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

NONE

1998-04-01

This Closure Report summarizes the corrective actions which were completed at the Corrective Action Sites within Corrective Action Unit 211 Area 15 Farm Waste Sties at the Nevada Test Site. Current site descriptions, observations and identification of wastes removed are included on FFACO Corrective Action Site housekeeping closure verification forms.

Comparison of the analgesic efficacy of ultrasound-guided rectus sheath block and local anesthetic infiltration for laparoscopic percutaneous extraperitoneal closure in children.

PubMed

Uchinami, Yuka; Sakuraya, Fumika; Tanaka, Nobuhiro; Hoshino, Koji; Mikami, Eri; Ishikawa, Taro; Fujii, Hitomi; Ishikawa, Takehiko; Morimoto, Yuji

2017-05-01

Ultrasound-guided rectus sheath block and local anesthetic infiltration are the standard options to improve postoperative pain for children undergoing surgery with a midline incision. However, there is no study comparing the effect of ultrasound-guided rectus sheath block with local anesthetic infiltration for children undergoing laparoscopic surgery. The aim of this trial was to compare the onset of ultrasound-guided rectus sheath block with that of local anesthetic infiltration for laparoscopic percutaneous extraperitoneal closure in children. We performed an observer-blinded, randomized, prospective trial. Enrolled patients were assigned to either an ultrasound-guided rectus sheath block group or a local anesthetic infiltration group. The ultrasound-guided rectus sheath block group (n = 17) received ultrasound-guided rectus sheath block with 0.2 ml·kg -1 of 0.375% ropivacaine per side in the posterior rectus sheath compartment. The local anesthetic infiltration group (n = 17) received local anesthetic infiltration with 0.2 ml·kg -1 of 0.75% ropivacaine. The Face, Legs, Activity, Cry, and Consolability (FLACC) pain scores were recorded at 0, 30, 60 min after arrival at the postanesthesia care unit. Of the 37 patients enrolled in this study, 34 completed the study protocol. A significant difference in the pain scale between the ultrasound-guided rectus sheath block group and local anesthetic infiltration group was found at 0 min (median: 0, interquartile range [IQR]: 0-1.5, vs median: 1, IQR 0-5, confidence interval of median [95% CI]: 0-3, P = 0.048), but no significant difference was found at 30 min (median: 1, IQR: 0-4 vs median: 6, IQR: 0-7, 95% CI: 0-5, P = 0.061), or 60 min (median: 0, IQR: 0-2 vs median: 1, IQR: 0-3, 95% CI: -1 to 1, P = 0.310). No significant difference was found in anesthesia time between the ultrasound-guided rectus sheath block and local anesthetic infiltration groups. No procedure-related complications were observed in either group. Ultrasound-guided rectus sheath block is a quicker way to control postoperative pain for pediatric patients undergoing laparoscopic extraperitoneal closure than local anesthetic infiltration, and thus may provide a clinical benefit. © 2017 John Wiley & Sons Ltd.

Reappraisal of adhesive strapping as treatment for infantile umbilical hernia.

PubMed

Yanagisawa, Satohiko; Kato, Mototoshi; Oshio, Takehito; Morikawa, Yasuhide

2016-05-01

Most umbilical hernias spontaneously close by 3-5 years of age; therefore, surgical repair is considered only in children whose hernias have not closed by this point. At present, adhesive strapping is not the preferred treatment for umbilical hernias because of the lack of supporting evidence regarding its efficacy, and its association with skin complications. This aim of this study was to examine umbilical hernia closure on ultrasonography, and reassess the merits of adhesive strapping. Between January 2013 and December 2014, 89 infants underwent adhesive strapping for umbilical hernia. The strapping was changed once a week. The diameter of the hernia orifice was measured on ultrasonography every 2 weeks until closure. The closure speed (CS) of the hernia orifice was compared between the infants treated with adhesive strapping and those undergoing observation alone. The association between CS and birthweight, gestational age, diameter of the hernia orifice, and timing of treatment (before 12 weeks of age vs between 12 and 26 weeks of age) was also analyzed. Closure was achieved after 2-13 weeks of strapping in 81 infants (91%), and the likelihood of closure was not affected by the diameter of the hernia orifice, gestational age, or the timing of treatment. The mean CS of the infants treated with adhesive strapping was significantly faster than that of the infants undergoing observation alone (2.59 vs 0.37 mm/week, P < 0.05). Adhesive strapping was discontinued in five of the 89 infants (5.6%) due to severe skin complications. Adhesive strapping promoted early spontaneous umbilical hernia closure compared with observation alone, regardless of the diameter of the hernia orifice. Adhesive strapping is an effective alternative to surgery and observation. © 2015 Japan Pediatric Society.

Limited utility of preoperative studies in preparation for colostomy closure.

PubMed

Pokorny, R M; Heniford, T; Allen, J W; Tuckson, W B; Galandiuk, S

1999-04-01

Numerous diagnostic and therapeutic practices are used in an attempt to reduce the morbidity of colostomy closures. Our principal aim was to evaluate the role of preoperative studies, specifically barium enemas and endoscopic examinations, performed before colostomy closures. Additionally, we wished to identify other practices involved in the perioperative management of patients undergoing colostomy closure that influenced morbidity. The records of 100 consecutive patients who underwent elective colostomy closure at University of Louisville Hospital between January 1989 and July 1995 were reviewed. Wound infection was the most common complication (12%). Various bowel preparations were equivalent in efficacy and did not influence the complication rate. Intermittent wound irrigation with antibiotics for 3 days postoperatively, via subcutaneous drains, was associated with a low incidence of incision infection. Preoperative barium enema or sigmoidoscopy were often performed but rarely useful. Performing these examinations merely increased hospital cost without a corresponding decline in morbidity.

Atelectasis after free rectus transfer and abdominal wall reconstruction.

PubMed

Lo, Jamie O; Weber, Stephen M; Andersen, Peter E; Gross, Neil D; Gosselin, Marc; Wax, Mark K

2008-10-01

Atelectasis is commonly encountered in patients undergoing rectus abdominus tissue transfer. Primary closure of the anterior rectus sheath may contribute to this process. Augmentation of the closure with mesh may decrease the incidence of Atelectasis. In this retrospective review 32 patients with preoperative and postoperative augmentation were compared to 23 who had primary closure of the anterior rectus sheath. Augmentation consisted of acellular dermis (25) or mesh (7). Postoperative atelectasis was radiographically detected in: 91% (n=29) of augmented patients versus 83% (n=19) of primary closure patients. Major atelectasis in 41% (n=13) of augmented patients versus 61% (n=14) of primary closure patients p<.05. The incidence of atelectasis was independent of skin flap size and operative times. The use of acellular dermis or mesh to augment the abdominal wall appears to reduce the high incidence of postoperative atelectasis following rectus-free flap harvest. Copyright (c) 2008 Wiley Periodicals, Inc. Head Neck 2008.

Ectocranial suture closure in Pan troglodytes and Gorilla gorilla: pattern and phylogeny.

PubMed

Cray, James; Meindl, Richard S; Sherwood, Chet C; Lovejoy, C Owen

2008-08-01

The order in which ectocranial sutures undergo fusion displays species-specific variation among primates. However, the precise relationship between suture closure and phylogenetic affinities is poorly understood. In this study, we used Guttman Scaling to determine if the modal progression of suture closure differs among Homo sapiens, Pan troglodytes, and Gorilla gorilla. Because DNA sequence homologies strongly suggest that P. troglodytes and Homo sapiens share a more recent common ancestor than either does with G. gorilla, we hypothesized that this phylogenetic relationship would be reflected in the suture closure patterns of these three taxa. Results indicated that while all three species do share a similar lateral-anterior closure pattern, G. gorilla exhibits a unique vault pattern, which, unlike humans and P. troglodytes, follows a strong posterior-to-anterior gradient. P. troglodytes is therefore more like Homo sapiens in suture synostosis. Copyright 2008 Wiley-Liss, Inc.

Self-testing security sensor for monitoring closure of vault doors and the like

DOEpatents

Cawthorne, Duane C.

1997-05-27

A self-testing device is provided for a monitoring system for monitoring whether a closure member such as a door or window is closed. The monitoring system includes a switch unit mounted on the frame of the closure member being monitored and including magnetically biased switches connected in one or more electrical monitoring circuits, and a door magnet unit mounted on the closure member being monitored. The door magnet includes one or more permanent magnets that produce a magnetic field which, when the closure member is closed, cause said switches to assume a first state. When the closure member is opened, the switches switch to a second, alarm state. The self-testing device is electrically controllable from a remote location and produces a canceling or diverting magnetic field which simulates the effect of movement of the closure member from the closed position thereof without any actual movement of the member.

Self-testing security sensor for monitoring closure of vault doors and the like

DOEpatents

Cawthorne, D.C.

1997-05-27

A self-testing device is provided for a monitoring system for monitoring whether a closure member such as a door or window is closed. The monitoring system includes a switch unit mounted on the frame of the closure member being monitored and including magnetically biased switches connected in one or more electrical monitoring circuits, and a door magnet unit mounted on the closure member being monitored. The door magnet includes one or more permanent magnets that produce a magnetic field which, when the closure member is closed, cause said switches to assume a first state. When the closure member is opened, the switches switch to a second, alarm state. The self-testing device is electrically controllable from a remote location and produces a canceling or diverting magnetic field which simulates the effect of movement of the closure member from the closed position thereof without any actual movement of the member. 5 figs.

Rationale and design of a randomised clinical trial comparing vascular closure device and manual compression to achieve haemostasis after diagnostic coronary angiography: the Instrumental Sealing of ARterial puncture site - CLOSURE device versus manual compression (ISAR-CLOSURE) trial.

PubMed

Xhepa, Erion; Byrne, Robert A; Schulz, Stefanie; Helde, Sandra; Gewalt, Senta; Cassese, Salvatore; Linhardt, Maryam; Ibrahim, Tareq; Mehilli, Julinda; Hoppe, Katharina; Grupp, Katharina; Kufner, Sebastian; Böttiger, Corinna; Hoppmann, Petra; Burgdorf, Christof; Fusaro, Massimiliano; Ott, Ilka; Schneider, Simon; Hengstenberg, Christian; Schunkert, Heribert; Laugwitz, Karl-Ludwig; Kastrati, Adnan

2014-06-01

Vascular closure devices (VCD) have been introduced into clinical practice with the aim of increasing the procedural efficiency and clinical safety of coronary angiography. However, clinical studies comparing VCD and manual compression have yielded mixed results, and large randomised clinical trials comparing the two strategies are missing. Moreover, comparative efficacy studies between different VCD in routine clinical use are lacking. The Instrumental Sealing of ARterial puncture site - CLOSURE device versus manual compression (ISAR-CLOSURE) trial is a prospective, randomised clinical trial designed to compare the outcomes associated with the use of VCD or manual compression to achieve femoral haemostasis. The test hypothesis is that femoral haemostasis after coronary angiography achieved using VCD is not inferior to manual compression in terms of access-site-related vascular complications. Patients undergoing coronary angiography via the common femoral artery will be randomised in a 1:1:1 fashion to receive FemoSeal VCD, EXOSEAL VCD or manual compression. The primary endpoint is the incidence of the composite of arterial access-related complications (haematoma ≥5 cm, pseudoaneurysm, arteriovenous fistula, access-site-related bleeding, acute ipsilateral leg ischaemia, the need for vascular surgical/interventional treatment or documented local infection) at 30 days after randomisation. According to power calculations based on non-inferiority hypothesis testing, enrolment of 4,500 patients is planned. The trial is registered at www.clinicaltrials.gov (study identifier: NCT01389375). The safety of VCD as compared to manual compression in patients undergoing transfemoral coronary angiography remains an issue of clinical equipoise. The aim of the ISAR-CLOSURE trial is to assess whether femoral haemostasis achieved through the use of VCD is non-inferior to manual compression in terms of access-site-related vascular complications.

Allgöwer-Donati Versus Vertical Mattress Suture Technique Impact on Perfusion in Ankle Fracture Surgery: A Randomized Clinical Trial Using Intraoperative Angiography.

PubMed

Shannon, Steven F; Houdek, Matthew T; Wyles, Cody C; Yuan, Brandon J; Cross, William W; Cass, Joseph R; Sems, Stephen A

2017-02-01

The purpose of this study was to evaluate which primary wound closure technique for ankle fractures affords the most robust perfusion as measured by laser-assisted indocyanine green angiography: Allgöwer-Donati or vertical mattress. Prospective, randomized. Level 1 Academic Trauma Center. Thirty patients undergoing open reduction internal fixation for ankle fractures were prospectively randomized to Allgöwer-Donati (n = 15) or vertical mattress (n = 15) closure. Demographics were similar for both cohorts with respect to age, sex, body mass index, surgical timing, and OTA/AO fracture classification. Skin perfusion (mean incision perfusion and mean perfusion impairment) was quantified in fluorescence units with laser-assisted indocyanine green angiography along the lateral incision as well as anterior and posterior to the incision at 30 separate locations. Minimum follow-up was 3 months with a mean follow-up 4.7 months. Allgöwer-Donati enabled superior perfusion compared with the vertical mattress suture technique. Mean incision perfusion for Allgöwer-Donati was 51 (SD = 13) and for vertical mattress was 28 (SD = 10, P < 0.0001). Mean perfusion impairment was less in the Allgöwer-Donati cohort (12.8, SD = 9) compared with that in the vertical mattress cohort (23.4, SD = 14; P = 0.03). One patient in each cohort experienced a wound complication. The Allgöwer-Donati suture technique offers improved incision perfusion compared with vertical mattress closure after open reduction internal fixation of ankle fractures. Theoretically, this may enhance soft tissue healing and decrease the risk of wound complications. Surgeons may take this into consideration when deciding closure techniques for ankle fractures. Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

40 CFR 267.143 - Financial assurance for closure.

Code of Federal Regulations, 2010 CFR

2010-07-01

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

Adjunctive treatment of abdominal catastrophes and sepsis with direct peritoneal resuscitation: indications for use in acute care surgery.

PubMed

Smith, Jason W; Neal Garrison, R; Matheson, Paul J; Harbrecht, Brian G; Benns, Matthew V; Franklin, Glen A; Miller, Keith R; Bozeman, Matthew C; David Richardson, J

2014-09-01

The success of damage-control surgery (DCS) for the treatment of trauma has led to its use in other surgical problems such as abdominal sepsis. Previous studies using direct peritoneal resuscitation (DPR) for the treatment of trauma have yielded promising results. We present the results of the application of this technique to patients experiencing abdominal sepsis. We enrolled 88 DCS patients during a 5 year-period (January 2008 to December 2012) into a propensity-matched study to evaluate the utility of using DPR in addition to standard resuscitation. DPR consisted of peritoneal lavage with 2.5% DELFLEX, and abdominal closure was standardized across both groups. Patients were matched using Acute Physiology and Chronic Health Evaluation II (APACHE II) variables. Univariate and multivariate analyses were performed. There were no differences between the control and experimental groups with regard to age, sex, ethnicity, or APACHE II at 24 hours. Indications for damage control included pancreatitis, perforated hollow viscous, bowel obstruction, and ischemic enterocolitis. Patients undergoing DPR had both a higher rate of (68% vs. 43%, p < 0.03) and a shorter time to definitive fascial closure (5.9 [3.2] days vs. 7.7 [4.1] days, p < 0.02). DPR patients had a decreased APACHE II and Sequential Organ Failure Assessment (SOFA) score compared with the controls at 48 hours. In addition, DPR patients had fewer abdominal complications compared with the controls (RR, 0.57; 95% confidence interval, 0.32-1.01; p = 0.038). Ventilator days and intensive care unit length of stay were both significantly reduced in the DPR group. The DPR group showed a lower overall mortality at 30 days (16% vs. 27%, p = 0.15). DPR reduces time to definitive abdominal closure, increases primary fascial closure, and reduces intra-abdominal complications following DCS. DPR may also attenuate progressive physiologic injury as demonstrated by a reduction in 48-hour intensive care unit severity scores. As a result, DPR following DCS may afford better outcomes to patients experiencing shock. Therapeutic study, level III.

40 CFR 265.1202 - Closure and post-closure care.

Code of Federal Regulations, 2013 CFR

2013-07-01

..., STORAGE, AND DISPOSAL FACILITIES Hazardous Waste Munitions and Explosives Storage § 265.1202 Closure and... as long as it remains in service as a munitions or explosives magazine or storage unit. (b) If, after...

40 CFR 265.1202 - Closure and post-closure care.

Code of Federal Regulations, 2014 CFR

2014-07-01

..., STORAGE, AND DISPOSAL FACILITIES Hazardous Waste Munitions and Explosives Storage § 265.1202 Closure and... as long as it remains in service as a munitions or explosives magazine or storage unit. (b) If, after...

40 CFR 265.1202 - Closure and post-closure care.

Code of Federal Regulations, 2011 CFR

2011-07-01

..., STORAGE, AND DISPOSAL FACILITIES Hazardous Waste Munitions and Explosives Storage § 265.1202 Closure and... as long as it remains in service as a munitions or explosives magazine or storage unit. (b) If, after...

40 CFR 265.1202 - Closure and post-closure care.

Code of Federal Regulations, 2012 CFR

2012-07-01

..., STORAGE, AND DISPOSAL FACILITIES Hazardous Waste Munitions and Explosives Storage § 265.1202 Closure and... as long as it remains in service as a munitions or explosives magazine or storage unit. (b) If, after...

Closure Report for Corrective Action Unit 127: Areas 25 and 26 Storage Tanks, Nevada Test Site, Nevada

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

NSTec Environmental Restoration

CAU 127, Areas 25 and 26 Storage Tanks, consists of twelve CASs located in Areas 25 and 26 of the NTS. The closure alternatives included no further action, clean closure, and closure in place with administrative controls. The purpose of this Closure Report is to provide a summary of the completed closure activities, documentation of waste disposal, and analytical data to confirm that the remediation goals were met.

Randomized clinical trial of intestinal ostomy takedown comparing pursestring wound closure vs conventional closure to eliminate the risk of wound infection.

PubMed

Camacho-Mauries, Daniel; Rodriguez-Díaz, José Luis; Salgado-Nesme, Noel; González, Quintín H; Vergara-Fernández, Omar

2013-02-01

The use of temporary stomas has been demonstrated to reduce septic complications, especially in high-risk anastomosis; therefore, it is necessary to reduce the number of complications secondary to ostomy takedowns, namely wound infection, anastomotic leaks, and intestinal obstruction. To compare the rates of superficial wound infection and patient satisfaction after pursestring closure of ostomy wound vs conventional linear closure. Patients undergoing colostomy or ileostomy closure between January 2010 and February 2011 were randomly assigned to linear closure (n = 30) or pursestring closure (n = 31) of their ostomy wound. Wound infection within 30 days of surgery was defined as the presence of purulent discharge, pain, erythema, warmth, or positive culture for bacteria. Patient satisfaction, healing time, difficulty managing the wound, and limitation of activities were analyzed with the Likert questionnaire. The infection rate for the control group was 36.6% (n = 11) vs 0% in the pursestring closure group (p < 0.0001). Healing time was 5.9 weeks in the linear closure group and 3.8 weeks in the pursestring group (p = 0.0002). Seventy percent of the patients with pursestring closure were very satisfied in comparison with 20% in the other group (p = 0.0001). This study was limited by the heterogeneity in the type of stoma in both groups. The pursestring method resulted in the absence of infection after ostomy wound closure (shorter healing time and improved patient satisfaction).

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

Code of Federal Regulations, 2011 CFR

2011-07-01

... care. 258.72 Section 258.72 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID... dollars, of the cost of hiring a third party to conduct post-closure care for the MSWLF unit in compliance with the post-closure plan developed under § 258.61 of this part. The post-closure cost estimate used...

Outcomes and Resource Utilization of Endoscopic Mass-Closure Technique for Laryngeal Clefts.

PubMed

Balakrishnan, Karthik; Cheng, Esther; de Alarcon, Alessandro; Sidell, Douglas R; Hart, Catherine K; Rutter, Michael J

2015-07-01

To compare resource utilization and clinical outcomes between endoscopic mass-closure and open techniques for laryngeal cleft repair. Case series with chart review. Tertiary academic children's hospital. Pediatric patients undergoing repair for Benjamin-Inglis type 1-3 laryngeal clefts over a 15-year period. All 20 patients undergoing endoscopic repair were included. Eight control patients undergoing open repair were selected using matching by age and cleft type. Demographic, clinical, and resource utilization data were collected. Twenty-eight patients were included (20 endoscopic, 8 open). Mean age, rates of tracheostomy and vocal fold immobility, and distribution of cleft types were not different between the 2 groups (all P > .2). Mean operative time (P = .004) and duration of hospital stay (P < .001) were significantly shorter in the endoscopic group. All repairs were intact in both groups at final postoperative endoscopy. Rates of persistent laryngeal penetration or aspiration on swallow study were not different between groups (P = 1.000), although results were available for only 11 patients. Endoscopic laryngeal cleft repair using a mass-closure technique provides a durable result while requiring significantly shorter operative times and hospital stays than open repair and avoiding the potential morbidity of laryngofissure. However, open repair may allow the simultaneous performance of other airway reconstructive procedures and may be a useful salvage technique when endoscopic repair fails. Postoperative swallowing results require further study. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2015.

CLOSURE REPORT FOR CORRECTIVE ACTION UNIT 528: POLYCHLORINATED BIPHENYLS CONTAMINATION NEVADA TEST SITE, NEVADA

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

BECHTEL NEVADA

2006-09-01

This Closure Report (CR) describes the closure activities performed at CAU 528, Polychlorinated Biphenyls Contamination, as presented in the Nevada Division of Environmental Protection (NDEP)-approved Corrective Action Plan (CAP) (US. Department of Energy, National Nuclear Security Administration Nevada Site Office [NNSAINSO], 2005). The approved closure alternative was closure in place with administrative controls. This CR provides a summary of the completed closure activities, documentation of waste disposal, and analytical data to confirm that the remediation goals were met.

Cystic Duct Closure by Sealing With Bipolar Electrocoagulation

PubMed Central

Damgaard, B.; Jorgensen, L. N.; Larsen, S. S.; Kristiansen, V. B.

2010-01-01

Background: Cystic duct leakage after cholecystectomy is not uncommon and is a potentially serious complication. The aim of this study was to assess a bipolar sealing system (LigaSure®) for closure of the cystic duct. Methods: The records from consecutive laparoscopic cholecystectomies performed in 2 hospitals with closure of the cystic duct with LigaSure after informed consent were recorded and complications and morbidity registered. The records were compared with those of patients undergoing laparoscopic cholecystectomy with closure of the cystic duct with clips during the same period. Results: During the study period, 218 laparoscopic cholecystectomies were performed; 102 of these were performed with the LigaSure. One patient was excluded due to violation of the protocol. We experienced no cases of cystic duct leakage, but in one patient, bile leakage from the gallbladder bed was observed probably due to a small aberrant duct. Conclusion: The LigaSure system was safe and effective for closure and division of the cystic duct in laparoscopic cholecystectomy. PMID:20412641

Analysis on influence of guide vanes closure laws of pump-turbine on load rejection transient process

NASA Astrophysics Data System (ADS)

Yao, Z.; Bi, H. L.; Huang, Q. S.; Li, Z. J.; Wang, Z. W.

2013-12-01

In load rejection transient process, the sudden shut down of guide vanes may cause units speed rise and a sharp increase in water hammer pressure of diversion system, which endangers the safety operation of the power plant. Adopting reasonable guide vane closure law is a kind of economic and effective measurement to reduce the water hammer pressure and limit rotational speed increases. In this paper, combined with Guangzhou Pumped Storage Power Station plant A, the load rejection condition under different guide vanes closure laws is calculated and the key factor of guide vanes closure laws on the impact of the load rejection transition process is analyzed. The different inflection points, which are the closure modes, on the impact of unit speed change, water level fluctuation of surge tank, and the pressure fluctuation of volute inlet and draft tube inlet are further discussed. By compared with the calculation results, a reasonable guide vanes inflection point position can be determined according to security requirements and a reasonable guide vanes closure law can be attained to effectively coordinate the unit speed rise and the rapid pressure change in the load rejection transient process.

A combination of subcuticular suture and sterile Micropore tape compared with conventional interrupted sutures for skin closure. A controlled trial.

PubMed Central

Taube, M.; Porter, R. J.; Lord, P. H.

1983-01-01

We have conducted a controlled trial to compare skin closure using conventional interrupted sutures with a combination of subcuticular suture and sterile Micropore tape in 169 patients undergoing appendicectomy, inguinal herniorrhaphy, or saphenofemoral ligation. We have found that the combination technique consistently gives a better cosmetic result and that the tape acts well as a dressing, is convenient, and is well tolerated by patients. Images Fig. 1 Fig. 2 Fig. 3 Fig. 4 PMID:6344732

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

PubMed

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

2013-08-20

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

The Use of the 'Preclosure' Technique for Antegrade Aspiration Thrombectomy with Large Catheters in Acute Limb Ischemia

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

Funke, C., E-mail: claas_funke@hotmail.com; Pfiffner, R.; Husmann, M.

2013-04-15

This study was designed to assess retrospectively short- and mid-term outcomes of the use of a suture-mediated closure device to close the antegrade access in patients undergoing percutaneous aspiration thrombectomy with large catheters for acute leg ischemia. Between November 2005 and February 2010, a suture-mediated active closure system (ProGlide{sup Registered-Sign} 6F, Abbott) was placed before arterial sheath (mean 9 F, range 6-12 F) introduction in 101 patients (74 men, 73 %, mean age 70.1 {+-} 12.6 years standard deviation). Data regarding mortality, complications, and factors contributing to vascular complications at the access site was collected for 6 month after themore » intervention to detect device-related problems. As a coincidence, 77 patients had follow-up visits for a duplex ultrasound. There were a total of 19 vascular complications (19 %) at the puncture site, all of which were of hemorrhagic nature and none of which consisted of vessel occlusion. Two major outcome complications (2 %) occurred. A retroperitoneal hematoma and a serious inguinal bleeding required additive treatment and did not result in permanent sequelae. Nine cases involved death of which eight were not attributable to the closure and one remained unclear. Successful closure was achieved in 95 patients (94 %); additional manual compression was sufficient in the majority of the remaining patients. Numerous factors contributing to vascular complications were encountered. With acceptable short- and mid-term outcomes, the 'preclose' technique can be a reliable option for the closure of a large antegrade femoral access even for patients at a high risk of vascular complications, such as those undergoing aspiration thrombectomy.« less

Short-Term Safety and Efficacy of Femoral Vascular Closure after Percutaneous Coronary Intervention with Combination of the Boomerang(TM) Device and Intravenous Protamine Sulfate.

PubMed

Chen, Ching-Pei; Huang, Huang-Kai; Hsia, Chien-Hsun; Chang, Yung-Ming; Lin, Lee-Shin; Lee, Cheng-Liang

2013-11-01

The Cardiva Boomerang(TM) is a device used to perform femoral vascular closure. It facilitates passive hemostasis at the arteriotomy site, leaving no residual foreign body. We performed a controlled, randomized study of 60 patients undergoing percutaneous coronary intervention. Patients were randomized into two groups (30 per group) to undergo vascular closure with the Boomerang(TM) or the Perclose(TM) suture-based device after the intravenous administration of protamine sulfate. We compared overall success rates, patient-reported pain, length of time to achieve hemostasis and mobilization of the patient, and the frequency of complications in the two groups. Overall success rates using the Boomerang(TM) and Perclose(TM) devices were similarly high, at 93% and 97%, respectively. The Boomerang(TM) was significantly quicker to deploy than the PercloseTM, device deployment time, median (Q1-Q3), [2.00 (1.33-2.75) vs. 3.84 (2.75-4.38) mins, p < 0.001)]. The pain score was significantly lower in the Boomerang(TM) group (1.1 ± 1.7 vs. 6.4 ± 2.9, p < 0.001). The time the device remained in the artery and manual compression time were significantly longer with the Boomerang(TM) (p < 0.001), as well as the time taken to achieve hemostasis and time to ambulation. There were no major complications in either group and no significant differences between the groups in the frequency of minor complications. We conclude that when used in combination with intravenous protamine sulfate, the Boomerang(TM) device is as safe and effective as the Perclose(TM) device for femoral vascular closure, but quicker to deploy and less painful to patients. Boomerang; Percutaneous intervention; Vascular closure device.

Cost savings associated with prevention of recurrent lumbar disc herniation with a novel annular closure device: a multicenter prospective cohort study.

PubMed

Parker, Scott L; Grahovac, Gordan; Vukas, Duje; Ledic, Darko; Vilendecic, Milorad; McGirt, Matthew J

2013-09-01

Same-level recurrent disc herniation is a well-defined complication following lumbar discectomy. Reherniation results in increased morbidity and health care costs. Techniques to reduce these consequences may improve outcomes and reduce cost after lumbar discectomy. In a prospective cohort study, we set out to evaluate the cost associated with surgical management of recurrent, same-level lumbar disc herniation following primary discectomy. Forty-six consecutive European patients undergoing lumbar discectomy for a single-level herniated disc at two institutions were prospectively followed with clinical and radiographic evaluations. A second consecutive cohort of 30 patients undergoing 31 lumbar discectomies with implantation of an annular closure device was followed at the same hospitals and same follow-up intervals. Cost estimates for reherniation were modeled on Medicare national allowable payment amounts (direct cost) and patient work-day losses (indirect cost). Annular closure and control cohorts were matched at baseline. By 2 years follow-up, symptomatic recurrent same-level disc herniation occurred in three (6.5%) patients in the control cohort versus zero (0%) patients in the annular closure cohort. For patients experiencing recurrent disc herniation, mean estimated direct and indirect cost of management of recurrent disc herniation was $34,242 and $3,778, respectively. Use of an annular closure device potentially results in a cost savings of $222,573 per 100 primary discectomy procedures performed (or $2,226 per discectomy), based solely on the reduction of reoperated reherniations when modeled on U.S. Medicare costs. Recurrent disc herniation did not occur in any patients after annular closure within the 12-month follow-up. The reduction in the incidence of reherniation was associated with potentially significant cost savings. Development of novel techniques to prevent recurrent lumbar disc herniation is warranted to decrease the associated morbidity and health care costs associated with this complication. Georg Thieme Verlag KG Stuttgart · New York.

Drosophila heart cell movement to the midline occurs through both cell autonomous migration and dorsal closure.

PubMed

Haack, Timm; Schneider, Matthias; Schwendele, Bernd; Renault, Andrew D

2014-12-15

The Drosophila heart is a linear organ formed by the movement of bilaterally specified progenitor cells to the midline and adherence of contralateral heart cells. This movement occurs through the attachment of heart cells to the overlying ectoderm which is undergoing dorsal closure. Therefore heart cells are thought to move to the midline passively. Through live imaging experiments and analysis of mutants that affect the speed of dorsal closure we show that heart cells in Drosophila are autonomously migratory and part of their movement to the midline is independent of the ectoderm. This means that heart formation in flies is more similar to that in vertebrates than previously thought. We also show that defects in dorsal closure can result in failure of the amnioserosa to properly degenerate, which can physically hinder joining of contralateral heart cells leading to a broken heart phenotype. Copyright © 2014 Elsevier Inc. All rights reserved.

Performance characteristics of a novel blood bag in-line closure device and subsequent product quality assessment

PubMed Central

Serrano, Katherine; Levin, Elena; Culibrk, Brankica; Weiss, Sandra; Scammell, Ken; Boecker, Wolfgang F; Devine, Dana V

2010-01-01

BACKGROUND In high-volume processing environments, manual breakage of in-line closures can result in repetitive strain injury (RSI). Furthermore, these closures may be incorrectly opened causing shear-induced hemolysis. To overcome the variability of in-line closure use and minimize RSI, Fresenius Kabi developed a new in-line closure, the CompoFlow, with mechanical openers. STUDY DESIGN AND METHODS The consistency of the performance of the CompoFlow closure device was assessed, as was its effect on component quality. A total of 188 RBC units using CompoFlow blood bag systems and 43 using the standard bag systems were produced using the buffy coat manufacturing method. Twenty-six CompoFlow platelet (PLT) concentrates and 10 control concentrates were prepared from pools of four buffy coats. RBCs were assessed on Days 1, 21, and 42 for cellular variables and hemolysis. PLTs were assessed on Days 1, 3, and 7 for morphology, CD62P expression, glucose, lactate, and pH. A total of 308 closures were excised after processing and the apertures were measured using digital image analysis. RESULTS The use of the CompoFlow device significantly improved the mean extraction time with 0.46 ± 0.11 sec/mL for the CompoFlow units and 0.52 ± 0.13 sec/mL for the control units. The CompoFlow closures showed a highly reproducible aperture after opening (coefficient of variation, 15%) and the device always remained opened. PLT and RBC products showed acceptable storage variables with no differences between CompoFlow and control. CONCLUSIONS The CompoFlow closure devices improved the level of process control and processing time of blood component production with no negative effects on product quality. PMID:20529007

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

Code of Federal Regulations, 2010 CFR

2010-07-01

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

40 CFR 258.50 - Applicability.

Code of Federal Regulations, 2011 CFR

2011-07-01

... in § 258.2) during the active life of the unit and the post-closure care period. This demonstration... shall be conducted throughout the active life and post-closure care period of that MSWLF unit as... scientist or engineer who has received a baccalaureate or post-graduate degree in the natural sciences or...

40 CFR 258.50 - Applicability.

Code of Federal Regulations, 2014 CFR

2014-07-01

... in § 258.2) during the active life of the unit and the post-closure care period. This demonstration... shall be conducted throughout the active life and post-closure care period of that MSWLF unit as... scientist or engineer who has received a baccalaureate or post-graduate degree in the natural sciences or...

40 CFR 258.50 - Applicability.

Code of Federal Regulations, 2012 CFR

2012-07-01

... in § 258.2) during the active life of the unit and the post-closure care period. This demonstration... shall be conducted throughout the active life and post-closure care period of that MSWLF unit as... scientist or engineer who has received a baccalaureate or post-graduate degree in the natural sciences or...

40 CFR 258.50 - Applicability.

Code of Federal Regulations, 2013 CFR

2013-07-01

... in § 258.2) during the active life of the unit and the post-closure care period. This demonstration... shall be conducted throughout the active life and post-closure care period of that MSWLF unit as... scientist or engineer who has received a baccalaureate or post-graduate degree in the natural sciences or...

Failure of mesenteric defect closure after Roux-en-Y gastric bypass.

PubMed

Hope, William W; Sing, Ronald F; Chen, Albert Y; Lincourt, Amy E; Gersin, Keith S; Kuwada, Timothy S; Heniford, B Todd

2010-01-01

Bowel obstructions following Roux-en-Y gastric bypass (RYGB) are a significant issue often caused by internal herniation. Controversy continues as to whether mesenteric defect closure is necessary to decrease the incidence of internal hernias after RYGB. Our purpose was to evaluate the effectiveness of closing the mesenteric defect at the jejunojejunostomy in patients who underwent RYGB by examining this potential space at reoperation for any reason. We retrospectively reviewed medical records of patients undergoing surgery after RYGB from August 1999 to October 2008 to determine the status of the mesentery at the jejunojejunostomy. Eighteen patients underwent surgery 2 to 19 months after open (n=8) or laparoscopic (n=10) RYGB. All patients had documented suture closure of their jejunojejunostomy at the time of RYGB. Permanent (n=12) or absorbable (n=6) sutures were used for closures. Patients lost 23.6 kg to 62.1 kg before a reoperation was required for a ventral hernia (n=8), cholecystectomy (n=4), abdominal pain (n=4), or small bowel obstruction (n=2). Fifteen of the 18 patients had open mesenteric defects at the jejunojejunostomy despite previous closure; none were the cause for reoperation. Routine suture closure of mesenteric defects after RYGB may not be an effective permanent closure likely due to the extensive fat loss and weight loss within the mesentery.

The modern staged repair of classic bladder exstrophy: a detailed postoperative management strategy for primary bladder closure.

PubMed

Stec, Andrew A; Baradaran, Nima; Schaeffer, Anthony; Gearhart, John P; Matthews, Ranjiv I

2012-10-01

Successful primary bladder closure of classic bladder exstrophy sets the stage for development of adequate bladder capacity and eventual voided continence. The postoperative pathway following primary bladder closure at the authors' institution is quantitatively and qualitatively detailed. Sixty-five consecutive newborns (47 male) undergoing primary closure of classic bladder exstrophy were identified and data were extracted relating to immediate postoperative care. Overall success rate was utilized to validate the pathway. Mean age at time of primary closure was 4.6 days and mean hospital stay was 35.8 days. Osteotomy was performed in 19 patients (mean age 8.8 days), and was not required in 39 infants (mean age 2.9 days). All patients were immobilized for 4 weeks. Tunneled epidural analgesia was employed in 61/65 patients. All patients had ureteral catheters and a suprapubic tube, along with a comprehensive antibiotic regimen. Postoperative total parenteral nutrition was commonly administered, and enteral feedings started around day 4.6. Our success rate of primary closure was 95.4%. A detailed and regimented plan for bladder drainage, immobilization, pain control, nutrition, antimicrobial prophylaxis, and adequate healing time is a cornerstone for the postoperative management of the primary closure of bladder exstrophy. Copyright © 2011 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

Length and pressure of the reconstructed lower esophageal sphincter is determined by both crural closure and Nissen fundoplication.

PubMed

Louie, Brian E; Kapur, Seema; Blitz, Maurice; Farivar, Alexander S; Vallières, Eric; Aye, Ralph W

2013-02-01

Laparoscopic Nissen fundoplication is comprised of: a wrap thought responsible for the lower esophageal sphincter function and crural closure performed to prevent herniation. We hypothesized gastroesophageal junction competence effected by Nissen fundoplication results from closure of the crural diaphragm and creation of the fundoplication. Patients with uncomplicated reflux undergoing Nissen fundoplication were prospectively enrolled. After hiatal dissection, patients were randomized to crural closure followed by fundoplication (group 1) or fundoplication followed by crural closure (group 2). Intra-operative high-resolution manometry collected sphincter pressure and length data after complete dissection and after each component repair. Eighteen patients were randomized. When compared to the completely dissected hiatus, the mean sphincter length increased 1.3 cm (p < 0.001), and mean sphincter pressure was increased by 13.7 mmHg (p < 0.001). Groups 1 and 2 had similar sphincter length and pressure changes. Crural closure and fundal wrap contribute equally to sphincter length, although crural closure appears to contribute more to sphincter pressure. The Nissen fundoplication restores the function of the gastroesophageal junction and thus the reflux barrier by means of two main components: the crural closure and the construction of a 360° fundal wrap. Each of these components is equally important in establishing both increased sphincter length and pressure.

Actomyosin purse strings: renewable resources that make morphogenesis robust and resilient

PubMed Central

Rodriguez-Diaz, Alice; Toyama, Yusuke; Abravanel, Daniel L.; Wiemann, John M.; Wells, Adrienne R.; Tulu, U. Serdar; Edwards, Glenn S.; Kiehart, Daniel P.

2008-01-01

Dorsal closure in Drosophila is a model system for cell sheet morphogenesis and wound healing. During closure two sheets of lateral epidermis move dorsally to close over the amnioserosa and form a continuous epidermis. Forces from the amnioserosa and actomyosin-rich, supracellular purse strings at the leading edges of these lateral epidermal sheets drive closure. Purse strings generate the largest force for closure and occur during development and wound healing throughout phylogeny. We use laser microsurgery to remove some or all of the purse strings from developing embryos. Free edges produced by surgery undergo characteristic responses as follows. Intact cells in the free edges, which previously had no purse string, recoil away from the incision and rapidly assemble new, secondary purse strings. Next, recoil slows, then pauses at a turning point. Following a brief delay, closure resumes and is powered to completion by the secondary purse strings. We confirm that the assembly of the secondary purse strings requires RhoA. We show that α-actinin alternates with nonmuscle myosin II along purse strings and requires nonmuscle myosin II for its localization. Together our data demonstrate that purse strings are renewable resources that contribute to the robust and resilient nature of closure. PMID:19404432

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

PubMed

Eliya-Masamba, Martha C; Banda, Grace W

2013-10-22

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

How long will I have my ACE? The natural history of the antegrade continence enema stoma in idiopathic constipation.

PubMed

Khoo, A Kate; Askouni, Evita; Basson, Sonia; Ng, Jessica; Cleeve, Stewart

2017-11-01

We aim to determine the natural history of the ACE in idiopathic constipation and factors predictive of closure. A retrospective case-note review of all patients undergo ACE formation for idiopathic constipation Jan 2003-Mar 2016. Kaplan-Meier analysis was used to determine ACE survival and Cox's proportional hazard models to examine potential predictors of closure. 29/84 (35%) ACEs were closed: 21/84 due to success and 8/84 due to failure. Median age of closure was 15.5 years (3.5-23.6). Median ACE survival was 77.0 months (95% CI 58.0-96.0). An ACE survival curve was derived from which we estimate that 5-year post-ACE, one-third of patients can expect to have had their ACE closed. Younger age at ACE was predictive of earlier closure (p = 0.023) and closure for success (p < 0.001). Neither patient sex (p = 0.546) nor presence of psychological comorbidities (p = 0.769) predicted likelihood of closure. Incontinence 6-week post-ACE was also associated with increased likelihood of closure (p = 0.042). The ACE survival curve estimates the proportion of patients with idiopathic constipation who can expect closure (either due to success or failure) at certain timepoints. This may be useful for patient counseling. Younger age at ACE was associated with earlier closure (for success).

Cost-effectiveness of Ward Closure to Control Outbreaks of Norovirus Infection in United Kingdom National Health Service Hospitals.

PubMed

Sadique, Zia; Lopman, Ben; Cooper, Ben S; Edmunds, W John

2016-02-01

Norovirus is the most common cause of outbreaks of acute gastroenteritis in National Health Service hospitals in the United Kingdom. Wards (units) are often closed to new admissions to stop the spread of the virus, but there is limited evidence describing the cost-effectiveness of ward closure. An economic analysis based on the results from a large, prospective, active-surveillance study of gastroenteritis outbreaks in hospitals and from an epidemic simulation study compared alternative ward closure options evaluated at different time points since first infection, assuming different efficacies of ward closure. A total of 232 gastroenteritis outbreaks occurring in 14 hospitals over a 1-year period were analyzed. The risk of a new outbreak in a hospital is significantly associated with the number of admission, general medical, and long-stay wards that are concurrently affected but is less affected by the level of community transmission. Ward closure leads to higher costs but reduces the number of new outbreaks by 6%-56% and the number of clinical cases by 1%-55%, depending on the efficacy of the intervention. The incremental cost per outbreak averted varies from £10 000 ($14 000) to £306 000 ($428 000), and the cost per case averted varies from £500 ($700) to £61 000 ($85 000). The cost-effectiveness of ward closure decreases as the efficacy of the intervention increases, and the cost-effectiveness increases with the timing of the intervention. The efficacy of ward closure is critical from a cost-effectiveness perspective. Ward closure may be cost-effective, particularly if targeted to high-throughput units. Published by Oxford University Press for the Infectious Diseases Society of America 2016. This work is written by (a) US Government employee(s) and is in the public domain in the US.

Closure Report for the 92-Acre Area and Corrective Action Unit 111: Area 5 WMD Retired Mixed Waste Pits, Nevada National Security Site, Nevada

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

NSTec Environmental Restoration

2012-02-21

This Closure Report (CR) presents information supporting closure of the 92-Acre Area, which includes Corrective Action Unit (CAU) 111, 'Area 5 WMD Retired Mixed Waste Pits.' This CR provides documentation supporting the completed corrective actions and confirmation that the closure objectives were met. This CR complies with the requirements of the Federal Facility Agreement and Consent Order (FFACO) (FFACO, 1996 [as amended March 2010]). Closure activities began in January 2011 and were completed in January 2012. Closure activities were conducted according to Revision 1 of the Corrective Action Decision Document/Corrective Action Plan (CADD/CAP) for the 92-Acre Area and CAU 111more » (U.S. Department of Energy, National Nuclear Security Administration Nevada Site Office [NNSA/NSO], 2010). The following closure activities were performed: (1) Construct an engineered evapotranspiration cover over the boreholes, trenches, and pits in the 92-Acre Area; (2) Install use restriction (UR) warning signs, concrete monuments, and subsidence survey monuments; and (3) Establish vegetation on the covers. UR documentation is included as Appendix C of this report. The post-closure plan is presented in detail in Revision 1 of the CADD/CAP for the 92-Acre Area and CAU 111, and the requirements are summarized in Section 5.2 of this document. When the next request for modification of Resource Conservation and Recovery Act Permit NEV HW0101 is submitted to the Nevada Division of Environmental Protection (NDEP), the requirements for post-closure monitoring of the 92-Acre Area will be included. NNSA/NSO requests the following: (1) A Notice of Completion from NDEP to NNSA/NSO for closure of CAU 111; and (2) The transfer of CAU 111 from Appendix III to Appendix IV, Closed Corrective Action Units, of the FFACO.« less

Addendum to the Closure Report for Corrective Action Unit 411: Double Tracks Plutonium Dispersion (Nellis), Nevada Test and Training Range, Nevada, Revision 0

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

Burmeister, Mark

2016-11-01

The Corrective Action Unit (CAU) 411 Closure Report (CR) was published in June 2016 (NNSA/NFO, 2016). The purpose of this addendum is to clarify language in the CR relating to the field instrument for the detection of low-energy radiation (FIDLER), provide the waste disposal documentation for waste generated during the corrective action investigation (CAI), and reference a letter from the U.S. Air Force (USAF) regarding the closure of CAU 411.

76 FR 39313 - Fisheries of the Northeastern United States; Atlantic Mackerel, Squid, and Butterfish Fisheries...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-06

.... 100804323-0569-02] RIN 0648-XA523 Fisheries of the Northeastern United States; Atlantic Mackerel, Squid, and Butterfish Fisheries; Closure of the Directed Butterfish Fishery AGENCY: National Marine Fisheries Service...; closure. SUMMARY: NMFS announces that the directed fishery for butterfish in the Exclusive Economic Zone...

Aortic valve replacement in a patient with severe nickel allergy.

PubMed

Lusini, Mario; Barbato, Raffaele; Spadaccio, Cristiano; Chello, Massimo

2011-11-01

Nickel allergy can raise clinical problems in patients undergoing cardiac surgery who require sternal closure with stainless steel wire. We describe the case of a 51-year-old woman with severe nickel allergy who underwent aortic valve replacement with a nickel-free ON-X prosthesis and sternal closure by Fiberwire # 2 suture without complications. Considering its biocompatibility and its mechanical characteristics including optimal strength and knot resistance, this suture might be a viable alternative in patients in which the use of stainless steel wire is contraindicated. © 2011 Wiley Periodicals, Inc.

36 CFR 13.1120 - Bartlett Cove Developed Area closures and restrictions.

Code of Federal Regulations, 2010 CFR

2010-07-01

... closures and restrictions. 13.1120 Section 13.1120 Parks, Forests, and Public Property NATIONAL PARK SERVICE, DEPARTMENT OF THE INTERIOR NATIONAL PARK SYSTEM UNITS IN ALASKA Special Regulations-Glacier Bay National Park and Preserve Bartlett Cove § 13.1120 Bartlett Cove Developed Area closures and restrictions...

36 CFR 13.1120 - Bartlett Cove Developed Area closures and restrictions.

Code of Federal Regulations, 2013 CFR

2013-07-01

... closures and restrictions. 13.1120 Section 13.1120 Parks, Forests, and Public Property NATIONAL PARK SERVICE, DEPARTMENT OF THE INTERIOR NATIONAL PARK SYSTEM UNITS IN ALASKA Special Regulations-Glacier Bay National Park and Preserve Bartlett Cove § 13.1120 Bartlett Cove Developed Area closures and restrictions...

36 CFR 13.1120 - Bartlett Cove Developed Area closures and restrictions.

Code of Federal Regulations, 2014 CFR

2014-07-01

... closures and restrictions. 13.1120 Section 13.1120 Parks, Forests, and Public Property NATIONAL PARK SERVICE, DEPARTMENT OF THE INTERIOR NATIONAL PARK SYSTEM UNITS IN ALASKA Special Regulations-Glacier Bay National Park and Preserve Bartlett Cove § 13.1120 Bartlett Cove Developed Area closures and restrictions...

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

Code of Federal Regulations, 2010 CFR

2010-07-01

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

Cost comparison of transcatheter and operative closures of ostium secundum atrial septal defects

PubMed Central

O’Byrne, Michael L.; Gillespie, Matthew J.; Shinohara, Russell T.; Dori, Yoav; Rome, Jonathan J.; Glatz, Andrew C.

2015-01-01

Background Clinical outcomes for transcatheter and operative closures of atrial septal defects (ASDs) are similar. Economic cost for each method has not been well described. Methods A single-center retrospective cohort study of children and adults <30 years of age undergoing closure for single secundum ASD from January 1, 2007, to April 1, 2012, was performed to measure differences in inflation-adjusted cost of operative and transcatheter closures of ASD. A propensity score weight-adjusted multivariate regression model was used in an intention-to-treat analysis. Costs for reintervention and crossover admissions were included in primary analysis. Results A total of 244 subjects were included in the study (64% transcatheter and 36% operative), of which 2% (n = 5) were ≥18 years. Crossover rate from transcatheter to operative group was 3%. Risk of reintervention (P = .66) and 30-day mortality (P = .37) were not significantly different. In a multivariate model, adjusted cost of operative closure was 2012 US $60,992 versus 2012 US $55,841 for transcatheter closure (P < .001). Components of total cost favoring transcatheter closure were length of stay, medications, and follow-up radiologic and laboratory testing, overcoming higher costs of procedure and echocardiography. Professional costs did not differ. The rate of 30-day readmission was greater in the operative cohort, further increasing the cost advantage of transcatheter closure. Sensitivity analyses demonstrated that costs of follow-up visits influenced relative cost but that device closure remained favorable over a broad range of crossover and reintervention rates. Conclusion For single secundum ASD, cost comparison analysis favors transcatheter closure over the short term. The cost of follow-up regimens influences the cost advantage of transcatheter closure. PMID:25965721

Corrective Action Decision Document/Closure Report for Corrective Action Unit 477: Area 12 N-Tunnel Muckpile, Nevada Test Site

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

NSTec Environmental Restoration

This Corrective Action Decision Document (CADD)/Closure Report (CR) was prepared by the Defense Threat Reduction Agency (DTRA) for Corrective Action Unit (CAU) 477, N-Tunnel Muckpile. This CADD/CR is consistent with the requirements of the Federal Facility Agreement and Consent Order (FFACO) agreed to by the State of Nevada, the U.S. Department of Energy, and the U.S. Department of Defense. Corrective Action Unit 477 is comprised of one Corrective Action Site (CAS): • 12-06-03, Muckpile The purpose of this CADD/CR is to provide justification and documentation supporting the recommendation for closure with no further action, by placing use restrictions on CAUmore » 477.« less

Association of land use and its change with beach closure in the United States, 2004-2013

EPA Science Inventory

Land use and its change have great influences on water quality. However, their impacts on microbial contamination of beach water have been rarely investigated and their relationship with beach closure is still unknown. Here, we analyzed beach closure data obtained from 2004 to 20...

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

Code of Federal Regulations, 2010 CFR

2010-07-01

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

78 FR 76759 - Fisheries of the Northeastern United States; Northeast Multispecies Fishery; Trimester Closure...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-12-19

... Fishery; Trimester Closure for the Common Pool Fishery AGENCY: National Marine Fisheries Service (NMFS... Trimester 3, from January 1, 2014, through April 30, 2014, to common pool vessels, because the Trimester 3... intended to prevent the overharvest of the common pool's allocation of GOM haddock. DATES: The closure of...

Results of comparing transthoracic device closure and surgical repair with right infra-axillary thoracotomy for perimembranous ventricular septal defects.

PubMed

Hu, Yijie; Li, Zhiping; Chen, Jianming; Li, Fuping; Shen, Cheng; Song, Yi; Zhao, Shulin; Peng, Caijing; Chen, Mingxiang; Zhong, Qianjin

2015-04-01

Transthoracic device closure (TTDC) and surgical repair with right infra-axillary thoracotomy (SRRIAT) are two main alternative minimally invasive approaches for restrictive perimembranous ventricular septal defect (VSD); however, few studies have compared them with each other in terms of effectiveness and cost. Patients with perimembranous VSD undergoing TTDC or SRRIAT from January 2012 to July 2013 were reviewed in a comparative investigation between the two procedures. Success from the procedures was achieved in 30 TTDC (30/33, 91%) and 96 SRRIAT patients (100%). Operation duration in the TTDC group was significantly shorter than that of the SRRIAT group (115.8 ± 43.8 vs 175.6 ± 41.3 min, P < 0.01). The total perioperative drainage, use of red blood cells, mechanical ventilation time, stay in the intensive care unit and hospital stay for the TTDC group were significantly less than those in the SRRIAT group. No deaths or complete atrioventricular block occurred in either group. One SRRIAT patient accepted a second surgery for residual shunt. TTDC costs slightly more than SRRIAT (40270.6 ± 2741.3 renmingbi [RMB] vs 32964.5 ± 8221.6 RMB, P < 0.01). Both TTDC and SRRIAT showed excellent outcomes and cosmetic appearance for suitable VSD candidates. Although its costs were higher, TTDC had the advantages over SRRIAT of a short operation duration and intensive care unit stay and fewer days in the hospital. © The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

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

PubMed

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

2014-11-01

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

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

PubMed

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

2016-10-01

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

Prospective evaluation of surgical site infection rate among patients with Mohs micrographic surgery without the use of prophylactic antibiotics.

PubMed

Maragh, Sherry L H; Brown, Marc D

2008-08-01

Antibiotics may be indiscriminately given to patients undergoing Mohs micrographic surgery (MMS) for the prevention of surgical site infections, despite a low risk of infection in these patients. We sought to evaluate the rate of wound infections among patients undergoing MMS without the use of prophylactic antibiotics. We prospectively evaluated 1000 consecutive patients undergoing MMS for nonmelanoma skin cancer or modified MMS/"slow Mohs" for lentigo maligna melanoma in situ. The overall wound infection rate among 1000 patients with 1115 tumors was 0.7% (8/1115 tumors). Five (62.5%) of 8 infections occurred on the nose with an overall 1.7% (5/302) nose infection rate. Seven (87.5%) of 8 infections occurred after flap reconstruction with an overall 2.4% (7/296) flap closure infection rate. Four (50%) of 8 infections occurred in patients requiring more than one Mohs stage for tumor clearance with a 0.8% (4/487) overall infection rate in cases requiring multiple Mohs stages. Two (25%) of 8 infections had cultures positive for oxacillin-resistant Staphylococcus aureus. No wound infections occurred in cases involving the lips or ears, skin-graft closures, or below-knee or modified MMS procedures. This was a prospective single institution uncontrolled study. Rates of infections among patients undergoing MMS or modified MMS are exceedingly low. Indiscriminate use of antibiotics increases patient risk to adverse drug reactions and antibiotic resistance. Administration of antibiotics to patients undergoing MMS should be on a case-by-case basis according to the known risk factors combined with clinical judgment.

Efficacy of stapler versus hand-sewn closure after distal pancreatectomy (DISPACT): a randomised, controlled multicentre trial.

PubMed

Diener, Markus K; Seiler, Christoph M; Rossion, Inga; Kleeff, Jörg; Glanemann, Matthias; Butturini, Giovanni; Tomazic, Ales; Bruns, Christiane J; Busch, Olivier R C; Farkas, Stefan; Belyaev, Orlin; Neoptolemos, John P; Halloran, Christopher; Keck, Tobias; Niedergethmann, Marco; Gellert, Klaus; Witzigmann, Helmut; Kollmar, Otto; Langer, Peter; Steger, Ulrich; Neudecker, Jens; Berrevoet, Frederik; Ganzera, Silke; Heiss, Markus M; Luntz, Steffen P; Bruckner, Thomas; Kieser, Meinhard; Büchler, Markus W

2011-04-30

The ideal closure technique of the pancreas after distal pancreatectomy is unknown. We postulated that standardised closure with a stapler device would prevent pancreatic fistula more effectively than would a hand-sewn closure of the remnant. This multicentre, randomised, controlled, parallel group-sequential superiority trial was done in 21 European hospitals. Patients with diseases of the pancreatic body and tail undergoing distal pancreatectomy were eligible and were randomly assigned by central randomisation before operation to either stapler or hand-sewn closure of the pancreatic remnant. Surgical performance was assessed with intraoperative photo documentation. The primary endpoint was the combination of pancreatic fistula and death until postoperative day 7. Patients and outcome assessors were masked to group assignment. Interim and final analysis were by intention to treat in all patients in whom a left resection was done. This trial is registered, ISRCTN18452029. Between Nov 16, 2006, and July 3, 2009, 450 patients were randomly assigned to treatment groups (221 stapler; 229 hand-sewn closure), of whom 352 patients (177 stapler, 175 hand-sewn closure) were analysed. Pancreatic fistula rate or mortality did not differ between stapler (56 [32%] of 177) and hand-sewn closure (49 [28%] of 175; OR 0·84, 95% CI 0·53–1·33; p=0·56). One patient died within the fi rst 7 days after surgery in the hand-sewn group; no deaths occurred in the stapler group. Serious adverse events did not differ between groups. Stapler closure did not reduce the rate of pancreatic fistula compared with hand-sewn closure for distal pancreatectomy. New strategies, including innovative surgical techniques, need to be identified to reduce this adverse outcome. German Federal Ministry of Education and Research.

Pericardium closure after heart operations: a safety option?

PubMed

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

2010-01-01

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

3718-F Alkali Metal Treatment and Storage Facility Closure Plan

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

None

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

Wound Complication Rates After Staples or Suture for Midline Vertical Skin Closure in Obese Women: A Randomized Controlled Trial.

PubMed

Kuroki, Lindsay M; Mullen, Mary M; Massad, L Stewart; Wu, Ningying; Liu, Jingxia; Mutch, David G; Powell, Matthew A; Hagemann, Andrea R; Thaker, Premal H; McCourt, Carolyn K; Novetsky, Akiva P

2017-07-01

To compare wound complication rates after skin closure with staples and subcuticular suture in obese gynecology patients undergoing laparotomy through a midline vertical incision. In this randomized controlled trial, women with body mass indexes (BMIs) of 30 or greater undergoing surgery by a gynecologic oncologist through a midline vertical incision were randomized to skin closure with staples or subcuticular 4-0 monofilament suture. The primary outcome was the rate of wound complication, defined as the presence of a wound breakdown, or infection, within 8 weeks postoperatively. Secondary outcomes included operative time, Stony Brook scar cosmetic score, and patient satisfaction. A sample size of 162 was planned to detect a 50% reduction in wound complications. At planned interim review (n=82), there was no significant difference in primary outcome. Between 2013 and 2016, 163 women were analyzed, including 84 who received staples and 79 suture. Women who received staples were older (mean age 59 compared with 57 years), had lower mean BMI (37.3 compared with 38.9), and fewer benign indications for surgery (22 compared with 27). There were no differences in wound complication rates between staple compared with suture skin closure (28 [33%] compared with 25 [32%], relative risk 1.05, 95% confidence interval [CI] 0.68-1.64). Women with staples reported worse median cosmetic scores (four of five compared with five of five, P<.001), darker scar color (37 [49%] compared with 13 [18%], relative risk 2.69, 95% CI 1.57-4.63), and more skin marks (30 [40%] compared with three [4%], relative risk 9.47, 95% CI 3.02-29.65) compared with women with suture closure. There was no group difference regarding satisfaction with their scar. Stepwise multivariate analysis revealed BMI (odds ratio [OR] 1.13, 95% CI 1.07-1.20), maximum postoperative glucose (OR 1.01, 95% CI 1.00-1.01), and cigarette smoking (OR 4.96, 95% CI 1.32-18.71) were correlates of wound complication. Closure of midline vertical skin incisions with subcuticular suture does not reduce surgical site wound complications compared with staples in obese gynecology patients. ClinicalTrials.gov, NCT01977612.

"We Felt They Took the Heart out of the Community": Examining a Community-Based Response to Urban School Closure

ERIC Educational Resources Information Center

Green, Terrance L.

2017-01-01

Massive school closures are occurring in urban school districts across the United States. Research suggests that school closures are the outcome of racialized neoliberal policies and decades of disinvestment that have left many urban districts with fiscal deficits and declining student enrollments. However, some urban communities have successfully…

Opening a spiropyran ring by way of an exciplex intermediate.

PubMed

Benniston, Andrew C; Harriman, Anthony; Howell, Sarah L; Li, Peiyi; Lydon, Donocadh P

2007-02-02

A molecular dyad has been synthesized in which the main chromophore is a 1,4-diethynylated benzene residue terminated with pyrene moieties, this latter unit acting as a single chromophore. A spiropyran group has been condensed to the central phenylene ring so as to position a weak electron donor close to the pyrene unit. Illumination of the pyrene-based chromophore leads to formation of a fluorescent exciplex in polar solvents but pyrene-like fluorescence is observed in nonpolar solvents. The exciplex has a lifetime of a few nanoseconds and undergoes intersystem crossing to the pyrene-like triplet state with low efficiency. Attaching a 4-nitrobenzene group to the open end of the spiropyran unit creates a new route for decay of the exciplex whereby the triplet state of the spiropyran is formed. Nonradiative decay of this latter species results in ring opening to form the corresponding merocyanine species. Rate constants for the various steps have been obtained from time-resolved fluorescence spectroscopy carried out over a modest temperature range. Under visible light illumination, the merocyanine form reverts to the original spiropyran geometry so that the cycle is closed. Energy transfer from the pyrene chromophore to the merocyanine unit leads to an increased rate of ring closure and serves to push the steady-state composition in favor of the spiropyran form.

Corrective Action Decision Document/Closure Report for Corrective Action Unit 478: Area 12 T-Tunnel Ponds, Nevada Test Site

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

NSTec Environmental Restoration

This Corrective Action Decision Document (CADD)/Closure Report (CR) was prepared by the Defense Threat Reduction Agency (DTRA) for Corrective Action Unit (CAU) 478, Area 12 T-Tunnel Ponds. This CADD/CR is consistent with the requirements of the Federal Facility Agreement and Consent Order (FFACO) agreed to by the State of Nevada, the U.S. Department of Energy (DOE), and the U.S. Department of Defense. Corrective Action Unit 478 is comprised of one corrective action site (CAS): • 12-23-01, Ponds (5) RAD Area The purpose of this CADD/CR is to provide justification and documentation supporting the recommendation for closure in place with usemore » restrictions for CAU 478.« less

Corrective Action Decision Document/Closure Report for Corrective Action Unit 559: T Tunnel Compressor/Blower Pad, Nevada Test Site

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

NSTec Environmental Restoration

This Corrective Action Decision Document (CADD)/Closure Report (CR) was prepared by the Defense Threat Reduction Agency (DTRA) for Corrective Action Unit (CAU) 559, T-Tunnel Compressor/Blower Pad. This CADD/CR is consistent with the requirements of the Federal Facility Agreement and Consent Order (FFACO) agreed to by the State of Nevada, the U.S. Department of Energy, and the U.S. Department of Defense. Corrective Action Unit 559 is comprised of one Corrective Action Site (CAS): • 12-25-13, Oil Stained Soil and Concrete The purpose of this CADD/CR is to provide justification and documentation supporting the recommendation for closure in place with use restrictionsmore » for CAU 559.« less

Babies born before arrival to hospital and maternity unit closures in Queensland and Australia.

PubMed

Kildea, Sue; McGhie, Alexandra C; Gao, Yu; Rumbold, Alice; Rolfe, Margaret

2015-09-01

Evidence suggests the closure of maternity units is associated with an increase in babies born before arrival (BBA). To explore the association between the number of maternity units in Australia and Queensland by birthing numbers, BBA rate and geographic remoteness of the health district where the mother lives. A retrospective study utilised routinely collected perinatal data (1992-2011). Pearson correlation tested the relationship between BBA rate and number of maternity units. Linear regression examined this association over time. During 1992-2011, the absolute numbers (N=22,814) of women having a BBA each year in Australia increased by 47% (N=836-1233); and 206% (n=140-429) in Queensland. This coincided with a 41% reduction in maternity units in Australia (N=623-368=18 per year) and a 28% reduction in Queensland (n=129-93). BBA rates increased significantly across Australia, r=0.837, n=20 years, p<0.001 and Queensland, r=0.917, n=20 years, p<0.001 and this was negatively correlated with the number of maternity units in Australia, r=-0.804, n=19 years, p<0.001 and Queensland, r=-0.906, n=19 years, p<0.001. The closure of maternity units over a 20-year period across Australia and Queensland is significantly associated with increased BBA rates. The distribution is not limited to rural and remote areas. Given the high risk of adverse maternal and neonatal outcomes associated with BBA, it is time to revisit the closure of units. Copyright © 2015 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

Laparoscopic antireflux surgery with routine mesh-hiatoplasty in the treatment of gastroesophageal reflux disease.

PubMed

Granderath, Frank A; Schweiger, Ursula M; Kamolz, Thomas; Pasiut, Martin; Haas, Christoph F; Pointner, Rudolph

2002-01-01

One of the most frequent complications after laparoscopic antireflux surgery is intrathoracic migration of the wrap ("slipped" Nissen fundoplication). The most common reasons for this are inadequate closure of the crura or disruption of the crural closure. The aim of this prospective study was to evaluate surgical outcomes in patients who underwent laparoscopic antireflux surgery with simple nonabsorbable polypropylene sutures for hiatal closure in comparison to patients who underwent routine mesh-hiatoplasty. Between 1993 and 1998, a group of 361 patients underwent primary laparoscopic Nissen or Toupet fundoplication with the use of simple nonabsorbable polypropylene sutures for hiatal closure. Since December 1998, in all patients (n = 170) who underwent laparoscopic antireflux surgery, a 1 x 3 cm polypropylene mesh was placed on the crura behind the esophagus to reinforce them. Functional outcome, symptoms of gastroesophageal reflux disease, and postoperative complications such as recurrent hiatal hernia with or without intrathoracic migration of the wrap have been used for assessment of outcomes. In the initial series of 361 patients, postoperative herniation of the wrap occurred in 22 patients (6.1%). Of these 22 patients, 17 of them (4.7%) had to undergo laparoscopic redo surgery. The remaining five patients were free of symptoms. In comparison to these results, in a second group of 170 patients there was only one (0.6%) who had postoperative herniation of the wrap into the chest. There have been no significant differences in objective data such as DeMeester scores or lower esophageal sphincter pressure between the two groups. Postoperative dysphagia was increased during the early period after surgery in patients undergoing mesh-hiatoplasty but resolved without any further treatment within the first year after laparoscopic antireflux surgery. We concluded that routine hiatoplasty with the use of a polypropylene mesh is effective in preventing postoperative herniation of the wrap and leads to a significantly better surgical outcome than closure of the hiatal crura with simple sutures, without any additional long-term side effects.

CLOSURE REPORT FOR CORRECTIVE ACTION UNIT165: AREA 25 AND 26 DRY WELL AND WASH DOWN AREAS, NEVADA TEST SITE, NEVADA

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

BECHTEL NEVADA

This Closure Report (CR) documents the closure activities for Corrective Action Unit (CAU) 165, Area 25 and 26 Dry Well and Washdown Areas, according to the Federal Facility Agreement and Consent Order (FFACO) of 1996. CAU 165 consists of 8 Corrective Action Sites (CASs) located in Areas 25 and 26 of the Nevada Test Site (NTS). The NTS is located approximately 105 kilometers (65 miles) northwest of Las Vegas, nevada. Site closure activities were performed according to the Nevada Division of Environmental Protection (NDEP)-approved Corrective Action Plan (CAP) for CAU 165. CAU 165 consists of the following CASs: (1) CASmore » 25-07-06, Train Decontamination Area; (2) CAS 25-07-07, Vehicle Washdown; (3) CAS 25-20-01, Lab Drain Dry Well; (4) CAS 25-47-01, Reservoir and French Drain; (5) CAS 25-51-02, Drywell; (6) CAS 25-59-01, Septic System; (7) CAS 26-07-01, Vehicle Washdown Station; and (8) CAS 26-59-01, Septic System. CAU 165, Area 25 and 26 Dry Well and Washdown Areas, consists of eight CASs located in Areas 25 and 26 of the NTS. The approved closure alternatives included No Further Action, Clean Closure, and Closure in Place with Administrative Controls.« less

Transcatheter Closure of Patent Foramen Ovale: Devices and Technique.

PubMed

Price, Matthew J

2017-10-01

Transcatheter closure of a patent foramen ovale (PFO) reduces the risk of recurrent cryptogenic stroke compared with medical therapy. PFO closure is a prophylactic procedure, and will not provide the patient with symptomatic improvement, except in cases of hypoxemia due to right-to-left shunt or possibly migraine headaches. Therefore, appropriate patient selection is critical, and procedural safety is paramount. Herein, we review key characteristics of the devices currently available for transcatheter PFO closure within the United States, and highlight key technical aspects of the PFO closure procedure that will maximize procedural success. Copyright © 2017 Elsevier Inc. All rights reserved.

Predictors of Salivary Fistulas in Patients Undergoing Salvage Total Laryngectomy

PubMed Central

Wang, Steven J.

2014-01-01

Background. Salivary fistula is a common complication after salvage total laryngectomy. Previous studies have not considered the number of layers of pharyngeal closure and have not classified fistulas according to severity. Our objective was to analyze our institutional experience with salvage total laryngectomy, categorize salivary fistulas based on severity, and study the effect of various pharyngeal closure techniques on fistula incidence. Methods. Retrospective analysis of 48 patients who underwent salvage total laryngectomy, comparing pharyngeal closure technique and use of a pectoralis major flap with regard to salivary fistula rate. Fistulas were categorized into major and minor fistulas based on whether operative intervention was required. Results. The major fistula rate was 18.8% (9/48) and the minor fistula rate was 29.2% (14/48). The overall (major plus minor) fistula rate was 47.9%. The overall fistula and major fistula rates decreased with increasing the number of closure layers and with use of a pectoralis major flap; however, these correlations did not reach statistical significance. Other than age, there were no clinicopathologic variables associated with salivary fistulas. Conclusion. For salvage total laryngectomies, increasing the number of closure layers or use of a pectoralis major flap may reduce the risk of salivary fistula. PMID:27355065

Effects of transcatheter closure of Fontan fenestration on exercise tolerance. kidecho@yahoo.com.

PubMed

Momenah, Tarek S; Eltayb, Haifa; Oakley, Reida El; Qethamy, Howeida Al; Faraidi, Yahya Al

2008-05-01

Baffle fenestration is associated with a significantly better outcome in standard and high-risk patients undergoing completion of Fontan. We report the effects of subsequent transcatheter closure of fenestration on exercise capacity and oxygen saturation. Sixteen patients with a mean age of 10.3 years underwent Amplatzer septal occluder (ASO) device transcatheter closure of Fontan fenestration. All had a fenestrated Fontan operation 6 month to 8 years prior to the procedure. A stress test was performed before and after device closure of fenestration in 14 patients (2 patients did not tolerate stress test before the procedure). The fenestrations in all patients were successfully occluded with the use of the Amplatzer device occluder. No complications occurred during or after the procedure. O2 saturation increased from a mean 85.1 +/- 7.89% to 94.5 +/- 3.63% (p < 0.01) at rest and from 66.2 +/- 12.86% to 87.2 +/- 8.64% (p < 0.01) following exercise. Exercise duration has also increased from 8.22 +/- 2.74 min to 10.29 +/- 1.91 min (p < 0.05). Transcatheter closure of Fontan fenestration increases the duration of exercise capacity and increases O2 saturation at rest and after exercise.

Corrective Action Decision Document/Closure Report for Corrective Action Unit 570: Area 9 Yucca Flat Atmospheric Test Sites, Nevada National Security Site, Nevada, Revision 0

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

Matthews, Patrick

2013-11-01

This Corrective Action Decision Document/Closure Report presents information supporting the closure of Corrective Action Unit (CAU) 570: Area 9 Yucca Flat Atmospheric Test Sites, Nevada National Security Site, Nevada. This complies with the requirements of the Federal Facility Agreement and Consent Order (FFACO) that was agreed to by the State of Nevada; U.S. Department of Energy (DOE), Environmental Management; U.S. Department of Defense; and DOE, Legacy Management. The purpose of the CADD/CR is to provide justification and documentation supporting the recommendation that no further corrective action is needed.

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

Federal Register 2010, 2011, 2012, 2013, 2014

2010-10-01

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

Concomitant surgical closure of left atrial appendage: A systematic review and meta-analysis.

PubMed

Ando, Masahiko; Funamoto, Masaki; Cameron, Duke E; Sundt, Thoralf M

2018-03-12

Although percutaneous closure of the left atrial appendage is supported as a potential alternative to lifelong anticoagulation in patients with atrial fibrillation, comprehensive evidence on surgical left atrial appendage closure in heart surgery is limited. We conducted a meta-analysis of studies comparing patients who underwent open cardiac surgery with or without left atrial appendage closure. A literature search was performed on PubMed, Embase, and Cochrane Trials databases. Outcomes of interest were 30-day/in-hospital mortality and cerebrovascular accident. I 2 statistics were used to evaluate heterogeneity, and publication bias was evaluated by Begg's and Egger's tests. We reviewed 1284 articles and selected for main analysis 7 articles including 3897 patients (1963 in the left atrial appendage closure group and 1934 in the non-left atrial appendage closure group). Among the 7 studies, 3 were randomized-controlled studies, 3 were propensity-matched studies, and 1 was a case-matching study. At 30-day/in-hospital follow-up, left atrial appendage closure was significantly associated with decreased risk of mortality and cerebrovascular accident (odds ratio, 0.384, 95% confidence interval, 0.233-0.631 for mortality, and odds ratio, 0.622, 95% confidence interval, 0.388-0.998 for cerebrovascular accident). Stratified analysis demonstrated that this association was more prominent in preoperative atrial fibrillation strata. Concomitant surgical left atrial appendage closure should be considered at the time of open cardiac surgery, particularly among those in atrial fibrillation preoperatively. The benefit of left atrial appendage closure for patients not in atrial fibrillation and for those undergoing nonvalvular surgery is still unclear. Further prospective investigations are indicated. Copyright © 2018. Published by Elsevier Inc.

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

PubMed

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

2018-01-01

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

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

PubMed

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

2016-01-01

The vial capping process is a critical unit operation during drug product manufacturing, as it could possibly generate cosmetic defects or even affect container closure integrity. Yet there is significant variability in capping equipment and processes, and their relation to potential defects or container closure integrity has not been thoroughly studied. In this study we applied several methods-residual seal force tester, a self-developed system of a piezo force sensor measurement, and computed tomography-to characterize different container closure system combinations that had been sealed using different capping process parameter settings. Additionally, container closure integrity of these samples was measured using helium leakage (physical container closure integrity) and compared to characterization data. The different capping equipment settings lead to residual seal force values from 7 to 115 N. High residual seal force values were achieved with high capping pre-compression force and a short distance between the capping plate and plunge. The choice of container closure system influenced the obtained residual seal force values. The residual seal force tester and piezoelectric measurements showed similar trends. All vials passed physical container closure integrity testing, and no stopper rupture was seen with any of the settings applied, suggesting that container closure integrity was warranted for the studied container closure system with the chosen capping setting ranges. The vial capping process is a critical unit operation during drug product manufacturing, as it could possibly generate cosmetic defects or even affect container closure integrity. Yet there is significant variability in capping equipment and processes, and their relation to potential defects or container closure integrity has not been thoroughly studied. In this study we applied several methods-residual seal force tester, a self-developed system of a piezo force sensor measurement, and computed tomography-to characterize different container closure system combinations that had been sealed using different capping process parameter settings. The residual seal force tester can analyze a variety of different container closure systems independent of the capping equipment. An adequate and safe residual seal force range for each container closure system configuration can be established with the residual seal force tester and additional methods like computed tomography scans and leak testing. In the residual seal force range studied, the physical container closure integrity of the container closure system was warranted. © PDA, Inc. 2016.

[Effect of amino acid and glucose infusion on perioperative body temperature and postoperative infection in patients undergoing total knee arthroplasty].

PubMed

Fujita, Yasuki; Yamaguchi, Sayo; Nakamura, Kayo; Horiguchi, Yuu; Ikeda, Daisuke; Kaneko, Michiko; Tomioka, Keiko; Tokunaga, Chiharu; Iwakura, Takeo

2012-01-01

We investigated whether the perioperative amino acid infusion with glucose is effective for preventing perioperative hypothermia and postoperative infection in patients undregoing total knee arthroplasty (TKA). Forty patients undergoing TKA under general anesthesia were enrolled in this study. The patients were randomly allocated to two groups: AA group (n = 22), to which amino acid was infused, and AAGlu group (n = 18), to which amino acid and glucose were infused. The infusions were started before the anesthetic induction. Remifentanil was administered during the surgery, and the dose of remifentanil was adjusted to keep stable hemodynamics. The levels of blood glucose and body temperature were evaluated. We also recorded the frequency of additional use of nonsteroidal anti-inflammatory drugs, the days required until the wound closure, and complications in the post-operative period. The levels of blood glucose in AAGlu group were significantly higher than those of AA group (P < 0.05). However, no significant differences were found in perioperative body temperature, postoperative days required until the wound closure and the frequency of additional use of analgesics between the groups. These results suggest that in patients undergoing TKA receiveing amino acid infusion perioperatively, thermogenic effect and prevention of postoperative infection are similar whether exogenous glucose is infused or not.

The importance of preoperative oxygen saturation as a predictor of pulmonary arterial hypertension after surgery of atrial septal defects.

PubMed

Park, Han Ki; Shin, Hong Ju; Park, Young Hwan; Ma, Bo Gyoung

2016-09-01

There is no concrete predictor of the change of pulmonary arterial pressure after surgical closure of an atrial septal defect (ASD) in patients with pulmonary arterial hypertension (PAH). The aim of this study was to investigate the role of preoperative room air arterial oxygen saturation (SaO2) (arterial blood gas data) as a predictor of postoperative PAH. The medical records of 36 patients [>20 years, mean pulmonary arterial pressure (mPAP) ≥25 mmHg] who underwent surgical closure of an ASD between March 2004 and January 2014 were retrospectively reviewed. The median age was 47 years (range, 24.6-65.9 years) and mPAP was 38 ± 14 mmHg. The mean pulmonary vascular resistance (Rp) was 3.9 ± 4.2 Wood units, and fenestration was performed in 12 (33%) patients. Only 1 patient received anti-PAH medication preoperatively. The median follow-up period was 4 years (range, 0-10 years). There were two hospital deaths, one of which was related to PAH. At the last follow-up, PAH (estimated tricuspid regurgitation velocity >3 m/s) existed in 7 patients (19%), and 10 patients (28%) were receiving anti-PAH medications (considered as clinical PAH). Univariate analysis for persistent clinical PAH revealed that mPAP, Qp/Qs, Rp, room air arterial oxygen saturation and postoperative functional class were significant risk factors. Only SaO2 remained a significant risk factor in multivariate analysis (P = 0.03). Preoperative room air SaO2 is a useful predictor of persistent PAH in adult patients undergoing surgical closure of an ASD. © The Author 2016. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

Delayed Sternal Closure in Infant Heart Surgery-The Importance of Where and When: An Analysis of the STS Congenital Heart Surgery Database.

PubMed

Nelson-McMillan, Kristen; Hornik, Christoph P; He, Xia; Vricella, Luca A; Jacobs, Jeffrey P; Hill, Kevin D; Pasquali, Sara K; Alejo, Diane E; Cameron, Duke E; Jacobs, Marshall L

2016-11-01

Delayed sternal closure (DSC) is commonly used to optimize hemodynamic stability after neonatal and infant heart surgery. We hypothesized that duration of sternum left open (SLO) was associated with rate of infection complications, and that location of sternal closure may mitigate infection risk. Infants (age ≤365 days) undergoing index operations with cardiopulmonary bypass and DSC at STS Congenital Heart Surgery Database centers (from 2007 to 2013) with adequate data quality were included. Primary outcome was occurrence of infection complication, defined as one or more of the following: endocarditis, pneumonia, wound infection, wound dehiscence, sepsis, or mediastinitis. Multivariable regression models were fit to assess association of infection complication with: duration of SLO (days), location of DSC procedure (operating room versus elsewhere), and patient and procedural factors. Of 6,127 index operations with SLO at 100 centers, median age and weight were 8 days (IQR, 5-24) and 3.3 kg (IQR, 2.9-3.8); 66% of operations were STAT morbidity category 4 or 5. At least one infection complication occurred in 18.7%, compared with 6.6% among potentially eligible neonates and infants without SLO. Duration of SLO (median, 3 days; IQR, 2-5) was associated with an increased rate of infection complications (p < 0.001). Location of DSC procedure was operating room (16%), intensive care unit (67%), or other (17%). Location of DSC was not associated with rate of infection complications (p = 0.45). Rate of occurrence of infectious complications is high among infants with sternum left open following cardiac surgery. Longer duration of SLO is associated with increased infection complications. Copyright © 2016 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Participation in Lifelong Learning: Reality or Myth? Issues Arising from a United Kingdom Coalfield Closure

ERIC Educational Resources Information Center

Thursfield, Denise; Henderson, Roger

2004-01-01

In the spring of 2004, the Selby Coalfield, the largest of the remaining coal mines in the United Kingdom (UK) will close and 2071 employees will lose their jobs. The impact of the closure will be severe in the surrounding area, and will present a challenge to local employment services and training agencies. It will also test the UK government's…

Closure Report for Corrective Action Unit 415: Project 57 No. 1 Plutonium Dispersion (NTTR) Nevada Test and Training Range, Nevada, Revision 0 with ROTC-1

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

Cabble, Kevin J.; Boehlecke, Robert F.

This Closure Report (CR) presents information supporting the closure of Corrective Action Unit (CAU) 415: Project 57 No. 1 Plutonium Dispersion, which is located on Range 4808A of the Nevada Test and Training Range (NTTR). This CR complies with the requirements of the Federal Facility Agreement and Consent Order (FFACO) that was agreed to by the State of Nevada; U.S. Department of Energy (DOE), Environmental Management; U.S. Department of Defense; and DOE, Legacy Management. CAU 415 comprises one corrective action site (CAS): NAFR-23-02, Pu Contaminated Soil. The purpose of this CR is to provide justification and documentation supporting the recommendationmore » that no further corrective action is needed for CAU 415 based on the implementation of the corrective action of Closure in Place.« less

Defense Base Closure and Realignment Commission

DTIC Science & Technology

1993-01-01

during, their training . DLI required Only 803 houising units oii thle Army students inl thle human intelligence field Annex, the post cýxchiaige arid...community also stressed the Navy did not proposes significantly reduccd closure costs by know the true cost of relocating or replicating taking...Warfare Center- Carderock, Annapolis Detachment, The Annapolis community stressed in 1991 theDefense Base Closure and Realignment Coin- Annapolis

Composite Materials with Improved Properties in Compression: Synthesis of 3-Methylene-1,1-Dichlorosilacyclobutane and 1,1-Dichlorosilacyclopent-3-ene

DTIC Science & Technology

1990-05-09

reagents may in fact be involved. Of synthetic interest, V undergoes intramolecular Grignard ring closure to yield III (10%). While the yield of III is low...VII) as the major product along with 1,4-bis(trichlorosilyl)- cis-2-butene (VIII). VII undergoes cyclization by an intramolec- ular Grignard ring...addition of methyl Grignard to III. The 1H 8 am NMR chemical shifts of I in diethyl ether are consistently about 0.4 ppm downfield from those previously

Closure Report for Corrective Action Unit 426: Cactus Spring Waste Trenches, Tonopah Test Range, Nevada

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

Dave Madsen

This Closure Report provides the documentation for closure of the Cactus Spring Waste Trenches Corrective Action Unit (CAU) 426. The site is located on the Tonopah Test Range, approximately 225 kilometers northwest of Las Vegas, NV. CAU 426 consists of one corrective action site (CAS) which is comprised of four waste trenches. The trenches were excavated to receive solid waste generated in support of Operation Roller Coaster, primary the Double Tracks Test in 1963, and were subsequently backfilled. The Double Tracks Test involved use of live animals to assess the biological hazards associated with the nonnuclear detonation of plutonium-bearing devices.more » The Nevada Division of Environmental Protection approved Corrective Action Plan (CAP)which proposed ''capping'' methodology. The closure activities were completed in accordance with the approved CAP and consisted of constructing an engineered cover in the area of the trenches, constructing/planting a vegetative cover, installing a perimeter fence and signs, implementing restrictions on future use, and preparing a Post-Closure Monitoring Plan.« less

New suturing technique for robotic-assisted vaginal cuff closure during single-site hysterectomy.

PubMed

Shin, So-Jin; Chung, Hyewon; Kwon, Sang-Hoon; Cha, Soon-Do; Cho, Chi-Heum

2017-06-01

To describe a simple and efficient technique for suturing the vaginal cuff in robotic-assisted single-site hysterectomy using barbed suture and a straight needle. Consecutive patients undergoing robotic-assisted single-site hysterectomy from February 2014 to August 2015 at Dong San Hospital, Keimyung University were included. Surgeons used two barbed sutures in a running fashion to close the vaginal cuff. A barbed suture was exclusively used with a straightened needle in upward direction from posterior vaginal cuff to anterior vaginal cuff which played a pivotal role for closure. A total of 100 patients underwent robotic-assisted single-site hysterectomy. The total operation time was 132.5 min and vaginal cuff closure time was 12.0 min. There were no postoperative complications; vaginal cuff dehiscence, vaginal cuff infection, and vaginal bleeding that require surgical intervention or admission. The use of barbed suture with straightened needle to close the vaginal cuff in robotic-assisted single-site hysterectomy is easy to perform and demonstrates safety and efficacy. This technique offers secure, fast, and effective incision closure.

Resource Conservation and Recovery Act (RCRA) Part B permit application for tank storage units at the Oak Ridge Y-12 Plant

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

Not Available

1994-05-01

In compliance with the Resource Conservation and Recovery Act (RCRA), this report discusses information relating to permit applications for three tank storage units at Y-12. The storage units are: Building 9811-1 RCRA Tank Storage Unit (OD-7); Waste Oil/Solvent Storage Unit (OD-9); and Liquid Organic Solvent Storage Unit (OD-10). Numerous sections discuss the following: Facility description; waste characteristics; process information; groundwater monitoring; procedures to prevent hazards; contingency plan; personnel training; closure plan, post closure plan, and financial requirements; record keeping; other federal laws; organic air emissions; solid waste management units; and certification. Sixteen appendices contain such items as maps, waste analysesmore » and forms, inspection logs, equipment identification, etc.« less

School closures during the 2009 influenza pandemic: national and local experiences

PubMed Central

2014-01-01

Background School closure is a non-pharmaceutical intervention that was considered in many national pandemic plans developed prior to the start of the influenza A(H1N1)pdm09 pandemic, and received considerable attention during the event. Here, we retrospectively review and compare national and local experiences with school closures in several countries during the A(H1N1)pdm09 pandemic. Our intention is not to make a systematic review of country experiences; rather, it is to present the diversity of school closure experiences and provide examples from national and local perspectives. Methods Data were gathered during and following a meeting, organized by the European Centres for Disease Control, on school closures held in October 2010 in Stockholm, Sweden. A standard data collection form was developed and sent to all participants. The twelve participating countries and administrative regions (Bulgaria, China, France, Hong Kong Special Administrative Region (SAR), Italy, Japan, New Zealand, Serbia, South Africa, Thailand, United Kingdom, and United States) provided data. Results Our review highlights the very diverse national and local experiences on school closures during the A(H1N1)pdm09 pandemic. The processes including who was in charge of making recommendations and who was in charge of making the decision to close, the school-based control strategies, the extent of school closures, the public health tradition of responses and expectations on school closure varied greatly between countries. Our review also discusses the many challenges associated with the implementation of this intervention and makes recommendations for further practical work in this area. Conclusions The single most important factor to explain differences observed between countries may have been the different public health practises and public expectations concerning school closures and influenza in the selected countries. PMID:24739814

Kyrgyzstan’s Closure of the Manas Airbase: Context and Implications

DTIC Science & Technology

2009-05-04

agreement with the United States, after the United States had criticized the Uzbek government for repressive actions against civilians. Some of the...Zealand, Norway, Poland , South Korea, Spain, and Turkey. Among the few legislators who opposed closing the airbase, Bakyt Beshimov, the leader of the...With Secretary of Defense Robert Gates, Krakow, Poland , February 20, 2009. 24 Saban Kardas “Will the Closure of Manas Airbase Strengthen U.S

4-inch sample recovery canisters, Test Model D series. Final report, September 1969--May 1970

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

Goode, P.L.; Neff, G.W.

1970-12-31

Six tests were conducted on 4-Inch Test Model D Closures to develop an improved closure for the redesigned Sandia Recovery Canister (SRC). The first three closures tested used variations of the high explosive (HE) design used on the previous Model B (Second) Series (P64283). The last three units tested used variations of the HE design used in the Midi Mist Event SRC.

Coincidental Impact of Transcatheter Patent Foramen Ovale Closure on Migraine with and without Aura - A Comprehensive Meta-Analysis.

PubMed

Kanwar, Siddak M; Noheria, Amit; DeSimone, Christopher V; Rabinstein, Alejandro A; Asirvatham, Samuel J

2016-03-01

We analyzed the literature to assess the coincidental impact on migraines of transcatheter patent foramen ovale (PFO) closure performed for secondary stroke prevention. We searched Medline, EMBASE, and the Cochrane database for studies published up until August 2013. We included English-language studies that provided information on complete resolution or improvement in migraine headaches following PFO closure. Two study authors identified 375 original articles and both independently reviewed 32 relevant manuscripts. Data including study methodology, inclusion criteria, PFO closure and migraine outcomes were extracted manually from all eligible studies. Pooled odds (and probability) of resolution or improvement of migraine headaches were calculated using random-effects models. Twenty studies were analyzed. Most were uncontrolled studies that included a small number of patients with cryptogenic stroke who had undergone PFO closure and had variable time of followup. The probability of complete resolution of migraine with PFO closure (18 studies, 917 patients) was 0.46 (95% confidence interval 0.39, 0.53) and of any improvement in migraine (17 studies, 881 patients) was 0.78 (0.74, 0.82). There was evidence for publication bias in studies reporting on improvement in migraines (Begg's p=0.002), but not for studies on complete resolution of migraine (p=0.3). In patients with aura, the probability of complete resolution of migraine post-PFO closure was 0.54 (0.43, 0.65), and in those without aura, complete resolution occurred in 0.39 (0.29, 0.51). Among patients with unexplained stroke and migraine undergoing transcatheter PFO closure, resolution of headaches occurred in a majority of patients with aura and for a smaller proportion of patients without aura.

Closure Report for Corrective Action Unit 536: Area 3 Release Site, Nevada Test Site, Nevada

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

NSTec Environmental Restoration

Corrective Action Unit (CAU) 536 is located in Area 3 of the Nevada Test Site. CAU 536 is listed in the Federal Facility Agreement and Consent Order of 1996 as Area 3 Release Site, and comprises a single Corrective Action Site (CAS): {sm_bullet} CAS 03-44-02, Steam Jenny Discharge The Nevada Division of Environmental Protection (NDEP)-approved corrective action alternative for CAS 03-44-02 is clean closure. Closure activities included removing and disposing of total petroleum hydrocarbon (TPH)- and polyaromatic hydrocarbon (PAH)-impacted soil, soil impacted with plutonium (Pu)-239, and concrete pad debris. CAU 536 was closed in accordance with the NDEP-approved CAU 536more » Corrective Action Plan (CAP), with minor deviations as approved by NDEP. The closure activities specified in the CAP were based on the recommendations presented in the CAU 536 Corrective Action Decision Document (U.S. Department of Energy, National Nuclear Security Administration Nevada Site Office, 2004). This Closure Report documents CAU 536 closure activities. During closure activities, approximately 1,000 cubic yards (yd3) of hydrocarbon waste in the form of TPH- and PAH-impacted soil and debris, approximately 8 yd3 of Pu-239-impacted soil, and approximately 100 yd3 of concrete debris were generated, managed, and disposed of appropriately. Additionally, a previously uncharacterized, buried drum was excavated, removed, and disposed of as hydrocarbon waste as a best management practice. Waste minimization techniques, such as the utilization of laboratory analysis to characterize and classify waste streams, were employed during the performance of closure« less

Closure and Post-Closure Care Requirements for Hazardous Waste Treatment, Storage and Disposal Facilities

EPA Pesticide Factsheets

When a hazardous waste management unit stops receiving waste at the end of its active life, it must be cleaned up, closed, monitored, and maintained in accordance with the Resource Conservation and Recovery Ac

75 FR 17618 - Fisheries of the Northeastern United States; Black Sea Bass Recreational Fishery; Emergency Rule...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-07

.... The initial closure was highly controversial and a great deal of negative reaction was received... the initial 180-day closure appear in the plaintiff's motion for relief and, as such, NMFS will...

Intracardiac Echocardiography for Structural Heart and Electrophysiological Interventions.

PubMed

Basman, Craig; Parmar, Yuvrajsinh J; Kronzon, Itzhak

2017-09-06

With an increasing number of interventional procedures performed for structural heart disease and cardiac arrhythmias each year, echocardiographic guidance is necessary for safe and efficient results. The purpose of this review article is to overview the principles of intracardiac echocardiography (ICE) and describes the peri-interventional role of ICE in a variety of structural heart disease and electrophysiological interventions. Both transthoracic (TTE) and transesophageal echocardiography have limitations. ICE provides the advantage of imaging from within the heart, providing shorter image distances and higher resolution. ICE may be performed without sedation and avoids esophageal intubation as with transesophageal echocardiography (TEE). Limitations of ICE include the need for additional venous access with possibility of vascular complications, potentially higher costs, and a learning curve for new operators. Data supports the use of ICE in guiding device closure of interatrial shunts, transseptal puncture, and electrophysiologic procedures. This paper reviews the more recent reports that ICE may be used for primary guidance or as a supplement to TEE in patients undergoing left atrial appendage (LAA) closure, interatrial shunt closure, transaortic valve implantation (TAVI), percutaneous mitral valve repair (PMVR), paravalvular leak (PVL) closure, aortic interventions, transcatheter pulmonary valve replacement (tPVR), ventricular septal defect (VSD), and patent ductus arteriosus (PDA) closure. ICE imaging technology will continue to expand and help improve structural heart and electrophysiology interventions.

Evaluating the use of fibrin glue for sealing low-output enterocutaneous fistulas: study protocol for a randomized controlled trial.

PubMed

Wu, Xiuwen; Ren, Jianan; Wang, Gefei; Wang, Jianzhong; Wang, Feng; Fan, Yueping; Li, Yuanxin; Han, Gang; Zhou, Yanbing; Song, Xiaofei; Quan, Bin; Yao, Min; Li, Jieshou

2015-10-07

The management of an enterocutaneous fistula poses a significant challenge to surgeons and is often associated with a costly hospital stay and long-term discomfort. The use of fibrin glue in the fistula tract has been shown to promote closure of low output enterocutaneous fistulas. Our previous nonrandomized study demonstrated that autologous platelet-rich fibrin glue treatment significantly decreased time to fistula closure and promoted closure rates. However, there are several limitations in the study, which may lead to bias in our conclusion. Thus, a multicenter, randomized, controlled clinical trial is required. The study is designed as a randomized, open-label, three-arm, multicenter study in nine Chinese academic hospitals for evaluating the efficacy and safety of fibrin glue for sealing low-output fistulas. An established number of 171 fistula patients will undergo prospective random assignment to autologous fibrin glue, commercial porcine fibrin sealants or drainage cessation (1:1:1). The primary endpoint is fistula closure time (defined as the interval between the day of enrollment and day of fistula closure) during the 14-day treatment period. To our knowledge, this is the first study to evaluate the safety and efficacy of both autologous and commercial fibrin glue sealing for patients with low-output volume fistulas. NCT01828892 . Registration date: April 2013.

Choice in maternity care: associations with unit supply, geographic accessibility and user characteristics

PubMed Central

2012-01-01

Background Despite national policies to promote user choice for health services in many European countries, current trends in maternity unit closures create a context in which user choice may be reduced, not expanded. Little attention has been paid to the potential impact of closures on pregnant women’s choice of maternity unit. We study here how pregnant women’s choices interact with the distance they must travel to give birth, individual socioeconomic characteristics and the supply of maternity units in France in 2003. Results Overall, about one-third of women chose their maternity units based on proximity. This proportion increased steeply as supply was constrained. Greater distances between the first and second closest maternity unit were strongly associated with increasing preferences for proximity; when these distances were ≥ 30 km, over 85% of women selected the closest unit (revealed preference) and over 70% reported that proximity was the reason for their choice (expressed preference). Women living at a short distance to the closest maternity unit appeared to be more sensitive to increases in distance between their first and second closest available maternity units. The preference for proximity, expressed and revealed, was related to demographic and social characteristics: women from households in the manual worker class chose a maternity unit based on its proximity more often and also went to the nearest unit when compared with women from professional and managerial households. These sociodemographic associations held true after adjusting for supply factors, maternal age and socioeconomic status. Conclusions Choice seems to be arbitrated in both absolute and relative terms. Taking changes in supply into consideration and how these affect choice is an important element for assessing the real impact of maternity unit closures on pregnant women’s experiences. An indicator measuring the proportion of women for whom the distance between the first and second maternity unit is greater than 30 km can provide a simple measure of choice to complement indicators of geographic accessibility in evaluations of the impact of maternity unit closures. PMID:22905951

The Effect on Somatic Growth of Surgical and Catheter Treatment of Secundum Atrial Septal Defects.

PubMed

Chlebowski, Meghan M; Dai, Hongying; Kaine, Stephen F

2017-10-01

Historical studies suggest an association between atrial septal defect (ASD) and impaired growth with inconsistent improvement following closure. Limited data exist regarding the impact on growth in the era of transcatheter therapy. To evaluate the effect of closure on growth, we conducted a retrospective review of patients undergoing surgical or transcatheter closure during two time periods. Four hundred patients with isolated secundum ASD were divided into three cohorts: early surgical, contemporary surgical, and transcatheter. Data collected included demographics; height, weight, and body mass index (BMI) percentiles; catheterization hemodynamics; and co-morbidities. For all cohorts, there was no significant change in height or weight percentiles during two years after ASD closure. Age at repair was later for contemporary surgical and transcatheter cohorts (p < 0.0001). In the transcatheter cohort, mean Qp:Qs was 1.65 ± 0.54, but there was no correlation between greater Qp:Qs and decreased somatic growth. Subgroup analysis for patients with any initial growth percentile <5th percentile demonstrated a significant change in weight and BMI percentiles in the first two years after closure (p < 0.0004). The advent of transcatheter therapy shifted institutional practice to later age at repair for both surgical and transcatheter closure. There was no significant change in weight and height percentiles during two years after closure. Only patients with initial weight and BMI <5th percentile had improved growth after treatment. Concern for impaired growth should not generally be an indication for early ASD repair. However, early repair may be indicated in children with existing significant growth failure.

Closure Report for Corrective Action Unit 117: Area 26 Pluto Disassembly Facility, Nevada Test Site, Nevada, Revision 0

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

Mark Burmeister

This Closure Report (CR) presents information supporting the closure of Corrective Action Unit (CAU) 117: Area 26 Pluto Disassembly Facility, Nevada Test Site, Nevada. This CR complies with the requirements of the Federal Facility Agreement and Consent Order that was agreed to by the State of Nevada; U.S. Department of Energy (DOE), Environmental Management; U.S. Department of Defense; and DOE, Legacy Management. Corrective Action Unit 117 comprises Corrective Action Site (CAS) 26-41-01, Pluto Disassembly Facility, located in Area 26 of the Nevada Test Site. The purpose of this CR is to provide documentation supporting the completed corrective actions and providemore » data confirming that the closure objectives for CAU 117 were met. To achieve this, the following actions were performed: • Review the current site conditions, including the concentration and extent of contamination. • Implement any corrective actions necessary to protect human health and the environment. • Properly dispose of corrective action and investigation wastes. • Document Notice of Completion and closure of CAU 117 issued by the Nevada Division of Environmental Protection. From May 2008 through February 2009, closure activities were performed as set forth in the Streamlined Approach for Environmental Restoration Plan for Corrective Action Unit 117, Area 26 Pluto Disassembly Facility, Nevada Test Site, Nevada. The purpose of the activities as defined during the data quality objectives process were: • Determine whether contaminants of concern (COCs) are present. • If COCs are present, determine their nature and extent, implement appropriate corrective actions, and properly dispose of wastes. Analytes detected during the closure activities were evaluated against final action levels to determine COCs for CAU 117. Assessment of the data generated from closure activities indicated that the final action levels were exceeded for polychlorinated biphenyls (PCBs) reported as total Aroclor and radium-226. A corrective action was implemented to remove approximately 50 cubic yards of PCB-contaminated soil, approximately 1 cubic foot of radium-226 contaminated soil (and scabbled asphalt), and a high-efficiency particulate air filter that was determined to meet the criteria of a potential source material (PSM). Electrical and lighting components (i.e., PCB-containing ballasts and capacitors) and other materials (e.g., mercury-containing thermostats and switches, lead plugs and bricks) assumed to be PSM were also removed from Building 2201, as practical, without the need for sampling. Because the COC contamination and PSMs have been removed, clean closure of CAS 26-41-01 is recommended, and no use restrictions are required to be placed on this CAU. No further action is necessary because no other contaminants of potential concern were found above preliminary action levels. The physical end state for Building 2201 is expected to be eventual demolition to slab. The DOE, National Nuclear Security Administration Nevada Site Office provides the following recommendations: • Clean closure is the recommended corrective action for CAS 26-41-01 in CAU 117. • A Notice of Completion to the DOE, National Nuclear Security Administration Nevada Site Office is requested from the Nevada Division of Environmental Protection for closure of CAU 117. • Corrective Action Unit 117 should be moved from Appendix III to Appendix IV of the Federal Facility Agreement and Consent Order.« less

Tonopah Test Range Post-Closure Inspection Annual Report, Tonopah Test Range, Nevada, Calendar Year 2003

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

U.S. Department of Energy, National Nuclear Security Administration Nevada Site Office; Bechtel Nevada

This post-closure inspection report provides documentation of the semiannual inspection activities, maintenance and repair activities, and conclusions and recommendations for calendar year 2003 for eight corrective action units located on the Tonopah Test Range, Nevada.

36 CFR 13.50 - Closure procedures.

Code of Federal Regulations, 2011 CFR

2011-07-01

... Section 13.50 Parks, Forests, and Public Property NATIONAL PARK SERVICE, DEPARTMENT OF THE INTERIOR NATIONAL PARK SYSTEM UNITS IN ALASKA General Provisions § 13.50 Closure procedures. (a) Authority. The... cultural or scientific values, subsistence uses, endangered or threatened species conservation, and other...

50 CFR 648.101 - Closures.

Code of Federal Regulations, 2011 CFR

2011-10-01

..., DEPARTMENT OF COMMERCE FISHERIES OF THE NORTHEASTERN UNITED STATES Management Measures for the Summer...) EEZ closure. The Regional Administrator shall close the EEZ to fishing for summer flounder by... notifying vessel and dealer permit holders that no commercial quota is available for landing summer flounder...

Streamlined Approach for Environmental Restoration Plan for Corrective Action Unit 574: Neptune, Nevada National Security Site, Nevada

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

NSTec Environmental Restoration

2011-08-31

This Streamlined Approach for Environmental Restoration (SAFER) Plan identifies the activities required for closure of Corrective Action Unit (CAU) 574, Neptune. CAU 574 is included in the Federal Facility Agreement and Consent Order (FFACO) (1996 [as amended March 2010]) and consists of the following two Corrective Action Sites (CASs) located in Area 12 of the Nevada National Security Site: (1) CAS 12-23-10, U12c.03 Crater (Neptune); (2) CAS 12-45-01, U12e.05 Crater (Blanca). This plan provides the methodology for the field activities that will be performed to gather the necessary information for closure of the two CASs. There is sufficient information andmore » process knowledge regarding the expected nature and extent of potential contaminants to recommend closure of CAU 574 using the SAFER process. Based on historical documentation, personnel interviews, site process knowledge, site visits, photographs, field screening, analytical results, the results of the data quality objective (DQO) process (Section 3.0), and an evaluation of corrective action alternatives (Appendix B), closure in place with administrative controls is the expected closure strategy for CAU 574. Additional information will be obtained by conducting a field investigation to verify and support the expected closure strategy and provide a defensible recommendation that no further corrective action is necessary. This will be presented in a Closure Report that will be prepared and submitted to the Nevada Division of Environmental Protection (NDEP) for review and approval.« less

Closure Report for Corrective Action Unit 563: Septic Systems, Nevada Test Site, Nevada

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

NSTec Environmental Restoration

2010-02-28

Corrective Action Unit (CAU) 563 is identified in the Federal Facility Agreement and Consent Order (FFACO) as “Septic Systems” and consists of the following four Corrective Action Sites (CASs), located in Areas 3 and 12 of the Nevada Test Site: · CAS 03-04-02, Area 3 Subdock Septic Tank · CAS 03-59-05, Area 3 Subdock Cesspool · CAS 12-59-01, Drilling/Welding Shop Septic Tanks · CAS 12-60-01, Drilling/Welding Shop Outfalls Closure activities were conducted from September to November 2009 in accordance with the FFACO (1996, as amended February 2008) and the Corrective Action Plan for CAU 563. The corrective action alternatives includedmore » No Further Action and Clean Closure.« less

Underground Test Area (UGTA) Closure Report for Corrective Action Unit 98: Frenchman Flat Nevada National Security Site, Nevada, Revision 1 ROTC-1

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

Farnham, Irene

This Closure Report (CR) has been prepared for Corrective Action Unit (CAU) 98, Frenchman Flat, Nevada National Security Site (NNSS), Nevada. The Frenchman Flat CAU was the site of 10 underground nuclear tests, some of which have impacted groundwater near the tests. This work was performed as part of the U.S. Department of Energy, National Nuclear Security Administration Nevada Field Office (NNSA/NFO) Underground Test Area (UGTA) Activity in accordance with the Federal Facility Agreement and Consent Order (FFACO). This CR describes the selected corrective action to be implemented during closure to protect human health and the environment from the impactedmore » groundwater« less

Postoperative Intravenous Acetaminophen for Craniotomy Patients: A Randomized Controlled Trial.

PubMed

Greenberg, Steven; Murphy, Glenn S; Avram, Michael J; Shear, Torin; Benson, Jessica; Parikh, Kruti N; Patel, Aashka; Newmark, Rebecca; Patel, Vimal; Bailes, Julian; Szokol, Joseph W

2018-01-01

To determine whether opioids during the first 24 postoperative hours were significantly altered when receiving intravenous (IV) acetaminophen during that time compared with those receiving placebo (normal saline). One hundred forty patients undergoing any type of craniotomy were randomly assigned to receive either 1 g of IV acetaminophen or placebo upon surgical closure, and every 6 hours thereafter, up to 18 hours postoperatively. Analgesic requirements for the first 24 postoperative hours were recorded. Time to rescue medications in the postanesthesia care unit (PACU)/intensive care unit (ICU), amount of rescue medication, ICU and hospital lengths of stay, number of successful neurological examinations, sedation, delirium, satisfaction, and visual analog scale pain scores were also recorded. Compared with the placebo group, more patients in the IV acetaminophen group (10/66 [15.2%] vs. 4/65 [6.2%] in the placebo group) did not require opioids within the first 24 postoperative hours, but this did not reach significance (odds ratio, -9.0%, 95% confidence interval -20.5% to 1.8%; P = 0.166). Both groups had similar times to rescue medications, amounts of rescue medications, ICU and hospital lengths of stay, numbers of successful neurological examinations, sedation, delirium, satisfaction scores, visual analog scale pain scores, and temperatures within the first 24 postoperative hours. The opioid requirements within the first 24 postoperative hours were similar in the placebo and acetaminophen groups. This study is informative for the design and planning of future studies investigating the management of postoperative pain in patients undergoing craniotomies. Copyright © 2017 Elsevier Inc. All rights reserved.

Closure Report for Corrective Action Unit 412: Clean Slate I Plutonium Dispersion (TTR) Tonopah Test Range, Nevada, Revision 0

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

Matthews, Patrick

This Closure Report (CR) presents information supporting the clean closure of Corrective Action Unit (CAU) 412: Clean Slate I Plutonium Dispersion (TTR), located on the Tonopah Test Range, Nevada. CAU 412 consists of a release of radionuclides to the surrounding soil from a storage–transportation test conducted on May 25, 1963. Corrective action investigation (CAI) activities were performed in April and May 2015, as set forth in the Streamlined Approach for Environmental Restoration (SAFER) Plan for Corrective Action Unit 412: Clean Slate I Plutonium Dispersion (TTR), Tonopah Test Range, Nevada; and in accordance with the Soils Activity Quality Assurance Plan. Themore » purpose of the CAI was to fulfill data needs as defined during the data quality objectives process. The CAU 412 dataset of investigation results was evaluated based on a data quality assessment. This assessment demonstrated the dataset is complete and acceptable for use in fulfilling the data needs identified by the data quality objectives process. This CR provides documentation and justification for the clean closure of CAU 412 under the FFACO without further corrective action. This justification is based on historical knowledge of the site, previous site investigations, implementation of the 1997 interim corrective action, and the results of the CAI. The corrective action of clean closure was confirmed as appropriate for closure of CAU 412 based on achievement of the following closure objectives: Radiological contamination at the site is less than the final action level using the ground troops exposure scenario (i.e., the radiological dose is less than the final action level): Removable alpha contamination is less than the high contamination area criterion: No potential source material is present at the site, and any impacted soil associated with potential source material has been removed so that remaining soil contains contaminants at concentrations less than the final action levels: and There is sufficient information to characterize investigation and remediation waste for disposal.« less

Closure Report for Corrective Action Unit 562: Waste Systems, Nevada National Security Site, Nevada

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

NSTec Environmental Restoration

2012-08-15

This Closure Report (CR) presents information supporting closure of Corrective Action Unit (CAU) 562, Waste Systems, and provides documentation supporting the completed corrective actions and confirmation that closure objectives for CAU 562 were met. This CR complies with the requirements of the Federal Facility Agreement and Consent Order (FFACO) that was agreed to by the State of Nevada; the U.S. Department of Energy (DOE), Environmental Management; the U.S. Department of Defense; and DOE, Legacy Management (FFACO, 1996 as amended). CAU 562 consists of the following 13 Corrective Action Sites (CASs), located in Areas 2, 23, and 25 of the Nevadamore » National Security Site: · CAS 02-26-11, Lead Shot · CAS 02-44-02, Paint Spills and French Drain · CAS 02-59-01, Septic System · CAS 02-60-01, Concrete Drain · CAS 02-60-02, French Drain · CAS 02-60-03, Steam Cleaning Drain · CAS 02-60-04, French Drain · CAS 02-60-05, French Drain · CAS 02-60-06, French Drain · CAS 02-60-07, French Drain · CAS 23-60-01, Mud Trap Drain and Outfall · CAS 23-99-06, Grease Trap · CAS 25-60-04, Building 3123 Outfalls Closure activities began in October 2011 and were completed in April 2012. Activities were conducted according to the Corrective Action Plan for CAU 562 (U.S. Department of Energy, National Nuclear Security Administration Nevada Site Office [NNSA/NSO], 2011). The corrective actions included No Further Action and Clean Closure. Closure activities generated sanitary waste and hazardous waste. Some wastes exceeded land disposal limits and required offsite treatment prior to disposal. Other wastes met land disposal restrictions and were disposed in appropriate onsite or offsite landfills. NNSA/NSO requests the following: · A Notice of Completion from the Nevada Division of Environmental Protection to NNSA/NSO for closure of CAU 562 · The transfer of CAU 562 from Appendix III to Appendix IV, Closed Corrective Action Units, of the FFACO« less

40 CFR 264.603 - Post-closure care.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 25 2010-07-01 2010-07-01 false Post-closure care. 264.603 Section 264.603 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID WASTES (CONTINUED... treatment or storage unit has contaminated soils or ground water that cannot be completely removed or...

THE U.S. EPA'S VISION FOR A BEACH FORECASTING TOOL

EPA Science Inventory

Beach closures due to water quality that exceeds standard limits occur frequently in the United States. These beach closures deprive the public of opportunities for recreational activities and can have a significant impact on local economics. Because of the large number of mari...

The macroeconomic impact of pandemic influenza: estimates from models of the United Kingdom, France, Belgium and The Netherlands.

PubMed

Keogh-Brown, Marcus Richard; Smith, Richard D; Edmunds, John W; Beutels, Philippe

2010-12-01

The 2003 outbreak of severe acute respiratory syndrome (SARS) showed that infectious disease outbreaks can have notable macroeconomic impacts. The current H1N1 and potential H5N1 flu pandemics could have a much greater impact. Using a multi-sector single country computable general equilibrium model of the United Kingdom, France, Belgium and The Netherlands, together with disease scenarios of varying severity, we examine the potential economic cost of a modern pandemic. Policies of school closure, vaccination and antivirals, together with prophylactic absence from work are evaluated and their cost impacts are estimated. Results suggest GDP losses from the disease of approximately 0.5-2% but school closure and prophylactic absenteeism more than triples these effects. Increasing school closures from 4 weeks at the peak to entire pandemic closure almost doubles the economic cost, but antivirals and vaccinations seem worthwhile. Careful planning is therefore important to ensure expensive policies to mitigate the pandemic are effective in minimising illness and deaths.

Management Modalities for Traumatic Macular Hole: A Systematic Review and Single-Arm Meta-Analysis.

PubMed

Gao, Min; Liu, Kun; Lin, Qiurong; Liu, Haiyun

2017-02-01

The purposes of this study were to (i) determine macular hole (MH) closure rates and visual outcomes by comparing two methods of managing traumatic MH (TMH)-an event resulting in severe loss of visual acuity (VA); (ii) characterize patients who undergo spontaneous TMH closure; (iii) determine which TMH patients should be observed before resorting to surgical repair; and (iv) elucidate factors that influence postoperative visual outcomes. Studies (n=10) of patients who were managed by surgery or observation for TMH were meta-analyzed retrospectively. Management modalities included surgical repair (surgery group) and observation for spontaneous hole closure (observation group). In addition, a 12-case series of articles (1990-2014) on spontaneous hole closure was statistically summarized. SAS and Comprehensive Meta-Analysis (CMA) (version 3.0) were used for analysis. For surgery group patients, the fixed-model pooled event rate for hole closure was 0.919 (range, 0.861-0.954) and for observation group patients, 0.368 (range, 0.236-0.448). The random-model pooled event rate for improvement of visual acuity (VA) for surgery group patients was 0.748 (range, 0.610-0.849) and for observation group patients, 0.505 (range, 0.397-0.613). For patients in both groups, the mean age of spontaneous closure was 18.71±10.64 years; mean size of TMHs, 0.18±0.06 decimal degrees (DD); and mean time for hole closure, 3.38±3.08 months. The pooled event rate for visual improvement was 0.748 (0.610-0.849). Hole closure and VA improvement rates of surgery group patients were significantly higher than those for observation group patients. Patients of ≤ 24 years of age with MH sizes of ≤ 0.2DD were more likely to achieve spontaneous hole closure. The interval of time from injury to surgery was statistically significantly associated with the level of visual improvement.

Planned secondary wound closure at the circular stapler insertion site after laparoscopic gastric bypass reduces postoperative morbidity, costs, and hospital stay.

PubMed

Vetter, Diana; Raptis, Dimitri Aristotle; Giama, Mira; Hosa, Hanna; Muller, Markus K; Nocito, Antonio; Schiesser, Marc; Moos, Rudolf; Bueter, Marco

2017-12-01

The aims of the present study were to assess whether planned secondary wound closure at the insertion site of the circular stapler reduces wound infection rate and postoperative morbidity after laparoscopic Roux-en-Y gastric bypass (RYGB) and to identify independent predictive factors increasing the risk for wound infections after RYGB. This paper is a retrospective single-center analysis of a prospectively collected database of 1400 patients undergoing RYGB surgery in circular technique between June 2000 and June 2016. Planned secondary wound closure at the circular stapler introduction site was performed at postoperative day 3 in 291 (20.8%) consecutive patients and compared to a historical control of 1109 (79.2%) consecutive patients with primary wound closure. Independent predictive factors for wound infection were assessed by multivariable analysis. Secondary wound closure significantly decreased wound infection rate from 9.3% (103/1109) to 1% (3/291) (p < 0.001) leading to a shorter hospital stay (mean 9 (SD8) vs. 7 days (SD2), p < 0.001), lower costs (p = 0.039), and reduced postoperative morbidity (mean 90-day Comprehensive Complication Index (CCI) 7.4 (SD14.0) vs. 5.1 (SD11.1) p = 0.008) when compared to primary wound closure. Primary wound closure, dyslipidemia, and preoperative gastritis were independent predictive risk factors for developing wound infections both in the univariate (p < 0.001; p = 0.048; p = 0.003) and multivariable analysis (p < 0.001; p = 0.040; p = 0.012). Further, on multivariable analysis, the female gender was a predictive factor (p = 0.034) for wound infection development. Secondary wound closure at the circular stapler introduction site in laparoscopic RYGB significantly reduces the overall wound infection rate as well as postoperative morbidity, costs, and hospital stay when compared to primary wound closure.

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

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

K. B. Campbell

2002-09-01

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

Post-Closure Report for Closed Resource Conservation and Recovery Act Corrective Action Units, Nevada National Security Site, Nevada for fiscal year 2013 (October 2012 - September 2013)

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

None, None

2014-01-31

This report serves as the combined annual report for post-closure activities for the following closed Corrective Action Units (CAUs): CAU 90, Area 2 Bitcutter Containment; CAU 91, Area 3 U-3fi Injection Well; CAU 92, Area 6 Decon Pond Facility; CAU 110, Area 3 WMD U-3ax/bl Crater; CAU 111, Area 5 WMD Retired Mixed Waste Pits; and, CAU 112, Area 23 Hazardous Waste Trenches.

Tactical Sensors for Dispersed TNF (Tactical Nuclear Force) Units. Appendix 1.Tactical Sensory Survey.

DTIC Science & Technology

1983-06-30

activating a separate transmitter, audible alarm, or contact closure. This sensor is compatible with any device that utilizes an input pulse or...transmitter, audible alarm, or contact closure. This sensor is compatible *i with any device that utilizes an output to produce an alarm. 110-4769-002. This...used to generate an alarm by activating a separate transmitter, audible alarm, or contact closure. This sensor is compatible with any device that

Corrective Action Decision Document/Closure Report for Corrective Action Unit 567: Miscellaneous Soil Sites - Nevada National Security Site, Nevada

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

Matthews, Patrick

2014-12-01

This Corrective Action Decision Document/Closure Report presents information supporting the closure of Corrective Action Unit (CAU) 567: Miscellaneous Soil Sites, Nevada National Security Site, Nevada. The purpose of this Corrective Action Decision Document/Closure Report is to provide justification and documentation supporting the recommendation that no further corrective action is needed for CAU 567 based on the implementation of the corrective actions. The corrective actions implemented at CAU 567 were developed based on an evaluation of analytical data from the CAI, the assumed presence of COCs at specific locations, and the detailed and comparative analysis of the CAAs. The CAAs weremore » selected on technical merit focusing on performance, reliability, feasibility, safety, and cost. The implemented corrective actions meet all requirements for the technical components evaluated. The CAAs meet all applicable federal and state regulations for closure of the site. Based on the implementation of these corrective actions, the DOE, National Nuclear Security Administration Nevada Field Office provides the following recommendations: • No further corrective actions are necessary for CAU 567. • The Nevada Division of Environmental Protection issue a Notice of Completion to the DOE, National Nuclear Security Administration Nevada Field Office for closure of CAU 567. • CAU 567 be moved from Appendix III to Appendix IV of the FFACO.« less

50 CFR 648.22 - Closure of the fishery.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 50 Wildlife and Fisheries 8 2010-10-01 2010-10-01 false Closure of the fishery. 648.22 Section 648.22 Wildlife and Fisheries FISHERY CONSERVATION AND MANAGEMENT, NATIONAL OCEANIC AND ATMOSPHERIC ADMINISTRATION, DEPARTMENT OF COMMERCE FISHERIES OF THE NORTHEASTERN UNITED STATES Management Measures for the...

36 CFR 13.1242 - BCDA closures and restrictions.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 36 Parks, Forests, and Public Property 1 2012-07-01 2012-07-01 false BCDA closures and restrictions. 13.1242 Section 13.1242 Parks, Forests, and Public Property NATIONAL PARK SERVICE, DEPARTMENT OF THE INTERIOR NATIONAL PARK SYSTEM UNITS IN ALASKA Special Regulations-Katmai National Park and...

California Emergency Department Closures Are Associated With Increased Inpatient Mortality At Nearby Hospitals

PubMed Central

Liu, Charles; Srebotnjak, Tanja; Hsia, Renee Y.

2014-01-01

Between 1996 and 2009 the annual number of emergency department (ED) visits in the United States increased by 51 percent while the number of EDs nationwide decreased by 6 percent, which placed unprecedented strain on the nation’s EDs. To investigate the effects of an ED closing on surrounding communities, we identified all ED closures in California during the period 1999–2010 and examined their association with inpatient mortality rates at nearby hospitals. We found that 24.9 percent of hospital admissions in this period occurred near an ED closure, and that these admissions had 5 percent higher odds of inpatient mortality than admissions not occurring near a closure. This association persisted whether we considered ED closures as affecting all future nearby admissions or only those occurring in the subsequent two years. These results suggest that ED closures have ripple effects on patient outcomes that should be considered when health systems and policy makers decide how to regulate ED closures. PMID:25092832

Monitoring calculation of closure change of Extradosed Cable-stayed Bridge

NASA Astrophysics Data System (ADS)

Shi, Jing Xian; Ran, Zhi Hong

2018-06-01

During the construction of extradosed cable-stayed bridge in Yunnan province, China, the construction unit has made certain changes in the construction process of the closure section due to environmental restrictions: remove the hanging basket after the closure, the sling shall not be provided in closure section, the function of the sling is realized by the hanging basket on the 16th beam. In case of this change, the bridge has been constructed to section 15th. In order to ensure the smooth and orderly progress of each stage in the closure phase, this article is arranged according to the construction plan, appropriate adjustment of related procedures, checking the bridge safety at all stages of construction, the stress and force of the main girder are compared to ensure the safety of the construction after closure changes. Adjust the height of the beam of the 16th and 17th to adapt the new construction plan, and the bridge closure smoothly.

50 CFR 36.42 - Public participation and closure procedures.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 50 Wildlife and Fisheries 9 2012-10-01 2012-10-01 false Public participation and closure procedures. 36.42 Section 36.42 Wildlife and Fisheries UNITED STATES FISH AND WILDLIFE SERVICE, DEPARTMENT OF... community post offices within the vicinity affected, made available for broadcast on local radio stations in...

50 CFR 36.42 - Public participation and closure procedures.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 50 Wildlife and Fisheries 9 2013-10-01 2013-10-01 false Public participation and closure procedures. 36.42 Section 36.42 Wildlife and Fisheries UNITED STATES FISH AND WILDLIFE SERVICE, DEPARTMENT OF... community post offices within the vicinity affected, made available for broadcast on local radio stations in...

40 CFR 264.119 - Post-closure notices.

Code of Federal Regulations, 2010 CFR

2010-07-01

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

40 CFR 264.119 - Post-closure notices.

Code of Federal Regulations, 2011 CFR

2011-07-01

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

36 CFR 13.1910 - KNHL and developed area closures and restrictions.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 36 Parks, Forests, and Public Property 1 2010-07-01 2010-07-01 false KNHL and developed area closures and restrictions. 13.1910 Section 13.1910 Parks, Forests, and Public Property NATIONAL PARK SERVICE, DEPARTMENT OF THE INTERIOR NATIONAL PARK SYSTEM UNITS IN ALASKA Special Regulations-Wrangell-St...

40 CFR 258.71 - Financial assurance for closure.

Code of Federal Regulations, 2011 CFR

2011-07-01

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

40 CFR 258.71 - Financial assurance for closure.

Code of Federal Regulations, 2010 CFR

2010-07-01

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

36 CFR 13.1328 - EGDA closures and restrictions.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 36 Parks, Forests, and Public Property 1 2012-07-01 2012-07-01 false EGDA closures and restrictions. 13.1328 Section 13.1328 Parks, Forests, and Public Property NATIONAL PARK SERVICE, DEPARTMENT OF THE INTERIOR NATIONAL PARK SYSTEM UNITS IN ALASKA Special Regulations-Kenai Fjords National Park Exit...

36 CFR 13.1120 - Bartlett Cove Developed Area closures and restrictions.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 36 Parks, Forests, and Public Property 1 2012-07-01 2012-07-01 false Bartlett Cove Developed Area closures and restrictions. 13.1120 Section 13.1120 Parks, Forests, and Public Property NATIONAL PARK SERVICE, DEPARTMENT OF THE INTERIOR NATIONAL PARK SYSTEM UNITS IN ALASKA Special Regulations-Glacier Bay...

36 CFR 13.1120 - Bartlett Cove Developed Area closures and restrictions.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 36 Parks, Forests, and Public Property 1 2011-07-01 2011-07-01 false Bartlett Cove Developed Area closures and restrictions. 13.1120 Section 13.1120 Parks, Forests, and Public Property NATIONAL PARK SERVICE, DEPARTMENT OF THE INTERIOR NATIONAL PARK SYSTEM UNITS IN ALASKA Special Regulations-Glacier Bay...

Closure Report for Corrective Action Unit 539: Areas 25 and 26 Railroad Tracks Nevada National Security Site, Nevada with ROTC-1, Revision 0

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

Mark Kauss

2011-06-01

This Closure Report (CR) presents information supporting the closure of Corrective Action Unit (CAU) 539: Areas 25 and 26 Railroad Tracks, Nevada National Security Site, Nevada. This CR complies with the requirements of the Federal Facility Agreement and Consent Order (FFACO) that was agreed to by the State of Nevada; U.S. Department of Energy (DOE), Environmental Management; U.S. Department of Defense; and DOE, Legacy Management. The corrective action sites (CASs) within CAU 539 are located within Areas 25 and 26 of the Nevada National Security Site. Corrective Action Unit 539 comprises the following CASs: • 25-99-21, Area 25 Railroad Tracksmore » • 26-99-05, Area 26 Railroad Tracks The purpose of this CR is to provide documentation supporting the completed corrective actions and provide data confirming that the closure objectives for CASs within CAU 539 were met. To achieve this, the following actions were performed: • Reviewed documentation on historical and current site conditions, including the concentration and extent of contamination. • Conducted radiological walkover surveys of railroad tracks in both Areas 25 and 26. • Collected ballast and soil samples and calculated internal dose estimates for radiological releases. • Collected in situ thermoluminescent dosimeter measurements and calculated external dose estimates for radiological releases. • Removed lead bricks as potential source material (PSM) and collected verification samples. • Implemented corrective actions as necessary to protect human health and the environment. • Properly disposed of corrective action and investigation wastes. • Implemented an FFACO use restriction (UR) for radiological contamination at CAS 25-99-21. The approved UR form and map are provided in Appendix F and will be filed in the DOE, National Nuclear Security Administration Nevada Site Office (NNSA/NSO), Facility Information Management System; the FFACO database; and the NNSA/NSO CAU/CAS files. From November 29, 2010, through May 2, 2011, closure activities were performed as set forth in the Streamlined Approach for Environmental Restoration (SAFER) Plan for Corrective Action Unit 539: Areas 25 and 26 Railroad Tracks, Nevada Test Site, Nevada. The purposes of the activities as defined during the data quality objectives process were as follows: • Determine whether contaminants of concern (COCs) are present. • If COCs are present, determine their nature and extent, implement appropriate corrective actions, and properly dispose of wastes. Analytes detected during the closure activities were evaluated against final action levels (FALs) to determine COCs for CAU 539. Assessment of the data generated from closure activities revealed the following: • At CAS 26-99-05, the total effective dose for radiological releases did not exceed the FAL of 25 millirem per Industrial Area year. Potential source material in the form of lead bricks was found at three locations. A corrective action of clean closure was implemented at these locations, and verification samples indicated that no further action is necessary. • At CAS 25-99-21, the total effective dose for radiological releases exceeds the FAL of 25 millirem per Industrial Area year. Potential source material in the form of lead bricks was found at eight locations. A corrective action was implemented by removing the lead bricks and soil above FALs at these locations, and verification samples indicated that no further action is necessary. Pieces of debris with high radioactivity were identified as PSM and remain within the CAS boundary. A corrective action of closure in place with a UR was implemented at this CAS because closure activities showed evidence of remaining soil contamination and radioactive PSM. Future land use will be restricted from surface and intrusive activities. Closure activities generated waste streams consisting of industrial solid waste, recyclable materials, low-level radioactive waste, and mixed low-level radioactive waste. Wastes were disposed of in the appropriate onsite landfills. The NNSA/NSO provides the following recommendations: • Clean closure is required at CAS 26-99-05. • Closure in place is required at CAS 25-99-21. • A UR is required at CAS 25-99-21. • A Notice of Completion to the NNSA/NSO is requested from the Nevada Division of Environmental Protection for closure of CAU 539. • Corrective Action Unit 539 should be moved from Appendix III to Appendix IV of the FFACO.« less

Addition of rectus sheath relaxation incisions to emergency midline laparotomy for peritonitis to prevent fascial dehiscence.

PubMed

Marwah, Sanjay; Marwah, Nisha; Singh, Mandeep; Kapoor, Ajay; Karwasra, Rajender Kumar

2005-02-01

The incidence of fascial dehiscence and incisional hernia after two methods for abdominal wound closure (rectus sheath relaxation incisions and conventional mass closure) was studied in a randomized prospective clinical trial in a consecutive series of 100 patients undergoing midline laparotomy for peritonitis. The two groups were well matched for etiologies of peritonitis, the surgical procedures performed, and the presence of known risk factors for fascial dehiscence. Fifty patients each were randomized either to the conventional continuous mass closure procedure or the rectus sheath relaxation incision technique (designed to increase wound elasticity and decrease tension in the suture line) using identical polypropylene sutures. The incidence of postoperative complications such as duration of ileus, chest infection, and wound infection were not statistically different between the two groups. The intensity of postoperative pain in the rectus sheath relaxation incision group was significantly less. The incidence of wound hematoma was significantly increased in the rectus sheath relaxation incision group. The incidences of fascial dehiscence (16% vs,28%; p < 0.05) and incisional hernia (18% vs, 30%; p < 0.05) were significantly lower after rectus sheath relaxation incisions compared to conventional mass closure. Closure of the midline laparotomy wound in cases of peritonitis using the rectus sheath relaxation technique is safe and less painful, provides increased wound elasticity and decreased tension on the suture line, and significantly decreases the incidence of wound dehiscence.

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

PubMed

Saaby, Marie-Louise

2014-02-01

Stress urinary incontinence (SUI) occurs when the bladder pressure exceeds the urethral pressure in connection with physical effort or exertion or when sneezing or coughing and depends both on the strength of the urethral closure function and the abdominal pressure to which it is subjected. The urethral closure function in continent women and the dysfunction causing SUI are not known in details. The currently accepted view is based on the concept of a sphincteric unit and a support system. Our incomplete knowledge relates to the complexity of the closure apparatus and to inadequate assessment methods which so far have not provided robust urodynamic diagnostic tools, severity measures, or parameters to assess outcome after intervention. Urethral Pressure Reflectometry (UPR) is a novel method that measures the urethral pressure and cross-sectional area (by use of sound waves) simultaneously. The technique involves insertion of only a small, light and flexible polyurethane bag in the urethra and therefore avoids the common artifacts encountered with conventional methods. The UPR parameters can be obtained at a specific site of the urethra, e.g. the high pressure zone, and during various circumstances, i.e. resting and squeezing. During the study period, we advanced the UPR technique to enable faster measurement (within 7 seconds by the continuous technique) which allowed assessment during increased intra-abdominal pressure induced by physical straining. We investigated the urethral closure function in continent and SUI women during resting and straining by the "fast" UPR technique. Thereby new promising urethral parameters were provided that allowed characterization of the closure function based on the permanent closure forces (primarily generated by the sphincteric unit, measured by the Po-rest) and the adjunctive closure forces (primarily generated by the support system, measured by the abdominal to urethral pressure impact ratio (APIR)). The new parameters enabled a more detailed description of the efficiency of the closure function and the extent and nature of a possible dysfunction in the individual woman. The urethral closure equation (UCE) and urethral opening pressure at an abdominal pressure of 50 cm H2O (Po-Abd 50), respectively, which combine the permanent and the adjunctive closure forces, could separate continent and SUI women and thus appear to be excellent diagnostic tests. Moreover, the parameters showed highly significant negative correlation with ICIQ-SF, pad test and the number of incontinence episodes per week and are therefore valid as urodynamic severity measures. UPR in SUI women before and after TVT demonstrated a more efficient urethral closure function after the operation. The Po-rest was unchanged suggesting that the sphincteric unit was virtually unaltered and hence the permanent closure forces unchanged. However, the resting opening elastance increased by 18% indicating that at the resting state the TVT somewhat improves the closure function by providing increased resistance against the dilation of the urethra, which probably explains the decreased maximum urine flow rate found after TVT in this and previous studies. The APIR increased in all patients after TVT suggesting that the support system was re-established and thus the adjunctive closure forces improved, regardless of the type of pre-operative dysfunction. The new UPR parameters may be used as outcome measures after treatment.

Patient Satisfaction After Femoral Arterial Access Site Closure Using the ExoSeal{sup ®} Vascular Closure Device Compared to Manual Compression: A Prospective Intra-individual Comparative Study

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

Pieper, Claus Christian, E-mail: claus.christian.pieper@ukb.uni-bonn.de; Thomas, Daniel, E-mail: daniel.thomas@ukb.uni-bonn.de; Nadal, Jennifer, E-mail: jennifer.nadal@ukb.uni-bonn.de

PurposeTo intra-individually compare discomfort levels and patient satisfaction after arterial access closure using the ExoSeal{sup ®} vascular closure device (VCD) and manual compression (MC) in a prospective study design.MethodsPatients undergoing two planned interventions from 07/2013 to 09/2014 could participate in the study. Access closure was performed with an ExoSeal{sup ®}-VCD in one and MC in the other intervention. Patients were clinically and sonographically examined and were given questionnaires 1 day after intervention [groin- and back-pain during bedrest (100-point visual analog scale; 0: no pain); comfortability of bedrest (10-point Likert scale, 1: comfortable), satisfaction with closure (10-point Likert scale, 1: very satisfied)].more » Results were analyzed in a cross-over design.Results48 patients (29 male, median age 62.5 (32–88) years) were included. An ExoSeal{sup ®}-VCD was used first in 25 cases. As four of these subsequently refused MC as second intervention, data from 44 patients could be analyzed. All closures were technically successful (successful device deployment) without major complications. Groin- and back-pain after VCD-use/MC was 0 (0–15) vs. 10 (0–80) and 0 (0–75) vs. 25 (0–90), respectively (p < 0.0001). Bedrest after VCD-use was more comfortable than after MC [1 (range 1–7) vs. 6 (2–10); p < 0.0001]. Satisfaction with the closure procedure and with the intervention in general was higher after VCD-use compared to MC [1 (1–3) vs. 5 (2–10) and 1 (1–2) vs. 2 (1–4), respectively; p < 0.0001].ConclusionIntra-individual comparison showed pain levels and discomfort to be significantly lower after ExoSeal{sup ®} use compared to MC. VCD closure was associated with higher satisfaction both with the closure itself and with the intervention in general.« less

Chemical Waste Landfill Annual Post-Closure Care Report Calendar Year 2014

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

Mitchell, Michael Marquand; Little, Bonnie Colleen

The CWL is a 1.9-acre remediated interim status landfill located in the southeastern corner of SNL/NM Technical Area III (Figures 2-1 and 2-2) undergoing post-closure care in accordance with the PCCP (NMED October 2009 and subsequent revisions). From 1962 until 1981, the CWL was used for the disposal of chemical and solid waste generated by SNL/NM research activities. Additionally, a small amount of radioactive waste was disposed of during the operational years. Disposal of liquid waste in unlined pits and trenches ended in 1981, and after 1982 all liquid waste disposal was terminated. From 1982 through 1985, only solid wastemore » was disposed of at the CWL, and after 1985 all waste disposal ended. The CWL was also used as a hazardous waste drum-storage facility from 1981 to 1989. A summary of the CWL disposal history is presented in the Closure Plan (SNL/NM December 1992) along with a waste inventory based upon available disposal records and information.« less

Coaptive film versus subcuticular suture: comparing skin closure time following identical, single-session, bilateral limb surgery in children.

PubMed

Rebello, Gleeson; Parikh, Ravi; Grottkau, Brian

2009-09-01

This study is a randomized controlled trial comparing skin closure time between coaptive film and subcuticular monocryl sutures in children undergoing identical single session, bilateral limb multiple soft tissue releases. Eight children less than 18 years of age (mean 14.5) with cerebral palsy underwent identical, single session bilateral multiple soft tissue releases in the lower limb from August 2005 to March 2007. There were 50 incisions in all in which 25 incisions were closed with 4-0 intracuticular monocryl sutures and 25 were closed with coaptive film (Steri Strip S; 3M company). Time taken for closure using either technique was recorded. A blinded plastic surgeon used a visual analog scale to assess the cosmetic results at the end of a 3 month follow-up. The average length of incisions closed with coaptive film was almost identical to the corresponding incision on the contralateral limb that was closed with subcuticular monocryl suture (4.45 and 4.81 cm, P=0.66). The average time for skin closure using monocryl sutures was 167.04 seconds compared with the average time of 79.36 seconds when using coaptive film (P <0.0001). There was no significant difference in the cosmetic results or the number of wound complications using either technique. Coaptive film is an attractive and cost-effective option for skin closure after pediatric surgery. The time saved, comparable cosmetic results and lack of complications makes coaptive film an attractive option for skin closure in the pediatric age group.

Caesarean section surgical techniques (CORONIS): a fractional, factorial, unmasked, randomised controlled trial.

PubMed

Abalos, E; Addo, V; Brocklehurst, P; El Sheikh, M; Farrell, B; Gray, S; Hardy, P; Juszczak, E; Mathews, J E; Masood, S Naz; Oyarzun, E; Oyieke, J; Sharma, J B; Spark, P

2013-07-20

Variations exist in the surgical techniques used for caesarean section and many have not been rigorously assessed in randomised controlled trials. We aimed to assess whether any surgical techniques were associated with improved outcomes for women and babies. CORONIS was a pragmatic international 2×2×2×2×2 non-regular fractional, factorial, unmasked, randomised controlled trial that examined five elements of the caesarean section technique in intervention pairs. CORONIS was undertaken at 19 sites in Argentina, Chile, Ghana, India, Kenya, Pakistan, and Sudan. Each site was assigned to three of the five intervention pairs: blunt versus sharp abdominal entry; exteriorisation of the uterus for repair versus intra-abdominal repair; single-layer versus double-layer closure of the uterus; closure versus non-closure of the peritoneum (pelvic and parietal); and chromic catgut versus polyglactin-910 for uterine repair. Pregnant women were eligible if they were to undergo their first or second caesarean section through a planned transverse abdominal incision. Women were randomly assigned by a secure web-based number allocation system to one intervention from each of the three assigned pairs. All investigators, surgeons, and participants were unmasked to treatment allocation. The primary outcome was the composite of death, maternal infectious morbidity, further operative procedures, or blood transfusion (>1 unit) up to the 6-week follow-up visit. Women were analysed in the groups into which they were allocated. The CORONIS Trial is registered with Current Controlled Trials: ISRCTN31089967. Between May 20, 2007, and Dec 31, 2010, 15 935 women were recruited. There were no statistically significant differences within any of the intervention pairs for the primary outcome: blunt versus sharp entry risk ratio 1·03 (95% CI 0·91-1·17), exterior versus intra-abdominal repair 0·96 (0·84-1·08), single-layer versus double-layer closure 0·96 (0·85-1·08), closure versus non-closure 1·06 (0·94-1·20), and chromic catgut versus polyglactin-910 0·90 (0·78-1·04). 144 serious adverse events were reported, of which 26 were possibly related to the intervention. Most of the reported serious adverse events were known complications of surgery or complications of the reasons for the caesarean section. These findings suggest that any of these surgical techniques is acceptable. However, longer-term follow-up is needed to assess whether the absence of evidence of short-term effects will translate into an absence of long-term effects. UK Medical Research Council and WHO. Copyright © 2013 Elsevier Ltd. All rights reserved.

Roles of Historical Photography in Waste Site Characterization, Closure, and Remediation

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

Mackey, H.

1998-07-01

Over 40,000 frames of vertical historical photography from 1938 to 1996 and over 10,000 frames of oblique photography from 1981 to 1991 of the 777-square kilometer Savannah River Site in south central South Carolina were reviewed, cataloged, and referenced utilizing ARCView and associated ArcInfo tools. This allows environmental reviews of over 400 potential waste units on the SRS to be conducted in a rapid fashion to support preparation of work plans, characterization, risk assessments, and closure of the waste units in a more cost effective manner.

Cellular basis of neuroepithelial bending during mouse spinal neural tube closure

PubMed Central

McShane, Suzanne G.; Molè, Matteo A.; Savery, Dawn; Greene, Nicholas D. E; Tam, Patrick P.L.; Copp, Andrew J.

2015-01-01

Summary Bending of the neural plate at paired dorsolateral hinge points (DLHPs) is required for neural tube closure in the spinal region of the mouse embryo. As a step towards understanding the morphogenetic mechanism of DLHP development, we examined variations in neural plate cellular architecture and proliferation during closure. Neuroepithelial cells within the median hinge point (MHP) contain nuclei that are mainly basally located and undergo relatively slow proliferation, with a 7 h cell cycle length. In contrast, cells in the dorsolateral neuroepithelium, including the DLHP, exhibit nuclei distributed throughout the apico-basal axis and undergo rapid proliferation, with a 4 h cell cycle length. As the neural folds elevate, cell numbers increase to a greater extent in the dorsolateral neural plate that contacts the surface ectoderm, compared with the more ventromedial neural plate where cells contact paraxial mesoderm and notochord. This marked increase in dorsolateral cell number cannot be accounted for solely on the basis of enhanced cell proliferation in this region. We hypothesised that neuroepithelial cells may translocate in a ventral-to-dorsal direction as DLHP formation occurs, and this was confirmed by vital cell labelling in cultured embryos. The translocation of cells into the neural fold, together with its more rapid cell proliferation, leads to an increase in cell density dorsolaterally compared with the more ventromedial neural plate. These findings suggest a model in which DLHP formation may proceed through ‘buckling’ of the neuroepithelium at a dorso-ventral boundary marked by a change in cell-packing density. PMID:26079577

Circumferentially oversewn inverted stapled anastomosis.

PubMed

Karam, Charbel; Lord, Sally; Gett, Rohan; Meagher, Alan P

2018-04-01

Leak rates of over 5% following anastomoses between the ileum and colon continue to be reported in large series and are associated with substantial morbidity and with mortality rates of 10-20%. In 1994, we began performing circumferentially oversewn inverted stapled anastomoses in patients undergoing ileo-colic anastomoses or ileostomy closure. It has become increasingly apparent that this method is associated with a low risk of leakage, which we should report. The anastomotic technique described was used in all patients undergoing ileo-colic anastomosis or closure of ileostomy by surgeon 1 (1994-2015) and in all ileo-colic anastomoses by surgeon 2 (2007-2015). All patients had a widely patent anastomosis constructed by two firings of a linear cutting stapler, as previously described. Additionally, the entire staple line was carefully oversewn with interrupted, inverting 4/0 polydioxanone sutures. Anastomotic leak was defined as a patient requiring re-operation or radiological drainage. One thousand and twelve patients underwent ileo-colic anastomosis and 685 patients underwent closure of ileostomy by surgeon 1, and 165 patients underwent ileo-colic anastomosis by surgeon 2. None of the 1862 patients required re-operation or radiological drainage for a leak (event rate 0%, 95% confidence interval 0-0.2%). However, there were three possible contained leaks treated successfully conservatively. The time taken to perform the actual anastomosis was measured in the last 30 ileo-colic resections. The median time was 42 min. While this method may well be too slow to gain widespread adoption, we hope this report encourages increased research into finding techniques with similar low leak rates. © 2016 Royal Australasian College of Surgeons.

Positive Catch & Economic Benefits of Periodic Octopus Fishery Closures: Do Effective, Narrowly Targeted Actions 'Catalyze' Broader Management?

PubMed

Oliver, Thomas A; Oleson, Kirsten L L; Ratsimbazafy, Hajanaina; Raberinary, Daniel; Benbow, Sophie; Harris, Alasdair

2015-01-01

Eight years of octopus fishery records from southwest Madagascar reveal significant positive impacts from 36 periodic closures on: (a) fishery catches and (b) village fishery income, such that (c) economic benefits from increased landings outweigh costs of foregone catch. Closures covered ~20% of a village's fished area and lasted 2-7 months. Octopus landings and catch per unit effort (CPUE) significantly increased in the 30 days following a closure's reopening, relative to the 30 days before a closure (landings: +718%, p<0.0001; CPUE: +87%, p<0.0001; n = 36). Open-access control sites showed no before/after change when they occurred independently of other management ("no ban", n = 17/36). On the other hand, open-access control sites showed modest catch increases when they extended a 6-week seasonal fishery shutdown ("ban", n = 19/36). The seasonal fishery shutdown affects the entire region, so confound all potential control sites. In villages implementing a closure, octopus fishery income doubled in the 30 days after a closure, relative to 30 days before (+132%, p<0.001, n = 28). Control villages not implementing a closure showed no increase in income after "no ban" closures and modest increases after "ban" closures. Villages did not show a significant decline in income during closure events. Landings in closure sites generated more revenue than simulated landings assuming continued open-access fishing at that site (27/36 show positive net earnings; mean +$305/closure; mean +57.7% monthly). Benefits accrued faster than local fishers' time preferences during 17-27 of the 36 closures. High reported rates of illegal fishing during closures correlated with poor economic performance. We discuss the implications of our findings for broader co-management arrangements, particularly for catalyzing more comprehensive management.

75 FR 79417 - Record of Vote of Meeting Closure

Federal Register 2010, 2011, 2012, 2013, 2014

2010-12-20

...] Record of Vote of Meeting Closure I, Isaac Fulwood, of the United States Parole Commission, was present... following Commissioners voted that the meeting be closed: Isaac Fulwood, Cranston J. Mitchell and Patricia K.... Isaac Fulwood, Chairman, U.S. Parole Commission. [FR Doc. 2010-31860 Filed 12-17-10; 8:45 am] BILLING...

50 CFR 36.16 - Closure to subsistence uses of fish and wildlife.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 50 Wildlife and Fisheries 9 2014-10-01 2014-10-01 false Closure to subsistence uses of fish and wildlife. 36.16 Section 36.16 Wildlife and Fisheries UNITED STATES FISH AND WILDLIFE SERVICE, DEPARTMENT OF THE INTERIOR (CONTINUED) THE NATIONAL WILDLIFE REFUGE SYSTEM ALASKA NATIONAL WILDLIFE REFUGES...

50 CFR 36.16 - Closure to subsistence uses of fish and wildlife.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 50 Wildlife and Fisheries 9 2012-10-01 2012-10-01 false Closure to subsistence uses of fish and wildlife. 36.16 Section 36.16 Wildlife and Fisheries UNITED STATES FISH AND WILDLIFE SERVICE, DEPARTMENT OF THE INTERIOR (CONTINUED) THE NATIONAL WILDLIFE REFUGE SYSTEM ALASKA NATIONAL WILDLIFE REFUGES...

50 CFR 36.16 - Closure to subsistence uses of fish and wildlife.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 50 Wildlife and Fisheries 9 2013-10-01 2013-10-01 false Closure to subsistence uses of fish and wildlife. 36.16 Section 36.16 Wildlife and Fisheries UNITED STATES FISH AND WILDLIFE SERVICE, DEPARTMENT OF THE INTERIOR (CONTINUED) THE NATIONAL WILDLIFE REFUGE SYSTEM ALASKA NATIONAL WILDLIFE REFUGES...

50 CFR 36.16 - Closure to subsistence uses of fish and wildlife.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 50 Wildlife and Fisheries 6 2010-10-01 2010-10-01 false Closure to subsistence uses of fish and wildlife. 36.16 Section 36.16 Wildlife and Fisheries UNITED STATES FISH AND WILDLIFE SERVICE, DEPARTMENT OF THE INTERIOR (CONTINUED) THE NATIONAL WILDLIFE REFUGE SYSTEM ALASKA NATIONAL WILDLIFE REFUGES...

50 CFR 36.16 - Closure to subsistence uses of fish and wildlife.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 50 Wildlife and Fisheries 8 2011-10-01 2011-10-01 false Closure to subsistence uses of fish and wildlife. 36.16 Section 36.16 Wildlife and Fisheries UNITED STATES FISH AND WILDLIFE SERVICE, DEPARTMENT OF THE INTERIOR (CONTINUED) THE NATIONAL WILDLIFE REFUGE SYSTEM ALASKA NATIONAL WILDLIFE REFUGES...

75 FR 32158 - New Pneumatic Off-the-Road Tires from the People's Republic of China: Extension of Preliminary...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-07

..., 2010, Tianjin United Tire & Rubber International Co., Ltd. (``TUTRIC''), a mandatory respondent... deadlines by seven calendar days due to closure of federal government offices in February 2010 from a...: Tolling of Administrative Deadlines As A Result of the Government Closure During the Recent Snowstorm...

77 FR 73013 - Stainless Steel Plate in Coils From Belgium: Antidumping Duty Administrative Review, 2010-2011

Federal Register 2010, 2011, 2012, 2013, 2014

2012-12-07

... Independent Organization, and the United Steel, Paper and Forestry, Rubber, Manufacturing, Energy, Allied... the closure of the Federal Government from October 29, through October 30, 2012. Thus, all deadlines... Government Closure during Hurricane Sandy,'' dated October 31, 2012. On October 22, 2012, the Department...

78 FR 45896 - Fisheries of the Northeastern United States; Northeast Multispecies Fishery; Trimester Closure...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-07-30

... Fishery; Trimester Closure for the Common Pool Fishery AGENCY: National Marine Fisheries Service (NMFS... remainder of Trimester 1, through August 31, 2013. Based on our projection, the common pool fishery has... area for the remainder of the trimester. This action is intended to prevent an overage of the common...

Corrective Action Decision Document/Closure Report for Corrective Action Unit 569: Area 3 Yucca Flat Atmospheric Test Sites Nevada National Security Site, Nevada with ROTC 1, Revision 0

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

Sloop, Christy

2013-04-01

This Corrective Action Decision Document/Closure Report presents information supporting the closure of Corrective Action Unit (CAU) 569: Area 3 Yucca Flat Atmospheric Test Sites, Nevada National Security Site, Nevada. CAU 569 comprises the following nine corrective action sites (CASs): • 03-23-09, T-3 Contamination Area • 03-23-10, T-3A Contamination Area • 03-23-11, T-3B Contamination Area • 03-23-12, T-3S Contamination Area • 03-23-13, T-3T Contamination Area • 03-23-14, T-3V Contamination Area • 03-23-15, S-3G Contamination Area • 03-23-16, S-3H Contamination Area • 03-23-21, Pike Contamination Area The purpose of this Corrective Action Decision Document/Closure Report is to provide justification and documentation supportingmore » the recommendation that no further corrective action is needed for CAU 569 based on the implementation of the corrective actions listed in Table ES-2.« less

A Foot-Mounted Inertial Measurement Unit (IMU) Positioning Algorithm Based on Magnetic Constraint

PubMed Central

Zou, Jiaheng

2018-01-01

With the development of related applications, indoor positioning techniques have been more and more widely developed. Based on Wi-Fi, Bluetooth low energy (BLE) and geomagnetism, indoor positioning techniques often rely on the physical location of fingerprint information. The focus and difficulty of establishing the fingerprint database are in obtaining a relatively accurate physical location with as little given information as possible. This paper presents a foot-mounted inertial measurement unit (IMU) positioning algorithm under the loop closure constraint based on magnetic information. It can provide relatively reliable position information without maps and geomagnetic information and provides a relatively accurate coordinate for the collection of a fingerprint database. In the experiment, the features extracted by the multi-level Fourier transform method proposed in this paper are validated and the validity of loop closure matching is tested with a RANSAC-based method. Moreover, the loop closure detection results show that the cumulative error of the trajectory processed by the graph optimization algorithm is significantly suppressed, presenting a good accuracy. The average error of the trajectory under loop closure constraint is controlled below 2.15 m. PMID:29494542

A Foot-Mounted Inertial Measurement Unit (IMU) Positioning Algorithm Based on Magnetic Constraint.

PubMed

Wang, Yan; Li, Xin; Zou, Jiaheng

2018-03-01

With the development of related applications, indoor positioning techniques have been more and more widely developed. Based on Wi-Fi, Bluetooth low energy (BLE) and geomagnetism, indoor positioning techniques often rely on the physical location of fingerprint information. The focus and difficulty of establishing the fingerprint database are in obtaining a relatively accurate physical location with as little given information as possible. This paper presents a foot-mounted inertial measurement unit (IMU) positioning algorithm under the loop closure constraint based on magnetic information. It can provide relatively reliable position information without maps and geomagnetic information and provides a relatively accurate coordinate for the collection of a fingerprint database. In the experiment, the features extracted by the multi-level Fourier transform method proposed in this paper are validated and the validity of loop closure matching is tested with a RANSAC-based method. Moreover, the loop closure detection results show that the cumulative error of the trajectory processed by the graph optimization algorithm is significantly suppressed, presenting a good accuracy. The average error of the trajectory under loop closure constraint is controlled below 2.15 m.

Can post-sternotomy mediastinitis be prevented by a closed incision management system?

PubMed Central

Dohmen, Pascal M.; Markou, Thanasie; Ingemansson, Richard; Rotering, Heinrich; Hartman, Jean M.; van Valen, René; Brunott, Maaike; Kramer, Axel; Segers, Patrique

2014-01-01

Post-sternotomy mediastinitis is a serious complication after cardiothoracic surgery and contribute significantly to post-operative morbidity, mortality, and healthcare costs. Negative pressure wound therapy is today’s golden standard for post-sternotomy mediastinitis treatment. A systematic literature search was conducted at PubMed until October 2012 to analyse whether vacuum-assisted closure technique prevents mediastinitis after clean surgical incisions closure. Today’s studies showed reduction of post-sternotomy mediastinitis including a beneficial socio-economic impact. Current studies, however included only high-risk patients, hence furthermore, larger randomised controlled trials are warranted to clarify the benefit for using surgical incision vacuum management systems in the general patient population undergoing sternotomy and clarify risk factor interaction. PMID:25285263

Addendum to the Closure Report for Corrective Action Unit 113: Area 25 R-MAD Facility, Nevada National Security Site, Nevada

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

NSTec Environmental Restoration

2011-02-24

This addendum to the Closure Report for Corrective Action Unit 113: Area 25, Reactor Maintenance, Assembly, and Disassembly Facility, Building 3110, Nevada Test Site, Nevada, DOE/NV--891-VOL I-Rev. 1, dated July 2003, provides details of demolition, waste disposal, and use restriction (UR) modification for Corrective Action Unit 113, Area 25 R-MAD Facility. Demolition was completed on July 15, 2010, when the last of the building debris was disposed. Final field activities were concluded on August 30, 2010, after all equipment was demobilized and UR signs were posted. This work was funded by the American Recovery and Reinvestment Act.

Factors associated with increasing nursing home closures.

PubMed

Castle, Nicholas G; Engberg, John; Lave, Judith; Fisher, Andrew

2009-06-01

We determine the rate of nursing home closures for 7 years (1999-2005) and examine internal (e.g., quality), organizational (e.g., chain membership), and external (e.g., competition) factors associated with these closures. The names of the closed facilities and dates of closure from state regulators in all 50 states were obtained. This information was linked to the Online Survey, Certification, and Reporting data, which contains information on internal, organizational, and market factors for almost all nursing homes in the United States. One thousand seven hundred and eighty-nine facilities closed over this time period (1999-2005). The average annual rate of closure was about 2 percent of facilities, but the rate of closure was found to be increasing. Nursing homes with higher rates of deficiency citations, hospital-based facilities, chain members, small bed size, and facilities located in markets with high levels of competition were more likely to close. High Medicaid occupancy rates were associated with a high likelihood of closure, especially for facilities with low Medicaid reimbursement rates. As states actively debate about how to redistribute long-term care services/dollars, our findings show that they should be cognizant of the potential these decisions have for facilitating nursing home closures.

Closure Report for Corrective Action Unit 139: Waste Disposal Sites, Nevada Test Site, Nevada

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

NSTec Environmental Restoration

2009-07-31

Corrective Action Unit (CAU) 139 is identified in the Federal Facility Agreement and Consent Order (FFACO) as 'Waste Disposal Sites' and consists of the following seven Corrective Action Sites (CASs), located in Areas 3, 4, 6, and 9 of the Nevada Test Site: CAS 03-35-01, Burn Pit; CAS 04-08-02, Waste Disposal Site; CAS 04-99-01, Contaminated Surface Debris; CAS 06-19-02, Waste Disposal Site/Burn Pit; CAS 06-19-03, Waste Disposal Trenches; CAS 09-23-01, Area 9 Gravel Gertie; and CAS 09-34-01, Underground Detection Station. Closure activities were conducted from December 2008 to April 2009 according to the FFACO (1996, as amended February 2008) andmore » the Corrective Action Plan for CAU 139 (U.S. Department of Energy, National Nuclear Security Administration Nevada Site Office, 2007b). The corrective action alternatives included No Further Action, Clean Closure, and Closure in Place with Administrative Controls. Closure activities are summarized. CAU 139, 'Waste Disposal Sites,' consists of seven CASs in Areas 3, 4, 6, and 9 of the NTS. The closure alternatives included No Further Action, Clean Closure, and Closure in Place with Administrative Controls. This CR provides a summary of completed closure activities, documentation of waste disposal, and confirmation that remediation goals were met. The following site closure activities were performed at CAU 139 as documented in this CR: (1) At CAS 03-35-01, Burn Pit, soil and debris were removed and disposed as LLW, and debris was removed and disposed as sanitary waste. (2) At CAS 04-08-02, Waste Disposal Site, an administrative UR was implemented. No postings or post-closure monitoring are required. (3) At CAS 04-99-01, Contaminated Surface Debris, soil and debris were removed and disposed as LLW, and debris was removed and disposed as sanitary waste. (4) At CAS 06-19-02, Waste Disposal Site/Burn Pit, no work was performed. (5) At CAS 06-19-03, Waste Disposal Trenches, a native soil cover was installed, and a UR was implemented. (6) At CAS 09-23-01, Area 9 Gravel Gertie, a UR was implemented. (7) At CAS 09-34-01, Underground Detection Station, no work was performed.« less

Left Atrial Appendage Closure for Stroke Prevention: Devices, Techniques, and Efficacy.

PubMed

Iskandar, Sandia; Vacek, James; Lavu, Madhav; Lakkireddy, Dhanunjaya

2016-05-01

Left atrial appendage closure can be performed either surgically or percutaneously. Surgical approaches include direct suture, excision and suture, stapling, and clipping. Percutaneous approaches include endocardial, epicardial, and hybrid endocardial-epicardial techniques. Left atrial appendage anatomy is highly variable and complex; therefore, preprocedural imaging is crucial to determine device selection and sizing, which contribute to procedural success and reduction of complications. Currently, the WATCHMAN is the only device that is approved for left atrial appendage closure in the United States. Copyright © 2016 Elsevier Inc. All rights reserved.

Association of land use and beach closure in the United ...

EPA Pesticide Factsheets

Swimming in natural waters (e.g., oceans, lakes, rivers) is one of most popular recreational activities in the United States. However, exposure to pathogens (e.g., Salmonella spp., Shigella spp., Cryptosporidium, Giardia, adenovirus, norovirus) in recreational waters can lead to a variety of adverse health outcomes. To protect public health and reduce the number of outbreaks associated with recreational waters, the BEACH Act was passed in 2000, which required beach regulators to develop a formal plan to assess beach water quality and to notify the public if recreational waters are unsafe. High levels of microorganisms in water often follow extreme weather events. Besides extreme weather events, the proximity of certain land uses to beaches may also have great influence on beach water quality. Microbial contaminants that lead to beach closures and human illness come mainly from land, either from discrete point sources or from diffuse non-point sources. It is expected that land use will have considerable influence on beach microbial water quality. However, to date, studies on impacts of land use on beach microbial contamination are rare, and few researchers are aware of the relationship between land use and beach closures.In this study, we analyzed beach closure data obtained from 2004 to 2013 for more than 500 beaches in the United States, and examined their associations with land use around beaches in 2006 and 2011. The results show that the number of beach clos

Closure Report for Corrective Action Unit 516: Septic Systems and Discharge Points

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

NSTec Environmental Restoration

Corrective Action Unit (CAU) 516 is located in Areas 3, 6, and 22 of the Nevada Test Site. CAU 516 is listed in the Federal Facility Agreement and Consent Order of 1996 as Septic Systems and Discharge Points, and is comprised of six Corrective Action Sites (CASs): {sm_bullet} CAS 03-59-01, Bldg 3C-36 Septic System {sm_bullet} CAS 03-59-02, Bldg 3C-45 Septic System {sm_bullet} CAS 06-51-01, Sump and Piping {sm_bullet} CAS 06-51-02, Clay Pipe and Debris {sm_bullet} CAS 06-51-03, Clean Out Box and Piping {sm_bullet} CAS 22-19-04, Vehicle Decontamination Area The Nevada Division of Environmental Protection (NDEP)-approved corrective action alternative for CASsmore » 06-51-02 and 22-19-04 is no further action. The NDEP-approved corrective action alternative for CASs 03-59-01, 03-59-02, 06-51-01, and 06-51-03 is clean closure. Closure activities included removing and disposing of total petroleum hydrocarbon (TPH)-impacted septic tank contents, septic tanks, distribution/clean out boxes, and piping. CAU 516 was closed in accordance with the NDEP-approved CAU 516 Corrective Action Plan (CAP). The closure activities specified in the CAP were based on the recommendations presented in the CAU 516 Corrective Action Decision Document (U.S. Department of Energy, National Nuclear Security Administration Nevada Site Office, 2004). This Closure Report documents CAU 516 closure activities. During closure activities, approximately 186 tons of hydrocarbon waste in the form of TPH-impacted soil and debris, as well as 89 tons of construction debris, were generated and managed and disposed of appropriately. Waste minimization techniques, such as field screening of soil samples and the utilization of laboratory analysis to characterize and classify waste streams, were employed during the performance of closure work.« less

78 FR 23515 - Regulated Navigation Areas, Security Zones: Dignitary Arrival/Departure and United Nations...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-04-19

... security zones as RNAs. The Marine Air Terminal, United Nations, and United Nations West Channel Closure... United Nations General Assembly RNA Regulated Navigation Area UN United Nations A. Public Participation... comment, it will be considered as having been received by the Coast Guard when it is received at the...

Vacuum assisted closure for the treatment of sternal wounds: the bridge between débridement and definitive closure.

PubMed

Song, David H; Wu, Liza C; Lohman, Robert F; Gottlieb, Lawrence J; Franczyk, Mieczyslawa

2003-01-01

A method to refine the treatment of sternal wounds using Vacuum Assisted Closure (V.A.C.) therapy as the bridge between débridement and delayed definitive closure is described. A retrospective review of 35 consecutive patients with sternal wound complications over a 2-year period (March of 1999 to March of 2001) was performed. The treatment of sternal wounds with traditional twice-a-day dressing changes was compared with the treatment with the wound V.A.C. device. An analysis of the number of days between initial débridement and closure, number of dressing changes, number and types of flaps needed for reconstruction, and complications was performed. Eighteen patients were treated with traditional twice-a-day dressing changes and 17 patients were treated with V.A.C. therapy alone. The two groups were similar regarding age, sex, type of cardiac procedure, and type of sternal wound. The V.A.C. therapy group had a trend toward a shorter interval between débridement and closure, with a mean of 6.2 days, whereas the dressing change group had mean of 8.5 days. The V.A.C. therapy group had a significantly lower number of dressing changes, with a mean of three, whereas the twice-a-day dressing change group had a mean of 17 (p < 0.05). Reconstruction required an average of 1.5 soft-tissue flaps per patient treated with traditional dressing changes versus 0.9 soft-tissue flaps per patient for those treated with V.A.C. therapy (p < 0.05). Before closure, there was one death among patients undergoing dressing changes and three in the V.A.C. therapy group, all of which were unrelated to the management of the sternal wound. Patients with sternal wounds who have benefited from V.A.C. therapy alone have a significant decrease in the number of dressing changes and number of soft-tissue flaps needed for closure. Finally, the V.A.C. therapy group had a trend toward a decreased number of days between débridement and closure.

Predictors of transient left ventricular dysfunction following transcatheter patent ductus arteriosus closure in pediatric age.

PubMed

Agha, Hala Mounir; Hamza, Hala S; Kotby, Alyaa; Ganzoury, Mona E L; Soliman, Nanies

2017-10-01

To evaluate the left ventricular function before and after transcatheter percutaneous patent ductus arteriosus (PDA) closure, and to identify the predictors of myocardial dysfunction post-PDA closure if present. Transcatheter PDA closure; conventional, Doppler, and tissue Doppler imaging; and speckle tracking echocardiography. To determine the feasibility and reliability of tissue Doppler and myocardial deformation imaging for evaluating myocardial function in children undergoing transcatheter PDA closure. Forty-two children diagnosed with hemodynamically significant PDA underwent percutaneous PDA closure. Conventional, Doppler, and tissue Doppler imaging, and speckle-derived strain rate echocardiography were performed at preclosure and at 48 hours, 1 month, and 6 months postclosure. Tissue Doppler velocities of the lateral and septal mitral valve annuli were obtained. Global and regional longitudinal peak systolic strain values were determined using two-dimensional speckle tracking echocardiography. The median age of the patients was 2 years and body weight was 15 kg, with the mean PDA diameter of 3.11 ± 0.99 mm. M-mode measurements (left ventricular end diastolic diameter, left atrium diameter to aortic annulus ratio, ejection fraction, and shortening fraction) reduced significantly early after PDA closure ( p  < 0.001). After 1 month, left ventricular end diastolic diameter and left atrium diameter to aortic annulus ratio continued to decrease, while ejection fraction and fractional shortening improved significantly. All tissue Doppler velocities showed a significant decrease at 48 hours with significant prolongation of global myocardial function ( p  < 0.001) and then were normalized within 1 month postclosure. Similarly, global longitudinal strain significantly decreased at 48 hours postclosure ( p  < 0.001), which also recovered at 1 month follow-up. Preclosure global longitudinal strain showed a good correlation with the postclosure prolongation of the myocardial performance index. Transcatheter PDA closure causes a significant decrease in left ventricular performance early after PDA closure, which recovers completely within 1 month. Preclosure global longitudinal strain can be a predictor of postclosure myocardial dysfunction.

Corrective Action Decision Document/Closure Report for Corrective Action Unit 383: Area E-Tunnel Sites, Nevada Test Site

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

NSTec Environmental Restoration

This Corrective Action Decision Document/Closure Report (CADD/CR) was prepared by the Defense Threat Reduction Agency (DTRA) for Corrective Action Unit (CAU) 383, Area 12 E-Tunnel Sites, which is the joint responsibility of DTRA and the U.S. Department of Energy (DOE), National Nuclear Security Administration Nevada Site Office (NNSA/NSO). This CADD/CR is consistent with the requirements of the Federal Facility Agreement and Consent Order (FFACO) agreed to by the State of Nevada, the DOE, and the U.S. Department of Defense. Corrective Action Unit 383 is comprised of three Corrective Action Sites (CASs) and two adjacent areas: • CAS 12-06-06, Muckpile •more » CAS 12-25-02, Oil Spill • CAS 12-28-02, Radioactive Material • Drainage below the Muckpile • Ponds 1, 2, and 3 The purpose of this CADD/CR is to provide justification and documentation to support the recommendation for closure with no further corrective action, by placing use restrictions at the three CASs and two adjacent areas of CAU 383.« less

36 CFR 13.1146 - What other closures and restrictions apply to commercial fishermen and commercial fishing vessels?

Code of Federal Regulations, 2013 CFR

2013-07-01

..., Forests, and Public Property NATIONAL PARK SERVICE, DEPARTMENT OF THE INTERIOR NATIONAL PARK SYSTEM UNITS IN ALASKA Special Regulations-Glacier Bay National Park and Preserve Commercial Fishing § 13.1146... 36 Parks, Forests, and Public Property 1 2013-07-01 2013-07-01 false What other closures and...

75 FR 31425 - Drill Pipe from the People's Republic of China: Postponement of Preliminary Determination of...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-03

..., as amended (``the Act'').\\1\\ \\1\\ Due to the extended closure of the Government between February 5 and... Government Closure During the Recent Snowstorm, available at http://ia.ita.doc.gov/download/administrative... Conversion, Inc., Rotary Drilling Tools, TMK IPSCO, and the United Steel, Paper and Forestry, Rubber...

Aim44p regulates phosphorylation of Hof1p to promote contractile ring closure during cytokinesis in budding yeast

PubMed Central

Wolken, Dana M. Alessi; McInnes, Joseph; Pon, Liza A.

2014-01-01

Whereas actomyosin and septin ring organization and function in cytokinesis are thoroughly described, little is known regarding the mechanisms by which the actomyosin ring interacts with septins and associated proteins to coordinate cell division. Here we show that the protein product of YPL158C, Aim44p, undergoes septin-dependent recruitment to the site of cell division. Aim44p colocalizes with Myo1p, the type II myosin of the contractile ring, throughout most of the cell cycle. The Aim44p ring does not contract when the actomyosin ring closes. Instead, it forms a double ring that associates with septin rings on mother and daughter cells after cell separation. Deletion of AIM44 results in defects in contractile ring closure. Aim44p coimmunoprecipitates with Hof1p, a conserved F-BAR protein that binds both septins and type II myosins and promotes contractile ring closure. Deletion of AIM44 results in a delay in Hof1p phosphorylation and altered Hof1p localization. Finally, overexpression of Dbf2p, a kinase that phosphorylates Hof1p and is required for relocalization of Hof1p from septin rings to the contractile ring and for Hof1p-triggered contractile ring closure, rescues the cytokinesis defect observed in aim44∆ cells. Our studies reveal a novel role for Aim44p in regulating contractile ring closure through effects on Hof1p. PMID:24451263

Streamlined Approach for Environmental Restoration (SAFER) Plan for Corrective Action Unit 411. Double Tracks Plutonium Dispersion (Nellis), Nevada Test and Training Range, Nevada, Revision 0

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

Matthews, Patrick K.

2015-03-01

This Streamlined Approach for Environmental Restoration (SAFER) Plan addresses the actions needed to achieve closure for Corrective Action Unit (CAU) 411, Double Tracks Plutonium Dispersion (Nellis). CAU 411 is located on the Nevada Test and Training Range and consists of a single corrective action site (CAS), NAFR-23-01, Pu Contaminated Soil. There is sufficient information and historical documentation from previous investigations and the 1996 interim corrective action to recommend closure of CAU 411 using the SAFER process. Based on existing data, the presumed corrective action for CAU 411 is clean closure. However, additional data will be obtained during a field investigationmore » to document and verify the adequacy of existing information, and to determine whether the CAU 411 closure objectives have been achieved. This SAFER Plan provides the methodology to gather the necessary information for closing the CAU. The results of the field investigation will be presented in a closure report that will be prepared and submitted to the Nevada Division of Environmental Protection (NDEP) for review and approval. The site will be investigated based on the data quality objectives (DQOs) developed on November 20, 2014, by representatives of NDEP, the U.S. Air Force (USAF), and the U.S. Department of Energy (DOE), National Nuclear Security Administration Nevada Field Office. The DQO process was used to identify and define the type, amount, and quality of data needed to determine whether CAU 411 closure objectives have been achieved. The following text summarizes the SAFER activities that will support the closure of CAU 411; Collect environmental samples from designated target populations to confirm or disprove the presence of contaminants of concern (COCs) as necessary to supplement existing information; If COCs are no longer present, establish clean closure as the corrective action; If COCs are present, the extent of contamination will be defined and further corrective actions will be evaluated with the stakeholders (NDEP, USAF); and Confirm the preferred closure option is sufficient to protect human health and the environment.« less

Patent Foramen Ovale Closure or Antiplatelet Therapy for Cryptogenic Stroke.

PubMed

Søndergaard, Lars; Kasner, Scott E; Rhodes, John F; Andersen, Grethe; Iversen, Helle K; Nielsen-Kudsk, Jens E; Settergren, Magnus; Sjöstrand, Christina; Roine, Risto O; Hildick-Smith, David; Spence, J David; Thomassen, Lars

2017-09-14

The efficacy of closure of a patent foramen ovale (PFO) in the prevention of recurrent stroke after cryptogenic stroke is uncertain. We investigated the effect of PFO closure combined with antiplatelet therapy versus antiplatelet therapy alone on the risks of recurrent stroke and new brain infarctions. In this multinational trial involving patients with a PFO who had had a cryptogenic stroke, we randomly assigned patients, in a 2:1 ratio, to undergo PFO closure plus antiplatelet therapy (PFO closure group) or to receive antiplatelet therapy alone (antiplatelet-only group). Imaging of the brain was performed at the baseline screening and at 24 months. The coprimary end points were freedom from clinical evidence of ischemic stroke (reported here as the percentage of patients who had a recurrence of stroke) through at least 24 months after randomization and the 24-month incidence of new brain infarction, which was a composite of clinical ischemic stroke or silent brain infarction detected on imaging. We enrolled 664 patients (mean age, 45.2 years), of whom 81% had moderate or large interatrial shunts. During a median follow-up of 3.2 years, clinical ischemic stroke occurred in 6 of 441 patients (1.4%) in the PFO closure group and in 12 of 223 patients (5.4%) in the antiplatelet-only group (hazard ratio, 0.23; 95% confidence interval [CI], 0.09 to 0.62; P=0.002). The incidence of new brain infarctions was significantly lower in the PFO closure group than in the antiplatelet-only group (22 patients [5.7%] vs. 20 patients [11.3%]; relative risk, 0.51; 95% CI, 0.29 to 0.91; P=0.04), but the incidence of silent brain infarction did not differ significantly between the study groups (P=0.97). Serious adverse events occurred in 23.1% of the patients in the PFO closure group and in 27.8% of the patients in the antiplatelet-only group (P=0.22). Serious device-related adverse events occurred in 6 patients (1.4%) in the PFO closure group, and atrial fibrillation occurred in 29 patients (6.6%) after PFO closure. Among patients with a PFO who had had a cryptogenic stroke, the risk of subsequent ischemic stroke was lower among those assigned to PFO closure combined with antiplatelet therapy than among those assigned to antiplatelet therapy alone; however, PFO closure was associated with higher rates of device complications and atrial fibrillation. (Funded by W.L. Gore and Associates; Gore REDUCE ClinicalTrials.gov number, NCT00738894 .).

Predictive Factors for Patients Undergoing ASD Device Occlusion Who "Crossover" to Surgery.

PubMed

Mulukutla, Venkatachalam; Qureshi, Athar M; Pignatelli, Ricardo; Ing, Frank F

2018-03-01

The aim of this study was to define characteristics of those patients who are referred for device closure of an Atrial septal defect (ASD), but identified to "crossover" surgery. All patients who underwent surgical and device (Amplatzer or Helex occluder) closures of secundum ASDs from 2001 to 2010 were reviewed and organized into three groups: surgical closure, device closure, and "crossover" group. 369 patients underwent ASD closure (265 device, 104 surgical). 42 of the 265 patients referred for device closure "crossed over" to the surgical group at various stages of the catheterization procedure. The device group had defect size measuring 14.2 mm (mean) and an ASD index (Defect Size (mm)/BSA) of 14.0 compared to the corresponding values in the surgical group (20.1 mm, ASD index 25.9) (P < 0.001) and in the "crossover" group (20.7 mm, 22.6 ASD index) (P < 0.001). 79 patients in the device group had a deficient rim, and 86% were located in the retroaortic region. 33 patients in the "crossover" group had deficient rims with 70% deficiency in the posterior/inferior rim. The device group with deficient rims had an ASD index of 14.7 compared with the crossover group ASD index of 23.8 (P < 0.001). Comparing the device and "crossover" groups, an ASD index greater than 23.7 had a 90% specificity in "crossing over" to surgery. The crossover and surgical groups had statistically larger ASD defect size indexes compared with the device group. Deficient rim in the posterior/inferior rim is associated with a large ASD size index which is a predictive factor for crossing over to surgery. Catheterization did not negatively impact surgical results in the "crossover" group.

Endoscopic closure of persistent gastrocutaneous fistulae, after percutaneous endoscopic gastrostomy (PEG) tube placement, using the over-the-scope-clip system

PubMed Central

Changela, Kinesh; Culliford, Andrea; Duddempudi, Sushil; Krishnaiah, Mahesh; Anand, Sury

2015-01-01

Objectives: The Over-The-Scope-Clip (OTSC) has had an evolving role in endoscopic closure of gastrointestinal wall defects, in hemostasis of primary or postinterventional bleeding, and approximation of postbariatric surgery defects. Rapid and effective closure of gastrocutaneous (GC) fistulae using this device has been recently described in the literature. The aim of this study was to evaluate the technical feasibility, efficacy and safety of OTSC as an effective tool in the management of persistent GC fistulae secondary to a complication of percutaneous endoscopic gastrostomy (PEG) tube placement. Method: In this multicenter prospective observational study, we describe our experience with OTSC in the closure of persistent GC fistulas secondary to PEG tube placement. Patients with GC fistulas were sequentially enrolled with a mean age of 84 years. Primary treatment outcome was the immediate successful closure of GC fistula and resolution of leak. Secondary outcome was no recurrence of the fistula and leaks on follow up. Results: A total of 10 patients were enrolled over the study period. Mean age was 84.4 ± 8.75 years. The primary treatment outcome was achieved in all the patients undergoing this intervention. Secondary outcome was observed in 9/10 (90%) subjects. No procedural complications were reported. Larger fistulae (>2.5 cm) and those with significant fibrosis were more difficult to close with the OTSC system. The mean follow-up time after OTSC application was 43.7 ± 20.57 days. A limitation of this study was that there was no control group. Conclusions: OTSC application is a safe and effective endoscopic approach for the closure of persistent GC fistulae secondary to a complication of PEG tube placement. PMID:26136836

Endoscopic closure of persistent gastrocutaneous fistulae, after percutaneous endoscopic gastrostomy (PEG) tube placement, using the over-the-scope-clip system.

PubMed

Singhal, Shashideep; Changela, Kinesh; Culliford, Andrea; Duddempudi, Sushil; Krishnaiah, Mahesh; Anand, Sury

2015-07-01

The Over-The-Scope-Clip (OTSC) has had an evolving role in endoscopic closure of gastrointestinal wall defects, in hemostasis of primary or postinterventional bleeding, and approximation of postbariatric surgery defects. Rapid and effective closure of gastrocutaneous (GC) fistulae using this device has been recently described in the literature. The aim of this study was to evaluate the technical feasibility, efficacy and safety of OTSC as an effective tool in the management of persistent GC fistulae secondary to a complication of percutaneous endoscopic gastrostomy (PEG) tube placement. In this multicenter prospective observational study, we describe our experience with OTSC in the closure of persistent GC fistulas secondary to PEG tube placement. Patients with GC fistulas were sequentially enrolled with a mean age of 84 years. Primary treatment outcome was the immediate successful closure of GC fistula and resolution of leak. Secondary outcome was no recurrence of the fistula and leaks on follow up. A total of 10 patients were enrolled over the study period. Mean age was 84.4 ± 8.75 years. The primary treatment outcome was achieved in all the patients undergoing this intervention. Secondary outcome was observed in 9/10 (90%) subjects. No procedural complications were reported. Larger fistulae (>2.5 cm) and those with significant fibrosis were more difficult to close with the OTSC system. The mean follow-up time after OTSC application was 43.7 ± 20.57 days. A limitation of this study was that there was no control group. OTSC application is a safe and effective endoscopic approach for the closure of persistent GC fistulae secondary to a complication of PEG tube placement.

Serum transferrin as a prognostic indicator of spontaneous closure and mortality in gastrointestinal cutaneous fistulas.

PubMed Central

Kuvshinoff, B W; Brodish, R J; McFadden, D W; Fischer, J E

1993-01-01

OBJECTIVE: This study determined whether there are any laboratory or other features that will enable prediction of spontaneous closure in patients with gastrointestinal cutaneous fistulas. SUMMARY BACKGROUND DATA: Although the anatomic criteria for spontaneous closure of gastrointestinal cutaneous fistulas have been presented by several authors, less than 50% of such fistulas tend to close, even in the most recent series. METHODS: A group of patients with gastrointestinal cutaneous fistulas with anatomical features favorable to study were investigated with respect to a series of parameters including the usual demographic parameters, plus fistula output, number of blood transfusions, presence of sepsis, as well as metabolic parameters including serum transferrin, retinol-binding protein, thyroxin-binding prealbumin, and serum albumin. RESULTS: Of 79 patients with 116 fistulas, 16 (20.3%) died. Causes of death were uncontrolled sepsis in eight patients and cancer in five patients. Postoperative fistulas constituted 80% of the group. The presence of local sepsis, systemic sepsis, remote sepsis (such as pneumonia or line sepsis), the number of fistulas, fistula output, and the number of blood transfusions were not predictive of spontaneous closure, whereas serum transferrin was predictive of spontaneous closure. Serum transferrin, retinol-binding protein, and thyroxin-binding prealbumin were predictive of mortality. CONCLUSIONS: Serum transferrin does not appear to be an entirely independent variable, but seems to identify those patients with significant remote sepsis, systemic sepsis, and neoplasia in whom these processes are clinically significant. The results, if confirmed, and provided that nutritional needs are met, suggest that short-turnover proteins, particularly serum transferrin, might be useful in predicting which patients with gastrointestinal cutaneous fistulas should undergo surgery despite anatomic criteria favorable for spontaneous closure. PMID:8507110

[Prompt control of an imported carbapenem-resistant Acinetobacter baumanii outbreak in a French intensive care unit].

PubMed

Guth, C; Cavalli, Z; Pernod, C; Lhopital, C; Wey, Pf; Gerome, P; Turc, J

2016-01-01

to describe the management and control of a limited outbreak of carbapenem-resistant Acinetobacter baumanii (CRAB) outbreak in a French intensive care unit. Careful review of the contact's and carrier's files and outbreak management procedures. An undiagnosed CRAB carrier was admitted to our intensive care unit after medical evacuation from Turkey. Despite preventive isolation and contact precautions, a secondary case was diagnosed 5 days after admission of the index case and resulted in the creation of a crisis unit. Prompt management included an epidemiologic investigation with contact screening and follow-up, environmental screening, and additional restrictive measures: isolation room, closure of adjacent rooms, patient cohorting with designated nurses, and reinforcement of contact precautions. restrictive management of CRAB outbreaks may allow prompt outbreak control and avoid prolonged room closures.

Long-Term Outcomes of Patent Foramen Ovale Closure or Medical Therapy after Stroke.

PubMed

Saver, Jeffrey L; Carroll, John D; Thaler, David E; Smalling, Richard W; MacDonald, Lee A; Marks, David S; Tirschwell, David L

2017-09-14

Whether closure of a patent foramen ovale reduces the risk of recurrence of ischemic stroke in patients who have had a cryptogenic ischemic stroke is unknown. In a multicenter, randomized, open-label trial, with blinded adjudication of end-point events, we randomly assigned patients 18 to 60 years of age who had a patent foramen ovale (PFO) and had had a cryptogenic ischemic stroke to undergo closure of the PFO (PFO closure group) or to receive medical therapy alone (aspirin, warfarin, clopidogrel, or aspirin combined with extended-release dipyridamole; medical-therapy group). The primary efficacy end point was a composite of recurrent nonfatal ischemic stroke, fatal ischemic stroke, or early death after randomization. The results of the analysis of the primary outcome from the original trial period have been reported previously; the current analysis of data from the extended follow-up period was considered to be exploratory. We enrolled 980 patients (mean age, 45.9 years) at 69 sites. Patients were followed for a median of 5.9 years. Treatment exposure in the two groups was unequal (3141 patient-years in the PFO closure group vs. 2669 patient-years in the medical-therapy group), owing to a higher dropout rate in the medical-therapy group. In the intention-to-treat population, recurrent ischemic stroke occurred in 18 patients in the PFO closure group and in 28 patients in the medical-therapy group, resulting in rates of 0.58 events per 100 patient-years and 1.07 events per 100 patient-years, respectively (hazard ratio with PFO closure vs. medical therapy, 0.55; 95% confidence interval [CI], 0.31 to 0.999; P=0.046 by the log-rank test). Recurrent ischemic stroke of undetermined cause occurred in 10 patients in the PFO closure group and in 23 patients in the medical-therapy group (hazard ratio, 0.38; 95% CI, 0.18 to 0.79; P=0.007). Venous thromboembolism (which comprised events of pulmonary embolism and deep-vein thrombosis) was more common in the PFO closure group than in the medical-therapy group. Among adults who had had a cryptogenic ischemic stroke, closure of a PFO was associated with a lower rate of recurrent ischemic strokes than medical therapy alone during extended follow-up. (Funded by St. Jude Medical; RESPECT ClinicalTrials.gov number, NCT00465270 .).

Hospital closures had no measurable impact on local hospitalization rates or mortality rates, 2003-11.

PubMed

Joynt, Karen E; Chatterjee, Paula; Orav, E John; Jha, Ashish K

2015-05-01

The Affordable Care Act (ACA) set in motion payment changes that could put pressure on hospital finances and lead some hospitals to close. Understanding the impact of closures on patient care and outcomes is critically important. We identified 195 hospital closures in the United States between 2003 and 2011. We found no significant difference between the change in annual mortality rates for patients living in hospital service areas (HSAs) that experienced one or more closures and the change in rates in matched HSAs without a closure (5.5 percent to 5.2 percent versus 5.4 percent to 5.4 percent, respectively). Nor was there a significant difference in the change in all-cause mortality rates following hospitalization (9.1 percent to 8.2 percent in HSAs with a closure versus 9.0 percent to 8.4 percent in those without a closure). HSAs with a closure had a drop in readmission rates compared to controls (19.4 percent to 18.2 percent versus 18.8 percent to 18.3 percent). Overall, we found no evidence that hospital closures were associated with worse outcomes for patients living in those communities. These findings may offer reassurance to policy makers and clinical leaders concerned about the potential acceleration of hospital closures as a result of health care reform. Project HOPE—The People-to-People Health Foundation, Inc.

78 FR 33067 - Fisheries of the United States; NOAA Fisheries Policy for Modifying Fisheries Closures in the...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-06-03

... regarding those closures to the public during a public health emergency or oil spill characterized by... regulations to address a public health emergency or oil spill. Section 305(c)(3) states: (3) Any emergency... on a permanent basis; (C) that responds to a public health emergency or an oil spill may remain in...

Corrective Action Decision Document/Closure Report for Corrective Action Unit 541: Small Boy Nevada National Security Site and Nevada Test and Training Range, Nevada, Revision 0 with ROTC-1

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

Kidman, Raymond; Matthews, Patrick

The purpose of this Corrective Action Decision Document/Closure Report is to provide justification and documentation supporting the recommendation that no further corrective action is needed for CAU 541 based on the no further action alternative listed in Table ES-1.

77 FR 73957 - Fisheries of the Northeastern United States; Atlantic Sea Scallop Fishery; Closure of the...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-12-12

... fishing effort in this area, which could reduce long-term scallop biomass and optimum yield from the ETA... them to grow. Following closure of the ETA, scallop biomass increased steadily in the area. When the ETA opened in 2007, it contained over one-quarter of the total scallop biomass. The area was fished as...

The Effects of Surgical Factors on Postoperative Astigmatism in Patients Enrolled in the Infant Aphakia Treatment Study (IATS)

PubMed Central

Wall, Palak B.; Lee, Jason A.; Lynn, Michael; Lambert, Scott R.; Traboulsi, Elias I.

2015-01-01

Purpose To evaluate the impact of surgical factors such as incision type, number of sutures, and technique of closure on postoperative astigmatism in infants undergoing cataract extraction with or without intraocular lens implantation. Methods The IATS is a multicenter (n=12) clinical trial in which 114 infants with unilateral congenital cataracts were randomized to undergo cataract extraction with intraocular lens (IOL) placement or contact lens aphakic correction. Surgical videos were reviewed with regard to incision type and location, whether the incision was extended, the number of sutures placed, and technique of closure. Corneal astigmatism was measured using a handheld keratometer prior to surgery and at 1 year of age. Results Corneal astigmatism decreased from a mean of 1.92 D at baseline to 1.62 D at age 1 year in the CL group, but remained almost unchanged from 2.00 D to 2.09 D in the IOL group (p=0.023). There was no statistical difference between the amount of corneal astigmatism irrespective of incision type (p=0.214) and no increase in astigmatism with extension of the incision to facilitate IOL placement (p=0.849) at 1 year. The number of sutures and technique of closure did not influence the amount of astigmatism at 1 year. Conclusions At the age of one year following cataract extraction in infants, contact lens correction and the lack of IOL placement are associated with a significant decrease in postoperative corneal astigmatism compared to intraocular lens placement. No other surgical factors considered in this study had a statistically significant impact on corneal astigmatism. PMID:25266831

Assessment of the selection process for myocutaneous flap repair and surgical complications in pelvic exenteration surgery.

PubMed

Jacombs, A S W; Rome, P; Harrison, J D; Solomon, M J

2013-03-01

This study aimed to explore and quantify the selection process to guide the decision on closure type (myocutaneous flap repair (MFR) or primary closure) for people undergoing pelvic exenteration. This was a retrospective analysis of a prospectively maintained database with review of hospital records for verification and capture of missing data. Associations between four risk factors (previous radiotherapy, previous abdominoperineal resection, need for total exenteration, need for sacrectomy) were assessed individually and collectively as predictors of closure type and wound complications. A total of 203 pelvic exenteration procedures were reviewed (75 primary and 122 recurrent cancers). Thirty-nine patients (19·2 per cent) had MFR and 164 (80·8 per cent) primary closure. Patients who had MFR were significantly more likely to exhibit each risk factor, confirming the selective decision process. MFR had higher rates of complications across all four risk factors, individually and combined. In the primary closure group, there was a significant correlation between the number of risk factors and the proportion of patients with a complication (r = 0·25, P = 0·008). In contrast, no such relationship was found for the MFR group (r = 0·01, P = 0·973). Among patients who had any complication, the primary closure group had significantly lower rates of any wound dehiscence (15 of 64 versus 17 of 28; P < 0·001) and total infection (16 of 64 versus 14 of 28; P = 0·019) compared with the MFR group. Rates of wound and septic complications after pelvic exenteration were low in patients with fewer than two risk factors who had a primary closure. MFR had significantly higher complication rates, and should be reserved for patients with two or more risk factors or extensive skin involvement. Copyright © 2012 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

Long-term outcome in dogs with patent ductus arteriosus: 520 cases (1994-2009).

PubMed

Saunders, A B; Gordon, S G; Boggess, M M; Miller, M W

2014-01-01

Published information regarding survival and long-term cardiac remodeling after patent ductus arteriosus (PDA) closure in dogs is limited. To report outcome and identify prognostic variables in dogs with PDA, and to identify risk factors for persistent remodeling in dogs with a minimum of 12 months of follow-up after closure. Five hundred and twenty client-owned dogs. Retrospective review of medical records of 520 dogs with PDA. Outcome was determined by contacting owners and veterinarians. Dogs with PDA closure and ≥ 12 months of follow-up were asked to return for a re-evaluation. In multivariable analysis of 506 dogs not euthanized at the time of diagnosis, not having a PDA closure procedure negatively affected survival (HzR = 16.9, P < .001). In 444 dogs undergoing successful PDA closure, clinical signs at presentation (HzR = 17, P = .02), concurrent congenital heart disease (HD) (HzR = 4.8, P = .038), and severe mitral regurgitation (MR) documented within 24 hours of closure (HzR = 4.5, P = .028) negatively affected survival. Seventy-one dogs with ≥ 12 months follow-up demonstrated a significant reduction in radiographic and echocardiographic measures of heart size (P = 0) and increased incidence of acquired HD (P = .001) at re-evaluation. Dogs with increased left ventricular size and low fractional shortening at baseline were more likely to have persistent remodeling at re-evaluation. Patent ductus arteriosus closure confers important survival benefits and results in long-term reverse remodeling in most dogs. Clinical signs at presentation, concurrent congenital HD, and severe MR negatively affect survival. Increased left ventricular systolic dimensions and systolic dysfunction at baseline correlated significantly with persistent remodeling. Copyright © 2013 by the American College of Veterinary Internal Medicine.

Experimental study on visual detection for fatigue of fixed-position staff.

PubMed

Nie, Baisheng; Huang, Xin; Chen, Yang; Li, Anjin; Zhang, Ruming; Huang, Jinxin

2017-11-01

Fatigue can lead to decreased work performance and poorer safety and health condition. Fatigue is ubiquitous in production and in life, while the research on it is mainly concentrated in the automotive driving, aircraft piloting and other fields, and it is insufficient to study on the fatigue of fixed-position staff. This paper puts forward a non-contact visual image method, which can monitor the extent of fatigue of fixed-position staff. Fatigue threshold used in judgment is obtained by processing the recorded data of visual images of the experimental subjects when fatiguing and by analyzing eye closure time, percentage of eyelid closure (PERCLOS) value, frequency and number of blinks. The results show that there is significant difference among the four indicators before and after experiment subjects undergo fatigue. The fatigue of experimental subjects is obvious when eye closure time is 3.5 s/min, PERCLOS value 6%, and blink frequency 0.4 times/s. This provides a reference for a wider range of detection of fatigue and a method for avoiding mistakes and accidents. Copyright © 2017 Elsevier Ltd. All rights reserved.

The non-canonical Wnt-PCP pathway shapes the mouse caudal neural plate.

PubMed

López-Escobar, Beatriz; Caro-Vega, José Manuel; Vijayraghavan, Deepthi S; Plageman, Timothy F; Sanchez-Alcazar, José A; Moreno, Roberto Carlos; Savery, Dawn; Márquez-Rivas, Javier; Davidson, Lance A; Ybot-González, Patricia

2018-05-08

The last stage of neural tube (NT) formation involves closure of the caudal neural plate (NP), an embryonic structure formed by neuromesodermal progenitors and newly differentiated cells that becomes incorporated into the NT. Here, we show in mouse that, as cell specification progresses, neuromesodermal progenitors and their progeny undergo significant changes in shape prior to their incorporation into the NT. The caudo-rostral progression towards differentiation is coupled to a gradual reliance on a unique combination of complex mechanisms that drive tissue folding, involving pulses of apical actomyosin contraction and planar polarised cell rearrangements, all of which are regulated by the Wnt-PCP pathway. Indeed, when this pathway is disrupted, either chemically or genetically, the polarisation and morphology of cells within the entire caudal NP is disturbed, producing delays in NT closure. The most severe disruptions of this pathway prevent caudal NT closure and result in spina bifida. In addition, a decrease in Vangl2 gene dosage also appears to promote more rapid progression towards a neural fate, but not the specification of more neural cells. © 2018. Published by The Company of Biologists Ltd.

Closure Report for Corrective Action Unit 104: Area 7 Yucca Flat Atmospheric Test Sites, Nevada National Security Site, Nevada

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

None

2013-06-27

This Closure Report (CR) presents information supporting closure of Corrective Action Unit (CAU) 104, Area 7 Yucca Flat Atmospheric Test Sites, and provides documentation supporting the completed corrective actions and confirmation that closure objectives for CAU 104 were met. This CR complies with the requirements of the Federal Facility Agreement and Consent Order (FFACO) that was agreed to by the State of Nevada; the U.S. Department of Energy (DOE), Environmental Management; the U.S. Department of Defense; and DOE, Legacy Management. CAU 104 consists of the following 15 Corrective Action Sites (CASs), located in Area 7 of the Nevada National Securitymore » Site: · CAS 07-23-03, Atmospheric Test Site T-7C · CAS 07-23-04, Atmospheric Test Site T7-1 · CAS 07-23-05, Atmospheric Test Site · CAS 07-23-06, Atmospheric Test Site T7-5a · CAS 07-23-07, Atmospheric Test Site - Dog (T-S) · CAS 07-23-08, Atmospheric Test Site - Baker (T-S) · CAS 07-23-09, Atmospheric Test Site - Charlie (T-S) · CAS 07-23-10, Atmospheric Test Site - Dixie · CAS 07-23-11, Atmospheric Test Site - Dixie · CAS 07-23-12, Atmospheric Test Site - Charlie (Bus) · CAS 07-23-13, Atmospheric Test Site - Baker (Buster) · CAS 07-23-14, Atmospheric Test Site - Ruth · CAS 07-23-15, Atmospheric Test Site T7-4 · CAS 07-23-16, Atmospheric Test Site B7-b · CAS 07-23-17, Atmospheric Test Site - Climax Closure activities began in October 2012 and were completed in April 2013. Activities were conducted according to the Corrective Action Decision Document/Corrective Action Plan for CAU 104. The corrective actions included No Further Action and Clean Closure. Closure activities generated sanitary waste, mixed waste, and recyclable material. Some wastes exceeded land disposal limits and required treatment prior to disposal. Other wastes met land disposal restrictions and were disposed in appropriate onsite landfills. The U.S. Department of Energy, National Nuclear Security Administration Nevada Field Office (NNSA/NFO) requests the following: · A Notice of Completion from the Nevada Division of Environmental Protection to NNSA/NFO for closure of CAU 104 · The transfer of CAU 104 from Appendix III to Appendix IV, Closed Corrective Action Units, of the FFACO« less

Closure Report for Corrective Action Unit 573: Alpha Contaminated Sites Nevada National Security Site, Nevada

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

Matthews, Patrick

This Closure Report (CR) presents information supporting the closure of Corrective Action Unit (CAU) 573: Alpha Contaminated Sites, Nevada National Security Site, Nevada. CAU 573 comprises the two corrective action sites (CASs): 05-23-02-GMX Alpha Contaminated Are-Closure in Place and 05-45-01-Atmospheric Test Site - Hamilton- Clean Closure. The purpose of this CR is to provide justification and documentation supporting the recommendation that no further corrective action is needed for CAU 573 based on the implementation of the corrective actions. Corrective action activities were performed at Hamilton from May 25 through June 30, 2016; and at GMX from May 25 to Octobermore » 27, 2016, as set forth in the Corrective Action Decision Document (CADD)/Corrective Action Plan (CAP) for Corrective Action Unit 573: Alpha Contaminated Sites; and in accordance with the Soils Activity Quality Assurance Plan, which establishes requirements, technical planning, and general quality practices. Verification sample results were evaluated against data quality objective criteria developed by stakeholders that included representatives from the Nevada Division of Environmental Protection and the DOE, National Nuclear Security Administration Nevada Field Office (NNSA/NFO) during the corrective action alternative (CAA) meeting held on November 24, 2015. Radiological doses exceeding the final action level were assumed to be present within the high contamination areas associated with CAS 05-23-02, thus requiring corrective action. It was also assumed that radionuclides were present at levels that require corrective action within the soil/debris pile associated with CAS 05-45-01. During the CAU 573 CAA meeting, the CAA of closure in place with a use restriction (UR) was selected by the stakeholders as the preferred corrective action of the high contamination areas at CAS 05-23-02 (GMX), which contain high levels of removable contamination; and the CAA of clean closure was selected by the stakeholders as preferred corrective action for the debris pile at CAS 05-45-01 (Hamilton). The closure in place was accomplished by posting signs containing a warning label on the existing contamination area fence line; and recording the FFACO UR and administrative UR in the FFACO database, the NNSA/NFO CAU/CAS files, and the management and operating contractor Geographic Information Systems. The clean closure was accomplished by excavating the soil/debris pile, disposing of the contents at the Area 5 Radioactive Waste Management Complex, and collecting verification samples. The corrective actions were implemented as stipulated in the CADD/CAP, and verification sample results confirm that the criteria for the completion of corrective actions have been met. Based on the implementation of these corrective actions, NNSA/NFO provides the following recommendations: No further corrective actions are necessary for CAU 573; The Nevada Division of Environmental Protection should issue a Notice of Completion to NNSA/NFO for closure of CAU 573; CAU 573 should be moved from Appendix III to Appendix IV of the FFACO.« less

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

PubMed

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

2007-07-01

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

Autonomic Closure for Turbulent Flows Using Approximate Bayesian Computation

NASA Astrophysics Data System (ADS)

Doronina, Olga; Christopher, Jason; Hamlington, Peter; Dahm, Werner

2017-11-01

Autonomic closure is a new technique for achieving fully adaptive and physically accurate closure of coarse-grained turbulent flow governing equations, such as those solved in large eddy simulations (LES). Although autonomic closure has been shown in recent a priori tests to more accurately represent unclosed terms than do dynamic versions of traditional LES models, the computational cost of the approach makes it challenging to implement for simulations of practical turbulent flows at realistically high Reynolds numbers. The optimization step used in the approach introduces large matrices that must be inverted and is highly memory intensive. In order to reduce memory requirements, here we propose to use approximate Bayesian computation (ABC) in place of the optimization step, thereby yielding a computationally-efficient implementation of autonomic closure that trades memory-intensive for processor-intensive computations. The latter challenge can be overcome as co-processors such as general purpose graphical processing units become increasingly available on current generation petascale and exascale supercomputers. In this work, we outline the formulation of ABC-enabled autonomic closure and present initial results demonstrating the accuracy and computational cost of the approach.

Columbus Closure Project Released without Radiological Restrictions

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

Henderson, G.

2007-07-01

The Columbus Closure Project (CCP), a historic radiological research complex, was cleaned up for future use without radiological restriction in 2006. The CCP research and development site contributed to national defense, nuclear fuel fabrication, and the development of safe nuclear reactors in the United States until 1988 when research activities were concluded for site decommissioning. In November of 2003, the Ohio Field Office of the U.S. Department of Energy contracted ECC/E2 Closure Services, LLC (Closure Services) to complete the removal of radioactive contamination from of a 1955 era nuclear sciences area consisting of a large hot cell facility, research reactormore » building and underground piping. The project known as the Columbus Closure Project (CCP) was completed in 27 months and brought to a close 16 years of D and D in Columbus, Ohio. This paper examines the project innovations and challenges presented during the Columbus Closure Project. The examination of the CCP includes the project regulatory environment, the CS safety program, accelerated clean up innovation, project execution strategies and management of project waste issues and the regulatory approach to site release 'without radiological restrictions'. (authors)« less

Positive Catch & Economic Benefits of Periodic Octopus Fishery Closures: Do Effective, Narrowly Targeted Actions ‘Catalyze’ Broader Management?

PubMed Central

Oliver, Thomas A.; Oleson, Kirsten L. L.; Ratsimbazafy, Hajanaina; Raberinary, Daniel; Benbow, Sophie; Harris, Alasdair

2015-01-01

Overview Eight years of octopus fishery records from southwest Madagascar reveal significant positive impacts from 36 periodic closures on: (a) fishery catches and (b) village fishery income, such that (c) economic benefits from increased landings outweigh costs of foregone catch. Closures covered ~20% of a village’s fished area and lasted 2-7 months. Fishery Catches from Each Closed Site Octopus landings and catch per unit effort (CPUE) significantly increased in the 30 days following a closure’s reopening, relative to the 30 days before a closure (landings: +718%, p<0.0001; CPUE: +87%, p<0.0001; n = 36). Open-access control sites showed no before/after change when they occurred independently of other management (“no ban”, n = 17/36). On the other hand, open-access control sites showed modest catch increases when they extended a 6-week seasonal fishery shutdown (“ban”, n = 19/36). The seasonal fishery shutdown affects the entire region, so confound all potential control sites. Fishery Income in Implementing Villages In villages implementing a closure, octopus fishery income doubled in the 30 days after a closure, relative to 30 days before (+132%, p<0.001, n = 28). Control villages not implementing a closure showed no increase in income after “no ban” closures and modest increases after “ban” closures. Villages did not show a significant decline in income during closure events. Net Economic Benefits from Each Closed Site Landings in closure sites generated more revenue than simulated landings assuming continued open-access fishing at that site (27/36 show positive net earnings; mean +$305/closure; mean +57.7% monthly). Benefits accrued faster than local fishers’ time preferences during 17-27 of the 36 closures. High reported rates of illegal fishing during closures correlated with poor economic performance. Broader Co-Management We discuss the implications of our findings for broader co-management arrangements, particularly for catalyzing more comprehensive management. PMID:26083862

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

PubMed

Nightingale, C; Jones, S P

2003-09-01

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

Hand-suture versus stapling for closure of loop ileostomy: HASTA-Trial: a study rationale and design for a randomized controlled trial

PubMed Central

2011-01-01

Background Colorectal cancer is the second most common tumor in developed countries, with a lifetime prevalence of 5%. About one third of these tumors are located in the rectum. Surgery in terms of low anterior resection with mesorectal excision is the central element in the treatment of rectal cancer being the only option for definite cure. Creating a protective diverting stoma prevents complications like anastomotic failure and meanwhile is the standard procedure. Bowel obstruction is one of the main and the clinically and economically most relevant complication following closure of loop ileostomy. The best surgical technique for closure of loop ileostomy has not been defined yet. Methods/Design A study protocol was developed on the basis of the only randomized controlled mono-center trial to solve clinical equipoise concerning the optimal surgical technique for closure of loop ileostomy after low anterior resection due to rectal cancer. The HASTA trial is a multi-center pragmatic randomized controlled surgical trial with two parallel groups to compare hand-suture versus stapling for closure of loop ileostomy. It will include 334 randomized patients undergoing closure of loop ileostomy after low anterior resection with protective ileostomy due to rectal cancer in approximately 20 centers consisting of German hospitals of all level of health care. The primary endpoint is the rate of bowel obstruction within 30 days after ileostomy closure. In addition, a set of surgical and general variables including quality of life will be analyzed with a follow-up of 12 months. An investigators meeting with a practical session will help to minimize performance bias and enforce protocol adherence. Centers are monitored centrally as well as on-site before and during recruitment phase to assure inclusion, treatment and follow up according to the protocol. Discussion Aim of the HASTA trial is to evaluate the efficacy of hand-suture versus stapling for closure of loop ileostomy in patients with rectal cancer. Trial registration German Clinical Trial Register Number: DRKS00000040 PMID:21303515

21 CFR 211.186 - Master production and control records.

Code of Federal Regulations, 2011 CFR

2011-04-01

... description of the drug product containers, closures, and packaging materials, including a specimen or copy of... form; (2) The name and weight or measure of each active ingredient per dosage unit or per unit of...

21 CFR 211.186 - Master production and control records.

Code of Federal Regulations, 2010 CFR

2010-04-01

... description of the drug product containers, closures, and packaging materials, including a specimen or copy of... form; (2) The name and weight or measure of each active ingredient per dosage unit or per unit of...

Multicenter review of robotic versus laparoscopic ventral hernia repair: is there a role for robotics?

PubMed

Walker, Peter A; May, Audriene C; Mo, Jiandi; Cherla, Deepa V; Santillan, Monica Rosales; Kim, Steven; Ryan, Heidi; Shah, Shinil K; Wilson, Erik B; Tsuda, Shawn

2018-04-01

The utilization of robotic platforms for general surgery procedures such as hernia repair is growing rapidly in the United States. A limited amount of data are available evaluating operative outcomes in comparison to standard laparoscopic surgery. We completed a retrospective review comparing robotic and laparoscopic ventral hernia repair to provide safety and outcomes data to help design a future prospective trial design. A retrospective review of 215 patients undergoing ventral hernia repair (142 robotic and 73 laparoscopic) was completed at two large academic centers. Primary outcome measure evaluated was recurrence. Secondary outcomes included incidence of primary fascial closure, and surgical site occurrences. Propensity for treatment match comparison demonstrated that robotic repair was associated with a decreased incidence of recurrence (2.1 versus 4.2%, p < 0.001) and surgical site occurrence (4.2 versus 18.8%, p < 0.001). This may be because robotic repair was associated with increased incidence of primary fascial closure (77.1 versus 66.7%, p < 0.01). Analysis of baseline patient populations showed that robotic repairs were completed on patients with lower body mass index (28.1 ± 3.6 versus 34.2 ± 6.4, p < 0.001) and fewer comorbidities. Our retrospective data show that robotic repair was associated with decreased recurrence and surgical site occurrence. However, the differences noted in the patient populations limit the interpretability of these results. As adoption of robotic ventral hernia repair increases, prospective trials need to be designed in order to investigate the efficacy, safety, and cost effectiveness of this evolving technique.

Symposium on Turbulence (13th) Held at Rolla, Missouri on September 21- 23, 1992

DTIC Science & Technology

1992-09-01

this article Is part of a project aimed at Increasing the role of computational fluid dynamics ( CFD ) in the process of developing more efficient gas...techniques in and fluid physics of high speed compressible or reacting flows undergoing significant changes of indices of refraction. Possible Topics...in experimental fluid mechanics; homogeneous turbulence, including closures and statistical properties; turbulence in compressible fluids ; fine scale

The Ketene-Surrogate Coupling: Catalytic Conversion of Aryl Iodides to Aryl Ketenes via Ynol Ethers**

PubMed Central

Zhang, Wenhan; Ready, Joseph M.

2014-01-01

tert-Butoxyacetylene is shown to undergo Sonogashira coupling with aryl iodides to yield aryl-substituted tert-butyl ynol ethers. These intermediates participate in a [1,5]-hydride shift, which results in the extrusion of isobutylene and the generation of aryl ketenes. The ketenes are trapped in situ with multiple nucleophiles or undergoelectrocyclic ring closure to yield hydroxynaphthalenes and quinolines. PMID:24975840

Closure Report for Corrective Action Unit 151: Septic Systems and Discharge Area, Nevada Test Site, Nevada

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

NSTec Environmental Restoration

2008-04-01

Corrective Action Unit (CAU) 151 is identified in the Federal Facility Agreement and Consent Order (FFACO) as Septic Systems and Discharge Area. CAU 151 consists of the following eight Corrective Action Sites (CASs), located in Areas 2, 12, and 18 of the Nevada Test Site, approximately 65 miles northwest of Las Vegas, Nevada: (1) CAS 02-05-01, UE-2ce Pond; (2) CAS 12-03-01, Sewage Lagoons (6); (3) CAS 12-04-01, Septic Tanks; (4) CAS 12-04-02, Septic Tanks; (5) CAS 12-04-03, Septic Tank; (6) CAS 12-47-01, Wastewater Pond; (7) CAS 18-03-01, Sewage Lagoon; and (8) CAS 18-99-09, Sewer Line (Exposed). CAU 151 closure activitiesmore » were conducted according to the FFACO (FFACO, 1996; as amended February 2008) and the Corrective Action Plan for CAU 151 (U.S. Department of Energy, National Nuclear Security Administration Nevada Site Office, 2007) from October 2007 to January 2008. The corrective action alternatives included no further action, clean closure, and closure in place with administrative controls. CAU 151 closure activities are summarized in Table 1. Closure activities generated liquid remediation waste, sanitary waste, hydrocarbon waste, and mixed waste. Waste generated was appropriately managed and disposed. Waste that is currently staged onsite is being appropriately managed and will be disposed under approved waste profiles in permitted landfills. Waste minimization activities included waste characterization sampling and segregation of waste streams. Some waste exceeded land disposal restriction limits and required offsite treatment prior to disposal. Other waste meeting land disposal restrictions was disposed of in appropriate onsite or offsite landfills. Waste disposition documentation is included as Appendix C.« less

Influence of canopy closure and shrub coverage on travel along coarse woody debris by Eastern chipmunks (Tamias striatus)

Treesearch

Patrick A. Zollner; Kevin J. Crane

2003-01-01

We investigated relationships between canopy closure, shrub cover and the use of coarse woody debris as a travel path by eastern chipmunks (Tamias striatus) in the north central United States. Fine scale movements of chipmunks were followed with tracking spools and the percentage of each movement path directly along coarse woody debris was recorded...

Closure Report for Corrective Action Unit 394: Areas 12, 18, and 29 Spill/Release Sites, Nevada Test Site, Nevada: Revision 0

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

U.S. Department of Energy, National Nuclear Security Administration Nevada Site Office

This Closure Report (CR) presents information supporting a closure recommendation for Corrective Action Unit (CAU) 394: Areas 12, 18, and 29 Spill/Release Sites, Nevada Test Site, Nevada, in compliance with the requirements of the Federal Facility Agreement and Consent Order. This CAU contains six Corrective Action Sites (CASs): 12-25-04, UST 12-16-2 Waste Oil Release; 18-25-01, 18-25-02, 18-25-03, Oil Spills; 18-25-04, Spill (Diesel Fuel); and 29-44-01, Fuel Spill, located within Areas 12, 18, and 29 on the Nevada Test Site. The purpose of this CR is to provide documentation supporting recommendations of no further action or closure in place for CASsmore » within CAU 394. Throughout late 2002 and early to mid 2003, closure activities were performed as set forth in the CAU 394 Streamlined Approach for Environmental Restoration Plan. The closure activities identified the nature and extent of contaminants of potential concern at the CASs, and provided sufficient information and data to complete appropriate corrective actions for the CASs. Soil in CASs 18-25-02 and 18-25-03 containing polychlorinated biphenyls exceeding the action levels established by the Nevada Administrative Code were removed for proper disposal. The soil remaining in these CASs containing petroleum hydrocarbons exceeding the action level were closed in place with use restrictions. Corrective Action Sites 18-25-04 required no further corrective action; closure in place is required at CASs 12-25-04, 18-25-01, 18-25-02, 18-25-03, and 29-44-01; and use restrictions are required at CASs 12-25-04, 18-25-01, 18-25-02, 18-25-03 and 29-44-01. In summary, no corrective action plan is required for CAU 394.« less

Post-Closure Report for Closed Resource Conservation and Recovery Act Corrective Action Units, Nevada National Security Site, Nevada For Fiscal Year 2012 (October 2011–September 2012)

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

NSTec Environmental Restoration

2013-01-17

This report serves as the combined annual report for post-closure activities for the following closed Corrective Action Units (CAUs): · CAU 90, Area 2 Bitcutter Containment · CAU 91, Area 3 U-3fi Injection Well · CAU 92, Area 6 Decon Pond Facility · CAU 110, Area 3 WMD U-3ax/bl Crater · CAU 111, Area 5 WMD Retired Mixed Waste Pits · CAU 112, Area 23 Hazardous Waste Trenches This report covers fiscal year 2012 (October 2011–September 2012).

Corrective Action Decision Document/Closure Report for Corrective Action Unit 105: Area 2 Yucca Flat Atmospheric Test Sites, Nevada National Security Site, Nevada, Revision 1

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

Matthews, Patrick

2014-01-01

The purpose of this Corrective Action Decision Document/Closure Report is to provide justification and documentation supporting the recommendation that no further corrective action is needed for CAU 105 based on the implementation of the corrective actions. Corrective action investigation (CAI) activities were performed from October 22, 2012, through May 23, 2013, as set forth in the Corrective Action Investigation Plan for Corrective Action Unit 105: Area 2 Yucca Flat Atmospheric Test Sites; and in accordance with the Soils Activity Quality Assurance Plan, which establishes requirements, technical planning, and general quality practices.

Addendum to the Closure Report for Corrective Action Unit 262: Area 25 Septic Systems and Underground Discharge Point, Nevada Test Site, Nevada

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

Lynn Kidman

2008-10-01

This document constitutes an addendum to the July 2003, Closure Report for Corrective Action Unit 262: Area 25 Septic Systems and Underground Discharge Point as described in the document Recommendations and Justifications for Modifications for Use Restrictions Established under the U.S. Department of Energy, National Nuclear Security Administration Nevada Site Office Federal Facility Agreement and Consent Order (UR Modification document) dated February 2008. The UR Modification document was approved by NDEP on February 26, 2008. The approval of the UR Modification document constituted approval of each of the recommended UR modifications.

Severe Accident Sequence Analysis Program: Anticipated transient without scram simulations for Browns Ferry Nuclear Plant Unit 1

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

Dallman, R J; Gottula, R C; Holcomb, E E

1987-05-01

An analysis of five anticipated transients without scram (ATWS) was conducted at the Idaho National Engineering Laboratory (INEL). The five detailed deterministic simulations of postulated ATWS sequences were initiated from a main steamline isolation valve (MSIV) closure. The subject of the analysis was the Browns Ferry Nuclear Plant Unit 1, a boiling water reactor (BWR) of the BWR/4 product line with a Mark I containment. The simulations yielded insights to the possible consequences resulting from a MSIV closure ATWS. An evaluation of the effects of plant safety systems and operator actions on accident progression and mitigation is presented.

Corrective Action Decision Document/Corrective Action Plan for the 92-Acre Area and Corrective Action Unit 111: Area 5 WMD Retired Mixed Waste Pits, Nevada National Security Site, Nevada

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

NSTec Environmental Restoration

This Corrective Action Decision Document/Corrective Action Plan (CADD/CAP) has been prepared for the 92-Acre Area, the southeast quadrant of the Radioactive Waste Management Site, located in Area 5 of the Nevada National Security Site (NNSS). The 92-Acre Area includes Corrective Action Unit (CAU) 111, 'Area 5 WMD Retired Mixed Waste Pits.' Data Quality Objectives (DQOs) were developed for the 92-Acre Area, which includes CAU 111. The result of the DQO process was that the 92-Acre Area is sufficiently characterized to provide the input data necessary to evaluate corrective action alternatives (CAAs) without the collection of additional data. The DQOs aremore » included as Appendix A of this document. This CADD/CAP identifies and provides the rationale for the recommended CAA for the 92-Acre Area, provides the plan for implementing the CAA, and details the post-closure plan. When approved, this CADD/CAP will supersede the existing Pit 3 (P03) Closure Plan, which was developed in accordance with Title 40 Code of Federal Regulations (CFR) Part 265, 'Interim Status Standards for Owners and Operators of Hazardous Waste Treatment, Storage, and Disposal Facilities.' This document will also serve as the Closure Plan and the Post-Closure Plan, which are required by 40 CFR 265, for the 92-Acre Area. After closure activities are complete, a request for the modification of the Resource Conservation and Recovery Act Permit that governs waste management activities at the NNSS will be submitted to the Nevada Division of Environmental Protection to incorporate the requirements for post-closure monitoring. Four CAAs, ranging from No Further Action to Clean Closure, were evaluated for the 92-Acre Area. The CAAs were evaluated on technical merit focusing on performance, reliability, feasibility, safety, and cost. Based on the evaluation of the data used to develop the conceptual site model; a review of past, current, and future operations at the site; and the detailed and comparative analysis of the potential CAAs, Closure in Place with Administrative Controls is the preferred CAA for the 92-Acre Area. Closure activities will include the following: (1) Constructing an engineered evapotranspiration cover over the 92-Acre Area; (2) Installing use restriction (UR) warning signs, concrete monuments, and subsidence survey monuments; (3) Establishing vegetation on the cover; (4) Implementing a UR; and (5) Implementing post-closure inspections and monitoring. The Closure in Place with Administrative Controls alternative meets all requirements for the technical components evaluated, fulfills all applicable federal and state regulations for closure of the site, and will minimize potential future exposure pathways to the buried waste at the site.« less

Corrective Action Decision Document/Corrective Action Plan for the 92-Acre Area and Corrective Action Unit 111: Area 5 WMD Retired Mixed Waste Pits, Nevada Test Site, Nevada

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

NSTec Environmental Restoration

2009-07-31

This Corrective Action Decision Document/Corrective Action Plan (CADD/CAP) has been prepared for the 92-Acre Area, the southeast quadrant of the Radioactive Waste Management Site, located in Area 5 of the Nevada Test Site (NTS). The 92-Acre Area includes Corrective Action Unit (CAU) 111, 'Area 5 WMD Retired Mixed Waste Pits.' Data Quality Objectives (DQOs) were developed for the 92-Acre Area, which includes CAU 111. The result of the DQO process was that the 92-Acre Area is sufficiently characterized to provide the input data necessary to evaluate corrective action alternatives (CAAs) without the collection of additional data. The DQOs are includedmore » as Appendix A of this document. This CADD/CAP identifies and provides the rationale for the recommended CAA for the 92-Acre Area, provides the plan for implementing the CAA, and details the post-closure plan. When approved, this CADD/CAP will supersede the existing Pit 3 (P03) Closure Plan, which was developed in accordance with Title 40 Code of Federal Regulations (CFR) Part 265, 'Interim Status Standards for Owners and Operators of Hazardous Waste Treatment, Storage, and Disposal Facilities.' This document will also serve as the Closure Plan and the Post-Closure Plan, which are required by 40 CFR 265, for the 92-Acre Area. After closure activities are complete, a request for the modification of the Resource Conservation and Recovery Act Permit that governs waste management activities at the NTS will be submitted to the Nevada Division of Environmental Protection to incorporate the requirements for post-closure monitoring. Four CAAs, ranging from No Further Action to Clean Closure, were evaluated for the 92-Acre Area. The CAAs were evaluated on technical merit focusing on performance, reliability, feasibility, safety, and cost. Based on the evaluation of the data used to develop the conceptual site model; a review of past, current, and future operations at the site; and the detailed and comparative analysis of the potential CAAs, Closure in Place with Administrative Controls is the preferred CAA for the 92-Acre Area. Closure activities will include the following: (1) Constructing an engineered evapotranspiration cover over the 92-Acre Area; (2) Installing use restriction (UR) warning signs, concrete monuments, and subsidence survey monuments; (3) Establishing vegetation on the cover; (4) Implementing a UR; and (5) Implementing post-closure inspections and monitoring. The Closure in Place with Administrative Controls alternative meets all requirements for the technical components evaluated, fulfills all applicable federal and state regulations for closure of the site, and will minimize potential future exposure pathways to the buried waste at the site.« less

Closure plan for Corrective Action Unit 109: U-2bu subsidence crater, Nevada Test Site, Nevada

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

NONE

1999-03-01

The U-2bu subsidence crater, Corrective Action Unit 109, will be closed in accordance with the Resource Conservation and Recovery Act, the Nevada Division of Environmental Protection operational permit, and the Federal Facility Agreement and Consent Order. The U-2bu subsidence crater is located in Area 2 of the Nevada Test Site. It was created in 1971 by an underground nuclear test with the name Miniata. The crater has a diameter of 288 meters (944 feet) and an approximate depth of 35 meters (115 feet). Based on the results of the analyses reported in the site characterization report, the only constituents ofmore » concern in the U-2bu subsidence crater include leachable lead and total petroleum hydrocarbons. Closure activities will include the excavation and disposal of impacted soil from the top of the crater. Upon completion of excavation, verification samples will be collected to show that the leachable lead has been removed to concentrations below the regulatory action level. After sample results show that the lead has been removed, the excavated area will be backfilled and a soil flood diversion berm will be constructed as a best management practice. An independent registered professional engineer will certify the site was closed following the approved Closure Plan. Post-closure care is not warranted for this site because closure activities will involve removal of the Resource Conservation and Recovery Act constituents of concern.« less

THE INTEGRATION OF THE 241-Z BUILDING DECONTAMINATION & DECOMMISSIONING (D&D) UNDER COMPREHENSIVE ENVIRONMENTAL RESPONSE COMPENSATION & LIABILITY ACT (CERCLA) WITH RESOURCE CONSERVATION & RECOVERY ACT (RCRA) CLOSURE AT THE PLUTONIUM FINISHING PLANT (PFP)

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

HOPKINS, A.M.

2007-02-20

The 241-Z treatment and storage tanks, a hazardous waste Treatment, Storage and Disposal (TSD) unit permitted pursuant to the ''Resource Conservation and Recovery Act of 1976'' (RCRA) and Washington State ''Hazardous Waste Management Act, RCW 70.105'', have been deactivated and are being actively decommissioned. The 241-Z TSD unit managed non-listed radioactive contaminated waste water, containing trace RCRA characteristic constituents. The 241-Z TSD unit consists of below grade tanks (D-4, D-5, D-7, D-8, and an overflow tank) located in a concrete containment vault, sample glovebox GB-2-241-ZA, and associated ancillary piping and equipment. The tank system is located beneath the 241-Z building.more » The 241-Z building is not a portion of the TSD unit. The sample glovebox is housed in the above-grade building. Waste managed at the TSD unit was received via underground mining from Plutonium Finishing Plant (PFP) sources. Tank D-6, located in the D-6 vault cell, is a past-practice tank that was taken out of service in 1972 and has never operated as a portion of the RCRA TSD unit. CERCLA actions address Tank D-6, its containment vault cell, and soil beneath the cell that was potentially contaminated during past-practice operations and any other potential past-practice contamination identified during 241-Z closure, while outside the scope of the ''Hanford Facility Dangerous Waste Closure Plant, 241-Z Treatment and Storage Tanks''.« less

Multidisciplinary management of patent foramen ovale (PFO) and cryptogenic stroke/TIA

PubMed Central

Mirzada, Naqibullah; Ladenvall, Per; Hansson, Per-Olof; Eriksson, Peter; Dellborg, Mikael

2013-01-01

Purpose Patent foramen ovale (PFO) has been implicated as a risk factor for cryptogenic ischemic stroke (CS). However, there is still a lack of widely accepted, undisputed indications for PFO closure. The present study describes the concept of the multidisciplinary PFO conference and a decision making process for closure versus no closure that was developed into a formalized clinical algorithm, and presents the results of implementing these, in terms of number and proportion of PFO closures as well as repeat referrals. Design Five specialists in neurology, cardiology, internal medicine, thromboembolism, and echocardiography evaluated the clinical data of 311 patients at PFO conferences during 2006 to 2009. The main criteria for closure were patients with first-ever CS with PFO and atrial septal aneurysm, or patients with recurrent CS and PFO without atrial septal aneurysm. Results A total of 143 patients (46%) were accepted for closure and 167 patients were rejected. Patients accepted for closure were younger (mean 50 years versus 58 years) (P < 0.001). The acceptance rate for PFO closure was similar throughout these years, with an average of 45%. Three of 167 patients (1.8%) initially rejected for PFO closure were re-referred due to recurrent stroke, and the PFO closure was subsequently performed. Conclusion The acceptance rate of less than 50% in the present study underscores the complex relationship between CS and PFO. Whatever the criteria used for PFO closure, any unit caring for these patients needs to have a rigorous process to avoid overtreatment as well as undertreatment and to ensure that personal preferences and economic incentives do not steer the selection process. Our algorithm provides a stable acceptance rate and a low rate of repeat referrals. PMID:24082787

Variability in school closure decisions in response to 2009 H1N1: a qualitative systems improvement analysis

PubMed Central

2011-01-01

Background School closure was employed as a non-pharmaceutical intervention against pandemic 2009 H1N1, particularly during the first wave. More than 700 schools in the United States were closed. However, closure decisions reflected significant variation in rationales, decision triggers, and authority for closure. This variability presents the opportunity for improved efficiency and decision-making. Methods We identified media reports relating to school closure as a response to 2009 H1N1 by monitoring high-profile sources and searching Lexis-Nexis and Google news alerts, and reviewed reports for key themes. News stories were supplemented by observing conference calls and meetings with health department and school officials, and by discussions with decision-makers and community members. Results There was significant variation in the stated goal of closure decision, including limiting community spread of the virus, protecting particularly vulnerable students, and responding to staff shortages or student absenteeism. Because the goal of closure is relevant to its timing, nature, and duration, unclear rationales for closure can challenge its effectiveness. There was also significant variation in the decision-making authority to close schools in different jurisdictions, which, in some instances, was reflected in open disagreement between school and public health officials. Finally, decision-makers did not appear to expect the level of scientific uncertainty encountered early in the pandemic, and they often expressed significant frustration over changing CDC guidance. Conclusions The use of school closure as a public health response to epidemic disease can be improved by ensuring that officials clarify the goals of closure and tailor closure decisions to those goals. Additionally, authority to close schools should be clarified in advance, and decision-makers should expect to encounter uncertainty disease emergencies unfold and plan accordingly. PMID:21284865

Effects of repeated gas sterilization on closure rates of ameroid ring constrictors in vitro.

PubMed

Kimberlin, William W; Wardlaw, Jennifer L; Madsen, Richard W

2016-01-01

To determine the effect of repeated gas sterilization on rate of closure of ameroid ring constrictors in vitro. Twenty-four 3.5-mm ameroid ring constrictors. Ameroid ring constrictors were allocated to 1 of 4 treatment groups (6/group) to undergo gas sterilization 0, 1, 5, or 10 times. After sterilization, constrictors were incubated in canine plasma at a protein concentration of 3 g/dL for 27 days. A digital camera was used to obtain images of the constrictors prior to and at various points during incubation, and lumen diameter was measured. Mean ± SD percentage of lumen closure for all groups of ameroid ring constrictors combined was 85.2 ± 1.6% at day 0 (prior to plasma incubation) and 95.4 ± 0.8% at day 27. Mean lumen area was 3.64 ± 0.43 mm(2) (95% confidence interval, 2.67 to 4.77 mm(2)) at day 0 and 1.32 ± 0.25 mm(2) (95% confidence interval, 0.76 to 2.04 mm(2)) at day 27. None of the ameroid ring constrictors had closed completely by day 27. Overall closure rates for ameroid ring constrictors appeared to be unaffected by repeated gas sterilization up to 10 times. Findings suggested that veterinary surgeons can resterilize ameroid ring constrictors up to 10 times with confidence that ring properties would remain suitable for clinical use.

Understanding the basis of space closure in Orthodontics for a more efficient orthodontic treatment

PubMed Central

Ribeiro, Gerson Luiz Ulema; Jacob, Helder B.

2016-01-01

ABSTRACT Introduction: Space closure is one of the most challenging processes in Orthodontics and requires a solid comprehension of biomechanics in order to avoid undesirable side effects. Understanding the biomechanical basis of space closure better enables clinicians to determine anchorage and treatment options. In spite of the variety of appliance designs, space closure can be performed by means of friction or frictionless mechanics, and each technique has its advantages and disadvantages. Friction mechanics or sliding mechanics is attractive because of its simplicity; the space site is closed by means of elastics or coil springs to provide force, and the brackets slide on the orthodontic archwire. On the other hand, frictionless mechanics uses loop bends to generate force to close the space site, allowing differential moments in the active and reactive units, leading to a less or more anchorage control, depending on the situation. Objective: This article will discuss various theoretical aspects and methods of space closure based on biomechanical concepts. PMID:27275623

Understanding the basis of space closure in Orthodontics for a more efficient orthodontic treatment.

PubMed

Ribeiro, Gerson Luiz Ulema; Jacob, Helder B

2016-01-01

Space closure is one of the most challenging processes in Orthodontics and requires a solid comprehension of biomechanics in order to avoid undesirable side effects. Understanding the biomechanical basis of space closure better enables clinicians to determine anchorage and treatment options. In spite of the variety of appliance designs, space closure can be performed by means of friction or frictionless mechanics, and each technique has its advantages and disadvantages. Friction mechanics or sliding mechanics is attractive because of its simplicity; the space site is closed by means of elastics or coil springs to provide force, and the brackets slide on the orthodontic archwire. On the other hand, frictionless mechanics uses loop bends to generate force to close the space site, allowing differential moments in the active and reactive units, leading to a less or more anchorage control, depending on the situation. This article will discuss various theoretical aspects and methods of space closure based on biomechanical concepts.

Post-Closure Report for Closed Resource Conservation and Recovery Act Corrective Action Units, Nevada National Security Site, Nevada: For Fiscal Year 2015 (October 2014–September 2015), Revision 0

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

Matthews, Patrick

This report serves as the combined annual report for post-closure activities for the following closed corrective action units (CAUs); CAU 90, Area 2 Bitcutter Containment; CAU 91, Area 3 U-3fi Injection Well; CAU 92, Area 6 Decon Pond Facility; CAU 110, Area 3 WMD U-3ax/bl Crater; CAU 111, Area 5 WMD Retired Mixed Waste Pits; and CAU 112, Area 23 Hazardous Waste Trenches. This report covers fiscal year 2015 (October 2014 through September 2015). The post-closure requirements for these sites are described in Resource Conservation and Recovery Act Permit Number NEV HW0101 and are summarized in each CAU-specific section inmore » Section 1.0 of this report. The results of the inspections, a summary of maintenance activities, and an evaluation of monitoring data are presented in this report.« less

Volumization of the Brow at the Time of Blepharoplasty: Treating the Eyebrow Fat Pad as an Independent Unit.

PubMed

Vrcek, Ivan; Chou, Eva; Somogyi, Marie; Shore, John W

Loss of volume in the sub-brow fat pad with associated descent of the eyebrow is a common anatomical finding resulting in both functional and aesthetic consequences. A variety of techniques have been described to address brow position at the time of blepharoplasty. To our knowledge, none of these techniques treat the sub-brow fat pad as an isolated unit. Doing so enables the surgeon to stabilize and volumize the brow without resultant tension on the blepharoplasty wound. The authors describe a technique for addressing volume loss in the eyebrow with associated brow descent that treats the sub-brow fat pad as an isolated unit. A retrospective review of all patients undergoing brow ptosis repair by a single surgeon (J.W.S.) over an 11-month period was performed. Eighteen patients and 33 brows underwent the technique described. Patients were followed for an average of 11 weeks (range: 4 weeks to 20 weeks). All patients preoperatively displayed both visually significant dermatochalasis and brow descent below the orbital rim. Evaluation of pre- and postoperative photos demonstrates successful volumization of the brow with skin redraping without focal dimpling or undue tension on the eyelid wound. Performing a dissection that allows the sub-brow fat pad to be elevated in isolation from the overlying orbicularis and underlying periosteum allows for volumization and of the brow without compromising closure. This technique is a safe and effective means of volumizing the brow and treating secondary brow descent.

Closure Report for Corrective Action Unit 568: Area 3 Plutonium Dispersion Sites Nevada National Security Site, Nevada, Revision 1

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

Matthews, Patrick

The purpose of this CR is to provide documentation and justification that no further corrective action is needed for the closure of CAU 568 based on the implementation of corrective actions. This includes a description of closure activities that were performed and an evaluation of the verification data. The CAP (NNSA/NFO, 2016a) and ROTC-1 (NNSA/NFO, 2016c) provide information relating to the selection of CAAs and the reasoning behind their selection. The CADD (NNSA/NFO, 2015) identifies the release sites that require additional corrective action and presents information supporting the selection of CAAs.

The Impact of Public Hospital Closure on Medical and Residency Education: Implications and Recommendations

PubMed Central

Walker, Kara Odom; Calmes, Daphne; Hanna, Nancy; Baker, Richard

2010-01-01

Background Challenges around safety-net hospital closure have impacted medical student and resident exposure to urban public healthcare sites that may influence their future practice choices. Objective To assess the impact of the closure of a public safety-net teaching hospital for the clinical medical education of Charles Drew University medical students and residents. Method Retrospective cohort study of medical students’ and residents’ and clinical placement into safety-net experiences after the closure of the primary teaching hospital. Results The hospital closure impacted both medical student and residency training experiences. Only 71% (17/24) of medical student rotations and 13% (23/180) of residents were maintained at public safety-net clinical sittings. The closure of the public safety-net hospital resulted in the loss of 36% of residency training spots sponsored by historically black medical schools in the United States and an even larger negative impact on the number of physicians training in underserved urban areas of Los Angeles County. Conclusion While the medical educational program changes undertaken in the wake of hospital closure have negatively affected the immediate clinical educational experiences of medical students and residents, it remains to be seen whether the training site location changes will alter their long-term preferences in specialty choice and practice location. PMID:19110905

The impact of public hospital closure on medical and residency education: implications and recommendations.

PubMed

Walker, Kara Odom; Calmes, Daphne; Hanna, Nancy; Baker, Richard

2008-12-01

Challenges around safety-net hospital closure have impacted medical student and resident exposure to urban public healthcare sites that may influence their future practice choices. To assess the impact of the closure of a public safety-net teaching hospital for the clinical medical education of Charles Drew University medical students and residents. Retrospective cohort study of medical students' and residents' and clinical placement into safety-net experiences after the closure of the primary teaching hospital. The hospital closure impacted both medical student and residency training experiences. Only 71% (17/24) of medical student rotations and 13% (23/180) of residents were maintained at public safety-net clinical sittings. The closure of the public safety-net hospital resulted in the loss of 36% of residency training spots sponsored by historically black medical schools in the United States and an even larger negative impact on the number of physicians training in underserved urban areas of Los Angeles County. While the medical educational program changes undertaken in the wake of hospital closure have negatively affected the immediate clinical educational experiences of medical students and residents, it remains to be seen whether the training site location changes will alter their long-term preferences in specialty choice and practice location.

Closure Report for Corrective Action Unit 408: Bomblet Target Area Tonopah Test Range (TTR), Nevada, Revision 0

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

Mark Krauss

2010-09-01

This Closure Report (CR) presents information supporting the closure of Corrective Action Unit (CAU) 408: Bomblet Target Area (TTR), Tonopah Test Range, Nevada. This CR complies with the requirements of the Federal Facility Agreement and Consent Order that was agreed to by the State of Nevada; U.S. Department of Energy (DOE), Environmental Management; U.S. Department of Defense; and DOE, Legacy Management. Corrective Action Unit 408 is located at the Tonopah Test Range, Nevada, and consists of Corrective Action Site (CAS) TA-55-002-TAB2, Bomblet Target Areas. This CAS includes the following seven target areas: • Mid Target • Flightline Bomblet Location •more » Strategic Air Command (SAC) Target Location 1 • SAC Target Location 2 • South Antelope Lake • Tomahawk Location 1 • Tomahawk Location 2 The purpose of this CR is to provide documentation supporting the completed corrective actions and data confirming that the closure objectives for the CAS within CAU 408 were met. To achieve this, the following actions were performed: • Review the current site conditions, including the concentration and extent of contamination. • Implement any corrective actions necessary to protect human health and the environment. • Properly dispose of corrective action and investigation wastes. • Document Notice of Completion and closure of CAU 408 issued by the Nevada Division of Environmental Protection. From July 2009 through August 2010, closure activities were performed as set forth in the Streamlined Approach for Environmental Restoration Plan for CAU 408: Bomblet Target Area, Tonopah Test Range (TTR), Nevada. The purposes of the activities as defined during the data quality objectives process were as follows: • Identify and remove munitions of explosive concern (MEC) associated with DOE activities. • Investigate potential disposal pit locations. • Remove depleted uranium-contaminated fragments and soil. • Determine whether contaminants of concern (COCs) are present. • If COCs are present, determine their nature and extent, implement appropriate corrective actions, and properly dispose of wastes. Analytes detected during the closure activities were evaluated against final action levels to determine COCs for CAU 408. Assessment of the data indicated COCs are not present at CAS TA-55-002-TAB2; therefore, no corrective action is necessary. No use restrictions are required to be placed on this CAU because the investigation showed no evidence of remaining soil contamination or remaining debris/waste upon completion of all investigation activities. The MEC was successfully removed and dispositioned as planned using current best available technologies. As MEC guidance and general MEC standards acknowledge that MEC response actions cannot determine with 100 percent certainty that all MEC and unexploded ordnance (UXO) are removed, the clean closure of CAU 408 will implement a best management practice of posting UXO hazard warning signs near the seven target areas. The signs will warn future land users of the potential for encountering residual UXO hazards. The DOE, National Nuclear Security Administration Nevada Site Office, provides the following recommendations: • A Notice of Completion to the DOE, National Nuclear Security Administration Nevada Site Office, is requested from the Nevada Division of Environmental Protection for closure of CAU 408. • Corrective Action Unit 408 should be moved from Appendix III to Appendix IV of the Federal Facility Agreement and Consent Order.« less

Corrective Action Decision Document/Closure Report for Corrective Action Unit 252: Area 25 Engine Test Stand 1 Decontamination Pad, Nevada Test Site, Nevada

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

DOE /NV

This Corrective Action Decision Document/Closure Report (CADD/CR) has been prepared for Corrective Action Unit (CAU) 252: Area 25 Engine Test Stand-1 Decontamination Pad, in accordance with the Federal Facility Agreement and Consent Order (FFACO). Located at the Nevada Test Site in Nevada, CAU 252 consists of only one Corrective Action Site (25-07-04, Decontamination Pad). This CADD/CR identifies and rationalizes the U.S. Department of Energy, Nevada Operations Office's (DOE/NV's) recommendation that no corrective action is deemed necessary at CAU 252. The Corrective Action Decision Document and Closure Report have been combined into one report because the potential contaminants of concern weremore » either not detected during the corrective action investigation or were only present at naturally occurring concentrations. Based on the field results, neither corrective action or a corrective action plan is required at this site. A Notice of Completion to DOE/NV is being requested from the Nevada Division of Environmental Protection for closure of CAU 252, as well as a request that this site be moved from Appendix III to Appendix IV of the FFACO. Further, no use restrictions are required to be placed on this CAU.« less

Intraoperative angiography provides objective assessment of skin perfusion in complex knee reconstruction.

PubMed

Wyles, Cody C; Taunton, Michael J; Jacobson, Steven R; Tran, Nho V; Sierra, Rafael J; Trousdale, Robert T

2015-01-01

Wound necrosis is a potentially devastating complication of complex knee reconstruction. Laser-assisted indocyanine green angiography (LA-ICGA) is a technology that has been described in the plastic surgery literature to provide an objective assessment of skin perfusion in the operating room. This novel technology uses a plasma protein bound dye (ICG) and a camera unit that is calibrated to view the frequency emitted by the dye. The intention of this technology is to offer real-time visualization of blood flow to skin and soft tissue in a way that might help surgeons make decisions about closure or coverage of a surgical site based on blood flow, potentially avoiding soft tissue reconstruction while preventing skin necrosis or wound breakdown after primary closures, but its efficacy is untested in the setting of complex TKA. The purpose of this study was to evaluate perfusion borders and tension ischemia in a series of complex knee reconstructions to guide optimal wound management. Beginning in mid-2011, an LA-ICGA system was used to evaluate soft tissue viability in knee reconstruction procedures that were considered high risk for wound complications. Seven patients undergoing complex primary or revision TKA from 2011 to 2013 were included. These patients were chosen as a convenience sample of knee reconstruction procedures for which we obtained consultation with the plastic surgery service. The perfusion of skin and soft tissue coverage was evaluated intraoperatively for all patients with the LA-ICGA system, and the information was used to guide wound management. Followup was at a mean of 9 months (range, 6-17 months), no patients were lost to followup, and the main study endpoint was uneventful healing of the surgical incision. All seven closures went on to heal without necrosis. One patient, however, was subsequently revised for a deep periprosthetic infection 4 months after their knee reconstruction and underwent flap coverage at the time of that revision. Implementation of LA-ICGA provides an objective intraoperative assessment of soft tissue perfusion. This technology may help guide the surgeon's decisions about wound closure in real-time to accommodate the perfusion challenges unique to each patient. Specifically, patients with medical risk factors for poor perfusion or wound healing (such as diabetes, peripheral vascular disease, tobacco use, corticosteroid therapy, infection) or anatomical/surgical risk factors (ie, previous surgery about the reconstruction site, trauma wounds, or reconstruction of severe deformity) may benefit from objective intraoperative information regarding perfusion of the wound site. Furthermore, LA-ICGA could be used to prospectively evaluate the physiologic impact of different wound closure techniques. Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

The Frequency of Optical Coherence Tomography Testing in Glaucoma at a Single Academic Medical Center.

PubMed

Griffith, Joseph F; Goldberg, Jeffrey L

2016-03-01

To determine the frequency of optical coherence tomography (OCT) examinations compared with clinical examinations and visual field (VF) tests in patients with 5 types of glaucoma. A retrospective, longitudinal cohort study was conducted of 5154 patients treated between 2003 and 2010 at a single academic medical center. Patients were classified using billing records as having primary open-angle glaucoma, low-tension open-angle glaucoma (NTG), pigmentary open-angle glaucoma, chronic angle-closure glaucoma, or pseudoexfoliation glaucoma. Analysis of variance, χ test, and exact χ test were performed to identify associations between glaucoma type and test frequency. Pigmentary open-angle glaucoma and NTG patients had a higher rate of undergoing at least 2 VFs (94.4%, 94.9%), and chronic angle-closure glaucoma patients had a lower rate of undergoing at least 2 OCTs (25.3%) than all other glaucoma types. NTG patients also had the highest rate of undergoing at least 2 OCTs and at least 2 VFs (36.6%). Overall, the rate of clinical examinations (2.68 examinations/y) exceeded the rates of OCTs (1.39 examinations/y), which exceeded the rate of VF tests (1.24 tests/y). There were no differences in OCT frequency between glaucoma types (0.91 to 1.63 OCTs/y). Within each glaucoma diagnosis, patients had clinical examinations more frequently than OCTs and clinical examinations more frequently than VFs. Primary open-angle glaucoma and pseudoexfoliation glaucoma patients also had OCTs more frequently than VFs. More patients had at least 2 VF tests than at least 2 OCTs (4481 vs. 1679). The relative use of clinical examinations, VF testing, and OCT imaging varies among glaucoma diagnoses.

Comparison of epsilon aminocaproic acid and tranexamic Acid in thoracic aortic surgery: clinical efficacy and safety.

PubMed

Makhija, Neeti; Sarupria, Anju; Kumar Choudhary, Shiv; Das, Sambhunath; Lakshmy, Ramakrishnan; Kiran, Usha

2013-12-01

To evaluate the efficacy and safety of tranexamic acid (TXA) versus epsilon aminocaproic acid (EACA) in patients undergoing thoracic aortic surgery. A prospective randomized study. A tertiary care center. The study was conducted on 64 consecutive adult patients undergoing thoracic aortic surgery with cardiopulmonary bypass (CPB). Group EACA received a bolus of 50 mg/kg of EACA after induction of anesthesia over 20 minutes followed by maintenance infusion of 25 mg/kg/h until chest closure. Group TXA received a bolus of 10 mg/kg of TXA after induction of anesthesia over 20 minutes followed by maintenance infusion of 1 mg/kg/h until chest closure. Cumulated mean blood loss, total packed red blood cells, and blood product requirement up to 24 h postoperatively were comparable between groups. A significant renal injury (EACA 40% v TXA 16%; p = 0.04) and increased tendency for renal failure (EACA 10% v TXA 0%, p = 0.11; relative risk 2.15) were observed with EACA compared to TXA. There was increased tendency of seizure with TXA (EACA v TXA: 3.3% v 10%; p>0.05, relative risk 1.53). There was significant increase in the D-dimer from preoperative to postoperative values in Group EACA. (p< 0.01). Both EACA and TXA were equally effective in reducing the perioperative blood loss and transfusion requirement in patients undergoing thoracic aortic surgery. While significant renal injury was observed with EACA, there was a tendency for higher incidence of seizure with TXA. Prospective placebo-controlled trials recruiting larger sample size using sensitive biomarkers are required before any recommendations. Copyright © 2013 Elsevier Inc. All rights reserved.

Post-Closure Inspection Report for the Tonopah Test Range, Nevada, for Calendar Year 2014

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

Silvas, A. J.; Lantow, Tiffany A.

This report provides the results of the annual post-closure inspections conducted at the closed Corrective Action Units (CAUs) located on the Tonopah Test Range (TTR), Nevada. This report covers calendar year 2014 and includes inspection and repair activities completed at the following CAUs; CAU 400: Bomblet Pit and Five Points Landfill (TTR); CAU 407: Roller Coaster RadSafe Area (TTR); CAU 424: Area 3 Landfill Complexes (TTR); CAU 453: Area 9 UXO Landfill (TTR); and CAU 487: Thunderwell Site (TTR) Inspections were conducted according to the post-closure plans in the approved Closure Reports and subsequent correspondence with the Nevada Division ofmore » Environmental Protection. The post-closure inspection plans and subsequent correspondence modifying the requirements for each CAU are included in Appendix B. The inspection checklists are included in Appendix C. Photographs taken during inspections are included in Appendix D. The annual post-closure inspections were conducted on May 28, 2014. Maintenance was required at CAU 407. Animal burrows were backfilled and erosion repairs were performed. Vegetation monitoring was performed at CAU 407 in June 2014. The vegetation monitoring report is included in Appendix E.« less

Near-IR squaraine dye–loaded gated periodic mesoporous organosilica for photo-oxidation of phenol in a continuous-flow device

PubMed Central

Borah, Parijat; Sreejith, Sivaramapanicker; Anees, Palapuravan; Menon, Nishanth Venugopal; Kang, Yuejun; Ajayaghosh, Ayyappanpillai; Zhao, Yanli

2015-01-01

Periodic mesoporous organosilica (PMO) has been widely used for the fabrication of a variety of catalytically active materials. We report the preparation of novel photo-responsive PMO with azobenzene-gated pores. Upon activation, the azobenzene gate undergoes trans-cis isomerization, which allows an unsymmetrical near-infrared squaraine dye (Sq) to enter into the pores. The gate closure by cis-trans isomerization of the azobenzene unit leads to the safe loading of the monomeric dye inside the pores. The dye-loaded and azobenzene-gated PMO (Sq-azo@PMO) exhibits excellent generation of reactive oxygen species upon excitation at 664 nm, which can be effectively used for the oxidation of phenol into benzoquinone in aqueous solution. Furthermore, Sq-azo@PMO as the catalyst was placed inside a custom-built, continuous-flow device to carry out the photo-oxidation of phenol to benzoquinone in the presence of 664-nm light. By using the device, about 23% production of benzoquinone with 100% selectivity was achieved. The current research presents a prototype of transforming heterogeneous catalysts toward practical use. PMID:26601266

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

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

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

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

Advances in the Surgical Treatment of Gastroschisis.

PubMed

Safavi, Arash; Skarsgard, Erik D

2015-05-01

Gastroschisis (GS) is a structural defect of the anterior abdominal wall, usually diagnosed antenatally, that occurs with a frequency of approximately 4 per 10,000 pregnancies. Babies born with GS require neonatal intensive care and surgical management of the abdominal wall defect soon after birth. Although contemporary survival rates for GS are over 90%, these babies are at risk for significant morbidity, and require 4 to 6 weeks of costly, resource-intensive care in specialized neonatal units. Much consideration has been given to how best to treat the abdominal wall defect of GS. The traditional approach, necessitated by a need to establish enteral feeding as quickly as possible, consists of early postnatal visceral reduction and sutured abdominal closure. Advances in neonatal nutritional support have enabled the development of surgical approaches, which permit gradual visceral reduction and delayed abdominal closure. In cases where early visceral reduction cannot be achieved, delayed closure enabled by the initial placement of a prosthetic silo has been a live-saving alternative. The development of preformed silos has simplified their use and led to an interest in treating all cases with a delayed closure philosophy. Most recently, a sutureless technique of abdominal closure has been reported, which has the benefit of avoiding general anesthesia and offers other outcome improvements over sutured closure of the defect. The debate over primary closure versus silo placement and delayed closure continues to receive much attention. The goal of this article is to review historical aspects of gastroschisis closure, and then focus on current surgical techniques, including the innovative sutureless closure, with an analysis of the comparative clinical effectiveness of these approaches to treatment of the abdominal wall defect in GS.

Post-Closure Inspection Letter Report for Corrective Action Units on the Nevada National Security Site

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

Boehleke, R. F.

2014-05-06

This letter serves as the post-closure inspection letter report for Corrective Action Units (CAUs) on the Nevada National Security Site for calendar year 2013. The inspections identified maintenance and repair is required at the following sites: sign and/or fence repair is necessary at CAUs 113, 137, 139, 140, 143, 262, 370, 371, 372, 374, 476, 478, 529, 542, and 560; animal burrows were identified at CAU 547; and erosion was identified at CAUs 366, 367, 383, 551, and 574. In addition, the following use restrictions were removed during 2013 and will no longer be inspected in 2014: 165, 357, andmore » 528.« less

Association of land use and beach closure in the United States

EPA Science Inventory

Swimming in natural waters (e.g., oceans, lakes, rivers) is one of most popular recreational activities in the United States. However, exposure to pathogens (e.g., Salmonella spp., Shigella spp., Cryptosporidium, Giardia, adenovirus, norovirus) in recreational waters can lead to ...

Transition State Gauche Effects Control the Torquoselectivities of the Electrocyclizations of Chiral 1-Azatrienes.

PubMed

Patel, Ashay; Vella, Joseph R; Ma, Zhi-Xiong; Hsung, R P; Houk, K N

2015-12-04

Hsung et al. have reported a series of torquoselective electrocyclizations of chiral 1-azahexa-1E,3Z,5E-trienes that yield functionalized dihydropyridines. To understand the origins of the torquoselectivities of these azaelectrocyclizations, we modeled these electrocyclic ring closures using the M06-2X density functional. A new stereochemical model that rationalizes the observed 1,2 stereoinduction emerges from these computations. This model is an improvement and generalization of the "inside-alkoxy" model used to rationalize stereoselectivities of the 1,3-dipolar cycloaddition of chiral allyl ethers and emphasizes a stabilizing hyperconjugative effect, which we have termed a transition state gauche effect. This stereoelectronic effect controls the conformational preferences at the electrocyclization transition states, and only in one of the allowed disrotatory electrocyclization transition states is the ideal stereoelectronic arrangement achieved without the introduction of a steric clash. Computational experiments confirm the role of this effect as a stereodeterminant since substrates with electropositive groups and electronegative groups have different conformational preferences at the transition state and undergo ring closure with divergent stereochemical outcomes. This predicted reversal of stereoselectivity for the ring closures of several silyl substituted azatrienes have been demonstrated experimentally.

Impact of Smoke Evacuation on Patient Experience During Mohs Surgery.

PubMed

Yonan, Yousif; Ochoa, Shari

2017-11-01

There have been several investigations into possible health risks of surgical smoke exposure, and it has previously been associated with harboring pathogens and carcinogens. Patients in the authors' practice have expressed that the odor from the smoke created by electrosurgical equipment is unpleasant. The authors sought to determine if smoke evacuation decreases patient perception of smoke created by electrosurgery during Mohs surgery and if it subsequently improves patient satisfaction with their surgical experience by minimizing the associated odor. Thirty patients were enrolled in this comparative trial. Smoke evacuation was used during closure but not during Mohs stages. Patients were queried regarding their experience and preferences during and at the end of the procedure. 100% of patients reported the perception of a burning odor during removal of Mohs stages, compared with 40% reporting the perception of a burning odor during closure. During the Mohs stages, 66.6% of patients reported the odor as unpleasant compared with 16.6% of patients during closure. There were no statistically significant differences in patient perceptions when stratified by age, sex, or surgical site. The authors believe that using a wall suction smoke evacuation system is simple and can result in a more pleasant experience for patients undergoing Mohs surgery.

Multistep Approach for Improved Aesthetic and Functional Outcomes for Lower Extremity Wound Closure After Mohs Micrographic Surgery.

PubMed

Kiwanuka, Elizabeth; Cruz, Antonio P

2017-05-01

Lower extremity wounds present a major clinical challenge. This paper introduces a new multistep approach for improved aesthetic and functional outcome for lower extremity wound closure after Mohs micrographic surgery. In this prospective case series, 12 consecutive patients undergoing Mohs micrographic surgery for cutaneous malignancies of the lower extremities underwent closure assisted by elastic bandages, proper positioning with 45° flexion of the knee, buried vertical mattress sutures, and careful eversion, using a premium angled stapler. Assessment of cosmetic outcome was performed by 2 blinded observers, using the Hollander Wound Evaluation Scale. The mean age was 73 ± 9 years with most patients having at least one comorbidity. Six patients (50%) underwent resection of a basal cell carcinoma and 5 patients (42%) underwent resection of a squamous cell carcinoma and 1 patient (8%) underwent resection of a keratoacanthomatous carcinoma. There were no wound complications, and at the 3- to 6-month follow-up, 11 of the 12 wounds (92%) had an optimal Hollander Wound Evaluation Scale score of 6. This new approach to lower extremity wounds provides excellent cosmetic outcome with no reported complications.

Communication strategies and timeliness of response to life critical telemetry alarms.

PubMed

Bonzheim, Kimberly A; Gebara, Rani I; O'Hare, Bridget M; Ellis, R Darin; Brand, Monique A; Balar, Salil D; Stockman, Rita; Sciberras, Annette M; Haines, David E

2011-05-01

A centralized electrocardiogram telemetry monitoring system (TMS) facilitates early identification of critical arrhythmias and acute medical decompensation. Timely intervention can only be performed if abnormalities are communicated rapidly to the direct caregiver. The study objectives were to measure effectiveness of bi-directional voice communication badges versus one-way alphanumeric pagers for telemetry alarm response and communication loop closure. A sequential observational pilot study of nursing response to TMS alarms compared communication technologies on four nursing units in a 1,061 bed tertiary care hospital with 264 TMS channels of telemetry over a 2-year period. Subsequently, the communication technologies were compared in a randomized fashion on a 68-bed progressive cardiac care unit. Caregivers were blinded to the protocol. All alarm responses were recorded during two periods using either pagers or voice communication devices. Alarm response time and closure of the communication loop were analyzed in a blinded fashion. The direct communication functionality of the badge significantly shortened the time to first contact, time to completion, and rate of closure of the communication loop in both the pilot and study phases. Median time to first contact with the communication badge was 0.5  min, compared to 1.6  min with pager communication (p < 0.0003). Communication loop closure was achieved in 100% of clinical alarms using the badge versus 19% with the pager (p < 0.0001). Communication badge technology reduced alarm time to first contact and completion as well as facilitated communication loop closures. Immediate two-way communication significantly impacted practice, alarm management, and resulted in faster bedside care.

Durability of central aortic valve closure in patients with continuous flow left ventricular assist devices.

PubMed

McKellar, Stephen H; Deo, Salil; Daly, Richard C; Durham, Lucian A; Joyce, Lyle D; Stulak, John M; Park, Soon J

2014-01-01

A competent aortic valve is essential to providing effective left ventricular assist device support. We have adopted a practice of central aortic valve closure by placing a simple coaptation stitch at left ventricular assist device implantation in patients with significant aortic insufficiency. We conducted a follow-up study to evaluate the efficacy and durability of this procedure. The study included patients who had undergone continuous flow left ventricular assist device implantation. The patients were divided into 2 groups, those who did not require any aortic procedure because the valve was competent and those who underwent central aortic valve closure for mild or greater aortic regurgitation. The clinical endpoints were mortality, progression or recurrence of aortic insufficiency, and reoperation for aortic valve pathologic features. Aortic insufficiency was measured qualitatively from mild to severe on a scale of 0 to 5. A total of 123 patients received continuous flow left ventricular assist devices from February 2007 to August 2011. Of those, 18 (15%) underwent central aortic valve closure at left ventricular assist device implantation because of significant aortic insufficiency (1.8 ± 1.4) and 105 who did not (competent aortic valve, 0.15 ± 0.43; P < .01). At follow-up (median, 312 days; range, 0-1429 days), the mean aortic insufficiency score remained low for the patients with central aortic valve closure (0.27 ± 0.46) in contrast to those without central aortic valve closure who experienced aortic insufficiency progression (0.78 ± 0.89; P = .02). In addition, the proportion of patients with more than mild aortic insufficiency was significantly less in the central aortic valve closure group (0% vs 18%; P = .05). The patients in the central aortic valve closure group were significantly older and had a greater incidence of renal failure at baseline. The 30-day mortality was greater in the central aortic valve closure group, but the late survival was similar between the 2 groups. No reoperations were required for recurrent aortic insufficiency. The results of our study have shown that repair of aortic insufficiency with a simple central coaptation stitch is effective and durable in left ventricular assist device-supported patients, with follow-up extending into 2 years. Although aortic insufficiency progressed over time in those with minimal native valve regurgitation initially, no such progression was noted in those with central aortic valve closure. Additional investigation is needed to evaluate whether prophylactic central aortic valve closure should be performed at left ventricular assist device implantation to avoid problematic aortic regurgitation developing over time, in particular in patients undergoing left ventricular assist device implantation for life-long (destination therapy) support. Copyright © 2014 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

Abdominal wall integrity after open abdomen: long-term results of vacuum-assisted wound closure and mesh-mediated fascial traction (VAWCM).

PubMed

Willms, A; Schaaf, S; Schwab, R; Richardsen, I; Bieler, D; Wagner, B; Güsgen, C

2016-12-01

The open abdomen has become a standard technique in the management of critically ill patients undergoing surgery for severe intra-abdominal conditions. Negative pressure and mesh-mediated fascial traction are commonly used and achieve low fistula rates and high fascial closure rates. In this study, long-term results of a standardised treatment approach are presented. Fifty-five patients who underwent OA management for different indications at our institution from 2006 to 2013 were enrolled. All patients were treated under a standardised algorithm that uses a combination of vacuum-assisted wound closure and mesh-mediated fascial traction. Structured follow-up assessments were offered to patients and included a medical history, a clinical examination and abdominal ultrasonography. The data obtained were statistically analysed. The fascial closure rate was 74 % in an intention-to-treat analysis and 89 % in a per-protocol analysis. The fistula rate was 1.8 %. Thirty-four patients attended follow-up. The median follow-up was 46 months (range 12-88 months). Incisional hernias developed in 35 %. Patients with hernias needed more operative procedures (10.3 vs 3.4, p = 0.03) than patients without hernia formation. A Patient Observer Scar Assessment Scale (POSAS) of 31.1 was calculated. Patients with symptomatic hernias (NAS of 2-10) had a significantly lower mean POSAS score (p = 0.04). Vacuum-assisted wound closure and mesh-mediated fascial traction (VAWCM) seem to result in low complication rates and high fascial closure rates. Abdominal wall reconstruction, which is a challenging and complex procedure and causes considerable patient discomfort, can thus be avoided in the majority of cases. Available results are based on studies involving only a small number of cases. Multi-centre studies and registry-based data are therefore needed to validate these findings.

Association of land use and its change with beach closure in ...

EPA Pesticide Factsheets

Land use and its change have great influences on water quality. However, their impacts on microbial contamination of beach water have been rarely investigated and their relationship with beach closure is still unknown. Here, we analyzed beach closure data obtained from 2004 to 2013 for more than 500 beaches in the United States, and examined their associations with land use around beaches in 2006 and 2011, respectively, as well as the land use change between 2011 and 2006. The results show that the number of beach closures is negatively associated with the percentages of forest, barren land, grassland and wetland, while positively associated with the percentage of urban area. The results from multi-level models also indicate the negative association with forest area but positive association with urban area and agriculture. The examination of the change of land use and the number of beach closures between 2011 and 2006 indicates that the increase in the number of beach closures is positively associated with the increase in urban (β=1.612, p<0.05) and agricultural area including pasture (β=0.098, p<0.05), but negatively associated with the increase in forest area (β= -1.789, p<0.05). The study suggests that urbanization and agriculture development near beaches have adverse effects on beach microbial water quality, while afforestation may protect beach water quality and reduce the number of beach closures. To compare differences in beach closures across the US u

Distally based sural neuro-fasciocutaneous perforator flap for foot and ankle reconstruction: Surgical modifications for flap pedicle and donor site closure without skin graft.

PubMed

Chi, Zhenglin; Chen, Yiheng; Chu, Tinggang; Gao, Weiyang; Li, Zhijie; Yan, Hede; Song, Yonghuan

2018-02-01

The conventional procedure of the sural neuro-fasciocutaneous flap enables the supply of blood and venous drainage by increasing the width of the adipofascial tissue and preserving tiny venous return routes. Moreover, skin graft is a common method for donor site closure, which may lead to some complications and influence the aesthetic appearance. We report modifications for a distally based sural neuro-fasciocutaneous perforator flap and a relaying flap for donor site closure without skin graft. Twelve patients undergoing the modified flap for foot and ankle reconstruction were included in this study between 2014 and 2016. A peroneal-based perforator, a superficial vein, and the vascular axis of the sural nerve were included in the pedicle. A Z-shape skin incision was performed to explore the perforator vessels and a relaying island perforator flap was used to close the donor site. All flaps survived completely without necrosis. The area of the flaps ranged from 16 × 8 cm to 30 × 15 cm. The diameter width of the pedicle ranged from 1.0 to 2.0 cm. A relaying perforator island flap was used in 10 cases for donor site closure and no skin graft was performed. There were no serious donor site complications. All patients were satisfied with the aesthetic outcome postoperatively at the final follow-up. The distally based sural neuro-fasciocutaneous perforator flap is considered a reliable method for foot and ankle reconstruction. The modification for flap pedicle and donor site closure method without skin graft should be recommended. Copyright © 2017. Published by Elsevier Ltd.

Clips versus suture technique: is there a difference?

PubMed

Chughtai, T; Chen, L Q; Salasidis, G; Nguyen, D; Tchervenkov, C; Morin, J F

2000-11-01

Coronary artery bypass grafting (CABG) is one of the most common procedures performed today, and wound complications are a major source of morbidity and cost. To determine whether there is any difference in wound outcome (including cost in a Canadian context) between a subcuticular suture technique and skin stapling technique for closure of sternal and leg incisions in CABG patients. One hundred and sixty-two patients undergoing CABG were prospectively, randomly placed to have their sternal and leg incisions closed with either a subcuticular suture technique or with a skin clip. Data were obtained through chart review, in-hospital assessments and follow-up visits. Nonblinded assessments were made regarding wound leakage, inflammation, infection, necrosis, swelling, dehiscence and cosmesis. Each of the parameters was graded on a scale from 1 to 4. The cost was evaluated in Canadian dollars. There were trends toward increased rates of in-hospital sternal (P=0.09) and leg (P=0.17) incision inflammation when the wounds were closed with skin clips. There was a significantly greater (P=0.05) rate of sternal wound infection with clips, as well as a tendency (P=0.15) toward a greater rate of mediastinitis at follow-up assessment. Cosmetic outcome was similar for both groups. The cost incurred was significantly greater when skin clips were used for closure. There was a greater than threefold difference, which translates to a greater than $10,000 difference over one year. Closure with a subcuticular technique achieves better outcomes than the use of skin clips. When factoring in the increased cost incurred by using clips, as well as other intangible factors such as surgical skill acquisition, subcuticular suture closure appears to be a favourable method of wound closure in CABG patients compared with the use of skin stapling techniques.

Endoloops or endostapler use in laparoscopic appendectomy for acute uncomplicated and complicated appendicitis : No difference in infectious complications.

PubMed

van Rossem, Charles C; van Geloven, Anna A W; Schreinemacher, Marc H F; Bemelman, Willem A

2017-01-01

The most appropriate closure for the appendicular stump with either endoloops or an endostapler in laparoscopic appendectomy remains unclear and under debate because of limited and conflicting evidence. In a 2-month prospective, observational, resident-led nationwide cohort study, patients undergoing laparoscopic appendectomy for both uncomplicated and complicated appendicitis were analysed. Logistic regression analyses were performed for identifying the possible effect of stump closure type and other risk factors for infectious complications. Laparoscopic appendectomy for acute appendicitis was performed in 1369 patients in 62 hospitals; endoloops were used in 76.7 % and an endostapler in other patients. Median operating time was not different between endoloop and endostapler use (42.0 vs. 44.0 min, P = 0.243). A superficial surgical site infection was seen in 2.0 % after uncomplicated appendicitis and in 0.8 % after complicated appendicitis. The intra-abdominal abscess rate was 1.9 % after uncomplicated and 11.0 % after complicated appendicitis. No significant effect of stump closure type was observed for any infectious complication (OR 1.05; 95 % CI 0.625-1.766, P = 0.853) or an intra-abdominal abscess (OR OR 0.96; 95 % CI 0.523-1.768, P = 0.899). In multivariable analysis, complicated appendicitis was identified as the only independent risk factor for an intra-abdominal abscess (OR 6.26; 95 % CI 3.454-11.341, P < 0.001). The infectious complication rate is not influenced by the type of appendicular stump closure with either endoloops or an endostapler in this study. If technically feasible, closure with endoloops is advised for cost considerations.

Is the new Occlutech duct occluder an appropriate device for transcatheter closure of patent ductus arteriosus?

PubMed

Godart, François; Houeijeh, Ali; Domanski, Olivia; Guillaume, Marie-Paule; Brard, Mélanie; Lucron, Hugues

2018-06-15

To describe our initial experience with the Occlutech Duct Occluder (ODO) for percutaneous closure of patent ductus arteriosus (PDA). Retrospective review of patients undergoing transcatheter PDA closure with the ODO in 2 academic centers. From April 2013 to September 2017, 42 patients underwent PDA closure. Median age at implantation was 34 months (range 4 months-68 years) and median weight was 12 kg (range 4.1-57 kg). Ducts were Krichenko type A duct (n = 34), type E (n = 6), and type C (n = 2). The mean duct diameter was 3.76 mm (range 1.69 to 9.95 mm, median 3.1 mm). Implantation succeeded in all. There was neither device embolization nor hemolysis. At device release, immediate angiogram showed a small residual shunt in 54.7%. During follow-up, Doppler echocardiography demonstrated 71% of full occlusion at day one, rising to 95% at one month and 100% at one year and half after implantation. The mean maximal systolic pressure gradient in left pulmonary artery was 4.2 ± 4.3 mm and across the distal aortic arch 5.4 ± 4.7 mm Hg. No patient had any significant stenosis with clinical relevance. ODO is safe and effective in transcatheter closure of PDA including relatively large sized ducts. The results are satisfactory with a high level of full occlusion and a low rate of complications. Further evaluation with larger studies and longer follow-up will be required to confirm these preliminary good results. Copyright © 2018. Published by Elsevier B.V.

Trial occlusion to assess the risk of persistent pulmonary arterial hypertension after closure of a large patent ductus arteriosus in adolescents and adults with elevated pulmonary artery pressure.

PubMed

Zhang, Duan-Zhen; Zhu, Xian-Yang; Lv, Bei; Cui, Chun-Sheng; Han, Xiu-Min; Sheng, Xiao-Tang; Wang, Qi-Guang; Zhang, Po

2014-08-01

No method is available to predict whether patients with patent ductus arteriosus (PDA) and severe pulmonary arterial hypertension (PAH) will show persistent postprocedural PAH (PP-PAH) after PDA closure. This study evaluated the usefulness of trial occlusion for predicting PP-PAH after transcatheter PDA closure in patients with severe PAH. Trial occlusion was performed in 137 patients (age ≥12 years) with PDA and severe PAH. All patients undergoing trial occlusion had a mean pulmonary artery pressure ≥45 mm Hg, pulmonary:systemic flow (Qp/Qs) ratio >1.5, and pulmonary:systemic resistance (Rp/Rs) ratio <0.7. A total of 135 patients (98%) showing stable hemodynamics during occlusion trial underwent successful device closure. Linear correlation analysis revealed weak or moderate relationships between the baseline and post-trial pulmonary artery pressures and pulmonary:systemic pressure (Pp/Ps) ratios. Patients were followed up for 1 to 10 years (median: 5 years). PP-PAH (systolic pulmonary artery pressure >50 mm Hg by Doppler echocardiography) was detected in 17 patients (13%), who displayed no significant differences in sex and age compared with patients without PP-PAH. According to discriminant analysis, the strongest discriminators between patients with and without PP-PAH were the baseline left ventricular end-diastolic volume and the baseline and post-trial systolic Pp/Ps ratios. In particular, a post-trial systolic Pp/Ps ratio >0.5 correctly classified 100% of the PP-PAH and non-PAH patients. Trial occlusion is a feasible method to predict PP-PAH in patients with PDA and severe PAH. A post-trial systolic Pp/Ps ratio >0.5 indicates a high risk of PP-PAH occurrence after device closure. © 2014 American Heart Association, Inc.

Closure Report for Corrective Action Unit 118: Area 27 Super Kukla Facility, Nevada Test Site, Nevada with ROTC 1, Revision 0

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

Mark Burmeister

2007-09-01

This CR provides documentation and justification for the closure of CAU 118 without further corrective action. This justification is based on process knowledge and the results of the investigative and closure activities conducted in accordance with the CAU 118 SAFER Plan: Streamlined Approach for Environmental Restoration (SAFER) Plan for CAU 118: Area 27 Super Kukla Facility, Nevada Test Site, Nevada (NNSA/NSO, 2006). The SAFER Plan provides information relating to site history as well as the scope and planning of the investigation. This CR also provides the analytical and radiological survey data to confirm that the remediation goals were met asmore » specified in the CAU 118 SAFER Plan (NNSA/NSO, 2006). The Nevada Division of Environmental Protection (NDEP) approved the CAU 118 SAFER Plan (Murphy, 2006), which recommends closure in place with use restrictions (URs).« less

Closure Plan for Corrective Action Unit 109: U-2bu Subsidence Crater Nevada Test Site, Nevada

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

Shannon Parsons

1999-03-01

The U-2bu subsidence crater, Corrective Action Unit 109, will be closed in accordance with the Resource Conservation and Recovery Act, the Nevada Division of Environmental Protection operational permit, and the Federal Facilities Agreement and Consent Order. The U-2bu subsidence crater is located in Area 2 of the Nevada Test Site. It was created in 1971 by an underground nuclear test with the name Miniata. The crater has a diameter of 288 meters (944 feet) and an approximate depth of 35 meters (115 feet). The subsidence crater was used as a land disposal unit for radioactive and hazardous waste from 1973more » to 1988. Site disposal history is supported by memorandums, letters, and personnel who worked at the Nevada Test Site at the time of active disposal. Closure activities will include the excavation and disposal of impacted soil form the tip of the crater. Upon completion of excavation, verification samples will be collected to show that lead has been removed to concentrations be low regulatory action level. The area will then be backfilled and a soil flood diversion berm will be constructed, and certified by an independent professional engineer as to having followed the approved Closure Plan.« less

Monitoring Potential Transport of Radioactive Contaminants in Shallow Ephemeral Channels: FY2013 and FY2014 (revised)

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

Mizell, Steve A.; Miller, Julianne J.; McCurdy, Greg D.

The Desert Research Institute (DRI) is conducting a field assessment of the potential for contaminated soil to be transported from the Smoky Contamination Area (CA) as a result of storm runoff, which supports National Nuclear Security Administration (NNSA) efforts to complete regulatory closure of the Soils Corrective Action Unit (CAU) contamination areas. The work is intended to confirm the likely mechanism of transport and determine the meteorological conditions that might cause movement of contaminated soils, as well as determine the particle size fraction that is most closely associated with transported radionuclide-contaminated soils. These data will facilitate the appropriate closure designmore » and post-closure monitoring program.« less

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

PubMed

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

2015-10-01

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

Closure Report (CR) for Corrective Action Unit (CAU) 91: Area 3 U-3fi Injection Well with Errata Sheet and Certification, Revision 0

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

Navarro Nevada Environmental Services

The closure report for CAU 91 has no Use Restriction Form or drawing/map included in the document to describe the use restricted area, however, Section 3.3.3 states that the site will be fenced and signage placed indicating the area as a Resource Conservation and Recovery Act (RCRA) Unit. The drawing that was placed in the FFACO indicating the use restricted area lists the coordinates for the RCRA Unit in Nevada State Plan Coordinates - North American Datum of 1983. In the ensuing years the reporting of coordinates has been standardized so that all coordinates are reported in the same manner,more » which is: NAD 27 UTM Zone 11 N, meters. This Errata Sheet updates the coordinate reporting to the currently accepted method and includes an aerial photo showing the RCRA Unit with the coordinates listed showing the use restricted area.« less

Risk factors for postoperative CSF leakage after elective craniotomy and the efficacy of fleece-bound tissue sealing against dural suturing alone: a randomized controlled trial.

PubMed

Hutter, Gregor; von Felten, Stefanie; Sailer, Martin H; Schulz, Marianne; Mariani, Luigi

2014-09-01

Cerebrospinal fluid leakage is an immanent risk of cranial surgery with dural opening. Recognizing the risk factors for this complication and improving the technique of dural closure may reduce the associated morbidity and its surgical burden. The aim of this paper was to investigate whether the addition of TachoSil on top of the dural suture reduces postoperative CSF leakage compared with dural suturing alone and to assess the frequency and risk factors for dural leakage and potentially related complications after elective craniotomy. The authors conducted a prospective, randomized, double-blinded single-center trial in patients undergoing elective craniotomy with dural opening. They compared their standard dural closure by running suture alone (with the use of a dural patch if needed) to the same closure with the addition of TachoSil on top of the suture. The primary end point was the incidence of CSF leakage, defined as CSF collection or any open CSF fistula within 30 days. Secondary end points were the incidence of infection, surgical revision, and length of stay in the intensive care unit (ICU) or intermediate care (IMC) unit. The site of craniotomy, a history of diabetes mellitus, a diagnosis of meningioma, the intraoperative need of a suturable dural substitute, and blood parameters were assessed as potential risk factors for CSF leakage. The authors enrolled 241 patients, of whom 229 were included in the analysis. Cerebrospinal fluid leakage, mostly self-limiting subgaleal collections, occurred in 13.5% of patients. Invasive treatment was performed in 8 patients (3.5%) (subgaleal puncture in 6, lumbar drainage in 1, and surgical revision in 1 patient). Diabetes mellitus, a higher preoperative level of C-reactive protein (CRP), and the intraoperative need for a dural patch were positively associated with the occurrence of the primary end point (p = 0.014, 0.01, and 0.049, respectively). Cerebrospinal fluid leakage (9.7% vs 17.2%, OR 0.53 [95% CI 0.23-1.15], p = 0.108) and infection (OR 0.18 [95% CI 0.01-1.18], p = 0.077) occurred less frequently in the study group than in the control group. TachoSil significantly reduced the probability of staying in the IMC unit for 1 day or longer (OR 0.53 [95% CI 0.27-0.99], p = 0.048). Postoperative epidural hematoma and empyema occurred in the control group but not in the study group. Dural leakage after elective craniotomy/durotomy occurs more frequently in association with diabetes mellitus, elevated preoperative CRP levels, and the intraoperative need of a dural patch. This randomized controlled trial showed no statistically significant reduction of postoperative CSF leakage and surgical site infections upon addition of TachoSil on the dural suture, but there was a significant reduction in the length of stay in the IMC unit. Dural augmentation with TachoSil was safe and not related to adverse events. Clinical trial registration no. NCT00999999 ( http://www.ClinicalTrials.gov ).

MACULAR HOLE FORMATION FOLLOWED BY SPONTANEOUS CLOSURE AFTER PNEUMATIC RETINOPEXY IN A PATIENT WITH DIABETIC MACULAR EDEMA.

PubMed

Cohen, Michael N; Baumal, Caroline R

2018-05-10

To report early formation and spontaneous closure of a full-thickness macular hole that developed after successful pneumatic retinopexy in a patient who had been undergoing treatment for diabetic macular edema. Case report of a 68-year-old man with bilateral nonproliferative diabetic retinopathy who was currently undergoing anti-vascular endothelial growth factor treatment for bilateral diabetic macular edema. On presentation, visual acuity was 20/200 in the left eye, and examination revealed a bullous, macula-off retinal detachment with a single horseshoe tear at 12 o'clock in the left eye. Pneumatic retinopexy was performed followed by laser augmentation 3 days later. Three weeks postoperatively, he returned with visual acuity of 20/50 and a full-thickness macular hole in the left eye. Although he elected for initial observation, he returned 2 weeks later with visual acuity of 20/50 in both eyes and a retinal detachment with a single break at 10 o'clock in the right eye. The macular hole in the left eye had spontaneously resolved. Pneumatic retinopexy was performed to the right eye. Over 1 year after bilateral pneumatic retinopexy, his retina remains without recurrence of a macular hole in the left eye. In the early postoperative period after pneumatic retinopexy to repair a retinal detachment, a macular hole can form and spontaneously close.

The Milieu Manager: A Nursing Staffing Strategy to Reduce Observer Use in the Acute Psychiatric Inpatient Setting.

PubMed

Triplett, Patrick; Dearholt, Sandra; Cooper, Mary; Herzke, John; Johnson, Erin; Parks, Joyce; Sullivan, Patricia; Taylor, Karin F; Rohde, Judith

Rising acuity levels in inpatient settings have led to growing reliance on observers and increased the cost of care. Minimizing use of observers, maintaining quality and safety of care, and improving bed access, without increasing cost. Nursing staff on two inpatient psychiatric units at an academic medical center pilot-tested the use of a "milieu manager" to address rising patient acuity and growing reliance on observers. Nursing cost, occupancy, discharge volume, unit closures, observer expense, and incremental nursing costs were tracked. Staff satisfaction and reported patient behavioral/safety events were assessed. The pilot initiatives ran for 8 months. Unit/bed closures fell to zero on both units. Occupancy, patient days, and discharges increased. Incremental nursing cost was offset by reduction in observer expense and by revenue from increases in occupancy and patient days. Staff work satisfaction improved and measures of patient safety were unchanged. The intervention was effective in reducing observation expense and improved occupancy and patient days while maintaining patient safety, representing a cost-effective and safe approach for management of acuity on inpatient psychiatric units.

Online Work Force Analyzes Social Media to Identify Consequences of an Unplanned School Closure - Using Technology to Prepare for the Next Pandemic.

PubMed

Rainey, Jeanette J; Kenney, Jasmine; Wilburn, Ben; Putman, Ami; Zheteyeva, Yenlik; O'Sullivan, Megan

During an influenza pandemic, the United States Centers for Disease Control and Prevention (CDC) may recommend school closures. These closures could have unintended consequences for students and their families. Publicly available social media could be analyzed to identify the consequences of an unplanned school closure. As a proxy for an unplanned, pandemic-related school closure, we used the district-wide school closure due to the September 10-18, 2012 teachers' strike in Chicago, Illinois. We captured social media posts about the school closure using the Radian6 social media-monitoring platform. An online workforce from Amazon Mechanical Turk categorized each post into one of two groups. The first group included relevant posts that described the impact of the closure on students and their families. The second group included irrelevant posts that described the political aspects of the strike or topics unrelated to the school closure. All relevant posts were further categorized as expressing a positive, negative, or neutral sentiment. We analyzed patterns of relevant posts and sentiment over time and compared our findings to household surveys conducted after other unplanned school closures. We captured 4,546 social media posts about the district-wide school closure using our search criteria. Of these, 930 (20%) were categorized as relevant by the online workforce. Of the relevant posts, 619 (67%) expressed a negative sentiment, 51 (5%) expressed a positive sentiment, and 260 (28%) were neutral. The number of relevant posts, and especially those with a negative sentiment, peaked on day 1 of the strike. Negative sentiment expressed concerns about childcare, missed school lunches, and the lack of class time for students. This was consistent with findings from previously conducted household surveys. Social media are publicly available and can readily provide information on the impact of an unplanned school closure on students and their families. Using social media to assess the impact of an unplanned school closure due to a public health event would be informative. An online workforce can effectively assist with the review process.

Online Work Force Analyzes Social Media to Identify Consequences of an Unplanned School Closure – Using Technology to Prepare for the Next Pandemic

PubMed Central

Rainey, Jeanette J.; Kenney, Jasmine; Wilburn, Ben; Putman, Ami; Zheteyeva, Yenlik; O’Sullivan, Megan

2016-01-01

Background During an influenza pandemic, the United States Centers for Disease Control and Prevention (CDC) may recommend school closures. These closures could have unintended consequences for students and their families. Publicly available social media could be analyzed to identify the consequences of an unplanned school closure. Methods As a proxy for an unplanned, pandemic-related school closure, we used the district-wide school closure due to the September 10–18, 2012 teachers’ strike in Chicago, Illinois. We captured social media posts about the school closure using the Radian6 social media-monitoring platform. An online workforce from Amazon Mechanical Turk categorized each post into one of two groups. The first group included relevant posts that described the impact of the closure on students and their families. The second group included irrelevant posts that described the political aspects of the strike or topics unrelated to the school closure. All relevant posts were further categorized as expressing a positive, negative, or neutral sentiment. We analyzed patterns of relevant posts and sentiment over time and compared our findings to household surveys conducted after other unplanned school closures. Results We captured 4,546 social media posts about the district-wide school closure using our search criteria. Of these, 930 (20%) were categorized as relevant by the online workforce. Of the relevant posts, 619 (67%) expressed a negative sentiment, 51 (5%) expressed a positive sentiment, and 260 (28%) were neutral. The number of relevant posts, and especially those with a negative sentiment, peaked on day 1 of the strike. Negative sentiment expressed concerns about childcare, missed school lunches, and the lack of class time for students. This was consistent with findings from previously conducted household surveys. Conclusion Social media are publicly available and can readily provide information on the impact of an unplanned school closure on students and their families. Using social media to assess the impact of an unplanned school closure due to a public health event would be informative. An online workforce can effectively assist with the review process. PMID:27655229

Efficacy of fibrin-sealants in reducing biliary leakage following laparoscopic common bile duct exploration.

PubMed

Parra-Membrives, Pablo; Martínez-Baena, Darío; Lorente-Herce, José Manuel; Martín-Balbuena, Ramón

2018-05-21

In spite of the acquired experience with laparoscopic common bile duct exploration (LCBDE) for choledocholithiasis management, there is still a risk of biliary leakage of 5% to 15% following choledochotomy closure. We evaluate the usefulness of fibrin-collagen sealants to reduce the incidence of biliary fistula after laparoscopic choledochorrhaphy. We report a retrospective analysis of 96 patients undergoing LCBDE from March 2009 to March 2017, whose closure of the bile duct was completed by antegrade stenting and choledochorraphy or by performing a primary suture. The study population was divided into two groups according to whether they received a collagen-fibrin sealant covering the choledochorrhaphy or not, analyzing the incidence of postoperative biliary fistula in each group. Thirty-nine patients (41%) received a fibrin-collagen sponge while the bile duct closure was not covered in the remaining 57 patients (59%). The incidence of biliary fistula was 7.7% (3 patients) in the first group and 14% (8 patients) in the second group (P=.338). In patients who underwent primary choledochorraphy, the fibrin-collagen sealant reduced the incidence of biliary leakage significantly (4.5% vs. 33%, P=.020), which was a protective factor with an odds ratio of 10.5. Fibrin-collagen sealants may decrease the incidence of biliary fistula in patients who have undergone primary bile duct closure following LCBDE. Copyright © 2018 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.

Comparison between two thoracotomy closure techniques: postoperative pain and pulmonary function*

PubMed Central

Leandro, Juliana Duarte; Rodrigues, Olavo Ribeiro; Slaets, Annie France Frere; Schmidt, Aurelino F.; Yaekashi, Milton L.

2014-01-01

OBJECTIVE: To compare two thoracotomy closure techniques (pericostal and transcostal suture) in terms of postoperative pain and pulmonary function. METHODS: This was a prospective, randomized, double-blind study carried out in the Department of Thoracic Surgery of the Luzia de Pinho Melo Hospital das Clínicas and at the University of Mogi das Cruzes, both located in the city of Mogi das Cruzes, Brazil. We included 30 patients (18-75 years of age) undergoing posterolateral or anterolateral thoracotomy. The patients were randomized into two groups by the type of thoracotomy closure: pericostal suture (PS; n = 16) and transcostal suture (TS; n = 14). Pain intensity during the immediate and late postoperative periods was assessed by a visual analogic scale and the McGill Pain Questionnaire. Spirometry variables (FEV1, FVC, FEV1/FVC ratio, and PEF) were determined in the preoperative period and on postoperative days 21 and 60. RESULTS: Pain intensity was significantly greater in the PS group than in the TS group. Between the preoperative and postoperative periods, there were decreases in the spirometry variables studied. Those decreases were significant in the PS group but not in the TS group. CONCLUSIONS: The patients in the TS group experienced less immediate and late post-thoracotomy pain than did those in the PS group, as well as showing smaller reductions in the spirometry parameters. Therefore, transcostal suture is recommended over pericostal suture as the thoracotomy closure technique of choice. PMID:25210961

Secondary angle closure caused by air migrating behind the pupil in descemet stripping endothelial keratoplasty.

PubMed

Lee, Jung S; Desai, Neel R; Schmidt, Gregory W; Jun, Albert S; Schein, Oliver D; Stark, Walter J; Eghrari, Allen O; Gottsch, John D

2009-07-01

To report secondary angle closure caused by air migrating behind the pupil in the context of intraocular pressure (IOP) elevation in the early postoperative period after Descemet stripping endothelial keratoplasty (DSEK). A retrospective case series was conducted on 100 consecutive DSEK cases from 90 patients undergoing DSEK because of corneal disease from Fuchs corneal dystrophy, pseudophakic bullous keratopathy, aphakic bullous keratopathy, and iridocorneal endothelial syndrome. Preoperative and postoperative slit-lamp examinations and IOP measurements were ascertained for all 100 eyes. Main outcome measures included preoperative and postoperative IOP. Thirteen of 100 eyes developed an IOP rise of greater than 30 mm Hg on the first postoperative day. Six of these 13 patients developed angle closure from air migrating posterior to the iris and causing iridocorneal adhesions. One of these 13 patients developed pupillary block from air anterior to iris. Six of 13 patients developed increased IOP without pupillary block or iridocorneal adhesions and had a history of preexisting primary or secondary glaucoma. A secondary angle closure associated with DSEK is reported with air migrating behind the iris, resulting in extensive iridocorneal adhesions. An acute increase in IOP after DSEK can also be induced by air anterior to the iris causing pupillary block. IOP spikes are much more common in the first few postoperative days after DSEK. Medical treatment can occasionally resolve air posterior to the iris, but if iridocorneal adhesions are extensive and persistent, air removal and angle reformation may be necessary.

Evaluation of a transient, simultaneous, arbitrary Lagrange-Euler based multi-physics method for simulating the mitral heart valve.

PubMed

Espino, Daniel M; Shepherd, Duncan E T; Hukins, David W L

2014-01-01

A transient multi-physics model of the mitral heart valve has been developed, which allows simultaneous calculation of fluid flow and structural deformation. A recently developed contact method has been applied to enable simulation of systole (the stage when blood pressure is elevated within the heart to pump blood to the body). The geometry was simplified to represent the mitral valve within the heart walls in two dimensions. Only the mitral valve undergoes deformation. A moving arbitrary Lagrange-Euler mesh is used to allow true fluid-structure interaction (FSI). The FSI model requires blood flow to induce valve closure by inducing strains in the region of 10-20%. Model predictions were found to be consistent with existing literature and will undergo further development.

Detection of patent ductus arteriosus with intraoperative transesophageal echocardiography in a patient undergoing closure of coronary artery to pulmonary artery fistula.

PubMed

Miyata, Yuka; Hayashi, Yukio

2017-01-01

Coronary artery to pulmonary artery fistula is an unusual vascular anomaly, and the shunt ratio of this fistula is usually small. We report anesthetic management of a 55-year-old female with annuloaortic ectasia, aortic valve regurgitation, and coronary artery to pulmonary artery fistula undergoing radical repair. We calculated the left-to-right shunt ratio after placement of a pulmonary artery catheter and found that the ratio was unexpectedly high. Thus, we explored the presence of another shunt by intraoperative transesophageal echocardiography and found patent ductus arteriosus undiagnosed before operation. A combination of a pulmonary artery catheter and transesophageal echocardiography is useful to explore the presence of another shunt, such as patent ductus arteriosus during anesthesia.

Urethral pressure reflectometry during intra-abdominal pressure increase-an improved technique to characterize the urethral closure function in continent and stress urinary incontinent women.

PubMed

Saaby, Marie-Louise; Klarskov, Niels; Lose, Gunnar

2013-11-01

to assess the urethral closure function by urethral pressure reflectometry (UPR) during intra-abdominal pressure-increase in SUI and continent women. Twenty-five urodynamically proven SUI women and eight continent volunteer women were assessed by ICIQ-SF, pad-weighing test, incontinence diary, and UPR. UPR was conducted during resting and increased intra-abdominal pressure (P(Abd)) by straining. Related values of P(Abd) and urethral opening pressure (P(o)) were plotted into an abdomino-urethral pressuregram. Linear regression of the values was conducted, and the slope of the line ("APIR") and the intercept with the y-axis found. By the equation of the line, Po was calculated for various values of P(Abd), for example, 50 cm H2O (P(o-Abd 50)). The resting P(o) (P(o-rest)) and APIR, respectively, significantly differed in SUI and continent women but could not separate the two groups. The urethral closure equation (UCE) based on P(o-rest) and APIR provided a more detailed characterization of a woman's closure function based on the permanent closure forces (primarily generated by the urethral sphincteric unit) and the adjunctive closure forces (primarily generated by the support system). P(o-Abd 50) and UCE, respectively, which express the combined permanent and adjunctive closure forces and estimate the efficiency of the closure function, separated SUI and continent women and were highly significantly negatively correlated with ICIQ-SF, pad test, and the number of incontinence episodes. New parameters for characterization of the urethral closure function and possible dysfunctions and its efficiency were provided. P(o-Abd 50) and UCE may be used as diagnostic tests and severity measures. © 2013 Wiley Periodicals, Inc.

Military Bases: Opportunities Exist to Improve Future Base Realignment and Closure Rounds

DTIC Science & Technology

2013-03-01

Operational Army—realigns Fort Bliss , TX; Fort Hood, TX; Fort Riley, KS; Fort Campbell, KY; and Fort Sill, OK to include rebasing of units from overseas to...Committee on Appropriations United States Senate The Honorable Tim Johnson Chairman The Honorable Mark Kirk Ranking Member Subcommittee on Military

Corrective Action Management Unit Report of Post-Closure Care Activities Calendar Year 2016.

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

Ziock, Robert; Little, Bonnie Colleen

The Corrective Action Management Unit (CAMU) at Sandia National Laboratories, New Mexico (SNL/NM) consisted of a containment cell, two treatment systems, four associated waste staging and storage areas, and support areas; all were used for management of remediation wastes between 1997 and 2003.

77 FR 22678 - Fisheries of the Northeastern United States; Atlantic Mackerel, Squid, and Butterfish Fisheries...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-04-17

.... 110707371-2136-02] RIN 0648- XB145 Fisheries of the Northeastern United States; Atlantic Mackerel, Squid, and Butterfish Fisheries; Closure of the Trimester 1 Longfin Squid Fishery AGENCY: National Marine Fisheries Service (NMFS), National Oceanic and Atmospheric Administration (NOAA), Commerce. ACTION...

40 CFR 239.6 - Permitting requirements.

Code of Federal Regulations, 2012 CFR

2012-07-01

... CFR part 257, subpart B or 40 CFR part 258 federal revised criteria. (e) For municipal solid waste... solid waste landfill units shall have a permit incorporating the conditions identified in paragraph (e... solid waste landfill units which achieve compliance with 40 CFR part 258, subpart E; (vi) Closure and...

40 CFR 239.6 - Permitting requirements.

Code of Federal Regulations, 2014 CFR

2014-07-01

... CFR part 257, subpart B or 40 CFR part 258 federal revised criteria. (e) For municipal solid waste... solid waste landfill units shall have a permit incorporating the conditions identified in paragraph (e... solid waste landfill units which achieve compliance with 40 CFR part 258, subpart E; (vi) Closure and...

40 CFR 239.6 - Permitting requirements.

Code of Federal Regulations, 2010 CFR

2010-07-01

... CFR part 257, subpart B or 40 CFR part 258 federal revised criteria. (e) For municipal solid waste... solid waste landfill units shall have a permit incorporating the conditions identified in paragraph (e... solid waste landfill units which achieve compliance with 40 CFR part 258, subpart E; (vi) Closure and...

Is size the only determinant of delayed abdominal closure in pediatric liver transplant?

PubMed

Khorsandi, Shirin Elizabeth; Day, Arthur William Raven; Cortes, Miriam; Deep, Akash; Dhawan, Anil; Vilca-Melendez, Hector; Heaton, Nigel

2017-03-01

The aim was to determine the factors associated with the use of delayed abdominal closure in pediatric liver transplantation (LT) and whether this affected outcome. From a prospectively maintained database, transplants performed in children (≤18 years) were identified (October 2010 to March 2015). Primary abdominal closure was defined as mass closure performed at time of transplant. Delayed abdominal closure was defined as mass closure not initially performed at the same time as transplant; 230 children underwent LT. Of these, 176 (76.5%) had primary closure. Age was similar between the primary and delayed groups (5.0 ± 4.9 versus 3.9 ± 5.0 years; P = 0.13). There was no difference in the graft-to-recipient weight ratio (GRWR) in the primary and delayed groups (3.4 ± 2.8 versus 4.1 ± 2.1; P = 0.12). Children with acute liver failure (ALF) were more likely to experience delayed closure then those with chronic liver disease (CLD; P < 0.001). GRWR was similar between the ALF and CLD (3.4 ± 2.4 versus 3.6 ± 2.7; P = 0.68). Primary closure children had a shorter hospital stay (P < 0.001), spent fewer days in pediatric intensive care unit (PICU; P = 0.001), and required a shorter duration of ventilation (P < 0.001). Vascular complications (arterial and venous) were similar (primary 8.2% versus delayed 5.6%; P = 0.52). Graft (P = 0.42) and child survival (P = 0.65) in the primary and delayed groups were similar. Considering timing of mass closure after transplant, patients in the early delayed closure group (<6 weeks) were found to experience a shorter time of ventilation (P = 0.03) and in PICU (P = 0.003). In conclusion, ALF was the main determinant of delayed abdominal closure rather than GRWR. The optimal time for delayed closure is within 6 weeks. The use of delayed abdominal closure does not adversely affect graft/child survival. Liver Transplantation 23 352-360 2017 AASLD. © 2016 by the American Association for the Study of Liver Diseases.

Closure Report for Corrective Action Unit 356: Mud Pits and Disposal Sites, Nevada Test Site, Nevada with Errata Sheet

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

NNSA /NV

2002-11-12

This Closure Report (CR) has been prepared for Corrective Action Unit (CAU) 356, Mud Pits and Disposal Sites, in accordance with the Federal Facility Agreement and Consent Order. This CAU is located in Areas 3 and 20 of the Nevada Test Site (NTS) approximately 65 miles northwest of Las Vegas, Nevada. Corrective Action Unit 356 consists of seven Corrective Action Sites (CASs): 03-04-01, Area 3 Change House Septic System; 03-09-01, Mud Pit Spill Over; 03-09-03, Mud Pit; 03-09-04, Mud Pit; 03-09-05, Mud Pit; 20-16-01, Landfill; and 20-22-21, Drums. This CR identifies and rationalizes the U.S. Department of Energy (DOE), Nationalmore » Nuclear Security Administration Nevada Operations Office's (NNSA/NV's) recommendation that no further corrective action and closure in place is deemed necessary for CAU 356. This recommendation is based on the results of field investigation/closure activities conducted November 20, 2001, through January 3, 2002, and March 11 to 14, 2002. These activities were conducted in accordance with the Streamlined Approach for Environmental Restoration Plan (SAFER) for CAU 356. For CASs 03-09-01, 03-09-03, 20-16-01, and 22-20-21, analytes detected in soil during the corrective action investigation were evaluated against Preliminary Action Levels (PALs) and it was determined that no Contaminants of Concern (COCs) were present. Therefore, no further action is necessary for the soil at these CASs. For CASs 03-04-01, 03-09-04, and 03-09-05, analytes detected in soil during the corrective action investigation were evaluated against PALs and identifies total petroleum hydrocarbons (TPHs) and radionuclides (i.e., americium-241 and/or plutonium 239/240) as COCs. The nature, extent, and concentration of the TPH and radionuclide COCs were bounded by sampling and shown to be relatively immobile. Therefore, closure in place is recommended for these CASs in CAU 356. Further, use restrictions are not required at this CAU beyond the NTS use restrictions identified in the SAFER Plan. In addition, the septic tank associated with CAU 356 will be closed in accordance with applicable regulations.« less

Closure Report for Corrective Action Unit 544: Cellars, Mud Pits, and Oil Spills, Nevada National Security Site, Nevada, Revision 0

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

Mark Krauss and Catherine Birney

2011-05-01

This Closure Report (CR) presents information supporting the closure of Corrective Action Unit (CAU) 544: Cellars, Mud Pits, and Oil Spills, Nevada National Security Site, Nevada. This CR complies with the requirements of the Federal Facility Agreement and Consent Order that was agreed to by the State of Nevada; U.S. Department of Energy (DOE), Environmental Management; U.S. Department of Defense; and DOE, Legacy Management. The corrective action sites (CASs) within CAU 544 are located within Areas 2, 7, 9, 10, 12, 19, and 20 of the Nevada National Security Site. Corrective Action Unit 544 comprises the following CASs: • 02-37-08,more » Cellar & Mud Pit • 02-37-09, Cellar & Mud Pit • 07-09-01, Mud Pit • 09-09-46, U-9itsx20 PS #1A Mud Pit • 10-09-01, Mud Pit • 12-09-03, Mud Pit • 19-09-01, Mud Pits (2) • 19-09-03, Mud Pit • 19-09-04, Mud Pit • 19-25-01, Oil Spill • 19-99-06, Waste Spill • 20-09-01, Mud Pits (2) • 20-09-02, Mud Pit • 20-09-03, Mud Pit • 20-09-04, Mud Pits (2) • 20-09-06, Mud Pit • 20-09-07, Mud Pit • 20-09-10, Mud Pit • 20-25-04, Oil Spills • 20-25-05, Oil Spills The purpose of this CR is to provide documentation supporting the completed corrective actions and data confirming that the closure objectives for CASs within CAU 544 were met. To achieve this, the following actions were performed: • Review the current site conditions, including the concentration and extent of contamination. • Implement any corrective actions necessary to protect human health and the environment. • Properly dispose of corrective action and investigation wastes. • Document Notice of Completion and closure of CAU 544 issued by the Nevada Division of Environmental Protection.« less

Intraperitoneal bupivacaine with or without incisional bupivacaine for postoperative analgesia in dogs undergoing ovariohysterectomy.

PubMed

Kalchofner Guerrero, Karin S; Campagna, Ivo; Bruhl-Day, Rodolfo; Hegamin-Younger, Cecilia; Guerrero, Tomas G

2016-09-01

Intraperitoneal (IP) bupivacaine provides postoperative analgesia in dogs undergoing ovariohysterectomy (OHE) alone or in combination with incisional (INC) bupivacaine. This study investigated whether the combination of INC and IP bupivacaine is superior to IP bupivacaine alone. Prospective, randomized, blinded clinical study. Thirty-nine privately owned dogs undergoing OHE, aged 25 ± 23 months and weighing 11.8 ± 5.7 kg. Dogs were premedicated with acepromazine (0.05 mg kg(-1) ) and morphine (0.5 mg kg(-1) ) intramuscularly (IM); anaesthesia was induced with propofol and maintained with isoflurane in oxygen. Carprofen (4 mg kg(-1) ) was administered subcutaneously (SC) after intubation. Bupivacaine (3 mg kg(-1) ) IP was administered before complete closure of the linea alba to all dogs. Dogs were randomly assigned into two groups: group B received bupivacaine (n = 20; 1 mg kg(-1) ) and group S received saline (n = 19; 0.2 mL kg(-1) ) INC as a subcutaneous 'splash' before skin closure. Postoperative analgesia was assessed with a dynamic interactive visual analogue scale, the short form of the Glasgow Composite Pain Scale, and mechanical nociceptive threshold (MNT) measurement at 0.5, 1, 2, 4, 6, 8, 12 and 20 hours after surgery by one blinded observer. Parametric data were tested using t-test; nonparametric data were analysed using the two-sample Wilcoxon test (p < 0.05). There was no significant difference between groups with regard to age, weight, surgical and anaesthetic duration, incision length, sedation and pain scores. MNT values decreased in both groups at all time points as compared with the baseline. No dog required rescue analgesia. No postoperative complications were observed. Bupivacaine IP and carprofen SC after morphine IM did provide satisfactory postoperative analgesia in dogs undergoing OHE with the anaesthetic protocol used. There appears to be no clinical advantage to adding bupivacaine INC. Neither protocol could prevent the development of primary hyperalgesia. © 2016 Association of Veterinary Anaesthetists and the American College of Veterinary Anesthesia and Analgesia.

Transcatheter closure of patent foramen ovale for secondary prevention of ischemic stroke: Quantitative synthesis of pooled randomized trial data.

PubMed

Hakeem, Abdul; Cilingiroglu, Mehmet; Katramados, Angelos; Boudoulas, Konstantinos Dean; Iliescu, Cezar; Gundogdu, Betul; Marmagkiolis, Konstantinos

2018-01-14

To evaluate the safety and efficacy of percutaneous device closure of patent foramen ovale (PFO) for secondary prevention of ischemic stroke BACKGROUND: Stroke remains the leading cause of serious long-term disability in the United States. The effectiveness of a percutaneous PFO closure in the prevention of recurrent cryptogenic strokes has not been established. We performed a literature search using PubMed, EMBASE, Cochrane Central Register of Controlled Trials, Google Scholar, and Internet-based sources from January 2003 to September 2017. Randomized controlled trails (RCTs) comparing percutaneous PFO closure to medical therapy alone. Five RCTs (CLOSURE I, PC Trial, REDUCE, RESPECT, and CLOSE) with 1,829 patients in the device group and 1,611 patients in the medical group met inclusion criteria. The cumulative incidence of recurrent stroke was 2.02% in the PFO closure arm and 4.4% in the medical therapy group (RR 0.42, 95%CI 0.20, 0.91; P = 0.03). There was no difference in the incidence of death [0.7% vs. 0.9%; RR 0.76 (95% CI 0.35, 1.64), P = 0.49] or adverse events during the follow-up period [24.6% vs. 23.7% (RR 1.03; 95% CI 0.91, 1.16), P = 0.65] between the closure and medical therapy groups. Incidence of atrial fibrillation was significantly higher in closure group compared to medical therapy [4% vs. 0.6% (RR 4.73; 95% CI 2.09, 10.70), P = 0.0002]. The comparative effectiveness of PFO closure (compared to medical therapy) was significantly more pronounced in those younger than 45 years, males, larger shunts and disc design platforms (P < 0.05). Based on the results of this analysis of randomized trial data, percutaneous PFO closure appears to be a safe and effective therapeutic option for the secondary prevention of ischemic stroke in patients with PFO and cryptogenic stroke. © 2018 Wiley Periodicals, Inc.

The Hanikoda Method: 3-layered Negative Pressure Wound Therapy in Wound Bed Preparation.

PubMed

Chik, Ian; Kelly, Enda G; Jarmin, Razman; Imran, Farrah-Hani

2016-10-01

Negative pressure wound therapy is a widely used method of wound dressing with various commercially available brands. The authors created the Hanikoda Method (HM) for effective wound bed preparation or definite wound closure. In this case series, the authors discuss 8 different wound cases that presented to their Plastics Unit from January 2014 to June 2015. Patients with traumatic or infected wounds were selected for treatment with the HM. Selected patients underwent multiple cycles of this method until their wounds were ready for definite wound closure or the wounds had closed by secondary closure. The purpose of any wound dressing is to encourage epithelization while ensuring no factors impede wound healing. An additional benefit is to reduce wound bed size so that it may close by secondary intention or require less skin graft coverage. Each layer of the dressing is described, along with its function in wound bed preparation or in closure. The HM facilitates reduction of wound size, wound bed preparation, and overall management.

Vascular Closure Devices in Interventional Radiology Practice

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

Patel, Rafiuddin, E-mail: rafiuddin.patel@ouh.nhs.uk; Muller-Hulsbeck, Stefan, E-mail: muehue@diako.de; Morgan, Robert, E-mail: robert.morgan@stgeorges.nhs.uk

2015-08-15

Manual compression (MC) is a well-established technique for haemostasis following percutaneous arterial intervention. However, MC is labour and time intensive with potential limitations, particularly for patients who are coagulopathic, unable to comply with bed rest or obese and when large sheaths or anti-coagulants are used. There are a variety of vascular closure devices (VCDs) available to overcome these limitations. This review gives an overview of current VCDs, their mechanism of action, individual strengths and weaknesses, evidence base and utility in interventional radiology (IR) practice. The majority of the published evidence on VCDs is derived from patients undergoing cardiac interventions, whichmore » should be borne in mind when considering the applicability and transfer of this data for general IR practice. Overall, the evidence suggests that most VCDs are effective in achieving haemostasis with a similar rate of complications to MC although the complication profile associated with VCDs is distinct to that of MC. There is insufficient evidence to comparatively analyse the different types of VCDs currently available or reliably judge their cost-effectiveness. The interventional radiologist should have a thorough understanding of the available techniques for haemostasis and be able to identify and utilise the most appropriate strategy and closure technique for the individual patient.« less

In vivo carotid artery closure by laser activation of hyaluronan-embedded gold nanorods

NASA Astrophysics Data System (ADS)

Matteini, Paolo; Ratto, Fulvio; Rossi, Francesca; Rossi, Giacomo; Esposito, Giuseppe; Puca, Alfredo; Albanese, Alessio; Maira, Giulio; Pini, Roberto

2010-07-01

We prove the first application of near-infrared-absorbing gold nanorods (GNRs) for in vivo laser closure of a rabbit carotid artery. GNRs are first functionalized with a biopolymeric shell and then embedded in hyaluronan, which gives a stabilized and handy laser-activable formulation. Four rabbits undergo closure of a 3-mm longitudinal incision performed on the carotid artery by means of a 810-nm diode laser in conjunction with the topical application of the GNRs composite. An effective surgery is obtained by using a 40-W/cm2 laser power density. The histological and electron microscopy evaluation after a 30-day follow-up demonstrates complete healing of the treated arteries with full re-endothelization at the site of GNRs application. The absence of microgranuloma formation and/or dystrophic calcification is evidence that no host reaction to nanoparticles interspersed through the vascular tissue occurred. The observation of a reshaping and associated blue shift of the NIR absorption band of GNRs after laser treatment supports the occurrence of a self-terminating process, and thus of additional safety of the minimally invasive laser procedure. This study underlines the feasibility of using GNRs for in vivo laser soldering applications, which represents a step forward toward the introduction of nanotechnology-based therapies in minimally invasive clinical practices.

[Pancreatic fistula after left pancreatectomy. Risk factors analysis on 68 patients].

PubMed

Pericoli Ridolfini, M; Alfieri, S; Gourgiotis, S; Di Miceli, D; Quero, G; Rotondi, F; Caprino, P; Sofo, L; Doglietto, B G

2008-06-01

The aim of this study was to identify risk factors related to pancreatic fistula after left pancreatectomy, considering the difference between the use of mechanical suture and the manual suture to close the pancreatic stump. Sixty-eight patients, undergoing left pancreatectomy, were included in this study during a 10-year period. Eight possible risk factors related to pancreatic fistula were examined, such as demographic data (age and sex), pathology (pancreatic and extrapancreatic), technical characteristics (stump closure, concomitant splenectomy, additional procedures), texture of pancreatic parenchyma, octreotide therapy. Fourty-one patients (60%) underwent left pancreatectomy for primary pancreatic disease and 27 (40%) for extrapancreatic malignancy. Postoperative mortality and morbidity rates were 1.5% and 35%, respectively. Fourteen patients (20%) developed pancreatic fistula: 4 of them were classified as Grade A, 9 as Grade B and only one as Grade C. Three factors have been significantly associated to the incidence of pancreatic fistula: none prophylactic octreotide therapy, spleen preserving and soft pancreatic texture. It's still unclear the influence of pancreatic stump closure (stapler vs hand closure) in the onset of pancreatic fistula. In this study the incidence of pancreatic fistula after left pancreatectomy has been 20%. This rate is lower for patients with fibrotic pancreatic tissue, concomitant splenectomy and postoperative prophylactic octreotide therapy.

40 CFR 267.115 - After I stop operating, how long until I must close?

Code of Federal Regulations, 2014 CFR

2014-07-01

... (CONTINUED) SOLID WASTES (CONTINUED) STANDARDS FOR OWNERS AND OPERATORS OF HAZARDOUS WASTE FACILITIES...? (a) Within 90 days after the final volume of hazardous waste is sent to a unit, you must treat or remove from the unit all hazardous wastes following the approved closure plan. (b) You must complete...

40 CFR 267.115 - After I stop operating, how long until I must close?

Code of Federal Regulations, 2010 CFR

2010-07-01

... (CONTINUED) SOLID WASTES (CONTINUED) STANDARDS FOR OWNERS AND OPERATORS OF HAZARDOUS WASTE FACILITIES...? (a) Within 90 days after the final volume of hazardous waste is sent to a unit, you must treat or remove from the unit all hazardous wastes following the approved closure plan. (b) You must complete...

40 CFR 267.115 - After I stop operating, how long until I must close?

Code of Federal Regulations, 2011 CFR

2011-07-01

... (CONTINUED) SOLID WASTES (CONTINUED) STANDARDS FOR OWNERS AND OPERATORS OF HAZARDOUS WASTE FACILITIES...? (a) Within 90 days after the final volume of hazardous waste is sent to a unit, you must treat or remove from the unit all hazardous wastes following the approved closure plan. (b) You must complete...

77 FR 52262 - Fisheries of the Northeastern United States; Summer Flounder Fishery; Commercial Quota Harvested...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-08-29

.... 111220786-1781-01] RIN 0648-XC176 Fisheries of the Northeastern United States; Summer Flounder Fishery...; closure. SUMMARY: NMFS announces that the 2012 summer flounder commercial quota allocated to the... summer flounder fishery may not land summer flounder in Massachusetts for the remainder of calendar year...

75 FR 52890 - Fisheries of the Northeastern United States; Summer Flounder Fishery; Commercial Quota Harvested...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-30

.... 0908191244-91427ndash;02] RIN 0648-XY35 Fisheries of the Northeastern United States; Summer Flounder Fishery...; closure. SUMMARY: NMFS announces that the 2010 summer flounder commercial quota allocated to the... summer flounder fishery may not land summer flounder in Massachusetts for the remainder of calendar year...

78 FR 51096 - Fisheries of the Northeastern United States; Summer Flounder Fishery; Commercial Quota Harvested...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-20

.... 111220786-1781-01] RIN 0648-XC811 Fisheries of the Northeastern United States; Summer Flounder Fishery...; closure. SUMMARY: NMFS announces that the 2013 summer flounder commercial quota allocated to the... summer flounder fishery may not land summer flounder in Massachusetts for the remainder of calendar year...

75 FR 44144 - Washington: Final Authorization of State Hazardous Waste Management Program Revisions

Federal Register 2010, 2011, 2012, 2013, 2014

2010-07-28

....19. 400(3)(c)(xiii)(A) Correction--the 265.300 Subpart word N--Landfills, carbonaceous related... recycling Subpart G exception from related; closure and 264.140, financial 265.140 Subpart responsibility H...) Correction--chang 264.143. e ``resource reclamation units'' to ``recycling units''. 620(4)(d)(iv...

Corrective Action Decision Document/Closure Report for Corrective Action Unit 367: Area 10 Sedan, Ess and Uncle Unit Craters Nevada National Security Site, Nevada, Revision 0

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

Patrick Matthews

2011-06-01

Corrective Action Unit 367 comprises four corrective action sites (CASs): • 10-09-03, Mud Pit • 10-45-01, U-10h Crater (Sedan) • 10-45-02, Ess Crater Site • 10-45-03, Uncle Crater Site The purpose of this Corrective Action Decision Document/Closure Report is to provide justification and documentation of the corrective actions and site closure activities implemented at CAU 367. A corrective action of closure in place with use restrictions was completed at each of the three crater CASs (10-45-01, 10-45-02, and 10-45-03); corrective actions were not required at CAS 10-09-03. In addition, a limited soil removal corrective action was conducted at the locationmore » of a potential source material release. Based on completion of these correction actions, no additional corrective action is required at CAU 367, and site closure is considered complete. Corrective action investigation (CAI) activities were performed from February 2010 through March 2011, as set forth in the Corrective Action Investigation Plan for Corrective Action Unit 367: Area 10 Sedan, Ess and Uncle Unit Craters, Nevada Test Site, Nevada. The approach for the CAI was divided into two facets: investigation of the primary release of radionuclides, and investigation of non-test or other releases (e.g., migration in washes and potential source material). Based on the proximity of the Uncle, Ess, and Sedan craters, the impact of the Sedan test on the fallout deposited from the two earlier tests, and aerial radiological surveys, the CAU 367 investigation was designed to study the releases from the three crater CASs as one combined release (primary release). Corrective Action Site 10-09-03, Mud Pit, consists of two mud pits identified at CAU 367. The mud pits are considered non-test releases or other releases and were investigated independent of the three crater CASs. The purpose of the CAI was to fulfill data needs as defined during the data quality objective (DQO) process. The CAU 367 dataset of investigation results was evaluated based on a data quality assessment. This assessment demonstrated the dataset is complete and acceptable for use in fulfilling the DQO data needs. Analytes detected during the CAI were evaluated against final action levels (FALs) established in this document. For the primary release, radiological doses exceeding the FAL of 25 millirem per year were not found to be present in the surface or shallow subsurface soil outside the default contamination boundary. However, it was assumed that radionuclides are present in subsurface media within each of the three craters (Sedan, Ess, and Uncle) due to prompt injection of radionuclides from the tests. Based on the assumption of radiological dose exceeding the FAL, corrective actions were undertaken that consisted of implementing a use restriction and posting warning signs at each crater CAS. These use restrictions were recorded in the FFACO database; the U.S. Department of Energy, National Nuclear Security Administration Nevada Site Office (NNSA/NSO) Facility Information Management System; and the NNSA/NSO CAU/CAS files. With regard to other releases, no contaminants of concern were identified at the mud pits or any of the other release locations, with one exception. Potential source material in the form of lead was found at one location. A corrective action of clean closure was implemented at this location, and verification samples indicated that no further action is necessary. Therefore, NNSA/NSO provides the following recommendations: • A Notice of Completion to NNSA/NSO is requested from the Nevada Division of Environmental Protection for closure of CAU 367. • Corrective Action Unit 367 should be promoted from Appendix III to Appendix IV of the FFACO.« less

Thermic sealing in femoral catheterisation: First experience with the Secure Device.

PubMed

Sacherer, Michael; Kolesnik, Ewald; von Lewinski, Friederike; Verheyen, Nicolas; Brandner, Karin; Wallner, Markus; Eaton, Deborah M; Luha, Olev; Zweiker, Robert; von Lewinski, Dirk

2018-04-03

Devices currently used to achieve hemostasis of the femoral artery following percutaneous cardiac catheterization are associated with vascular complications and remnants of artificial materials are retained at the puncture site. The SECURE arterial closure device induces hemostasis by utilizing thermal energy, which causes collagen shrinking and swelling. In comparison to established devices, it has the advantage of leaving no foreign material in the body following closing. This study was designed to evaluate the efficacy and safety of the SECURE device to close the puncture site following percutaneous cardiac catheterization. The SECURE device was evaluated in a prospective non-randomized single-centre trial with patients undergoing 6 F invasive cardiac procedures. A total of 67 patients were enrolled and the device was utilized in 63 patients. 50 diagnostic and 13 interventional cases were evaluated. Femoral artery puncture closure was performed immediately after completion of the procedure. Time to hemostasis (TTH), time to ambulation (TTA) and data regarding short-term and 30-day clinical follow-up were recorded. Mean TTH was 4:30 ± 2:15 min in the overall observational group. A subpopulation of patients receiving anticoagulants had a TTH of 4:53 ± 1:43 min. There were two access site complications (hematoma > 5 cm). No major adverse events were identified during hospitalization or at the 30 day follow-up. The new SECURE device demonstrates that it is feasible in diagnostic and interventional cardiac catheterization. With respect to safety, the SECURE device was non-inferior to other closure devices as tested in the ISAR closure trial.

Morphologic changes of the anal sphincter musculature during and after temporary stool deviation.

PubMed

Sailer, M; Fein, M; Fuchs, K H; Bussen, D; Grun, C; Thiede, A

2001-04-01

Temporary stool deviation, using a stoma, is a well-known surgical principle to protect low colorectal or coloanal anastomoses. The purpose of this study was to evaluate any morphologic changes with regard to the anal sphincter muscles during and after temporary ileostomy. Forty-four patients with rectal carcinomas were studied prospectively. All patients underwent low anterior resection. Reconstruction was performed using either a coloanal pouch or a straight end-to-end anastomosis. A protective stoma was fashioned in all 44 patients (ileostomy n=41; colostomy n=3). Stoma closure was carried out after a median of 85 days (41-330 days). Using a standard protocol, anal-sphincter thickness [m. puborectalis, external anal sphincter (EAS) and internal anal (IAS) sphincter] was assessed by means of endoanal ultrasonography preoperatively, at the time of stoma closure, and every 3 months thereafter for 1 year. The diameter of the puborectal muscle decreased from a median preoperative value of 6.3 mm to 5.7 mm at the time of stoma closure (P=0.03). After 3 months, 6.2 mm was measured. This value remained stable for the complete follow-up period. Similar results were recorded for the EAS. The IAS thickness remained stable throughout the study period, measuring between 2.1 mm and 2.4 mm. Temporary stool deviation does lead to morphologic changes of the anal sphincter. While the smooth muscle remains unchanged, the striated counterpart undergoes atrophic transformation. However, after passage reconstruction, i.e., stoma closure, a rapid regeneration of the voluntary muscles is observed.

Flap reconstruction does not increase complication rates following surgical resection of extremity soft tissue sarcoma.

PubMed

Slump, Jelena; Hofer, Stefan O P; Ferguson, Peter C; Wunder, Jay S; Griffin, Anthony M; Hoekstra, Harald J; Bastiaannet, Esther; O'Neill, Anne C

2018-02-01

Flap reconstruction plays an essential role in the surgical management of extremity soft tissue sarcoma (ESTS) for many patients. But flaps increase the duration and complexity of the surgery and their contribution to overall morbidity is unclear. This study directly compares the complication rates in patients with ESTS undergoing either flap reconstruction or primary wound closure and explores contributing factors. Eight hundred and ninety-seven patients who underwent ESTS resection followed by primary closure (631) or flap reconstruction (266) were included in this study. Data on patient, tumour and treatment variables and post-operative medical and surgical complications were collected. Univariate and multivariate regression analyses were performed to identify independent predictors of complications. Post-operative complications occurred in 33% of patients. Flap patients were significantly older, had more advanced disease and were more likely to require neoadjuvant chemo- and radiotherapy. There was no significant difference in complication rates following flap reconstruction compared to primary closure on multivariate analysis (38 vs 30.9% OR 1.12, CI 0.77-1.64, p = 0.53). Pre-operative radiation and distal lower extremity tumour location were significant risk factors in patients who underwent primary wound closure but not in those who had flap reconstruction. Patients with comorbidities, increased BMI and systemic disease were at increased risk of complications following flap reconstruction. Flap reconstruction is not associated with increased post-operative complications following ESTS resection. Flaps may mitigate the effects of some risk factors in selected patients. Copyright © 2017. Published by Elsevier Ltd.

Corrective Action Decision Document/Closure Report for Corrective Action Unit 371: Johnnie Boy Crater and Pin Stripe Nevada Test Site, Nevada, Revision 0

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

Patrick Matthews

This Corrective Action Decision Document/Closure Report has been prepared for Corrective Action Unit 371, Johnnie Boy Crater and Pin Stripe, located within Areas 11 and 18 at the Nevada Test Site, Nevada, in accordance with the Federal Facility Agreement and Consent Order (FFACO). Corrective Action Unit (CAU) 371 comprises two corrective action sites (CASs): • 11-23-05, Pin Stripe Contamination Area • 18-45-01, U-18j-2 Crater (Johnnie Boy) The purpose of this Corrective Action Decision Document/Closure Report is to provide justification and documentation supporting the recommendation that no further corrective action is needed for CAU 371 based on the implementation of correctivemore » actions. The corrective action of closure in place with administrative controls was implemented at both CASs. Corrective action investigation (CAI) activities were performed from January 8, 2009, through February 16, 2010, as set forth in the Corrective Action Investigation Plan for Corrective Action Unit 371: Johnnie Boy Crater and Pin Stripe. The approach for the CAI was divided into two facets: investigation of the primary release of radionuclides and investigation of other releases (migration in washes and chemical releases). The purpose of the CAI was to fulfill data needs as defined during the data quality objective (DQO) process. The CAU 371 dataset of investigation results was evaluated based on the data quality indicator parameters. This evaluation demonstrated the dataset is acceptable for use in fulfilling the DQO data needs. Analytes detected during the CAI were evaluated against final action levels (FALs) established in this document. Radiological doses exceeding the FAL of 25 millirem per year were not found to be present in the surface soil. However, it was assumed that radionuclides are present in subsurface media within the Johnnie Boy crater and the fissure at Pin Stripe. Due to the assumption of radiological dose exceeding the FAL, corrective actions were undertaken that consist of implementing a use restriction and posting warning signs at each site. These use restrictions were recorded in the FFACO database; the U.S. Department of Energy, National Nuclear Security Administration Nevada Site Office (NNSA/NSO) Facility Information Management System; and the NNSA/NSO CAU/CAS files. Therefore, NNSA/NSO provides the following recommendations: • No further corrective actions are necessary for CAU 371. • A Notice of Completion to NNSA/NSO is requested from the Nevada Division of Environmental Protection for closure of CAU 371. • Corrective Action Unit 371 should be moved from Appendix III to Appendix IV of the FFACO.« less

32 CFR 174.18 - Historic preservation.

Code of Federal Regulations, 2010 CFR

2010-07-01

... REVITALIZING BASE CLOSURE COMMUNITIES AND ADDRESSING IMPACTS OF REALIGNMENT Environmental Matters § 174.18... planning and zoning actions undertaken by units of State or local government; if so, working with such...

32 CFR 174.18 - Historic preservation.

Code of Federal Regulations, 2011 CFR

2011-07-01

... REVITALIZING BASE CLOSURE COMMUNITIES AND ADDRESSING IMPACTS OF REALIGNMENT Environmental Matters § 174.18... planning and zoning actions undertaken by units of State or local government; if so, working with such...

Closure Report for Corrective Action Unit 224: Decon Pad and Septic Systems, Nevada Test Site, Nevada

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

NSTec Environmental Restoration

Corrective Action Unit (CAU) 224 is located in Areas 02, 03, 05, 06, 11, and 23 of the Nevada Test Site, which is situated approximately 65 miles northwest of Las Vegas, Nevada. CAU 224 is listed in the Federal Facility Agreement and Consent Order (FFACO) of 1996 as Decon Pad and Septic Systems and is comprised of the following nine Corrective Action Sites (CASs): CAS 02-04-01, Septic Tank (Buried); CAS 03-05-01, Leachfield; CAS 05-04-01, Septic Tanks (4)/Discharge Area; CAS 06-03-01, Sewage Lagoons (3); CAS 06-05-01, Leachfield; CAS 06-17-04, Decon Pad and Wastewater Catch; CAS 06-23-01, Decon Pad Discharge Piping; CASmore » 11-04-01, Sewage Lagoon; and CAS 23-05-02, Leachfield. The Nevada Division of Environmental Protection (NDEP)-approved corrective action alternative for CASs 02-04-01, 03-05-01, 06-03-01, 11-04-01, and 23-05-02 is no further action. As a best management practice, the septic tanks and distribution box were removed from CASs 02-04-01 and 11-04-01 and disposed of as hydrocarbon waste. The NDEP-approved correction action alternative for CASs 05-04-01, 06-05-01, 06-17-04, and 06-23-01 is clean closure. Closure activities for these CASs included removing and disposing of radiologically and pesticide-impacted soil and debris. CAU 224 was closed in accordance with the NDEP-approved CAU 224 Corrective Action Plan (CAP). The closure activities specified in the CAP were based on the recommendations presented in the CAU 224 Corrective Action Decision Document (U.S. Department of Energy, National Nuclear Security Administration Nevada Site Office, 2005). This Closure Report documents CAU 224 closure activities. During closure activities, approximately 60 cubic yards (yd3) of mixed waste in the form of soil and debris; approximately 70 yd{sup 3} of sanitary waste in the form of soil, liquid from septic tanks, and concrete debris; approximately 10 yd{sup 3} of hazardous waste in the form of pesticide-impacted soil; approximately 0.5 yd{sup 3} of universal waste in the form of fluorescent light bulbs; and approximately 0.5 yd{sup 3} of low-level waste in the form of a radiologically impacted fire hose rack were generated, managed, and disposed of appropriately. Waste minimization techniques, such as the utilization of laboratory analysis and field screening to guide the extent of excavations, were employed during the performance of closure work.« less

Jam proof closure assembly for lidded pressure vessels

DOEpatents

Cioletti, Olisse C.

1992-01-01

An expendable closure assembly is provided for use (in multiple units) with a lockable pressure vessel cover along its rim, such as of an autoclave. This assembly is suited to variable compressive contact and locking with the vessel lid sealing gasket. The closure assembly consists of a thick walled sleeve insert for retention in the under bores fabricated in the cover periphery and the sleeve is provided with internal threading only. A snap serves as a retainer on the underside of the sleeve, locking it into an under bore retention channel. Finally, a standard elongate externally threaded bolt is sized for mating cooperation with the so positioned sleeve, whereby the location of the bolt shaft in the cover bore hole determines its compressive contact on the underlying gasket.

Stapler versus scalpel resection followed by hand-sewn closure of the pancreatic remnant for distal pancreatectomy.

PubMed

Probst, Pascal; Hüttner, Felix J; Klaiber, Ulla; Knebel, Phillip; Ulrich, Alexis; Büchler, Markus W; Diener, Markus K

2015-11-06

Resections of the pancreatic body and tail reaching to the left of the superior mesenteric vein are defined as distal pancreatectomy. Most distal pancreatectomies are elective treatments for chronic pancreatitis, benign or malignant diseases, and they have high morbidity rates of up to 40%. Pancreatic fistula formation is the main source of postoperative morbidity, associated with numerous further complications. Researchers have proposed several surgical resection and closure techniques of the pancreatic remnant in an attempt to reduce these complications. The two most common techniques are scalpel resection followed by hand-sewn closure of the pancreatic remnant and stapler resection and closure. To compare the rates of pancreatic fistula in people undergoing distal pancreatectomy using scalpel resection followed by hand-sewn closure of the pancreatic remnant versus stapler resection and closure. We searched Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, Biosis and Science Citation Index from database inception to October 2015. We included randomised controlled trials (RCTs) comparing stapler versus scalpel resection followed by hand-sewn closure of the pancreatic remnant for distal pancreatectomy (irrespective of language or publication status). Two authors independently assessed trials for inclusion and extracted the data. Taking into consideration the clinical heterogeneity between the trials (e.g. different endpoint definitions), we analysed data using a random-effects model with Review Manager (RevMan), calculating risk ratio (RR) or mean difference (MD) with 95% confidence intervals (CI). In two eligible trials, a total of 381 participants underwent distal pancreatic resection and were randomised to closure of the pancreatic remnant either with stapler (n = 191) or scalpel resection followed by hand-sewn closure (n = 190). One was a single centre pilot RCT and the other was a multicentre blinded RCT. The single centre pilot RCT evaluated 69 participants in five intervention arms (stapler, hand-sewn, fibrin glue, mesh and pancreaticojejunostomy), although we only assessed the stapler and hand-sewn closure groups (14 and 15 participants, respectively). The multicentre RCT had two interventional arms: stapler (n = 177) and hand-sewn closure (n = 175). The rate of postoperative pancreatic fistula was the main outcome, and it occurred in 79 of 190 participants in the hand-sewn group compared to 65 of 191 participants in the stapler group. Neither the individual trials nor the meta-analysis showed a significant difference between resection techniques (RR 0.90; 95% CI 0.55 to 1.45; P = 0.66). In the same way, postoperative mortality and operation time did not differ significantly. The single centre RCT had an unclear risk of bias in the randomisation, allocation and both blinding domains. However, the much larger multicentre RCT had a low risk of bias in all domains. Due to the small number of events and the wide confidence intervals that cannot exclude clinically important benefit or harm with stapler versus hand-sewn closure, there is a serious possibility of imprecision, making the overall quality of evidence moderate. The quality of evidence is moderate and mainly based on the high weight of the results of one multicentre RCT. Unfortunately, there are no other completed RCTs on this topic except for one relevant ongoing trial. Neither stapler nor scalpel resection followed by hand-sewn closure of the pancreatic remnant for distal pancreatectomy showed any benefit compared to the other method in terms of postoperative pancreatic fistula, overall postoperative mortality or operation time. Currently, the choice of closure is left up to the preference of the individual surgeon and the anatomical characteristics of the patient. Another (non-European) multicentre trial (e.g. with an equality or non-inferiority design) would help to corroborate the findings of this meta-analysis. Future trials assessing novel methods of stump closure should compare them either with stapler or hand-sewn closure as a control group to ensure comparability of results.

Polarization curling and flux closures in multiferroic tunnel junctions

NASA Astrophysics Data System (ADS)

Peters, Jonathan J. P.; Apachitei, Geanina; Beanland, Richard; Alexe, Marin; Sanchez, Ana M.

2016-11-01

Formation of domain walls in ferroelectrics is not energetically favourable in low-dimensional systems. Instead, vortex-type structures are formed that are driven by depolarization fields occurring in such systems. Consequently, polarization vortices have only been experimentally found in systems in which these fields are deliberately maximized, that is, in films between insulating layers. As such configurations are devoid of screening charges provided by metal electrodes, commonly used in electronic devices, it is wise to investigate if curling polarization structures are innate to ferroelectricity or induced by the absence of electrodes. Here we show that in unpoled Co/PbTiO3/(La,Sr)MnO3 ferroelectric tunnel junctions, the polarization in active PbTiO3 layers 9 unit cells thick forms Kittel-like domains, while at 6 unit cells there is a complex flux-closure curling behaviour resembling an incommensurate phase. Reducing the thickness to 3 unit cells, there is an almost complete loss of switchable polarization associated with an internal gradient.

Polarization curling and flux closures in multiferroic tunnel junctions

PubMed Central

Peters, Jonathan J. P.; Apachitei, Geanina; Beanland, Richard; Alexe, Marin; Sanchez, Ana M.

2016-01-01

Formation of domain walls in ferroelectrics is not energetically favourable in low-dimensional systems. Instead, vortex-type structures are formed that are driven by depolarization fields occurring in such systems. Consequently, polarization vortices have only been experimentally found in systems in which these fields are deliberately maximized, that is, in films between insulating layers. As such configurations are devoid of screening charges provided by metal electrodes, commonly used in electronic devices, it is wise to investigate if curling polarization structures are innate to ferroelectricity or induced by the absence of electrodes. Here we show that in unpoled Co/PbTiO3/(La,Sr)MnO3 ferroelectric tunnel junctions, the polarization in active PbTiO3 layers 9 unit cells thick forms Kittel-like domains, while at 6 unit cells there is a complex flux-closure curling behaviour resembling an incommensurate phase. Reducing the thickness to 3 unit cells, there is an almost complete loss of switchable polarization associated with an internal gradient. PMID:27848970

43 CFR 3809.431 - When must I modify my plan of operations?

Code of Federal Regulations, 2012 CFR

2012-10-01

... impacts from unanticipated events or conditions or newly discovered circumstances or information... units; (6) Providing for post-closure management; and (7) Eliminating hazards to public safety. ...

43 CFR 3809.431 - When must I modify my plan of operations?

Code of Federal Regulations, 2013 CFR

2013-10-01

... impacts from unanticipated events or conditions or newly discovered circumstances or information... units; (6) Providing for post-closure management; and (7) Eliminating hazards to public safety. ...

Calendar Year 2007 Resource Conservation and Recovery Act Annual Monitoring Report for the U.S. Department of Energy Y-12 National Security Complex, Oak Ridge, Tennessee - RCRA Post-Closure Permit Nos. TNHW-113, TNHW-116, and TNHW-128

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

Elvado Environmental

2008-02-01

This report contains groundwater quality monitoring data obtained during calendar year (CY) 2007 at the following hazardous waste treatment, storage, and disposal (TSD) units located at the US Department of Energy (DOE) Y-12 National Security Complex (hereafter referenced as Y-12) in Oak Ridge, Tennessee; this S-3 Site, Oil Landfarm, Bear Creek Burial Grounds/Walk-In Pits (BCBG/WIP), Eastern S-3 Site Plume, Chestnut Ridge Security Pits (CRSP), Chestnut Ridge Sediment Disposal Baste (CRSDB), few Hollow Quarry (KHQ), and East Chestnut Ridge Waste Pile (ECRWP). Hit monitoring data were obtained in accordance with the applicable Resource Conservation and Recovery Act of 1976 (RCRA) hazardousmore » waste post-closure permit (PCP). The Tennessee Department of Environment and Conservation (TDEC) - Division of Solid Waste Management issued the PCPs to define the requirements for RCRA post-closure inspection, maintenance, and groundwater monitoring at the specified TSD units located within the Bear Creek Hydrogeologic Regime (PCP no. TNHW-116), Upper East Fork Poplar Creek Hydrogeologic Regime (PCP no. TNHW-113), and Chestnut Ridge Hydrogeologic Regime (PCP no. TNHW-128). Each PCP requires the Submittal of an annual RCRA groundwater monitoring report containing the groundwater sampling information and analytical results obtained at each applicable TSD unit during the preceding CY, along with an evaluation of groundwater low rates and directions and the analytical results for specified RCRA groundwater target compounds; this report is the RCRA annual groundwater monitoring report for CY 2007. The RCRA post-closure groundwater monitoring requirements specified in the above-referenced PCP for the Chestnut Ridge Regime replace those defined in the previous PCP (permit no. TNHW-088), which expired on September 18, 2005, but remained effective until the TDEC issued the new PCP in September 2006. The new PCP defines site-specific groundwater sampling and analysis requirements for the CRSDB, CRSP, and KHQ that differ from those established under the expired PCP, including modified suites of laboratory analytes (RCRA groundwater target compounds) for each site and annual rather than semiannual sampling frequencies for the CRSDB and KHQ. The new PCP also specifies the RCRA post-closure groundwater monitoring requirements for the ECRWP, a closed TSD unit that was not addressed in the expired PCP.« less

A field evaluation of the Eye-Closure Interview with witnesses of serious crimes.

PubMed

Vredeveldt, Annelies; Tredoux, Colin G; Nortje, Alicia; Kempen, Kate; Puljević, Cheneal; Labuschagne, Gérard N

2015-04-01

Laboratory research shows that eye-closure during memory retrieval improves both the amount and the factual accuracy of memory reports about witnessed events. Based on these findings, we developed the Eye-Closure Interview, and examined its feasibility (in terms of compliance with the instructions) and effectiveness (in terms of the quantity and quality of reported information) in eyewitness interviews conducted by the South African Police Service. Police interviewers from the Facial Identification Unit were randomly assigned to receive Eye-Closure Interview training or no training. We analyzed 95 interviews with witnesses of serious crimes (including robbery, rape, and murder), some of whom were instructed to close their eyes during salient parts of the interview. Witnesses in the control condition rarely spontaneously closed their eyes, but witnesses in the Eye-Closure Interview condition kept their eyes closed during 97% of their descriptions, suggesting that the Eye-Closure Interview would be easy to implement in a field setting. Although witnesses who closed their eyes did not remember more information overall, the information they provided was considered to be of significantly greater forensic relevance (as reflected in 2 independent blind assessments, 1 by a senior police expert and 1 by a senior researcher). Thus, based on the findings from this field study and from previous laboratory research, we conclude that implementation of the Eye-Closure Interview in witness interviews would help police interviewers to elicit more valuable information from witnesses, which could be relevant to the police investigation and/or in court. (PsycINFO Database Record (c) 2015 APA, all rights reserved).

Corrective Action Decision Document/Closure Report for Corrective Action Unit 571: Area 9 Yucca Flat Plutonium Dispersion Sites, Nevada National Security Site, Nevada, Revision 0

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

Matthews, Patrick

2014-08-01

The purpose of this CADD/CR is to provide documentation and justification that no further corrective action is needed for the closure of CAU 571 based on the implementation of corrective actions. This includes a description of investigation activities, an evaluation of the data, and a description of corrective actions that were performed. The CAIP provides information relating to the scope and planning of the investigation. Therefore, that information will not be repeated in this document.

Post-Closure Inspection Report for the Tonopah Test Range, Nevada, for Calendar Year 2012

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

NSTec Environmental Restoration

2013-01-28

This report provides the results of the annual post-closure inspections conducted at the closed Corrective Action Units (CAUs) located on the Tonopah Test Range (TTR), Nevada. This report covers calendar year 2012 and includes inspection and repair activities completed at the following CAUs: · CAU 400: Bomblet Pit and Five Points Landfill (TTR) · CAU 407: Roller Coaster RadSafe Area (TTR) · CAU 424: Area 3 Landfill Complexes (TTR) · CAU 453: Area 9 UXO Landfill (TTR) · CAU 487: Thunderwell Site (TTR)

Update: independently owned pharmacy closures in rural America, 2003-2013.

PubMed

Ullrich, Fred; Mueller, Keith J

2014-06-01

Key Findings. (1) From March 2003 to December 2013, there was a loss of 924 (12.1%) independently owned rural pharmacies in the United States. The most drastic loss occurred between 2007 and 2009. From 2010-2013, the trend has been for more closures, although the decline is not as pronounced or clear as in earlier years. (2) Four hundred ninety rural communities that had one or more retail pharmacy (including independent, chain, or franchise pharmacy) in March 2003 had no retail pharmacy in December 2013.

Colonic injuries and the damage control abdomen: does management strategy matter?

PubMed Central

Georgoff, Patrick; Perales, Paul; Laguna, Benjamin; Holena, Daniel; Reilly, Patrick; Sims, Carrie

2013-01-01

Background The optimal management of colon injury patients requiring damage control laparotomy (DCL) is controversial. The objective of this study was to assess the safety of colonic resection and anastomosis versus fecal diversion in trauma patients requiring DCL. Methods Patients with traumatic colon injuries undergoing DCL between 2000 and 2010 were identified by the database and chart review. Those who died within 48 h were excluded. Patients were divided into two groups: those undergoing one or more colonic anastomoses with or without distal colostomy (group 1) and those undergoing colostomy only or one or more colonic anastomoses with a protecting proximal ostomy (group 2). Variables were compared using Wilcoxon rank sum, χ2, or Fisher exact tests as appropriate. Results Sixty-one patients were included (group 1, n = 28 and group 2, n = 33). Fascial closure rates (group 1, 50% versus group 2, 61%; P = 0.45), hospital length of stay (29 versus 23 d; P = 0.89), and in-patient mortality (11% versus 12%; P = 1.0) were similar between groups. There were a total of 11 anastomotic leaks, five of which were related to non-colonic enteric repairs. Colonic anastomosis leak rates were 16% overall (six of the 38 patients), 14% in group 1 (four of the 28 patients), and 20% in group 2 (two of the 10 patients). Compared with patients who did not leak, patients who leaked had a higher median age (37 versus 25 y; P = 0.05), greater likelihood of not achieving facial closure before post-injury day 5 (18% versus 2%; P = 0.003), and a longer hospital length of stay (46 versus 25 d; P = 0.003). Conclusions Outcomes after colonic injury in the setting of DCL were similar regardless of the surgical management strategy. Based on these findings, a strategy of diversion over anastomosis cannot be strongly recommended. PMID:22884449

An FGF3-BMP Signaling Axis Regulates Caudal Neural Tube Closure, Neural Crest Specification and Anterior-Posterior Axis Extension

PubMed Central

Anderson, Matthew J.; Schimmang, Thomas; Lewandoski, Mark

2016-01-01

During vertebrate axis extension, adjacent tissue layers undergo profound morphological changes: within the neuroepithelium, neural tube closure and neural crest formation are occurring, while within the paraxial mesoderm somites are segmenting from the presomitic mesoderm (PSM). Little is known about the signals between these tissues that regulate their coordinated morphogenesis. Here, we analyze the posterior axis truncation of mouse Fgf3 null homozygotes and demonstrate that the earliest role of PSM-derived FGF3 is to regulate BMP signals in the adjacent neuroepithelium. FGF3 loss causes elevated BMP signals leading to increased neuroepithelium proliferation, delay in neural tube closure and premature neural crest specification. We demonstrate that elevated BMP4 depletes PSM progenitors in vitro, phenocopying the Fgf3 mutant, suggesting that excessive BMP signals cause the Fgf3 axis defect. To test this in vivo we increased BMP signaling in Fgf3 mutants by removing one copy of Noggin, which encodes a BMP antagonist. In such mutants, all parameters of the Fgf3 phenotype were exacerbated: neural tube closure delay, premature neural crest specification, and premature axis termination. Conversely, genetically decreasing BMP signaling in Fgf3 mutants, via loss of BMP receptor activity, alleviates morphological defects. Aberrant apoptosis is observed in the Fgf3 mutant tailbud. However, we demonstrate that cell death does not cause the Fgf3 phenotype: blocking apoptosis via deletion of pro-apoptotic genes surprisingly increases all Fgf3 defects including causing spina bifida. We demonstrate that this counterintuitive consequence of blocking apoptosis is caused by the increased survival of BMP-producing cells in the neuroepithelium. Thus, we show that FGF3 in the caudal vertebrate embryo regulates BMP signaling in the neuroepithelium, which in turn regulates neural tube closure, neural crest specification and axis termination. Uncovering this FGF3-BMP signaling axis is a major advance toward understanding how these tissue layers interact during axis extension with important implications in human disease. PMID:27144312

Closure technique after carotid endarterectomy influences local hemodynamics.

PubMed

Harrison, Gareth J; How, Thien V; Poole, Robert J; Brennan, John A; Naik, Jagjeeth B; Vallabhaneni, S Rao; Fisher, Robert K

2014-08-01

Meta-analysis supports patch angioplasty after carotid endarterectomy (CEA); however, studies indicate considerable variation in practice. The hemodynamic effect of a patch is unclear and this study attempted to elucidate this and guide patch width selection. Four groups were selected: healthy volunteers and patients undergoing CEA with primary closure, trimmed patch (5 mm), or 8-mm patch angioplasty. Computer-generated three-dimensional models of carotid bifurcations were produced from transverse ultrasound images recorded at 1-mm intervals. Rapid prototyping generated models for flow visualization studies. Computational fluid dynamic studies were performed for each model and validated by flow visualization. Mean wall shear stress (WSS) and oscillatory shear index (OSI) maps were created for each model using pulsatile inflow at 300 mL/min. WSS of <0.4 Pa and OSI >0.3 were considered pathological, predisposing to accretion of intimal hyperplasia. The resultant WSS and OSI maps were compared. The four groups comprised 8 normal carotid arteries, 6 primary closures, 6 trimmed patches, and seven 8-mm patches. Flow visualization identified flow separation and recirculation at the bifurcation increased with a patch and was related to the patch width. Computational fluid dynamic identified that primary closure had the fewest areas of low WSS or elevated OSI but did have mild common carotid artery stenoses at the proximal arteriotomy that caused turbulence. Trimmed patches had more regions of abnormal WSS and OSI at the bifurcation, but 8-mm patches had the largest areas of deleteriously low WSS and high OSI. Qualitative comparison among the four groups confirmed that incorporation of a patch increased areas of low WSS and high OSI at the bifurcation and that this was related to patch width. Closure technique after CEA influences the hemodynamic profile. Patching does not appear to generate favorable flow dynamics. However, a trimmed 5-mm patch may offer hemodynamic benefits over an 8-mm patch and may be the preferred option. Copyright © 2014 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.

Is it too early to recommend patent foramen ovale closure for all patients who suffer from migraine? A single-centre study.

PubMed

Chessa, Massimo; Colombo, Chiara; Butera, Gianfranco; Negura, Diana; Piazza, Luciane; Varotto, Leonardo; Bussadori, Claudio; Fesslova, Vlasta; Meola, Giovanni; Carminati, Mario

2009-05-01

To evaluate the course of migraine in migraine headache patients undergoing patent foramen ovale (PFO) transcatheter closure. Migraine has an important impact on the quality of life, and it seems to be one of the most disabling medical illnesses. In several studies, a high prevalence of right-to-left shunt has been described in patients with migraine, especially migraine with aura. The presence of right-to-left shunt, whatever the mechanism, may be the most potent trigger of migraine attacks in both migraine with aura and migraine without aura and the main determinant of aura in migraine with aura. A cohort of 42 patients (nine men/33 women; mean age 39 +/- 11.2 years), current migraineurs, underwent PFO percutaneous closure in our centre between January 2004 and December 2007. All patients rated the severity of their migraine preoperatively and 6 months postoperatively, indicating the frequency, duration, and intensity of the attacks and the occurrence of the aura in the prodromal phase, during the past 6 months, according to the migraine severity score. Baseline severity of migraine was higher in migraine with aura patients than in migraine without aura ones (8.8 vs. 7.5; P = 0.037). The resolution of migraine was verified in 11 patients (26%) after the closure of the PFO. A reduction in the frequency of the attacks (>=50%) was observed in 22 patients (52%). Multiple logistic regression analysis showed that the improvement in migraine with aura and migraine without aura was independent of migraine type, sex, age, cerebrovascular risk factors and cerebrovascular events, type of cardiac defect, and thrombophilic conditions. The consistent observations of this and other studies are provocative and worthy of evaluation with a prospective randomized trial using objective measures of migraine frequency and severity. However, it seems too early to recommend PFO closure for all patients who suffer from migraine until the results of ongoing large randomized trials are available.

Causes and consequences of anterior pharyngeal pouch after total laryngectomy.

PubMed

Anderson, S; Hogan, D; Panizza, B

2014-07-01

To assess the frequency of anterior pharyngeal pouch formation after total laryngectomy, and to discuss the causes and consequences of anterior pharyngeal pouch formation. A prospective, observational study of 43 patients undergoing total laryngectomy. Data collected included laryngeal defect closure type, tumour staging and demographic information. A barium swallow was performed on day 7-14 after surgery to assess for anterior pharyngeal pouch formation and fistula formation. The incidence of anterior pharyngeal pouch formation was 47 per cent. Patients who did not have an anterior pharyngeal pouch on swallow imaging assessment were less likely to develop a pharyngo-cutaneous fistula. There was no statistically significant association between laryngeal defect closure type and anterior pharyngeal pouch formation. The anterior pharyngeal pouch is a dynamic phenomenon best investigated with a fluoroscopic swallow imaging study. Its causes are multi-factorial. Absence of an anterior pharyngeal pouch appears to confer protection against pharyngo-cutaneous fistula formation, hastening commencement of adjuvant therapy and an oral diet.

Efficacy of autologous platelets in macular hole surgery.

PubMed

Konstantinidis, Aristeidis; Hero, Mark; Nanos, Panagiotis; Panos, Georgios D

2013-01-01

The introduction of optical coherence tomography has allowed accurate measurement of the size of macular holes. A retrospective consecutive review was performed of 21 patients undergoing macular hole repair with vitrectomy, gas tamponade, and autologous platelet injection and we assessed the effect of macular hole parameters on anatomic and functional outcomes. We looked at the demographic features, final visual outcome, and anatomical closure. Twenty-one patients were included in the study. They underwent routine vitrectomy with gas tamponade (C3F8) and injection of autologous platelets. All patients were advised to maintain a facedown posture for 2 weeks. Anatomical closure was confirmed in all cases and 20 out of 21 of patients had improved postoperative visual acuity by two or more lines. In our series, the macular hole dimensions did not have much effect on the final results. The use of autologous platelets and strict facedown posture seems to be the deciding factor in good anatomical and visual outcome irrespective of macular hole dimensions.

Autophagy can promote but is not required for epithelial cell extrusion in the amnioserosa of the Drosophila embryo.

PubMed

Cormier, Olga; Mohseni, Nilufar; Voytyuk, Iryna; Reed, Bruce H

2012-02-01

During Drosophila embryogenesis the majority of the extra-embryonic epithelium known as the amnioserosa (AS) undergoes programmed cell death (PCD) following the completion of the morphogenetic process of dorsal closure. Approximately ten percent of AS cells, however, are eliminated during dorsal closure by extrusion from the epithelium. Using biosensors that report autophagy and caspase activity in vivo, we demonstrate that AS cell extrusion occurs in the context of elevated autophagy and caspase activation. Furthermore, we evaluate AS extrusion rates, autophagy, and caspase activation in embryos in which caspase activity or autophagy are altered by genetic manipulation. This includes using the GAL4/UAS system to drive expression of p35, reaper, dINR (ACT) and Atg1 in the AS; we also analyze embryos lacking both maternal and zygotic expression of Atg1. Based on our results we suggest that autophagy can promote, but is not required for, epithelial extrusion and caspase activation in the amnioserosa.

10 CFR 61.52 - Land disposal facility operation and disposal site closure.

Code of Federal Regulations, 2013 CFR

2013-01-01

... meters below the top surface of the cover or must be disposed of with intruder barriers that are designed... mapped by means of a land survey. Near-surface disposal units must be marked in such a way that the boundaries of each unit can be easily defined. Three permanent survey marker control points, referenced to...

10 CFR 61.52 - Land disposal facility operation and disposal site closure.

Code of Federal Regulations, 2014 CFR

2014-01-01

... meters below the top surface of the cover or must be disposed of with intruder barriers that are designed... mapped by means of a land survey. Near-surface disposal units must be marked in such a way that the boundaries of each unit can be easily defined. Three permanent survey marker control points, referenced to...

10 CFR 61.52 - Land disposal facility operation and disposal site closure.

Code of Federal Regulations, 2010 CFR

2010-01-01

... meters below the top surface of the cover or must be disposed of with intruder barriers that are designed... mapped by means of a land survey. Near-surface disposal units must be marked in such a way that the boundaries of each unit can be easily defined. Three permanent survey marker control points, referenced to...

10 CFR 61.52 - Land disposal facility operation and disposal site closure.

Code of Federal Regulations, 2011 CFR

2011-01-01

... meters below the top surface of the cover or must be disposed of with intruder barriers that are designed... mapped by means of a land survey. Near-surface disposal units must be marked in such a way that the boundaries of each unit can be easily defined. Three permanent survey marker control points, referenced to...

10 CFR 61.52 - Land disposal facility operation and disposal site closure.

Code of Federal Regulations, 2012 CFR

2012-01-01

... meters below the top surface of the cover or must be disposed of with intruder barriers that are designed... mapped by means of a land survey. Near-surface disposal units must be marked in such a way that the boundaries of each unit can be easily defined. Three permanent survey marker control points, referenced to...

The Learned Report on Teacher Education: A Vision Delayed

ERIC Educational Resources Information Center

Imig, David; Imig, Scott

2005-01-01

Ninety-five years ago, the Carnegie Foundation for the Advancement of Teaching released Bulletin #4, otherwise known as The Flexner Report on Medical Education in the United States and Canada, a report on the education of physicians in the United States and Canada that lead to closure of half the medical schools in the country and determine the…

75 FR 54656 - Government-Owned Inventions, Available for Licensing

Federal Register 2010, 2011, 2012, 2013, 2014

2010-09-08

... Aeronautics and Space Administration, have been filed in the United States Patent and Trademark office, and...; (281) 483-6936 [Facsimile]. NASA Case No. MSC-24238-1: Microwave Tissue Welding for Wound Closure...

31 CFR 413.2 - Coordination with other authorities.

Code of Federal Regulations, 2014 CFR

2014-07-01

...) SECRET SERVICE, DEPARTMENT OF THE TREASURY CLOSURE OF STREETS NEAR THE WHITE HOUSE § 413.2 Coordination... Secretary of the Interior, the Secretary of the Treasury or the Director, United States Secret Service. ...

31 CFR 413.2 - Coordination with other authorities.

Code of Federal Regulations, 2010 CFR

2010-07-01

...) SECRET SERVICE, DEPARTMENT OF THE TREASURY CLOSURE OF STREETS NEAR THE WHITE HOUSE § 413.2 Coordination... Secretary of the Interior, the Secretary of the Treasury or the Director, United States Secret Service. ...

31 CFR 413.2 - Coordination with other authorities.

Code of Federal Regulations, 2011 CFR

2011-07-01

...) SECRET SERVICE, DEPARTMENT OF THE TREASURY CLOSURE OF STREETS NEAR THE WHITE HOUSE § 413.2 Coordination... Secretary of the Interior, the Secretary of the Treasury or the Director, United States Secret Service. ...

31 CFR 413.2 - Coordination with other authorities.

Code of Federal Regulations, 2013 CFR

2013-07-01

...) SECRET SERVICE, DEPARTMENT OF THE TREASURY CLOSURE OF STREETS NEAR THE WHITE HOUSE § 413.2 Coordination... Secretary of the Interior, the Secretary of the Treasury or the Director, United States Secret Service. ...

31 CFR 413.2 - Coordination with other authorities.

Code of Federal Regulations, 2012 CFR

2012-07-01

...) SECRET SERVICE, DEPARTMENT OF THE TREASURY CLOSURE OF STREETS NEAR THE WHITE HOUSE § 413.2 Coordination... Secretary of the Interior, the Secretary of the Treasury or the Director, United States Secret Service. ...

Modelling the impact of local reactive school closures on critical care provision during an influenza pandemic

PubMed Central

House, Thomas; Baguelin, Marc; Van Hoek, Albert Jan; White, Peter J.; Sadique, Zia; Eames, Ken; Read, Jonathan M.; Hens, Niel; Melegaro, Alessia; Edmunds, W. John; Keeling, Matt J.

2011-01-01

Despite the fact that the 2009 H1N1 pandemic influenza strain was less severe than had been feared, both seasonal epidemics of influenza-like-illness and future influenza pandemics have the potential to place a serious burden on health services. The closure of schools has been postulated as a means of reducing transmission between children and hence reducing the number of cases at the peak of an epidemic; this is supported by the marked reduction in cases during school holidays observed across the world during the 2009 pandemic. However, a national policy of long-duration school closures could have severe economic costs. Reactive short-duration closure of schools in regions where health services are close to capacity offers a potential compromise, but it is unclear over what spatial scale and time frame closures would need to be made to be effective. Here, using detailed geographical information for England, we assess how localized school closures could alleviate the burden on hospital intensive care units (ICUs) that are reaching capacity. We show that, for a range of epidemiologically plausible assumptions, considerable local coordination of school closures is needed to achieve a substantial reduction in the number of hospitals where capacity is exceeded at the peak of the epidemic. The heterogeneity in demand per hospital ICU bed means that even widespread school closures are unlikely to have an impact on whether demand will exceed capacity for many hospitals. These results support the UK decision not to use localized school closures as a control mechanism, but have far wider international public-health implications. The spatial heterogeneities in both population density and hospital capacity that give rise to our results exist in many developed countries, while our model assumptions are sufficiently general to cover a wide range of pathogens. This leads us to believe that when a pandemic has severe implications for ICU capacity, only widespread school closures (with their associated costs and organizational challenges) are sufficient to mitigate the burden on the worst-affected hospitals. PMID:21288945

Improving the ward-based care of patients post-thyroidectomy.

PubMed

Mahalingam, Sridhayan; Singhal, Rachit; Mugilan, Sridhayani; Choudhury, Natasha

2016-11-02

Nursing staff play a crucial role in managing surgical patients in the postoperative period. However, with an increasing risk of subspecialty wards facing closure as a result of financial pressures within the NHS, the knowledge base and expertise of ward-based nursing staff of surgical subspecialties is becoming increasingly limited. Using patients undergoing thyroidectomy as an example, a quality improvement multidisciplinary audit is presented, which shows how simple targeted interventions through a multidisciplinary approach can help maintain high standards of patient care in a secondary care setting.

Managing hospitals in turbulent times: do organizational changes improve hospital survival?

PubMed Central

Lee, S Y; Alexander, J A

1999-01-01

OBJECTIVE: To examine (1) the degree to which organizational changes affected hospital survival; (2) whether core and peripheral organizational changes affected hospital survival differently; and (3) how simultaneous organizational changes affected hospital survival. DATA SOURCES: AHA Hospital Surveys, the Area Resource File, and the AHA Hospital Guides, Part B: Multihospital Systems. STUDY DESIGN: The study employed a longitudinal panel design. We followed changes in all community hospitals in the continental United States from 1981 through 1994. The dependent variable, hospital closure, was examined as a function of multiple changes in a hospital's core and peripheral structures as well as the hospital's organizational and environmental characteristics. Cox regression models were used to test the expectations that core changes increased closure risk while peripheral changes decreased such risk, and that simultaneous core and peripheral changes would lead to higher risk of closure. PRINCIPAL FINDINGS: Results indicated more peripheral than core changes in community hospitals. Overall, findings contradicted our expectations. Change in specialty, a core change, was beneficial for hospitals, because it reduced closure risk. The two most frequent peripheral changes, downsizing and leadership change, were positively associated with closure. Simultaneous organizational changes displayed a similar pattern: multiple core changes reduced closure risk, while multiple peripheral changes increased the risk. These patterns held regardless of the level of uncertainty in hospital environments. CONCLUSIONS: Organizational changes are not all beneficial for hospitals, suggesting that hospital leaders should be both cautious and selective in their efforts to turn their hospitals around. PMID:10536977

Sixteen-week analysis of unaltered elastomeric chain relating in-vitro force degradation with in-vivo extraction space tooth movement.

PubMed

Evans, Kristin S; Wood, Cory M; Moffitt, Allen H; Colgan, John A; Holman, J Kevin; Marshall, Steven D; Pope, D Spencer; Sample, Lew B; Sherman, Stephen L; Sinclair, Peter M; Trulove, Tim S

2017-04-01

The purposes of this study were to evaluate whether unaltered elastomeric chain can continue to move teeth for 16 weeks and to relate it to the amount of force remaining for the same batch of elastomeric chains. The in-vivo portion of the study had a sample of 30 paired extraction space sites from 22 subjects who were measured for closure of the space every 28 days. The altered side elastomeric chain served as the control and was replaced at 28-day intervals whereas the experimental side remained unaltered. In the in-vitro portion of the study, 100 each of 2-unit and 3-unit segments of the same batch of elastomeric chains were placed in a water bath, and the force was measured for 20 of each segment length at the 28-day measurement points. Statistically significant amounts of space closure occurred at both the altered and unaltered sites at all measurement time points. The mean space closure at the altered sites was minimally greater than that observed at the paired unaltered sites. The mean differences of space closure between the altered and unaltered sites ranged from a minimum of -0.05 mm at 4 weeks to a maximum of -0.14 mm at 8 weeks. The elastomeric chain force degraded rapidly by 4 weeks but continued a gradual diminution of force to 86 g at 16 weeks. Unaltered elastomeric chain continued to move teeth into extraction spaces for 16 weeks in this sample from both statistically and clinically significant standpoints. There were minimal and statistically insignificant differences in the mean space closure measurements between the paired altered and unaltered sites. The elastomeric chain force at 16 weeks was less than 100 g, yet at the same time point, teeth continued to move clinically. Copyright © 2016 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.

50 CFR 648.101 - Closures.

Code of Federal Regulations, 2010 CFR

2010-10-01

..., DEPARTMENT OF COMMERCE FISHERIES OF THE NORTHEASTERN UNITED STATES Management Measures for the Summer... fishing for summer flounder by commercial vessels for the remainder of the calendar year by publishing... available for landing summer flounder in that state. ...

Laparoscopic inguinal hernia repair in children with transperitoneal division of the hernia sac and proximal purse string closure of peritoneum: our modified new approach.

PubMed

Wheeler, A A; Matz, S T; Schmidt, S; Pimpalwar, A

2011-12-01

To describe our results of laparoscopic transperitoneal division of the hernia sac with purse string closure of the proximal peritoneum for inguinal hernia repair in children. A retrospective case review of all patients undergoing laparoscopic herniorrhaphy with herniotomy by a single surgeon between January and August 2007 was performed evaluating perioperative and postoperative outcomes. A complete intracorporeal laparoscopic technique was utilized to inspect bilateral inguinal canals followed by circumferential division of the peritoneum at the deep ring (patent processus vaginalis) followed by purse string closure of the proximal peritoneum. 31 inguinal hernias were repaired laparoscopically in 26 patients (23 boys, 3 girls). Median age was 36 months (range 1-168 months). 22 children had unilateral inguinal hernia repairs including 2 recurrent hernias; 4 children underwent repair of bilateral inguinal hernias. Mean operating time for unilateral and bilateral inguinal hernia repairs were 48.5 ± 14 min and 61 ± 13.8 min, respectively. 2 patients with a preoperative unilateral inguinal hernia were found to have bilateral inguinal hernias upon laparoscopic examination which were repaired. Postoperative pain was minimal in 20 (77%) patients at discharge. Mean telephone follow-up at 8 ± 9.6 months demonstrated no recurrences to date. Laparoscopic inguinal hernia repair with transperitoneal division of the hernia sac and purse string closure of the proximal peritoneum allows for a minimally invasive option for pediatric inguinal hernia repair that mimics open inguinal hernia repair. At medium term follow-up there have been no recurrences to date, high parent satisfaction, minimal scarring and good cosmetic results. © Georg Thieme Verlag KG Stuttgart · New York.

Hepatic Tract Plug-Embolisation After Biliary Stenting. Is It Worthwhile?

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

Dale, Adam P., E-mail: adamdale@doctors.org.uk; Khan, Rafeh, E-mail: rafeh.khan@yahoo.com; Mathew, Anup, E-mail: anup.mathew@sth.nhs.uk

PurposePTC and stenting procedures are associated with significant risks including life-threatening haemorrhage, sepsis, renal failure and high mortality rates. PTC tract closure methods are utilised to reduce haemorrhagic complications despite little evidence to support their use. The current study assesses the incidence of haemorrhagic complications following PTC and stenting procedures, both prior to and following the introduction of a dedicated expanding gelatin foam-targeted embolisation liver tract closure technique.Materials and MethodsHaemorrhagic complications were retrospectively identified in patients undergoing PTC procedures both prior to (subgroup 1) and following (subgroup 2) the introduction of a dedicated targeted liver tract closure method between 9/11/2010more » and 10/08/2012 in a single tertiary referral centre. Mean blood Hb decrease following PTC was established in subgroups 1 and 2. Kaplan–Meier life-table analysis was performed to compare survival outcomes between subgroups using the log-rank test.ResultsHaemorrhagic complications were significantly reduced following the introduction of the targeted PTC tract closure method [(12 vs. 3 % of subgroups 1 (n = 101) and 2 (n = 92), respectively (p = 0.027)]. Mean blood Hb decrease following PTC was 1.40 versus 0.68 g/dL in subgroups 1 and 2, respectively (p = 0.069). 30-day mortality was 14 and 12 % in subgroups 1 and 2, respectively. 50 % of the entire cohort had died by 174 days post-PTC.ConclusionIntroduction of liver tract embolisation significantly reduced haemorrhagic complications in our patient cohort. Utilisation of this method has the potential to reduce the morbidity and mortality burden associated with post-PTC haemorrhage by preventing bleeding from the liver access tract.« less

Factors associated with the failure of obstetric fistula repair in Guinea: implications for practice.

PubMed

Delamou, Alexandre; Delvaux, Therese; Beavogui, Abdoul Habib; Toure, Abdoulaye; Kolié, Delphin; Sidibé, Sidikiba; Camara, Mandian; Diallo, Kindy; Barry, Thierno Hamidou; Diallo, Moustapha; Leveque, Alain; Zhang, Wei-Hong; De Brouwere, Vincent

2016-11-08

The prevention and treatment of obstetric fistula still remains a concern and a challenge in low income countries. The objective of this study was to estimate the overall proportions of failure of fistula closure and incontinence among women undergoing repair for obstetric fistula in Guinea and identify its associated factors. This was a retrospective cohort study using data extracted from medical records of fistula repairs between 1 January 2012 and 30 September 2013. The outcome was the failure of fistula closure and incontinence at hospital discharge evaluated by a dye test. A sub-sample of women with vesicovaginal fistula was used to identify the factors associated with these outcomes. Overall, 109 women out of 754 (14.5 %; 95 % CI:11.9-17.0) unsuccessful repaired fistula at discharge and 132 (17.5 %; 95 % CI:14.8-20.2) were not continent. Failure of fistula closure was associated with vaginal delivery (AOR: 1.9; 95 % CI: 1.0-3.6), partially (AOR: 2.0; 95 % CI: 1.1-5.6) or totally damaged urethra (AOR: 5.9; 95 % CI: 2.9-12.3) and surgical repair at Jean Paul II Hospital (AOR: 2.5; 95 % CI: 1.2-4.9). Women who had a partially damaged urethra (AOR: 2.5; 95 % CI: 1.5-4.4) or a totally damaged urethra (AOR: 6.3; 95 % CI: 3.0-13.0) were more likely to experience post-repair urinary incontinence than women who had their urethra intact. At programmatic level in Guinea, caution should be paid to the repair of women who present with a damaged urethra and those who delivered vaginally as they carry greater risks of experiencing a failure of fistula closure and incontinence.

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

PubMed

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

2018-07-01

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

Streamlined Approach for Environmental Restoration Plan for Corrective Action Unit 489: WWII UXO Sites, Tonopah Test Range, Nevada; May 2005

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

Bechtel Nevada; U.S. Department of Energy, National Nuclear Security Administration Nevada Site Office

2005-05-01

This Streamlined Approach for Environmental Restoration Plan provides the details for the closure of Corrective Action Unit (CAU) 489: WWII UXO Sites, Tonopah Test Range. CAU 489 is located at the Tonopah Test Range and is currently listed in Appendix III of the Federal Facility Agreement and Consent Order of 1996.

33 CFR 165.164 - Regulated Navigation Areas, Security Zones: Dignitary Arrival/Departure and United Nations...

Code of Federal Regulations, 2014 CFR

2014-07-01

... regulated navigation areas (RNA) or security zones: (1) Wall Street Heliport RNA. All waters of the East... northwest corner of Pier 2 North, Brooklyn (NAD 1983). (2) Randalls and Wards Islands RNA: All waters of the..., and all waters south of the Queensboro Bridge (NAD 1983). (6) United Nations Full River Closure RNA...

Nickel titanium springs versus stainless steel springs: A randomized clinical trial of two methods of space closure.

PubMed

Norman, Noraina Hafizan; Worthington, Helen; Chadwick, Stephen Mark

2016-09-01

To compare the clinical performance of nickel titanium (NiTi) versus stainless steel (SS) springs during orthodontic space closure. Two-centre parallel group randomized clinical trial. Orthodontic Department University of Manchester Dental Hospital and Orthodontic Department Countess of Chester Hospital, United Kingdom. Forty orthodontic patients requiring fixed appliance treatment were enrolled, each being randomly allocated into either NiTi (n = 19) or SS groups (n = 21). Study models were constructed at the start of the space closure phase (T0) and following the completion of space closure (T1). The rate of space closure achieved for each patient was calculated by taking an average measurement from the tip of the canine to the mesiobuccal groove on the first permanent molar of each quadrant. The study was terminated early due to time constraints. Only 30 patients completed, 15 in each study group. There was no statistically significant difference between the amounts of space closed (mean difference 0.17 mm (95%CI -0.99 to 1.34; P = 0.76)). The mean rate of space closure for NiTi coil springs was 0.58 mm/4 weeks (SD 0.24) and 0.85 mm/4 weeks (SD 0.36) for the stainless steel springs. There was a statistically significant difference between the two groups (P = 0.024), in favour of the stainless steel springs, when the mean values per patient were compared. Our study shows that stainless steel springs are clinically effective; these springs produce as much space closure as their more expensive rivals, the NiTi springs.

Lower Hospital Charges and Societal Costs for Catheter Device Closure of Atrial Septal Defects.

PubMed

Sanchez, Jessica N; Seckeler, Michael D

2017-10-01

Atrial septal defects (ASD) are among the most common congenital heart defects. As more ASDs are corrected by interventional catheterization instead of surgery, it is critical to understand the associated clinical and societal costs. The goal of this study was to use a national U.S. database to describe hospital charges and societal costs for surgical and catheter-based (ASD) closure. Retrospective review of hospital discharge data from the Kids' Inpatient Database from January 2010 to December 2012. The database was queried for admissions for <21 years old with ICD-9 procedure codes for surgical (35.51 or 35.61) or catheter (35.52) ASD closure; those with other cardiac conditions and/or additional cardiac procedures were excluded. Age, length of stay (LOS), and hospital charges and lost parental wages (societal costs) were compared between groups using t test or Mann-Whitney U test, as appropriate. Four hundred and eighty-six surgical and 305 catheter ASD closures were identified. LOS, hospital charges, and total societal costs were higher in surgical ASD compared to catheter ASD admissions (3.6 vs. 1.3 days, p < 0.001, $87,465 vs. $64,109, p < 0.001, and $90,000 vs. $64,966, p < 0.001, respectively). In this review of a large national inpatient database, we found that hospital and societal costs for surgical ASD closure are significantly higher than catheter ASD closure in the United States in the current era. Factors that likely contribute to this include longer LOS and longer post-operative recovery. Using "real-world" data, this study demonstrates a substantial cost advantage for catheter ASD closure compared to surgical.

Stapedotomy in osteogenesis imperfecta: a prospective study of 32 consecutive cases.

PubMed

Vincent, Robert; Wegner, Inge; Stegeman, Inge; Grolman, Wilko

2014-12-01

To prospectively evaluate hearing outcomes in patients with osteogenesis imperfecta undergoing primary stapes surgery and to isolate prognostic factors for success. A nonrandomized, open, prospective case series. A tertiary referral center. Twenty-five consecutive patients who underwent 32 primary stapedotomies for osteogenesis imperfecta with evidence of stapes fixation and available postoperative pure-tone audiometry. Primary stapedotomy with vein graft interposition and reconstruction with a regular Teflon piston or bucket handle-type piston. Preoperative and postoperative audiometric evaluation using conventional 4-frequency (0.5, 1, 2, and 4 kHz) audiometry. Air-conduction thresholds, bone-conduction thresholds, and air-bone gap were measured. The overall audiometric results as well as the results of audiometric evaluation at 3 months and at least 1 year after surgery were used. Overall, postoperative air-bone gap closure to within 10 dB was achieved in 88% of cases. Mean (standard deviation) gain in air-conduction threshold was 22 (9.4) dB for the entire case series, and mean (standard deviation) air-bone gap closure was 22 (9.0) dB. Backward multivariate logistic regression showed that a model with preoperative air-bone gap closure and intraoperatively established incus length accurately predicts success after primary stapes surgery. Stapes surgery is a feasible and safe treatment option in patients with osteogenesis imperfecta. Success is associated with preoperative air-bone gap and intraoperatively established incus length.

Comparison of Negative Pressure Wound Therapy and Silver-Coated Foam Dressings in Open Wound Treatment in Dogs: A Prospective Controlled Clinical Trial.

PubMed

Nolff, Mirja C; Albert, Rebecca; Reese, Sven; Meyer-Lindenberg, Andrea

2018-06-11

 To evaluate negative pressure wound therapy (NPWT) for treatment of complicated wounds in dogs.  Prospective randomized clinical study MATERIALS AND METHODS:  Dogs ( n  = 26) undergoing open-wound treatment were randomly assigned to one of two groups: Group A ( n  = 13) NPWT; Group B ( n  = 13) silver-coated foam dressing. Pairs of patients were matched based on wound conformation, localization, and underlying cause and compared in terms of duration of previous treatment, development of wound size (wound planimetry), time to closure, bacterial bio-burden and complications. Wound dressing changes were performed every 3 days during the first 9 days of therapy for both groups. Statistical analysis was performed.  Pre-treatment signalment and bacterial status were comparable between groups. Total time to closure was significantly ( p  = 0.018) shorter in Group A (14.2 days) compared with Group B (28.6 days), and wound planimetry on days 3, 6 and 9 showed significant greater reduction in total wound area for Group A at all-time points ( p  < 0.05). Furthermore, wounds in Group A showed less progression of local infection than did wounds in Group B ( p  = 0.01).  NPWT-treated wounds showed faster closure, improved macro-deformation and less local signs of infection. Schattauer GmbH Stuttgart.

Reductive ring closure methodology toward heteroacenes bearing a dihydropyrrolo[3,2-b]pyrrole core: scope and limitation.

PubMed

Qiu, Li; Wang, Xiao; Zhao, Na; Xu, Shiliang; An, Zengjian; Zhuang, Xuhui; Lan, Zhenggang; Wen, Lirong; Wan, Xiaobo

2014-12-05

A newly developed reductive ring closure methodology to heteroacenes bearing a dihydropyrrolo[3,2-b]pyrrole core was systematically studied for its scope and limitation. The methodology involves (i) the cyclization of an o-aminobenzoic acid ester derivative to give an eight-membered cyclic dilactam, and (ii) the conversion of the dilactams into the corresponding diimidoyl chloride, which undergoes (iii) reductive ring closure to install the dihydropyrrolo[3,2-b]pyrrole core. The first step of the methodology plays the key role due to its substrate limitation, which suffers from the competition of oligomerization and hydrolysis. All the dilactams could successfully convert to the corresponding diimidoyl chlorides, most of which succeeded to give the dihydropyrrolo[3,2-b]pyrrole core. The influence of the substituents and the elongation of conjugated length on the photophysical properties of the obtained heteroacenes were then investigated systematically using UV-vis spectroscopy and cyclic voltammetry. It was found that chlorination and fluorination had quite a different effect on the photophysical properties of the heteroacene, and the ring fusing pattern also had a drastic influence on the band gap of the heteroacene. The successful preparation of a series of heteroacenes bearing a dihydropyrrolo[3,2-b]pyrrole core would provide a wide variety of candidates for further fabrication of organic field-effect transistor devices.

Risk factors for wound disruption following cesarean delivery.

PubMed

Subramaniam, Akila; Jauk, Victoria C; Figueroa, Dana; Biggio, Joseph R; Owen, John; Tita, Alan T N

2014-08-01

Risk factors for post-cesarean wound infection, but not disruption, are well-described in the literature. The primary objective of this study was to identify risk factors for non-infectious post-cesarean wound disruption. Secondary analysis was conducted using data from a single-center randomized controlled trial of staple versus suture skin closure in women ≥24 weeks' gestation undergoing cesarean delivery. Wound disruption was defined as subcutaneous skin or fascial dehiscence excluding primary wound infections. Composite wound morbidity (disruption or infection) was examined as a secondary outcome. Patient demographics, medical co-morbidities, and intrapartum characteristics were evaluated as potential risk factors using multivariable logistic regression. Of the 398 randomized patients, 340, including 26 with disruptions (7.6%) met inclusion criteria and were analyzed. After multivariable adjustments, African-American race (aOR 3.9, 95% CI 1.1-13.8) and staple - as opposed to suture - wound closure (aOR 5.4, 95% CI 1.8-16.1) remained significant risk factors for disruption; non-significant increases were observed for body mass index ≥30 (aOR 2.1, 95% CI 0.6-7.5), but not for diabetes mellitus (aOR 0.9, 95% CI 0.3-2.9). RESULTS for composite wound morbidity were similar. Skin closure with staples, African-American race, and considering the relatively small sample size, potentially obesity are associated with increased risk of non-infectious post-cesarean wound disruption.

The Impact of Surgical Patent Ductus Arteriosus Closure on Autonomic Function in Premature Infants.

PubMed

Andescavage, Nickie N; Metzler, Marina; Govindan, Vedavalli; Al-Shargabi, Tareq; Nath, Dilip S; Krishnan, Anita; Massaro, An; Wang, Yunfei; duPlessis, Adre J; Govindan, R B

2017-07-01

Background  Patent ductus arteriosus (PDA) is a common complication of prematurity and a risk factor for poor outcome. Infants undergoing surgical PDA ligation are at highest risk for neurodevelopmental injury. Autonomic dysfunction has been described in premature infants with PDA. Aim  To interrogate the autonomic nervous system by analysis of advanced heart rate variability (HRV) metrics before and after surgical closure of the PDA. Study Design  Prospective, observational study. Subjects  Twenty-seven infants born before 28 weeks' gestation were included in this study. Methods  Continuous electrocardiogram data were sampled at a rate of 125 Hz for a total of 6 hours before and 6 hours after 30 hours of surgical closure. HRV was determined by detrended fluctuation analysis to calculate the short and long root mean square (RMS L and RMS S ) and α components at two time scales (long and short). Results  Gestational age (GA) was positively associated with RMS L , RMS S , and α S and was negatively associated with α L . There was no difference between RMS s , RMS L , α S , or α L before and after surgery; however, median heart rate was lower after surgery ( p  < 0.01). Conclusion  Advancing GA is highly associated with increasing HRV; however, surgical ligation does not affect HRV in the postoperative period. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Maximal potential patent foramen diameter does not correlate with the type or frequency of the neurologic event prior to closure.

PubMed

Kutty, Shelby; Brown, Kimberly; Qureshi, Athar M; Latson, Larry A

2009-01-01

We analyzed our data on patients undergoing transcatheter patent foramen ovale (PFO) closure to determine if the maximal potential PFO diameter (MPPD) by balloon sizing correlates with important clinical characteristics in this population. We defined stroke as a focal neurologic deficit lasting >24 h, or focal deficit of shorter duration associated with permanent MRI/CT changes consistent with a focal infarction. Parameters analyzed included age, gender, anticoagulation, hypertension, smoking, MRI/CT findings and MPPD at catheterization. We specifically analyzed the type of neurologic event (stroke/transient ischemic attack, TIA), and number of recorded preceding clinical neurologic events. In 216 consecutive patients, 167 suffered a stroke. MRI/CT changes consistent with one or more embolic events were seen in 156 patients; 49 had a clinical TIA. There was no significant difference in MPPD between stroke (11.0 +/- 3.6 mm) and TIA groups (10.9 +/- 3.9 mm; 95% confidence interval for difference: -1.33 to 1.00). MPPD did not differ between MRI/CT-positive vs. -negative strokes, and had no correlation with the number of identified pre-closure clinical neurologic events. Continued investigation is needed to determine whether other PFO characteristics, or other anatomic/physiologic parameters, may be useful to identify patients at high risk for cryptogenic stroke/TIA, even before they have their first neurologic event. Copyright 2008 S. Karger AG, Basel.

Preoperative But Not Postoperative Flurbiprofen Axetil Alleviates Remifentanil-induced Hyperalgesia After Laparoscopic Gynecological Surgery: A Prospective, Randomized, Double-blinded, Trial.

PubMed

Zhang, Linlin; Shu, Ruichen; Zhao, Qi; Li, Yize; Wang, Chunyan; Wang, Haiyun; Yu, Yonghao; Wang, Guolin

2017-05-01

Acute remifentanil exposure during intraoperative analgesia might enhance sensitivity to noxious stimuli and nociceptive responses to innocuous irritation. Cyclooxygenase inhibition was demonstrated to attenuate experimental remifentanil-induced hyperalgesia (RIH) in rodents and human volunteers. The study aimed to compare the effects of preoperative and postoperative flurbiprofen axetil (FA) on RIH after surgery. Ninety patients undergoing elective laparoscopic gynecologic surgery were randomly assigned to receive either intravenous placebo before anesthesia induction (Group C); or intravenous FA (1.0 mg/kg) before anesthesia induction (Group F1) or before skin closure (Group F2). Anesthesia consisted off sevoflurane and remifentanil (0.30 μg/kg/min). Postoperative pain was managed by sufentanil titration in the postanesthetic care unit, followed by sufentanil infusion via patient-controlled analgesia. Mechanical pain threshold (primary outcome), pain scores, sufentanil consumption, and side-effects were documented for 24 hours postoperatively. Postoperative pain score in Group F1 was lower than Group C. Time of first postoperative sufentanil titration was prolonged in Group F1 than Group C (P=0.021). Cumulative sufentanil consumption in Group F1 was lower than Group C (P<0.001), with a mean difference of 8.75 (95% confidence interval, 5.21-12.29) μg. Mechanical pain threshold on the dominant inner forearm was more elevated in Group F1 than Group C (P=0.005), with a mean difference of 17.7 (95% confidence interval, 5.4-30.0) g. Normalized hyperalgesia area was decreased in Group F1 compared to Group C (P=0.007). No statistically significant difference was observed between Group F2 and Group C. Preoperative FA reduces postoperative RIH in patients undergoing laparoscopic gynecologic surgery under sevoflurane-remifentanil anesthesia.

Pdf prediction of supersonic hydrogen flames

NASA Technical Reports Server (NTRS)

Eifler, P.; Kollmann, W.

1993-01-01

A hybrid method for the prediction of supersonic turbulent flows with combustion is developed consisting of a second order closure for the velocity field and a multi-scalar pdf method for the local thermodynamic state. It is shown that for non-premixed flames and chemical equilibrium mixture fraction, the logarithm of the (dimensionless) density, internal energy per unit mass and the divergence of the velocity have several advantages over other sets of scalars. The closure model is applied to a supersonic non-premixed flame burning hydrogen with air supplied by a supersonic coflow and the results are compared with a limited set of experimental data.

Corrective Action Decision Document/Closure Report for Corrective Action Unit 372: Area 20 Cabriolet/Palanquin Unit Craters, Nevada National Security Site, Nevada, Revision 0

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

Matthews, Patrick and Sloop, Christy

2011-04-01

This Corrective Action Decision Document (CADD)/Closure Report (CR) has been prepared for Corrective Action Unit (CAU) 372, Area 20 Cabriolet/Palanquin Unit Craters, located within Areas 18 and 20 at the Nevada National Security Site, Nevada, in accordance with the Federal Facility Agreement and Consent Order (FFACO). Corrective Action Unit 372 comprises four corrective action sites (CASs): • 18-45-02, Little Feller I Surface Crater • 18-45-03, Little Feller II Surface Crater • 20-23-01, U-20k Contamination Area • 20-45-01, U-20L Crater (Cabriolet) The purpose of this CADD/CR is to provide justification and documentation supporting the recommendation that no further corrective action ismore » needed for CAU 372 based on the implementation of the corrective action of closure in place with administrative controls at all CASs. Corrective action investigation (CAI) activities were performed from November 9, 2009, through December 10, 2010, as set forth in the Corrective Action Investigation Plan for Corrective Action Unit 372: Area 20 Cabriolet/Palanquin Unit Craters. The approach for the CAI was divided into two facets: investigation of the primary release of radionuclides and investigation of other releases (migration in washes and chemical releases). The purpose of the CAI was to fulfill data needs as defined during the data quality objective (DQO) process. The CAU 372 dataset of investigation results was evaluated based on a data quality assessment. This assessment demonstrated the dataset is acceptable for use in fulfilling the DQO data needs. Investigation results were evaluated against final action levels (FALs) established in this document. A radiological dose FAL was established of 25 millirem per year based on the Remote Work Area exposure scenario (336 hours of annual exposure). Radiological doses exceeding the FAL were found to be present at all four CASs. It is assumed that radionuclide levels present within the Little Feller I and Cabriolet high contamination areas and within the craters at Palanquin and Cabriolet exceed the FAL. It is also assumed that potential source material in the form of lead bricks at Little Feller I and lead-acid batteries at Palanquin and Cabriolet exceed the FAL. Therefore, corrective actions were undertaken that consist of removing potential source material, where present, and implementing a use restriction and posting warning signs at each CAS. These use restrictions were recorded in the FFACO database; the U.S. Department of Energy, National Nuclear Security Administration Nevada Site Office (NNSA/NSO) Facility Information Management System; and the NNSA/NSO CAU/CAS files. Therefore, NNSA/NSO provides the following recommendations: • No further corrective actions are necessary for CAU 372. • A Notice of Completion to NNSA/NSO is requested from the Nevada Division of Environmental Protection for closure of CAU 372. • Corrective Action Unit 372 should be moved from Appendix III to Appendix IV of the FFACO.« less

Closure Report for Corrective Action Unit 574: Neptune, Nevada National Security Site, Nevada

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

NSTec Environmental Restoration

Corrective Action Unit (CAU) 574 is identified in the Federal Facility Agreement and Consent Order (FFACO) as 'Neptune' and consists of the following two Corrective Action Sites (CASs), located in Area 12 of the Nevada National Security Site: (1) CAS 12-23-10, U12c.03 Crater (Neptune); and (2) CAS 12-45-01, U12e.05 Crater (Blanca). This Closure Report presents information supporting closure of CAU 574 according to the FFACO (FFACO, 1996 [as amended March 2010]) and the Streamlined Approach for Environmental Restoration Plan for CAU 574 (U.S. Department of Energy, National Nuclear Security Administration Nevada Site Office [NNSA/NSO], 2011). The following activities were performedmore » to support closure of CAU 574: (1) In situ external dose rate measurements were collected using thermoluminescent dosimeters at CAS 12-45-01, U12e.05 Crater (Blanca). (2) Total effective dose rates were determined at both sites by summing the internal and external dose rate components. (3) A use restriction (UR) was implemented at CAS 12-23-10, U12c.03 Crater (Neptune). Areas that exceed the final action level (FAL) of 25 millirems per year (mrem/yr) based on the Occasional Use Area exposure scenario are within the existing use restricted area for CAU 551. The 25-mrem/yr FAL is not exceeded outside the existing CAU 551 UR for any of the exposure scenarios (Industrial Area, Remote Work Area, and Occasional Use Area). Therefore, the existing UR for CAU 551 is sufficient to bound contamination that exceeds the FAL. (4) An administrative UR was implemented at CAS 12-45-01, U12e.05 Crater (Blanca) as a best management practice (BMP). The 25-mrem/yr FAL was not exceeded for the Remote Work Area or Occasional Use Area exposure scenarios; therefore, a UR is not required. However, because the 25-mrem/yr FAL was exceeded for the Industrial Area exposure scenario, an administrative UR was established as a BMP. UR documentation is included as Appendix B. The UR at CAS 12-23-10, U12c.03 Crater (Neptune), is within the existing UR for CAU 551. Additional postings were not installed, and annual post-closure inspections will be performed in conjunction with the inspections performed for CAU 551. At CAS 12-45-01, U12e.05 Crater (Blanca), the administrative UR does not require postings or inspections. NNSA/NSO requests the following: (1) A Notice of Completion from the Nevada Division of Environmental Protection to NNSA/NSO for closure of CAU 574; and (2) The transfer of CAU 574 from Appendix III to Appendix IV, Closed Corrective Action Units, of the FFACO« less

Historical trends in creel limits, length-based limits, and season restrictions for black basses in the United States and Canada

USGS Publications Warehouse

Paukert, C.; McInerny, M.; Schultz, Ronald

2007-01-01

We determined for largemouth bass (Micropterus salmoides), smallmouth bass (M. dolomeui), and spotted bass (M. punctulatus) historical trends in state- and province-wide creel limits, length limits, and season closures along with the rationale justifying these regulations. Based on data gathered via mail surveys and the Internet, 55 jurisdictions had state- or province-wide creel limits, minimum length limits, or season closures, with each regulation type enacted as early as pre-1900. Most early regulations were established to protect spawning bass, but providing equitable distribution of harvest and increasing the quality of bass catch or harvest were the most common rationales for current regulations. Spatial and temporal trends in regulations were similar among species, were affected by geographic location, were not affected by angler preference except for season closures, and were frequently uninfluenced by advances in scientific knowledge of black bass biology.

Pediatric lower extremity mower injuries.

PubMed

Hill, Sean M; Elwood, Eric T

2011-09-01

Lawn mower injuries in children represent an unfortunate common problem to the plastic reconstructive surgeon. There are approximately 68,000 per year reported in the United States. Compounding this problem is the fact that a standard treatment algorithm does not exist. This study follows a series of 7 pediatric patients treated for lower extremity mower injuries by a single plastic surgeon. The extent of soft tissue injury varied. All patients were treated with negative pressure wound therapy as a bridge to definitive closure. Of the 7 patients, 4 required skin grafts, 1 required primary closure, 1 underwent a lower extremity amputation secondary to wounds, and 1 was repaired using a cross-leg flap. Function limitations were minimal for all of our patients after reconstruction. Our basic treatment algorithm is presented with initial debridement followed by the simplest method possible for wound closure using negative pressure wound therapy, if necessary.

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

PubMed

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

2013-06-21

Between 5% and 11% of people undergoing cholecystectomy have common bile duct stones. Stones may be removed at the time of cholecystectomy by opening and clearing the common bile duct. The optimal technique is unclear. The aim is to assess the benefits and harms of T-tube drainage versus primary closure without biliary stent after open common bile duct exploration for common bile duct stones. We searched the Cochrane Hepato-Biliary Group Controlled Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, MEDLINE, EMBASE, and Science Citation Index Expanded until April 2013. We included all randomised clinical trials comparing T-tube drainage versus primary closure after open common bile duct exploration. Two of four authors independently identified the studies for inclusion and extracted data. We analysed the data with both the fixed-effect and the random-effects model using Review Manager (RevMan) analyses. For each outcome we calculated the risk ratio (RR), rate ratio (RaR), or mean difference (MD) with 95% confidence interval (CI) based on intention-to-treat analysis. We included six trials randomising 359 participants, 178 to T-tube drainage and 181 to primary closure. All trials were at high risk of bias. There was no significant difference in mortality between the two groups (4/178 (weighted percentage 1.2%) in the T-tube group versus 1/181 (0.6%) in the primary closure group; RR 2.25; 95% CI 0.55 to 9.25; six trials). There was no significant difference in the serious morbidity rate between the two groups (24/136 (weighted serious morbidity rate, 145 events per 1000 patients) in the T-tube group versus 9/136 (weighted serious morbidity rate, 66 events per 1000 patients) in the primary closure group; RaR 2.19; 95% CI 0.98 to 4.91; four trials). Quality of life and return to work were not reported in any of the trials. The operating time was significantly longer in the T-tube drainage group compared with the primary closure group (MD 28.90 minutes; 95% CI 17.18 to 40.62 minutes; one trial). The hospital stay was significantly longer in the T-tube drainage group compared with the primary closure group (MD 4.72 days; 95% CI 0.83 days to 8.60 days; five trials). T-tube drainage appeared to result in significantly longer operating time and hospital stay compared with primary closure without any apparent evidence of benefit on clinically important outcomes after open common bile duct exploration. Based on the currently available evidence, there is no justification for the routine use of T-tube drainage after open common bile duct exploration in patients with common bile duct stones. T-tube drainage should not be used outside well designed randomised clinical trials. More randomised trials comparing the effects of T-tube drainage versus primary closure after open common bile duct exploration may be needed. Such trials should be conducted with low risk of bias and assessing the long-term beneficial and harmful effects of T-tube drainage, including long-term complications such as bile stricture and recurrence of common bile duct stones.

OMC Compressor Case

NASA Technical Reports Server (NTRS)

Humphrey, W. Donald

1997-01-01

This report summarizes efforts expended in the development of an all-composite compressor case. Two pre-production units have been built, one utilizing V-CAP and one utilizing AFR-700B resin systems. Both units have been rig tested at elevated temperatures well above design limit loads. This report discusses the manufacturing processes, test results, and Finite Element Analysis performed. The V-CAP unit was funded by NASA-Lewis Research Center in 1994 under contract number NAS3- 27442 for Development of an All-Composite OMC Compressor Case. This contract was followed by an Air Force study in 1996 to build and identical unit using the AFR-700B resin system in place of the V-CAP system. The second compressor case was funded under U.S. Air Force contract F33615-93-D-5326, Advanced Materials for Aerospace Structures Special Studies (AMAS3), Delivery Order 0021 entitled "Advanced Polymeric Composite Materials and Structures Technology for Advanced High Temperature Gas Turbine Engines.' Initial studies using the V-CAP resin system were undertaken in 1993 under a NASA Lewis contract (NAS3-26829). A first prototype unit was developed in a joint program between Textron-Lycoming (now Allied Signal) and Brunswick (now Lincoln Composites). This unit included composite end closures using low density, high temperature molded end closures. The units was similar in size and shape to a titanium case currently used on the PT-21 0 engine and was funded as part of the integrated High Performance Turbine Engine Technology (EHPTET) initiative of DOD and NASA.

A questionnaire based assessment of numbers, motivation and medical care of UK patients undergoing liver transplant abroad.

PubMed

Kerr Winter, Ben; Odedra, Anand; Green, Steve

Medical tourism, where patients travel abroad intentionally to access medical treatment, is a growing trend. Some of these patients travel to undergo organ transplantation. This study aims to quantify the number of UK patients who undergo liver transplantation abroad, assessing their motivations and management. Questionnaires were sent to all seven UK liver transplant units enquiring about liver patients receiving transplant abroad. Included were questions on destination, motivation, and pre and post-transplant care. Responses were received from six of the seven transplant centres (86%). A total of 12 patients were identified as having undergone liver transplantation overseas. The top destinations were India, China and Egypt. Four units responded to questions regarding pre-transplant screening. One unit reported Hepatitis B and C screening not taking place. Four units responded to questions regarding post-transplant antimicrobial therapy. This revealed examples of patients inappropriately not receiving valganciclovir, co-trimoxazole, anti-fungal treatment and Hepatitis B immunoglobulins. UK patients are undergoing liver transplant abroad, albeit in small numbers. Pre and post-transplant management of these patients is of a lower standard than that provided to those undergoing transplantation in the UK. Information transfer between overseas and UK based transplant teams is poor. Copyright © 2016 Elsevier Ltd. All rights reserved.

The Installation Funding Dilemma

DTIC Science & Technology

2008-04-04

role in supporting the Army’s plans for supporting base realignment and closure (BRAC) requirements, global defense posture realignment ( GDPR ...relation to their affect on installation management funding. First, the initiative known as the GDPR will return many units to the United States from...three initiatives ( GDPR , BRAC and Modularity) and certain other restationing moves, the Army expects a net gain of about 154,000 personnel at its domestic

RCRA, superfund and EPCRA hotline training module. Introduction to: Land disposal units (40 cfr parts 264/265, subparts k, l, m, n) updated July 1996

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

NONE

1996-07-01

The module provides an overview of the requirements for landfills, surface impoundments, waste piles, and land treatment units. It summarizes the differences between interim status (Part 265) and permitted (Part 264) standards for land disposal units. It defines `surface impoundment` and distinguishes surface impoundments from tanks and describes surface impoundment retrofitting and retrofitting variance procedures. It explains the connection between land disposal standards, post-closure, and groundwater monitoring.

78 FR 16573 - Fisheries of the Northeastern United States; Atlantic Sea Scallop Fishery and Northeast...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-03-15

... (Framework Adjustment 49). Framework 24 also continues the closures of the Delmarva and Elephant Trunk... 25). Framework 24 would close both the Elephant Trunk (ET) area and the Delmarva Access Area (DMV...

50 CFR 648.231 - Closures.

Code of Federal Regulations, 2011 CFR

2011-10-01

... Dogfish Monitoring Committee shall identify and review the relevant sources of management uncertainty to... management uncertainty that were considered, technical approaches to mitigating these sources of uncertainty..., DEPARTMENT OF COMMERCE FISHERIES OF THE NORTHEASTERN UNITED STATES Management Measures for the Spiny Dogfish...

40 CFR 264.603 - Post-closure care.

Code of Federal Regulations, 2011 CFR

2011-07-01

....603 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID WASTES (CONTINUED) STANDARDS FOR OWNERS AND OPERATORS OF HAZARDOUS WASTE TREATMENT, STORAGE, AND DISPOSAL FACILITIES... treatment or storage unit has contaminated soils or ground water that cannot be completely removed or...

Effectiveness of early lens extraction for the treatment of primary angle-closure glaucoma (EAGLE): a randomised controlled trial.

PubMed

Azuara-Blanco, Augusto; Burr, Jennifer; Ramsay, Craig; Cooper, David; Foster, Paul J; Friedman, David S; Scotland, Graham; Javanbakht, Mehdi; Cochrane, Claire; Norrie, John

2016-10-01

Primary angle-closure glaucoma is a leading cause of irreversible blindness worldwide. In early-stage disease, intraocular pressure is raised without visual loss. Because the crystalline lens has a major mechanistic role, lens extraction might be a useful initial treatment. From Jan 8, 2009, to Dec 28, 2011, we enrolled patients from 30 hospital eye services in five countries. Randomisation was done by a web-based application. Patients were assigned to undergo clear-lens extraction or receive standard care with laser peripheral iridotomy and topical medical treatment. Eligible patients were aged 50 years or older, did not have cataracts, and had newly diagnosed primary angle closure with intraocular pressure 30 mm Hg or greater or primary angle-closure glaucoma. The co-primary endpoints were patient-reported health status, intraocular pressure, and incremental cost-effectiveness ratio per quality-adjusted life-year gained 36 months after treatment. Analysis was by intention to treat. This study is registered, number ISRCTN44464607. Of 419 participants enrolled, 155 had primary angle closure and 263 primary angle-closure glaucoma. 208 were assigned to clear-lens extraction and 211 to standard care, of whom 351 (84%) had complete data on health status and 366 (87%) on intraocular pressure. The mean health status score (0·87 [SD 0·12]), assessed with the European Quality of Life-5 Dimensions questionnaire, was 0·052 higher (95% CI 0·015-0·088, p=0·005) and mean intraocular pressure (16·6 [SD 3·5] mm Hg) 1·18 mm Hg lower (95% CI -1·99 to -0·38, p=0·004) after clear-lens extraction than after standard care. The incremental cost-effectiveness ratio was £14 284 for initial lens extraction versus standard care. Irreversible loss of vision occurred in one participant who underwent clear-lens extraction and three who received standard care. No patients had serious adverse events. Clear-lens extraction showed greater efficacy and was more cost-effective than laser peripheral iridotomy, and should be considered as an option for first-line treatment. Medical Research Council. Copyright © 2016 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY license. Published by Elsevier Ltd.. All rights reserved.

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

PubMed

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

2015-02-01

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

A tensegrity model for hydrogen bond networks in proteins.

PubMed

Bywater, Robert P

2017-05-01

Hydrogen-bonding networks in proteins considered as structural tensile elements are in balance separately from any other stabilising interactions that may be in operation. The hydrogen bond arrangement in the network is reminiscent of tensegrity structures in architecture and sculpture. Tensegrity has been discussed before in cells and tissues and in proteins. In contrast to previous work only hydrogen bonds are studied here. The other interactions within proteins are either much stronger - covalent bonds connecting the atoms in the molecular skeleton or weaker forces like the so-called hydrophobic interactions. It has been demonstrated that the latter operate independently from hydrogen bonds. Each category of interaction must, if the protein is to have a stable structure, balance out. The hypothesis here is that the entire hydrogen bond network is in balance without any compensating contributions from other types of interaction. For sidechain-sidechain, sidechain-backbone and backbone-backbone hydrogen bonds in proteins, tensegrity balance ("closure") is required over the entire length of the polypeptide chain that defines individually folding units in globular proteins ("domains") as well as within the repeating elements in fibrous proteins that consist of extended chain structures. There is no closure to be found in extended structures that do not have repeating elements. This suggests an explanation as to why globular domains, as well as the repeat units in fibrous proteins, have to have a defined number of residues. Apart from networks of sidechain-sidechain hydrogen bonds there are certain key points at which this closure is achieved in the sidechain-backbone hydrogen bonds and these are associated with demarcation points at the start or end of stretches of secondary structure. Together, these three categories of hydrogen bond achieve the closure that is necessary for the stability of globular protein domains as well as repeating elements in fibrous proteins.

Letter Report to Address Comments on the Closure Report for Corrective Action Unit 224: Decon Pad and Septic Systems, Nevada Test Site, Nevada, Revision 0, March 2008

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

NSTec Environmental Restoration

2008-03-17

The Closure Report (CR) for Corrective Action Unit (CAU) 224, Decon Pad and Septic Systems, was approved by the Nevada Department of Environmental Protection (NDEP) on November 01, 2007. The approval letter contained the following two comments: Comment 1--For 06-05-01, 06-17-04, 06-23-01 provide evidence that the 6 inch VCP pipe originating from building CP-2 is no longer active and sealed to prevent possible future contamination. Comment 2--For the area that includes 06-03-01, provide evidence that active lines are no longer feeding the North and South lagoons and have been sealed to prevent possible future contamination. To address these comments, closuremore » documentation was reviewed, and site visits were conducted to locate and document the areas of concern. Additional fieldwork was conducted in March 2008 to seal the lines and openings described in the two comments. Photographs were taken of the closed drains and lines to document that the NDEP comments were adequately addressed and potential inadvertent discharge to the environment has been eliminated. Investigation and closure documentation was reviewed to identify the locations of potential drains, lines, and other features that could receive and/or transmit liquid. Based on the investigation findings and subsequent closure activities, no openings, distribution boxes, or other features (excluding known floor drains at CP-2) that could receive liquid were found at the CP-2 location (Figure 1), and potential manholes for the north and south sewage lagoons were identified for Corrective Action Site (CAS) 06-03-01 (Figure 2). The distribution box identified in Figure 1 was not located during the investigation and was assumed to have been previously removed.« less

Control of extended-spectrum β-lactamase-producing Enterobacteriaceae nosocomial acquisition in an intensive care unit: A time series regression analysis.

PubMed

Boyer, Alexandre; Couallier, Vincent; Clouzeau, Benjamin; Lasheras, Agnes; M'zali, Fatima; Kann, Michael; Rogues, Anne-Marie; Gruson, Didier

2015-12-01

This study was undertaken to determine the temporal relationship between implementation of different interventions in an intensive care unit (ICU) and control of endemic nosocomial acquisition of extended-spectrum β-lactamase Enterobacteriaceae (ESBLE). This was a prospective observational study with time-series analysis of the monthly incidence of ESBLE and its predictors. In November 2007, after a 14-month baseline period, an intervention consisting of restriction of third-generation cephalosporins (3 GC) and increased use of alcohol-based hand rubs was implemented. In January 2008, an increased health care worker (HCW):patient ratio was also implemented. In March 2010, the ICU was closed, and patients were moved to a clean ICU. The first intervention resulted in global reduction in 3 GC and increased use of alcohol-based hand rub. A significant change in ESBLE incidence was observed in a full segmented univariate regression analysis (mean change in level, -0.91 ± 0.19; P < .0001). After ICU closure, there was a dramatic reduction in ESBLE acquisition. According to the multivariate model, the ICU closure was the main protective factor. Before ICU closure, an increase in the HCW:patient ratio of 0.1 point tended to be associated with a decreased risk of ESBLE acquisition (relative risk, 0.28; 95% confidence interval, 0.06-1.25; P = .09). This study shows that ICU closure was associated with, but not necessarily the reason for, control of ESBLE cross-transmission in a nonoutbreak setting. Environmental ESBE sources may play a role in cross-transmission. Copyright © 2015 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Robotic-assisted laparoscopic prostatectomy in umbilical hernia patients: University of California, Irvine, technique for port placement and repair.

PubMed

Kim, William; Abdelshehid, Corollos; Lee, Hak J; Ahlering, Thomas

2012-06-01

To discuss a technique currently used at our institution for the management of umbilical hernias during robot-assisted laparoscopic prostatectomy. As more patients undergo robot-assisted radical prostatectomy, there will be an increase in patients who qualify for robotic surgery with comorbidities. This technique has been utilized in clinically localized prostate cancer patients with umbilical hernias using the da Vinci Surgical System and standard laparoscopic instrumentation. Port placements and closures were performed by a resident assistant and a nurse at the operating table. The prostatectomy was performed by a single experienced surgeon at the console. Currently, no data are available regarding patients with umbilical hernias undergoing robotic prostatectomy. We reviewed our technique of port placement for patients with a pre-existing umbilical hernia undergoing robot-assisted laparoscopic prostatectomy. This technique allows for a reduction of the umbilical hernia, the use of the fascial defect as a robotic port, and the removal of the prostate by way of transverse incision and transverse repair. In our experience, this technique is feasible and reproducible for any small or large umbilical hernia. Copyright © 2012 Elsevier Inc. All rights reserved.

Closure Report for Corrective Action Unit 5: Landfills, Nevada Test Site, Nevada, Revision 0 with Errata Sheet and ROTC 1

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

None, None

The purpose of this CR is to document that the closure of CAU 5 complied with the NDEP-approved CAP closure requirements (NNSA/NSO, 2004). The closure activities specified in the CAP were based on the recommendations presented in the corrective action decision document (CADD) (NNSA/NSO, 2003). ROTC 1: The UR form was updated to the current format to include a. more detailed description of the UR and maintenance requirements. Information was edited due to the change of UR signs at the site to UR monuments/signs. The maintenance frequency was changed to annually because sign damage due to high winds was evidencedmore » during recent site inspections. The coordinates for the UR were originally based on NAD 27 and were modified to NAD 83 to comply with the most recent M&O database requirements. The modifications identified in this ROTC will supersede the existing posting requirements for the UR at CASs 06-1S-02 and 06-15-03 as identified in the CAU 5 CADD; CAU 5 CR; and the UR form associated with CASs 06-15-02 and 06-15-03.« less

78 FR 27088 - Fisheries of the Northeastern United States; Atlantic Sea Scallop Fishery and Northeast...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-09

...). Framework 24 also continues the closures of the Delmarva and Elephant Trunk scallop access areas, refines... Scallop Access Areas Framework 24 closes both the Elephant Trunk (ET) area and the Delmarva Access Area...

50 CFR 648.141 - Closure.

Code of Federal Regulations, 2011 CFR

2011-10-01

... Bass Monitoring Committee shall identify and review the relevant sources of management uncertainty to... sources of management uncertainty that were considered, technical approaches to mitigating these sources..., DEPARTMENT OF COMMERCE FISHERIES OF THE NORTHEASTERN UNITED STATES Management Measures for the Black Sea Bass...

50 CFR 648.121 - Closures.

Code of Federal Regulations, 2011 CFR

2011-10-01

... management uncertainty to recommend ACTs for the commercial and recreational fishing sectors as part of the... sources of management uncertainty that were considered, technical approaches to mitigating these sources..., DEPARTMENT OF COMMERCE FISHERIES OF THE NORTHEASTERN UNITED STATES Management Measures for the Scup Fishery...

BACTERIA, BEACHES AND SWIMMABLE WATERS: INTRODUCING VIRTUAL BEACH

EPA Science Inventory

Safe beaches meet water quality standards and are valued for their aesthetics and the recreational opportunities that they afford. In the United States recreational water quality assessments and beach closure decisions are presently based on samples of enterococci or Escherichia ...

Guided surgical debridement: staining tissues with methylene blue.

PubMed

Dorafshar, Amir H; Gitman, Marina; Henry, Ginard; Agarwal, Shailesh; Gottlieb, Lawrence J

2010-01-01

Precise surgical debridement of wounds is required to achieve wound closure. The authors describe their experience with a technique using topical methylene blue to facilitate precise surgical debridement. In this technique, methylene blue dye is applied topically to the wound surface at the onset of surgery. The stained wound site is then wiped to remove dye from the surface of normal epithelium; eschar, nonviable tissue, and granulation tissue remain stained. The methylene blue-stained tissue is surgically removed, and the newly debrided surface of the wound is assessed for adequate vascularity and biopsied to verify presence of bacteriologic balance before closure. The authors have used this technique in more than 200 wound debridements during the past year, including acute surgical or traumatic wounds, acute and subacute burn wounds, chronic granulating wounds, partially epithelialized wounds, sinus tracts, and fistulae. No adverse reactions have been noted, even on patients undergoing multiple applications through serial operations. Topical application of methylene blue to wounds with mixed tissue content helps to distinguish between viable and nonviable tissue and between epithelialized and nonepithelialized areas, facilitating more precise and complete wound debridement.

Reconstruction of total pelvic exenteration defects with rectus abdominus myocutaneous flaps versus primary closure.

PubMed

Chokshi, Ravi J; Kuhrt, Maureen P; Arrese, David; Martin, Edward W

2013-01-01

Total pelvic exenteration (TPE) is reserved for patients with locally invasive and recurrent pelvic malignancies. Complications such as wound infections, dehiscence, hernias, abscesses, and fistulas are common after this procedure. The purpose of this study was to determine whether tissue transfer to the pelvis after TPE decreases wound complications. Fifty-three patients who underwent TPE between 2004 and 2010 were reviewed. Two groups were identified, those who underwent pelvic reconstruction with a vertical rectus abdominus myocutaneous flap (n = 17) and those who underwent primary closure (n = 36). Demographics, clinicopathologic characteristics, and outcomes were compared. The 2 groups were similar in demographics and histopathologic characteristics. Preoperative and surgical factors including comorbidities, nutrition, radiation, surgical times, blood loss, length of stay, and complications were similar between the groups. Of the 17 patients undergoing vertical rectus abdominus myocutaneous flap placement, complications were seen in 11 patients (65%), with most of them stemming from flap dehiscence (n = 7). In our study, the transfer of tissue into the pelvis did not increase surgical times, blood loss, length of stay, or wound complications. Copyright © 2013 Elsevier Inc. All rights reserved.

Piezosurgery for the repair of middle cranial fossa meningoencephaloceles.

PubMed

Acharya, Aanand N; Rajan, Gunesh P

2015-03-01

To describe the use of a piezosurgery medical device to perform a craniotomy and produce a split calvarial graft for the repair of middle cranial fossa meningoencephaloceles. Retrospective case review. Tertiary referral hospital. Ten consecutive patients undergoing middle cranial fossa approach for the repair of meningoencephaloceles. Therapeutic. Intraoperative and postoperative complications, success rate as defined by the ability to fashion a split calvarial graft that achieves complete closure of the tegmen defect. As a secondary outcome measure, evidence of integration of the split calvarial bone graft with the adjacent skull base was assessed. There were no intraoperative or postoperative complications. An appropriately sized calvarial bone graft was produced, and complete closure of the tegmen defect was achieved in all 10 cases. Computed tomography demonstrated evidence of integration of the bone graft in eight cases between 4 and 9 months after surgery. The piezosurgery medical device provides a safe and effective means by which the middle fossa craniotomy and split calvarial bone graft can be produced to repair defects of the middle fossa tegmen, with integration of the bone graft in the majority of cases.

Prospective, randomized, controlled trial comparing a tissue adhesive (Dermabond™) with adhesive strips (Steri-Strips™) for the closure of laparoscopic trocar wounds in children.

PubMed

Romero, P; Frongia, G; Wingerter, S; Holland-Cunz, S

2011-05-01

4 methods are used in pediatric laparoscopic surgery to close trocar wounds. While tissue adhesives or adhesive strips have been shown to produce fewer wound complications and a better cosmetic result compared to trans- or only subcutaneous sutures, the choice of technique is still often based on the surgeon's personal experience. Thus, the objective of this trial was to assess the impact of tissue adhesives (Dermabond™) compared to adhesive strips (Steri-Strip™) on potential complications of wound healing, wound pain, cosmetic outcome, and patient satisfaction after laparoscopic appendectomy in children. 49 patients undergoing laparoscopic appendectomy were enrolled in this prospective randomized trial. In every patient, two 5-mm and one 10-mm port-site incision was closed either with Dermabond™ or Steri-Strip™ after placing subcuticular absorbable sutures (4-0 Vicryl™). Postoperative complications, pain, and patient satisfaction with scars were evaluated at follow-up on day 10 and day 90 after the operation using a questionnaire and a visual analogue scale (VAS). Photographs of scars taken on day 90 were evaluated on a VAS by 2 pediatric surgeons blinded to the closure method used. According to the surgeons' evaluation of the cosmetic outcome, a significant difference between the 2 groups with regard to the cosmetic score was found on day 90 of follow-up, favoring Steri-Strip™ wound closure (p < 0.05). On day 10 and 90 there were no statistical differences between the 2 methods as regards the result of patient evaluations (p > 0.05). Only one wound infection (4%) was observed in the Steri-Strip™ group (n = 25) on day 10. At follow-up on day 90 two patients (9.1%) in the Dermabond™ group and one (4.8%) in the Steri-strip™ group complained of wound pain (p = 0.52). Both tissue adhesives and adhesive strips are excellent "no needle" alternatives for the closure of laparoscopic port-site incisions in children. As regards cosmetic outcome, Steri-Strip™ wound closure seems to be the most suitable and is also the less expensive technique. © Georg Thieme Verlag KG Stuttgart · New York.

Outcomes and costs of left atrial appendage closure from randomized controlled trial and real-world experience relative to oral anticoagulation

PubMed Central

Panikker, Sandeep; Lord, Joanne; Jarman, Julian W.E.; Armstrong, Shannon; Jones, David G.; Haldar, Shouvik; Butcher, Charles; Khan, Habib; Mantziari, Lilian; Nicol, Edward; Hussain, Wajid; Clague, Jonathan R.; Foran, John P.; Markides, Vias; Wong, Tom

2016-01-01

Aims The aim of this study was to analyse randomized controlled study and real-world outcomes of patients with non-valvular atrial fibrillation (NVAF) undergoing left atrial appendage closure (LAAC) with the Watchman device and to compare costs with available antithrombotic therapies. Methods and results Registry data of LAAC from two centres were prospectively collected from 110 patients with NVAF at risk of stroke, suitable and unsuitable for long-term anticoagulation (age 71.3 ± 9.2 years, CHADS2 2.8 ± 1.2, CHA2DS2-VASc 4.5 ± 1.6, and HAS-BLED 3.8 ± 1.1). Outcomes from PROTECT AF and registry study LAAC were compared with warfarin, dabigatran, rivaroxaban, apixaban, aspirin, and no treatment using a network meta-analysis. Costs were estimated over a 10-year horizon. Uncertainty was assessed using sensitivity analyses. The procedural success rate was 92% (103/112). Follow-up was 24.1 ± 4.6 months, during which annual rates of stroke, major bleeding, and all-cause mortality were 0.9% (2/223 patient-years), 0.9% (2/223 patient-years), and 1.8% (4/223 patient-years), respectively. Anticoagulant therapy was successfully stopped in 91.2% (93/102) of implanted patients by 12 months. Registry study LAAC stroke and major bleeding rates were significantly lower than PROTECT AF results: mean absolute difference of stroke, 0.89% (P = 0.02) and major bleeding, 5.48% (P < 0.001). Left atrial appendage closure achieved cost parity between 4.9 years vs. dabigatran 110 mg and 8.4 years vs. warfarin. At 10 years, LAAC was cost-saving against all therapies (range £1162–£7194). Conclusion Left atrial appendage closure in NVAF in a real-world setting may result in lower stroke and major bleeding rates than reported in LAAC clinical trials. Left atrial appendage closure in both settings achieves cost parity in a relatively short period of time and may offer substantial savings compared with current therapies. Savings are most pronounced among higher risk patients and those unsuitable for anticoagulation. PMID:26935273

Post-Closure Report for Closed Resource Conservation and Recovery Act Corrective Action Units, Nevada National Security Site, Nevada, for Fiscal Year 2014

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

Silvas, Alissa J.

2015-01-01

This report serves as the combined annual report for post-closure activities for several Corrective Action Units (CAUs). The locations of the sites are shown in Figure 1. This report covers fiscal year 2014 (October 2013–September 2014). The post-closure requirements for these sites are described in Resource Conservation and Recovery Act Permit Number NEV HW0101 and summarized in each CAU-specific section in Section 1.0 of this report. The results of the inspections, a summary of maintenance activities, and an evaluation of monitoring data are presented in this report. Site inspections are conducted semiannually at CAUs 90 and 91 and quarterly atmore » CAUs 92, 110, 111, and 112. Additional inspections are conducted at CAU 92 if precipitation occurs in excess of 0.50 inches (in.) in a 24-hour period and at CAU 111 if precipitation occurs in excess of 1.0 in. in a 24-hour period. Inspections include an evaluation of the condition of the units, including covers, fences, signs, gates, and locks. In addition to visual inspections, soil moisture monitoring, vegetation evaluations, and subsidence surveys are conducted at CAU 110. At CAU 111, soil moisture monitoring, vegetation evaluations, subsidence surveys, direct radiation monitoring, air monitoring, radon flux monitoring, and groundwater monitoring are conducted. The results of the vegetation surveys and an analysis of the soil moisture monitoring data at CAU 110 are presented in this report. Results of additional monitoring at CAU 111 are documented annually in the Nevada National Security Site Waste Management Monitoring Report Area 3 and Area 5 Radioactive Waste Management Sites and in the Nevada National Security Site Data Report: Groundwater Monitoring Program Area 5 Radioactive Waste Management Site, which will be prepared in approximately June 2015. All required inspections, maintenance, and monitoring were conducted in accordance with the post-closure requirements of the permit. It is recommended to continue inspections and monitoring as scheduled.« less

Surgical Treatment of Pressure Ulcers with a Fibrin Sealant in Patients with Spinal Cord Injury: A Cost-Consequence Analysis.

PubMed

Velasco, Jose Manuel Arévalo; Lozano, Virginia; Oyagüez, Itziar; Casado, Miguel Angel

2015-11-01

A comparative study was performed to evaluate the effectiveness and costs of a fibrin sealant (Tissucol Duo [known as Tisseel in the United States], Baxter International, Deerfield, Illinois) to improve postoperative outcomes in patients with spinal cord injury undergoing surgical treatment for pressure ulcers (PrUs). Between January and June 2011, 27 patients underwent surgical treatment for PrUs with the direct application of Tissucol Duo sprayed before closure. The costs and outcomes obtained in this cohort were compared with those obtained in a previous retrospective study where 71 patients underwent conventional surgery. Lower rates of hematoma-seroma were observed in the study group (3.7% vs 33.8%; P < .05). Drain removal occurred earlier (10 vs 15 days; P < .05), and the average drain volume was also lower (155 vs 360 mL; P < .05) for this group. The mean length of hospital stay was significantly lower in the study group and was the main contributing factor to the overall costs. The application of Tissucol Duo during surgical treatment of PrUs in patients with spinal cord injury has been shown to be effective in reducing postoperative complications and in shortening the duration of the hospital stay with a consequent savings in costs.

Laryngeal complications after type 1 thyroplasty.

PubMed

Cotter, C S; Avidano, M A; Crary, M A; Cassisi, N J; Gorham, M M

1995-12-01

Type I thyroplasty has become a primary surgical choice for voice restoration in patients with glottal incompetence. This study examines factors associated with laryngeal complications after type I thyroplasty. Ten laryngoscopic variables were analyzed from preoperative, intraoperative, and postoperative videolaryngoscopies of 51 patients undergoing 58 medialization procedures. Ten patient and operative variables were examined by medical record review. Major complications were defined as wound hemorrhage, airway obstruction, or prosthesis extrusion. Minor complications were defined as vocal fold hematoma without airway obstruction or prosthesis movement. The major complication rate was 8.6%, and the minor complication rate was 29%. No delayed hemorrhage or airway obstruction occurred. Prosthesis extrusion occurred in five (8.6%) patients 1 week to 5 months after surgery. Extrusion was associated with suboptimal prosthesis placement in 80% of cases. Two patients retained excellent glottal closure despite extrusion. Vocal fold hematoma was identified in 14 (24%) cases and resolved within 1 week. Prosthesis movement occurred in three (5%) patients 1 week to 6 months after surgery and resulted in poor glottal closure. All patients with prosthesis extrusion or movement were female. Type I thyroplasty remains a safe outpatient procedure with few major complications. Prosthesis extrusion was associated with suboptimal prosthesis placement and may or may not result in poor glottal closure. Minor vocal fold hematomas were relatively frequent, resolved rapidly, and were not associated with airway obstruction. Female patients may be more prone to complications because of their small laryngeal size.

Pulmonary artery dissection in eight dogs with patent ductus arteriosus.

PubMed

Scansen, Brian A; Simpson, Elaine M; López-Alvarez, Jordi; Thomas, William P; Bright, Janice M; Eason, Bryan D; Rush, John E; Dukes-McEwan, Joanna; Green, Henry W; Cunningham, Suzanne M; Visser, Lance C; Kent, Agnieszka M; Schober, Karsten E

2015-06-01

To describe a series of dogs with pulmonary artery dissection and patent ductus arteriosus (PDA). Eight dogs. Retrospective case series. Pulmonary artery dissection was diagnosed in 8 dogs, 3 were Weimaraners. Four dogs presented in left-sided congestive heart failure, 4 presented for murmur evaluation and without clinical signs, and 1 presented in right-sided congestive heart failure. In 7 dogs the dissection was first documented concurrent with a diagnosis of uncorrected PDA. In the other dog, with pulmonary valve stenosis and PDA, the dissection was observed on autopsy examination 17 months after balloon pulmonary valvuloplasty and ductal closure. Median age at presentation for the 7 dogs with antemortem diagnosis of pulmonary artery dissection was 3.5 years (range, 1.5-4 years). Three dogs had the PDA surgically ligated, 2 dogs did not undergo PDA closure, 1 dog failed transcatheter occlusion of the PDA with subsequent surgical ligation, 1 dog underwent successful transcatheter device occlusion of the PDA, and 1 dog had the PDA closed by transcatheter coil delivery 17 months prior to the diagnosis of pulmonary artery dissection. The 2 dogs that did not have the PDA closed died 1 and 3 years after diagnosis due to heart failure. Pulmonary artery dissection is a potential complication of PDA in dogs, the Weimaraner breed may be at increased risk, presentation is often in mature dogs, and closure of the PDA can be performed and appears to improve outcome. Copyright © 2014 Elsevier B.V. All rights reserved.

A randomised controlled trial comparing fresh, dried, and dried-then-rehydrated temporalis fascia in myringoplasty.

PubMed

Loock, J W; Naude, N

2008-04-01

To determine whether the way in which temporalis fascia is treated during myringoplasty affects the rate of successful perforation closure. A randomised controlled trial. A tertiary ENT Department within the Tygerberg Academic Hospital. One hundred and fifty patients with perforations between 30% and 70% of the surface area of the eardrum undergoing elective myringoplasty were randomised into three groups by the way in which the temporalis fascia used was treated prior to insertion: fresh fascia; dried fascia; and fascia which was dried and then rehydrated. The outcome measure was intactness of the tympanic membrane 6 weeks after surgery. Preoperative and follow-up audiometry was obtained, but was not evaluated as an outcome measure. Successful closure of the perforation was achieved in 89% in the dried fascia group (42 of 47 patients), 84% in the fresh fascia group (37 of 44 patients), and 85% in the dried and rehydrated group (39 of 46 patients). The study showed no statistically significant difference between the three groups (P = 0.728). The study would have to had more than 800 patients in each group to have the power to show a 5% difference in take rates. While the dessication of temporalis fascia prior to use in myringoplasy results in degeneration of cellular and stromal elements histologically, this does not affect the successful closure of perforations. Clinicians should feel free to prepare the fascia in whichever way they find easiest to work with.

76 FR 50186 - Surplus Properties

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-12

... Report, as approved, and following screening with Federal agencies and Department of Defense components... DEPARTMENT OF DEFENSE Department of the Army Surplus Properties AGENCY: Department of the Army, Do... have been determined surplus to the United States needs in accordance with the Defense Base Closure and...

Negative pressure wound therapy reduces incidence of postoperative wound infection and dehiscence after long-segment thoracolumbar spinal fusion: a single institutional experience.

PubMed

Adogwa, Owoicho; Fatemi, Parastou; Perez, Edgar; Moreno, Jessica; Gazcon, Gustavo Chagoya; Gokaslan, Ziya L; Cheng, Joseph; Gottfried, Oren; Bagley, Carlos A

2014-12-01

Wound dehiscence and surgical site infections (SSIs) can have a profound impact on patients as they often require hospital readmission, additional surgical interventions, lengthy intravenous antibiotic administration, and delayed rehabilitation. Negative pressure wound therapy (NPWT) exposes the wound site to negative pressure, resulting in the improvement of blood supply, removal of excess fluid, and stimulation of cellular proliferation of granulation tissue. To assess the incidence of wound infection and dehiscence in patients undergoing long-segment thoracolumbar fusion before and after the routine use of NPWT. Retrospective study. One hundred sixty patients undergoing long-segment thoracolumbar spine fusions were included in this study. Postoperative incidence of wound infection and dehiscence. All adult patients undergoing thoracolumbar fusion for spinal deformity over a 6-year period at Duke University Medical Center by the senior author (CB) were included in this study. In 2012, a categorical change was made by the senior author (CB) that included the postoperative routine use of incisional NPWT devices after primary wound closure in all long-segment spine fusions. Before 2012, NPWT was not used. After primary wound closure, a negative pressure device is contoured to the size of the incision and placed over the incision site for 3 postoperative days. We retrospectively review the first 46 cases in which NPWT was used and compared them with the immediately preceding 114 cases to assess the incidence of wound infection and dehiscence. One hundred sixty (NPWT: 46 cases, non-NPWT: 114 cases) long-segment thoracolumbar spine fusions were performed for deformity correction. Baseline characteristics were similar between both cohorts. Compared with the non-NPWT cohort, a 50% decrease in the incidence of wound dehiscence was observed in the NPWT patient cohort (6.38% vs. 12.28%, p=.02). Similarly, compared with the non-NPWT cohort, the incidence of postoperative SSIs was significantly decreased in the NPWT cohort (10.63% vs. 14.91%, p=.04). Routine use of incisional NPWT was associated with a significant reduction in the incidence of postoperative wound infection and dehiscence. Copyright © 2014 Elsevier Inc. All rights reserved.

Transverse versus Longitudinal Incisions for Femoral Artery Exposure in Treating Patients with Peripheral Vascular Disease.

PubMed

Parikh, Punam P; Rubio, Gustavo A; Patel, Kunal; Gupta, Kapil; Jones, Keith; Rey, Jorge; Robinson, Handel

2018-02-01

This study evaluates differences in wound complication rate when transverse versus longitudinal incision is utilized to expose femoral vessels in managing patients with peripheral vascular disease. A retrospective review from 2013 to 2015 was conducted of 150 patients undergoing 156 lower extremity revascularizations with femoral artery exposure through a groin incision. Patients were stratified into 2 groups, transverse versus longitudinal groin incision. Data were reviewed for 3 surgeons that utilize either transverse or longitudinal groin incision in patients undergoing common or iliofemoral endarterectomies, or where femoral artery was used as inflow and/or outflow vessel for limb revascularization. Each group had a comparative outcomes analysis based on incision type. The primary outcome was wound complication, defined as any wound infection, lymphocele, hematoma, dehiscence, pseudoaneurysm, or necrosis. Other outcomes studied included unplanned return to operating room for wound complication, wound vacuum therapy, and soft-tissue flap closure. Data were analyzed using 2-tailed chi-squared test and Student's t-test. Patients in the transverse (n = 85 cases) versus longitudinal (n = 71 cases) cohorts were similar in relation to demographics and comorbidities. Overall mean follow-up was 220 days. Patients with a transverse as compared to longitudinal incision had a significantly lower overall wound complication rate, 7% vs. 42%, respectively (P < 0.001). Furthermore, transverse incisions were associated with lower incidence of unplanned return to the operating room to manage wound complications than patients with a longitudinal incision (5% vs. 23%, respectively; P < 0.001). Transverse versus longitudinal incisions were also associated with significantly lower need for wound vacuum therapy (6% vs. 15%, respectively; P < 0.05) and muscle flap closure (0% vs. 13%, respectively; P < 0.001) for wound complications. Transverse groin incisions for femoral artery exposure may offer a lower risk of wound complications for open procedures as compared to a longitudinal incision. While longitudinal incisions may have higher wound complication rates, incisional approach is contingent on anatomical circumstance and treated disease pattern. Patients should undergo appropriate preoperative counseling regarding wound healing in preparation for limb revascularization. Copyright © 2017 Elsevier Inc. All rights reserved.

A randomized, blinded, multicenter trial of a gentamicin vancomycin gel (DFA-02) in patients undergoing abdominal surgery.

PubMed

Bennett-Guerrero, Elliott; Berry, Scott M; Bergese, Sergio D; Fleshner, Phillip R; Minkowitz, Harold S; Segura-Vasi, Alvaro M; Itani, Kamal M F; Henderson, Karen W; Rackowski, Felicia P; Aberle, Laura H; Stryjewski, Martin E; Corey, G Ralph; Allenby, Kent S

2017-06-01

SI is a significant medical problem. DFA-02 is an investigational bioresorbable modified release gel consisting of both gentamicin (16.8 mg/mL) and vancomycin (18.8 mg/mL). A Phase 2a study, where the drug was applied during surgical incision closure, suggested safety and tolerability but was not designed to assess its efficacy. In a Phase 2b randomized, blinded trial patients undergoing abdominal, primarily colorectal, surgery were randomized (4:1:1) to one of three study arms: DFA-02, matching placebo gel, or standard of care (SOC) involving irrigation of the wound with normal saline. The DFA-02 and placebo gel groups received up to 20 mL of study drug inserted above the fascia during wound closure, and were treated in a double-blind manner; the SOC group was treated in a single-blind manner. The primary endpoint was SSI (adjudicated centrally by a blinded committee) through postoperative day 30. Overall, 445 subjects (intention-to-treat) were randomized at 35 centers with 425 subjects completing the study and being evaluable. There were 67 SSIs (15.8%): 64.2% superficial, 7.5% deep, and 28.4% organ space. The incidence of SSI was not statistically significantly different between the DFA-02 and the placebo gel/SOC arms combined, 42/287 = 14.6% vs 25/138 = 18.1% (p = 0.36), respectively. Rehospitalization within 30 days was also similar between study groups (DFA-02 28.6%, placebo gel 21.4%, SOC 27.3%). In this multicenter, blinded, randomized trial with central adjudication, the gentamicin/vancomycin gel was not associated with a significant reduction in SSI. Patients undergoing abdominal surgery were randomized to one of three study arms: DFA-02 gel consisting of both gentamicin and vancomycin, matching placebo gel, or standard of care (SOC). Of 425 patients completing the study at 35 sites the gentamicin/vancomycin gel was not associated with a significant reduction in SSI. Copyright © 2016 Elsevier Inc. All rights reserved.

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

PubMed

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

2012-01-01

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

Open abdomen with vacuum-assisted wound closure and mesh-mediated fascial traction in patients with complicated diffuse secondary peritonitis: A single-center 8-year experience.

PubMed

Tolonen, Matti; Mentula, Panu; Sallinen, Ville; Rasilainen, Suvi; Bäcklund, Minna; Leppäniemi, Ari

2017-06-01

Open abdomen (OA) treatment in patients with peritonitis is increasing worldwide. Various temporary abdominal closure devices are being used. This study included patients with complicated diffuse secondary peritonitis, OA, and vacuum-assisted wound closure and mesh-mediated fascial traction (VAWCM). The aim of this study was to describe mortality and major morbidity in terms of delayed primary fascial closure and enteroatmospheric fistula rates. This was a single-academic-center retrospective study of consecutive patients with diffuse peritonitis, OA, and VAWCM between years 2008 and 2016. Descriptive and univariate analyses were performed. Forty-one patients were identified and analyzed. Median age was 59 years, preoperative septic shock was diagnosed in 54% (n = 22), and 59% (n = 24) had a postoperative peritonitis. Mortality was 29% (n = 12), and 76% (n = 31) of patients were admitted in the intensive care unit. The median duration of OA was 7 days with a median of two dressing changes. Delayed primary fascial closure rate among survivors was 92% (n = 33), and enteroatmospheric fistulas developed in 7% (n = 3). In a subgroup analysis, patients with OA in the primary laparotomy for peritonitis (n = 27) were compared with patients with OA in the subsequent laparotomies (n = 14). There were no significant differences between groups. The VAWCM technique in patients with complicated secondary diffuse peritonitis and OA yields excellent results in terms of delayed primary fascial closure rate and a low number of enteroatmospheric fistulas. It seems to be safe to close the abdomen at the index laparotomy, if possible, even if there is a risk of a need of OA later. Therapeutic/care management study, level IV.

Evaluation of New Zealand’s High-Seas Bottom Trawl Closures Using Predictive Habitat Models and Quantitative Risk Assessment

PubMed Central

Penney, Andrew J.; Guinotte, John M.

2013-01-01

United Nations General Assembly Resolution 61/105 on sustainable fisheries (UNGA 2007) establishes three difficult questions for participants in high-seas bottom fisheries to answer: 1) Where are vulnerable marine systems (VMEs) likely to occur?; 2) What is the likelihood of fisheries interaction with these VMEs?; and 3) What might qualify as adequate conservation and management measures to prevent significant adverse impacts? This paper develops an approach to answering these questions for bottom trawling activities in the Convention Area of the South Pacific Regional Fisheries Management Organisation (SPRFMO) within a quantitative risk assessment and cost : benefit analysis framework. The predicted distribution of deep-sea corals from habitat suitability models is used to answer the first question. Distribution of historical bottom trawl effort is used to answer the second, with estimates of seabed areas swept by bottom trawlers being used to develop discounting factors for reduced biodiversity in previously fished areas. These are used in a quantitative ecological risk assessment approach to guide spatial protection planning to address the third question. The coral VME likelihood (average, discounted, predicted coral habitat suitability) of existing spatial closures implemented by New Zealand within the SPRFMO area is evaluated. Historical catch is used as a measure of cost to industry in a cost : benefit analysis of alternative spatial closure scenarios. Results indicate that current closures within the New Zealand SPRFMO area bottom trawl footprint are suboptimal for protection of VMEs. Examples of alternative trawl closure scenarios are provided to illustrate how the approach could be used to optimise protection of VMEs under chosen management objectives, balancing protection of VMEs against economic loss to commercial fishers from closure of historically fished areas. PMID:24358162

Post-Closure Inspection Report for the Tonopah Test Range, Nevada. For Calendar Year 2015, Revision 0

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

Matthews, Patrick; Petrello, Jaclyn

This report provides the results of the annual post-closure inspections conducted at the closed corrective action units (CAUs) located on the Tonopah Test Range (TTR), Nevada. This report covers calendar year 2015 and includes inspection and repair activities completed at the following CAUs; CAU 400: Bomblet Pit and Five Points Landfill (TTR); CAU 407: Roller Coaster RadSafe Area (TTR); CAU 424: Area 3 Landfill Complexes (TTR); CAU 453: Area 9 UXO Landfill (TTR); and CAU 487: Thunderwell Site (TTR) Inspections were conducted according to the post-closure plans in the approved closure reports and subsequent correspondence with the Nevada Division ofmore » Environmental Protection. The post-closure inspection plans and subsequent correspondence modifying the requirements for each CAU are included in Appendix B. The inspection checklists are included in Appendix C. Field notes are included in Appendix D. The annual post-closure inspections were conducted on May 12, 2015. Maintenance was required at CAU 453. Cracking along the north trench was repaired. One monument is missing at CAU 424; it will be replaced in 2016. Postings at CAUs 407, 424, 453, and 487 contain contact information for TTR Security. It was noted that protocols may not be in place to ensure that the U.S. Department of Energy, National Nuclear Security Administration Nevada Field Office (NNSA/NFO) is notified if access is needed at these sites. NNSA/NFO is working with the U.S. Air Force and Sandia to determine whether more appropriate contact information or new protocols are warranted for each CAU. Based on these inspections, there has not been a significant change in vegetation, and vegetation monitoring was not recommended at CAU 400 or CAU 407 in 2015.« less

Post-Closure Inspection Report for the Tonopah Test Range, Nevada, for Calendar Year 2013

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

Silvas, A. J.

2014-03-03

This report provides the results of the annual post-closure inspections conducted at the closed Corrective Action Units (CAUs) located on the Tonopah Test Range (TTR), Nevada. This report covers calendar year 2013 and includes inspection and repair activities completed at the following CAUs: • CAU 400: Bomblet Pit and Five Points Landfill (TTR) • CAU 407: Roller Coaster RadSafe Area (TTR) • CAU 424: Area 3 Landfill Complexes (TTR) • CAU 453: Area 9 UXO Landfill (TTR) • CAU 487: Thunderwell Site (TTR) Inspections were conducted according to the post-closure plans in the approved Closure Reports and subsequent correspondence withmore » the Nevada Division of Environmental Protection. The post-closure inspection plans and subsequent correspondence modifying the requirements for each CAU are included in Appendix B. The inspection checklists are included in Appendix C. Field notes are included in Appendix D. Photographs taken during inspections are included in Appendix E. The annual post-closure inspections were conducted on May 14, 2013. Maintenance was performed at CAU 400, CAU 424, and CAU 453. At CAU 400, animal burrows were backfilled. At CAU 424, erosion repairs were completed at Landfill Cell A3-3, subsidence was repaired at Landfill Cell A3-4, and additional lava rock was placed in high-traffic areas to mark the locations of the surface grade monuments at Landfill Cell A3-3 and Landfill Cell A3-8. At CAU 453, two areas of subsidence were repaired and animal burrows were backfilled. Vegetation monitoring was performed at the CAU 400 Five Points Landfill and CAU 407 in June 2013. The vegetation monitoring report is included in Appendix F.« less

Evaluation of New Zealand's high-seas bottom trawl closures using predictive habitat models and quantitative risk assessment.

PubMed

Penney, Andrew J; Guinotte, John M

2013-01-01

United Nations General Assembly Resolution 61/105 on sustainable fisheries (UNGA 2007) establishes three difficult questions for participants in high-seas bottom fisheries to answer: 1) Where are vulnerable marine systems (VMEs) likely to occur?; 2) What is the likelihood of fisheries interaction with these VMEs?; and 3) What might qualify as adequate conservation and management measures to prevent significant adverse impacts? This paper develops an approach to answering these questions for bottom trawling activities in the Convention Area of the South Pacific Regional Fisheries Management Organisation (SPRFMO) within a quantitative risk assessment and cost : benefit analysis framework. The predicted distribution of deep-sea corals from habitat suitability models is used to answer the first question. Distribution of historical bottom trawl effort is used to answer the second, with estimates of seabed areas swept by bottom trawlers being used to develop discounting factors for reduced biodiversity in previously fished areas. These are used in a quantitative ecological risk assessment approach to guide spatial protection planning to address the third question. The coral VME likelihood (average, discounted, predicted coral habitat suitability) of existing spatial closures implemented by New Zealand within the SPRFMO area is evaluated. Historical catch is used as a measure of cost to industry in a cost : benefit analysis of alternative spatial closure scenarios. Results indicate that current closures within the New Zealand SPRFMO area bottom trawl footprint are suboptimal for protection of VMEs. Examples of alternative trawl closure scenarios are provided to illustrate how the approach could be used to optimise protection of VMEs under chosen management objectives, balancing protection of VMEs against economic loss to commercial fishers from closure of historically fished areas.

Post-Closure Report for Closed Resource Conservation and Recovery Act Corrective Action Units, Nevada National Security Site, Nevada: For Calendar Year 2017, Revision 0

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

Matthews, Patrick; Alvarado, Juan

This report serves as the combined annual report for post-closure activities for the following closed corrective action units (CAUs): CAU 90, Area 2 Bitcutter Containment CAU 91, Area 3 U-3fi Injection Well CAU 92, Area 6 Decon Pond Facility CAU 110, Area 3 WMD U-3ax/bl Crater CAU 111, Area 5 WMD Retired Mixed Waste Pits CAU 112, Area 23 Hazardous Waste Trenches The results of the inspections, a summary of maintenance activities, and an evaluation of monitoring data are presented in this report. Site inspections are conducted annually at CAUs 90, 91, and 112; semiannually at CAUs 92 and 110;more » and quarterly at CAU 111. Additional inspections are conducted at CAU 92 if precipitation occurs in excess of 1.0 inches in a 24-hour period and at CAU 111 if precipitation occurs in excess of 1.0 inch in a 24-hour period. Inspections include an evaluation of the condition of the units, including covers, fences, signs, gates, and locks. At CAU 110, soil moisture monitoring, vegetation evaluations, and subsidence surveys are conducted in addition to the visual inspections. At CAU 111, soil moisture monitoring, vegetation evaluations, subsidence surveys, direct radiation monitoring, air monitoring, radon flux monitoring, and groundwater monitoring are conducted. This report will address all monitoring items notes above except groundwater monitoring. Groundwater monitoring is documented in the Nevada National Security Site Data Report: Groundwater Monitoring Program Area 5 Radioactive Waste Management Site. All required inspections, maintenance, and monitoring were conducted in accordance with the post-closure requirements of the permit. Revision 4 of Permit NEV HW0101 was issued effective December 10, 2015, and remains in effect until December 10, 2020.« less

Streamlined Approach for Environmental Restoration (SAFER) Plan for Corrective Action Unit 544: Cellars, Mud Pits, and Oil Spills, Nevada Test Site, Nevada, Revision 0

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

Mark Krauss

2010-07-01

This Streamlined Approach for Environmental Restoration (SAFER) Plan addresses the actions needed to achieve closure for Corrective Action Unit (CAU) 544, Cellars, Mud Pits, and Oil Spills, identified in the Federal Facility Agreement and Consent Order (FFACO). Corrective Action Unit 544 comprises the following 20 corrective action sites (CASs) located in Areas 2, 7, 9, 10, 12, 19, and 20 of the Nevada Test Site (NTS): • 02-37-08, Cellar & Mud Pit • 02-37-09, Cellar & Mud Pit • 07-09-01, Mud Pit • 09-09-46, U-9itsx20 PS #1A Mud Pit • 10-09-01, Mud Pit • 12-09-03, Mud Pit • 19-09-01, Mudmore » Pits (2) • 19-09-03, Mud Pit • 19-09-04, Mud Pit • 19-25-01, Oil Spill • 19-99-06, Waste Spill • 20-09-01, Mud Pits (2) • 20-09-02, Mud Pit • 20-09-03, Mud Pit • 20-09-04, Mud Pits (2) • 20-09-06, Mud Pit • 20-09-07, Mud Pit • 20-09-10, Mud Pit • 20-25-04, Oil Spills • 20-25-05, Oil Spills This plan provides the methodology for field activities needed to gather the necessary information for closing each CAS. There is sufficient information and process knowledge from historical documentation and investigations of similar sites regarding the expected nature and extent of potential contaminants to recommend closure of CAU 544 using the SAFER process. Using the approach approved for previous mud pit investigations (CAUs 530–535), 14 mud pits have been identified that • are either a single mud pit or a system of mud pits, • are not located in a radiologically posted area, and • have no evident biasing factors based on visual inspections. These 14 mud pits are recommended for no further action (NFA), and further field investigations will not be conducted. For the sites that do not meet the previously approved closure criteria, additional information will be obtained by conducting a field investigation before selecting the appropriate corrective action for each CAS. The results of the field investigation will support a defensible recommendation for closure of the remaining CASs in CAU 544. This will be presented in a closure report (CR) that will be prepared and submitted to the Nevada Division of Environmental Protection (NDEP) for review and approval. The sites will be investigated based on the data quality objectives (DQOs) developed on April 27, 2010, by representatives of NDEP and the U.S. Department of Energy (DOE), National Nuclear Security Administration Nevada Site Office (NNSA/NSO). The DQO process was used to identify and define the type, amount, and quality of data needed to determine and implement appropriate corrective actions for each CAS in CAU 544. The DQO process developed for this CAU identified the following expected closure options: (1) investigation and confirmation that no contamination exists above the final action levels (FALs) leading to an NFA declaration, (2) characterization of the nature and extent of contamination leading to closure in place with use restrictions, (3) clean closure by remediation and verification, (4) closure in place with use restrictions with no investigation if CASs are in crater areas that have been determined to be unsafe to enter, or (5) NFA if the mud pit CAS meets the criteria established during the CAUs 530–535 SAFER investigation. The following summarizes the SAFER activities that will support the closure of CAU 544: • Perform visual inspection of all CASs. • Perform site preparation activities (e.g., utilities clearances, construction of temporary site exclusion zones). • Removal of easily managed, nonhazardous, and nonradioactive debris, including vegetation (e.g., tumbleweeds), at various CASs that interfere with sampling, if required to inspect soil surface or collect soil sample. • Collect environmental samples from designated target populations (e.g., mud pits, cellars, stained soil) to confirm or disprove the presence of contaminants of concern (COCs) as necessary to supplement existing information. • If no COCs are present at a CAS, establish NFA as the corrective action. • If COCs exist, collect environmental samples from designated target populations (e.g., clean soil adjacent to contaminated soil) and submit for laboratory analyses to define the extent of COC contamination. • If a COC is present at a CAS, either - Establish clean closure as the corrective action. The material to be remediated will be removed, disposed of as waste, and verification samples will be collected from remaining soil, or - Establish closure in place as the corrective action and implement the appropriate use restrictions. • Confirm the preferred closure option is sufficient to protect human health and the environment.« less

The effects of surgical factors on postoperative astigmatism in patients enrolled in the Infant Aphakia Treatment Study (IATS).

PubMed

Wall, Palak B; Lee, Jason A; Lynn, Michael J; Lambert, Scott R; Traboulsi, Elias I

2014-10-01

To evaluate the effect of surgical factors on postoperative astigmatism in infants undergoing cataract extraction with or without intraocular lens (IOL) implantation. The Infant Aphakia Treatment Study is a multicenter clinical trial in which 114 infants with unilateral congenital cataracts were randomized to undergo cataract extraction with IOL placement or contact lens aphakic correction. Surgical videos were reviewed with regard to incision type and location, whether the incision was extended, the number of sutures placed, and technique of closure. Corneal astigmatism was measured using a handheld keratometer prior to surgery and at 1 year of age. Corneal astigmatism decreased from a mean of 1.92 D at baseline to 1.62 D at age 1 year in the contact lens group but remained almost unchanged from 2.00 D to 2.09 D in the IOL group (P = 0.023). There was no statistical difference between the amount of corneal astigmatism with regard to incision type (P = 0.214) and no increase in astigmatism with extension of the incision to facilitate IOL placement (P = 0.849) at 1 year. The number of sutures and technique of closure did not influence the amount of astigmatism at 1 year. At the age of 1 year following cataract extraction in infants, contact lens correction and the lack of IOL placement are associated with a significant decrease in postoperative corneal astigmatism compared to IOL placement. No other surgical factors considered in this study had a statistically significant effect on corneal astigmatism. Copyright © 2014 American Association for Pediatric Ophthalmology and Strabismus. Published by Elsevier Inc. All rights reserved.

Intraoperative device closure of atrial septal defects with inferior vena cava rim deficiency: a safe alternative to surgical repair.

PubMed

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

2011-03-01

Our objective was to evaluate the safety and feasibility of intraoperative device closure of atrial septal defects with inferior vena cava rim deficiency. From January 2005 to December 2008, we enrolled 65 patients who had a secundum atrial septal defect with inferior vena cava rim deficiency closure in our institution. Patients were divided into 2 groups: 35 patients in group I underwent intraoperative device closure with a right lateral minithoracotomy and 30 in group II underwent open cardiac repair with a right lateral thoracotomy and cardiopulmonary bypass. Intraoperative device closure involved a minimal intercostal incision that was performed after full evaluation of the atrial septal defect by transthoracic echocardiography and the insertion of the device through the delivery sheath to occlude the atrial septal defect. The procedure was successful in all patients. In group I, the diameter of the atrial septal defect ranged from 30 to 44 mm (mean, 35.3 ± 3.9 mm), and the size of the implanted occluder ranged from 34 to 48 mm (mean, 40 ± 2.1 mm). The total occlusion rate was 82.9% immediately after the operation, 97.1% at 3 months, and 100% at 12 and 24 months of follow-up. In group II, all patients had successful closure. A follow-up period of 12 to 24 months was obtained in both groups. During the follow-up, there was no recurrence, thrombosis, or device failure. In our comparative studies, group II had significantly longer operative time, intensive care unit stay, and hospital stay than group I (P < .001). The cost of group I was less than that of group II (20,450.9 ± 840.8 RMB vs 25,884.9 ± 701.8; P < .001). Intraoperative device closure of atrial septal defects with inferior vena cava rim deficiency is a safe and feasible technique. It has the advantages of cost savings, cosmetic results, and less trauma than surgical closure. Early and midterm results are encouraging. Crown Copyright © 2011. Published by Mosby, Inc. All rights reserved.

Eye care for patients receiving neuromuscular blocking agents or propofol during mechanical ventilation.

PubMed

Lenart, S B; Garrity, J A

2000-05-01

The presence of a corneal reflex and the ability to maintain eye closure are instrumental in protecting the cornea. Use of neuromuscular blocking agents or propofol can result in impaired eyelid closure and loss of corneal reflex, leading to corneal exposure. The cornea is then at risk for drying, infection, and scarring, which may lead to permanent visual loss. To determine whether applying artificial tear ointment to the eyes of paralyzed or heavily sedated patients receiving mechanical ventilation decreases the prevalence of exposure keratitis more than does passive closure of the eyelid. A prospective, randomized control trial was done. The sample was 50 patients in the intensive care unit receiving either neuromuscular blocking agents or propofol during mechanical ventilation. In each patient, artificial tear ointment was applied to one eye; passive closure of the eyelid was used for the other eye (control eye). Nine patients had evidence of exposure keratitis in the untreated eye, and 2 had corneal abrasions in both the treated and the control eyes. The remaining 39 patients did not have corneal abrasions in either eye. Use of the artificial tear ointment was more effective in preventing corneal exposure than was passive eyelid closure (P = .004). Eye care with a lubricating ointment on a regular, set schedule can effectively reduce the prevalence of corneal abrasions in patients who are either paralyzed or heavily sedated and thus can help prevent serious complications such as corneal ulceration, infection, and visual loss.

A ten-year review of enterocutaneous fistulas after laparotomy for trauma.

PubMed

Fischer, Peter E; Fabian, Timothy C; Magnotti, Louis J; Schroeppel, Thomas J; Bee, Tiffany K; Maish, George O; Savage, Stephanie A; Laing, Ashley E; Barker, Andrew B; Croce, Martin A

2009-11-01

In the era of open abdomen management, the complication of enterocutaneous fistula (ECF) seems to be increasing in frequency. In nontrauma patients, reported mortality rates are 7% to 20%, and spontaneous closure rates are approximately 25%. This study is the largest series of ECFs reported exclusively caused by trauma and examines the characteristics unique to this population. Trauma patients with an ECF at a single regional trauma center over a 10-year period were reviewed. Parameters studied included fistula output, site, nutritional status, operative history, and fistula resolution (spontaneous vs. operative). Approximately 2,224 patients received a trauma laparotomy and survived longer than 4 days. Of these, 43 patients (1.9%) had ECF. The rate of ECF in men was 2.22% and 0.74% in women. Patients with open abdomen had a higher ECF incidence (8% vs. 0.5%) and lower rate of spontaneous closure (37% vs. 45%). Spontaneous closure occurred in 31% with high-output fistulas, 13% with medium output, and 55% with low output. The mortality rate of ECF was 14% after an average stay of 59 days in the intensive care unit. With damage-control laparotomies, the traumatic ECF rate is increasing and is a different entity than nontraumatic ECF. Although the two populations have similar mortality rates, the trauma cohort demonstrates higher spontaneous closure rates and a curiously higher rate of development in men. Fistula output was not predictive of spontaneous closure.

A current-driven resistive instability and its nonlinear effects in simulations of coaxial helicity injection in a tokamak

DOE PAGES

Hooper, E. B.; Sovinec, C. R.

2016-10-06

An instability observed in whole-device, resistive magnetohydrodynamic simulations of the driven phase of coaxial helicity injection in the National Spherical Torus eXperiment is identified as a current-driven resistive mode in an unusual geometry that transiently generates a current sheet. The mode consists of plasma flow velocity and magnetic field eddies in a tube aligned with the magnetic field at the surface of the injected magnetic flux. At low plasma temperatures (~10–20 eV), the mode is benign, but at high temperatures (~100 eV) its amplitude undergoes relaxation oscillations, broadening the layer of injected current and flow at the surface of themore » injected toroidal flux and background plasma. The poloidal-field structure is affected and the magnetic surface closure is generally prevented while the mode undergoes relaxation oscillations during injection. Furthermore, this study describes the mode and uses linearized numerical computations and an analytic slab model to identify the unstable mode.« less

U.S. Global Defense Posture, 1783-2011

DTIC Science & Technology

2012-01-01

in global affairs to further the nation’s interests. Second, as a consequence of its victory in the Spanish -American War of 1898, the United States...planning process . Despite their importance, the Pentagon needs to ensure that its global defense posture is developed from a top-down, not a bottom-up...to the continental United States (CONUS) or leaving it, both of which have implications for the base realignment and closure process . Despite this

Kyrgyzstan and the Status of the U.S. Manas Airbase: Context and Implications

DTIC Science & Technology

2009-07-01

United States, after the United States had criticized the Uzbek government for repressive actions against civilians. Some of the functions of this...New Zealand, Norway, Poland , South Korea, Spain, and Turkey. Among the few legislators who opposed closing the airbase, Bakyt Beshimov, the leader of...Department of Defense. Roundtable With Secretary of Defense Robert Gates, Krakow, Poland , February 20, 2009. 26 Saban Kardas “Will the Closure of

Closure Report for Corrective Action Unit 465: Hydronuclear Nevada National Security Site, Nevada, Revision 0

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

Mark Burmeister and Patrick Matthews

2012-11-01

The corrective action sites (CASs) within CAU 465 are located within Areas 6 and 27 of the NNSS. CAU 465 comprises the following CASs: • 00-23-01, Hydronuclear Experiment, located in Area 27 of the NNSS and known as the Charlie site. • 00-23-02, Hydronuclear Experiment, located in Area 27 of the NNSS and known as the Dog site. • 00-23-03, Hydronuclear Experiment, located in Area 27 of the NNSS and known as the Charlie Prime and Anja sites. • 06-99-01, Hydronuclear, located in Area 6 of the NNSS and known as the Trailer 13 site. The purpose of this CRmore » is to provide documentation supporting the completed corrective actions and provide data confirming that the closure objectives for CASs within CAU 465 were met. From September 2011 through July 2012, closure activities were performed as set forth in the Streamlined Approach for Environmental Restoration Plan for CAU 465: Hydronuclear, Nevada National Security Site, Nevada.« less

Business closure and relocation: a comparative analysis of the Loma Prieta earthquake and Hurricane Andrew.

PubMed

Wasileski, Gabriela; Rodríguez, Havidán; Diaz, Walter

2011-01-01

The occurrence of a number of large-scale disasters or catastrophes in recent years, including the Indian Ocean tsunami (2004), the Kashmir earthquake (2005), Hurricane Katrina (2005) and Hurricane Ike (2008), have raised our awareness regarding the devastating effects of disasters on human populations and the importance of developing mitigation and preparedness strategies to limit the consequences of such events. However, there is still a dearth of social science research focusing on the socio-economic impact of disasters on businesses in the United States. This paper contributes to this research literature by focusing on the impact of disasters on business closure and relocation through the use of multivariate logistic regression models, specifically focusing on the Loma Prieta earthquake (1989) and Hurricane Andrew (1992). Using a multivariate model, we examine how physical damage to the infrastructure, lifeline disruption and business characteristics, among others, impact business closure and relocation following major disasters. © 2011 The Author(s). Disasters © Overseas Development Institute, 2011.

Comparative analysis of ear-hole closure identifies epimorphic regeneration as a discrete trait in mammals

PubMed Central

Gawriluk, Thomas R.; Simkin, Jennifer; Thompson, Katherine L.; Biswas, Shishir K.; Clare-Salzler, Zak; Kimani, John M.; Kiama, Stephen G.; Smith, Jeramiah J.; Ezenwa, Vanessa O.; Seifert, Ashley W.

2016-01-01

Why mammals have poor regenerative ability has remained a long-standing question in biology. In regenerating vertebrates, injury can induce a process known as epimorphic regeneration to replace damaged structures. Using a 4-mm ear punch assay across multiple mammalian species, here we show that several Acomys spp. (spiny mice) and Oryctolagus cuniculus completely regenerate tissue, whereas other rodents including MRL/MpJ ‘healer' mice heal similar injuries by scarring. We demonstrate ear-hole closure is independent of ear size, and closure rate can be modelled with a cubic function. Cellular and genetic analyses reveal that injury induces blastema formation in Acomys cahirinus. Despite cell cycle re-entry in Mus musculus and A. cahirinus, efficient cell cycle progression and proliferation only occurs in spiny mice. Together, our data unite blastema-mediated regeneration in spiny mice with regeneration in other vertebrates such as salamanders, newts and zebrafish, where all healthy adults regenerate in response to injury. PMID:27109826

Corrective Action Decision Document/Closure Report for Corrective Action Unit 375: Area 30 Buggy Unit Craters, Nevada National Security Site, Nevada, Revision 0

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

Patrick Matthews

2011-08-01

Corrective Action Unit 375 comprises three corrective action sites (CASs): (1) 25-23-22, Contaminated Soils Site; (2) 25-34-06, Test Cell A Bunker; and (3) 30-45-01, U-30a, b, c, d, e Craters. The purpose of this CADD/CR is to provide justification and documentation supporting the recommendation that no further corrective action is needed for CAU 375 based on the implementation of corrective action of closure in place with administrative controls at CAS 25-23-22, no further action at CAS 25-34-06, and closure in place with administrative controls and removal of potential source material (PSM) at CAS 30-45-01. Corrective action investigation (CAI) activities weremore » performed from July 28, 2010, through April 4, 2011, as set forth in the Corrective Action Investigation Plan for Corrective Action Unit 375: Area 30 Buggy Unit Craters. The approach for the CAI was divided into two facets: investigation of the primary release of radionuclides, and investigation of other releases (migration in washes and chemical releases). The purpose of the CAI was to fulfill data needs as defined during the data quality objective (DQO) process. The CAU 375 dataset of investigation results was evaluated based on the data quality assessment. This assessment demonstrated the dataset is acceptable for use in fulfilling the DQO data needs. Investigation results were evaluated against final action levels (FALs) established in this document. A radiological dose FAL of 25 millirem per year was established based on the Remote Work Area exposure scenario (336 hours of annual exposure). Radiological doses exceeding the FAL were assumed to be present within the default contamination boundaries at CASs 25-23-22 and 30-45-01. No contaminants were identified at CAS 25-34-06, and no corrective action is necessary. Potential source material in the form of lead plate, lead-acid batteries, and oil within an abandoned transformer were identified at CAS 30-45-01, and corrective actions were undertaken that consisted of removing the PSM. Use restrictions and warning signs were implemented for the remaining radiological contamination at CASs 25-23-22 and 30-45-01. These use restrictions were recorded in the FFACO database; the U.S. Department of Energy, National Nuclear Security Administration Nevada Site Office (NNSA/NSO) Facility Information Management System; and the NNSA/NSO CAU/CAS files. Therefore, NNSA/NSO provides the following recommendations: (1) No further corrective actions are necessary for CAU 375; (2) A Notice of Completion to NNSA/NSO is requested from the Nevada Division of Environmental Protection for closure of CAU 375; and (3) Move CAU 375 from Appendix III to Appendix IV of the FFACO.« less

Corrective Action Decision Document/Closure Report for Corrective Action Unit 374: Area 20 Schooner Unit Crater, Nevada National Security Site, Nevada with ROTC 1 and 2, Revision 0

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

Matthews, Patrick

Corrective Action Unit 374 comprises five corrective action sites (CASs): • 18-22-05, Drum • 18-22-06, Drums (20) • 18-22-08, Drum • 18-23-01, Danny Boy Contamination Area • 20-45-03, U-20u Crater (Schooner) The purpose of this Corrective Action Decision Document/Closure Report is to provide justification and documentation supporting the recommendation that no further corrective action is needed for CAU 374 based on the implementation of corrective actions. The corrective action of closure in place with administrative controls was implemented at CASs 18-23-01 and 20-45-03, and a corrective action of removing potential source material (PSM) was conducted at CAS 20-45-03. The othermore » CASs require no further action; however, best management practices of removing PSM and drums at CAS 18-22-06, and removing drums at CAS 18-22-08 were performed. Corrective action investigation (CAI) activities were performed from May 4 through October 6, 2010, as set forth in the Corrective Action Investigation Plan for Corrective Action Unit 374: Area 20 Schooner Unit Crater, Nevada Test Site, Nevada. The approach for the CAI was divided into two facets: investigating the primary release of radionuclides and investigating other releases (migration in washes and chemical releases). The purpose of the CAI was to fulfill data needs as defined during the data quality objective (DQO) process. The CAU 374 dataset of investigation results was evaluated based on the data quality indicator parameters. This evaluation demonstrated the dataset is acceptable for use in fulfilling the DQO data needs. Analytes detected during the CAI were evaluated against final action levels (FALs) established in this document. Radiological doses exceeding the FAL of 25 millirem per year were found to be present in the surface soil that was sampled. It is assumed that radionuclide levels present in subsurface media within the craters and ejecta fields (default contamination boundaries) at the Danny Boy and Schooner sites exceed the FAL. It is also assumed that PSM in the form of lead-acid batteries at Schooner exceeds the FAL. Therefore, corrective actions were undertaken that consist of removing PSM, where present, and implementing a use restriction and posting warning signs at the Danny Boy and Schooner sites. These use restrictions were recorded in the FFACO database; the U.S. Department of Energy, National Nuclear Security Administration Nevada Site Office (NNSA/NSO) Facility Information Management System; and the NNSA/NSO CAU/CAS files. Therefore, NNSA/NSO provides the following recommendations: • No further corrective actions are necessary for CAU 374. • A Notice of Completion to NNSA/NSO is requested from the Nevada Division of Environmental Protection for closure of CAU 374. • Corrective Action Unit 374 should be moved from Appendix III to Appendix IV of the FFACO.« less

Treatment of severe pulmonary hypertension in the setting of the large patent ductus arteriosus.

PubMed

Niu, Mary C; Mallory, George B; Justino, Henri; Ruiz, Fadel E; Petit, Christopher J

2013-05-01

Treatment of the large patent ductus arteriosus (PDA) in the setting of pulmonary hypertension (PH) is challenging. Left patent, the large PDA can result in irreversible pulmonary vascular disease. Occlusion, however, may lead to right ventricular failure for certain patients with severe PH. Our center has adopted a staged management strategy using medical management, noninvasive imaging, and invasive cardiac catheterization to treat PH in the presence of a large PDA. This approach determines the safety of ductal closure but also leverages medical therapy to create an opportunity for safe PDA occlusion. We reviewed our experience with this approach. Patients with both severe PH and PDAs were studied. PH treatment history and hemodynamic data obtained during catheterizations were reviewed. Repeat catheterizations, echocardiograms, and clinical status at latest follow-up were also reviewed. Seven patients had both PH and large, unrestrictive PDAs. At baseline, all patients had near-systemic right ventricular pressures. Nine catheterizations were performed. Two patients underwent 2 catheterizations each due to poor initial response to balloon test occlusion. Six of 7 patients exhibited subsystemic pulmonary pressures during test occlusion and underwent successful PDA occlusion. One patient did not undergo PDA occlusion. In follow-up, 2 additional catheterizations were performed after successful PDA occlusion for subsequent hemodynamic assessment. At the latest follow-up, the 6 patients who underwent PDA occlusion are well, with continued improvement in PH. Five patients remain on PH treatment. A staged approach to PDA closure for patients with severe PH is an effective treatment paradigm. Aggressive treatment of PH creates a window of opportunity for PDA occlusion, echocardiography assists in identifying the timing for closure, and balloon test occlusion during cardiac catheterization is critical in determining safety of closure. By safely eliminating the large PDA, this treatment algorithm can halt the perilous combination of the large shunting from the PDA and PH in a population at high risk of morbidity and mortality.

Impact of Pulmonary Flow Study Pressure on Outcomes After One-Stage Unifocalization.

PubMed

Trezzi, Matteo; Albanese, Sonia B; Albano, Antonio; Rinelli, Gabriele; D'Anna, Carolina; Polito, Angelo; Cetrano, Enrico; Carotti, Adriano

2017-12-01

The purpose of this study was to evaluate the accuracy of the pulmonary flow study in (1) predicting the feasibility of concomitant intracardiac repair after one-stage unifocalization; and in (2) predicting long-term survival and the onset of right ventricular dysfunction after surgery. Between October 1996 and July 2015, a flow study was obtained in 95 patients undergoing complete one-stage unifocalization for pulmonary atresia with ventricular septal defect and major aortopulmonary collaterals. The ability to achieve 100% flow (approximately 2.5 L · min -1 · m -2 ) into the pulmonary bed at a mean pressure of 30 mm Hg or less was utilized as an indicator for acceptability of ventricular septal defect closure. Overall survival was 78% ± 6% at 15 years. Sixty-four patients underwent successful one-stage intracardiac repair. The flow study accurately predicted suitability for VSD closure (area under the curve = 0.855). After one-stage ventricular septal defect closure, no difference in survival was observed after stratification according to flow study pressures (25 mm Hg or less versus greater than 25 mm Hg, log rank p = 0.20). At a median follow-up of 7 years, no association was found between flow study pressure and the onset of right ventricular dysfunction (p = 0.21). Overall, the inability to achieve final intracardiac repair was a strong predictor of death (hazard ratio 9.14, 95% confidence interval: 1.98 to 42.07, p < 0.0001). Suitability for ventricular septal defect closure is reliably defined by the flow study with a cutoff of 30 mm Hg. Flow study pressure values do not affect long-term outcomes. The ability to obtain intracardiac repair (in either one or more stages) is the strongest predictor of survival. Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

The CORONIS Trial. International study of caesarean section surgical techniques: a randomised fractional, factorial trial

PubMed Central

2007-01-01

Background Caesarean section is one of the most commonly performed operations on women throughout the world. Rates have increased in recent years – about 20–25% in many developed countries. Rates in other parts of the world vary widely. A variety of surgical techniques for all elements of the caesarean section operation are in use. Many have not yet been rigorously evaluated in randomised controlled trials, and it is not known whether any are associated with better outcomes for women and babies. Because huge numbers of women undergo caesarean section, even small differences in post-operative morbidity rates between techniques could translate into improved health for substantial numbers of women, and significant cost savings. Design CORONIS is a multicentre, fractional, factorial randomised controlled trial and will be conducted in centres in Argentina, Ghana, India, Kenya, Pakistan and Sudan. Women are eligible if they are undergoing their first or second caesarean section through a transverse abdominal incision. Five comparisons will be carried out in one trial, using a 2 × 2 × 2 × 2 × 2 fractional factorial design. This design has rarely been used, but is appropriate for the evaluation of several procedures which will be used together in clinical practice. The interventions are: • Blunt versus sharp abdominal entry • Exteriorisation of the uterus for repair versus intra-abdominal repair • Single versus double layer closure of the uterus • Closure versus non-closure of the peritoneum (pelvic and parietal) • Chromic catgut versus Polyglactin-910 for uterine repair The primary outcome is death or maternal infectious morbidity (one or more of the following: antibiotic use for maternal febrile morbidity during postnatal hospital stay, antibiotic use for endometritis, wound infection or peritonitis) or further operative procedures; or blood transfusion. The sample size required is 15,000 women in total; at least 7,586 women in each comparison. Discussion Improvements in health from optimising caesarean section techniques are likely to be more significant in developing countries, because the rates of postoperative morbidity in these countries tend to be higher. More women could therefore benefit from improvements in techniques. Trial registration The CORONIS Trial is registered in the Current Controlled Trials registry. ISCRTN31089967. PMID:18336721

Emergent material properties of developing epithelial tissues.

PubMed

Machado, Pedro F; Duque, Julia; Étienne, Jocelyn; Martinez-Arias, Alfonso; Blanchard, Guy B; Gorfinkiel, Nicole

2015-11-23

Force generation and the material properties of cells and tissues are central to morphogenesis but remain difficult to measure in vivo. Insight is often limited to the ratios of mechanical properties obtained through disruptive manipulation, and the appropriate models relating stress and strain are unknown. The Drosophila amnioserosa epithelium progressively contracts over 3 hours of dorsal closure, during which cell apices exhibit area fluctuations driven by medial myosin pulses with periods of 1.5-6 min. Linking these two timescales and understanding how pulsatile contractions drive morphogenetic movements is an urgent challenge. We present a novel framework to measure in a continuous manner the mechanical properties of epithelial cells in the natural context of a tissue undergoing morphogenesis. We show that the relationship between apicomedial myosin fluorescence intensity and strain during fluctuations is consistent with a linear behaviour, although with a lag. We thus used myosin fluorescence intensity as a proxy for active force generation and treated cells as natural experiments of mechanical response under cyclic loading, revealing unambiguous mechanical properties from the hysteresis loop relating stress to strain. Amnioserosa cells can be described as a contractile viscoelastic fluid. We show that their emergent mechanical behaviour can be described by a linear viscoelastic rheology at timescales relevant for tissue morphogenesis. For the first time, we establish relative changes in separate effective mechanical properties in vivo. Over the course of dorsal closure, the tissue solidifies and effective stiffness doubles as net contraction of the tissue commences. Combining our findings with those from previous laser ablation experiments, we show that both apicomedial and junctional stress also increase over time, with the relative increase in apicomedial stress approximately twice that of other obtained measures. Our results show that in an epithelial tissue undergoing net contraction, stiffness and stress are coupled. Dorsal closure cell apical contraction is driven by the medial region where the relative increase in stress is greater than that of stiffness. At junctions, by contrast, the relative increase in the mechanical properties is the same, so the junctional contribution to tissue deformation is constant over time. An increase in myosin activity is likely to underlie, at least in part, the change in medioapical properties and we suggest that its greater effect on stress relative to stiffness is fundamental to actomyosin systems and confers on tissues the ability to regulate contraction rates in response to changes in external mechanics.

Out-of-hospital births and the supply of maternity units in France.

PubMed

Blondel, Béatrice; Drewniak, Nicolas; Pilkington, Hugo; Zeitlin, Jennifer

2011-09-01

Maternity unit closures in France have increased distances that women travel to deliver in hospital. We studied how the supply of maternity units influences the rate of out-of-hospital births using birth certificate data. In 2005-6, 4.3 per 1000 births were out-of-hospital. Rates were more than double for women living 30km or more from their nearest unit and were even higher for women of high parity. These associations persisted in multilevel analyses adjusting for other maternal characteristics. Long distances to maternity units should be a concern to health planners because of the maternal and infant health risks. Copyright © 2011 Elsevier Ltd. All rights reserved.

Data system for multiplexed water-current meters

NASA Technical Reports Server (NTRS)

Ramsey, C. R.

1977-01-01

Flow rates at 32 flood plain locations are measured simultaneously by single digital logic unit with high noise immunity. Water flowing through pygmy current meters rotates element that closes electrical contact once every resolution, so flow rate is measured by counting number of closures in time interval.

Monitoring Potential Transport of Radioactive Contaminants in Shallow Ephemeral Channels: FY2015 and FY2016

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

Mizell, Steve A; Miller, Julianne J; McCurdy, Greg

The Desert Research Institute (DRI) is conducting a field assessment of the potential for contaminated soil to be transported from the Smoky Contamination Area (CA) as a result of storm runoff. This activity supports Nevada Nuclear Security Administration (NNSA) efforts to complete regulatory closure of the Soils Corrective Action Unit (CAU) contamination areas. The work is intended to confirm the likely mechanism of transport and determine the meteorological conditions that might cause movement of contaminated soils, as well as determine the particle size fraction that is most closely associated with transported radionuclide-contaminated soils. These data will facilitate the appropriate closuremore » design and post-closure monitoring program.« less

Implementing supercritical water oxidation technology in a lunar base environmental control/life support system

NASA Technical Reports Server (NTRS)

Meyer Sedej, M.

1985-01-01

A supercritical water oxidation system (SCWOS) offers several advantages for a lunar base environmental control/life support system (ECLSS) compared to an ECLSS based on Space Station technology. In supercritically heated water (630 K, 250 atm) organic materials mix freely with oxygen and undergo complete combustion. Inorganic salts lose solubility and precipitate out. Implementation of SCWOS can make an ECLSS more efficient and reliable by elimination of several subsystems and by reduction in potential losses of life support consumables. More complete closure of the total system reduces resupply requirements from the earth, a crucial cost item in maintaining a lunar base.

SIGNIFICANCE OF PREOPERATIVE EXTERNAL LIMITING MEMBRANE HEIGHT ON VISUAL PROGNOSIS IN PATIENTS UNDERGOING MACULAR HOLE SURGERY.

PubMed

Geenen, Caspar; Murphy, Declan C; Sandinha, Maria T; Rees, Jon; Steel, David H W

2018-03-05

To investigate the association between the vertical elevation of the external limiting membrane (ELM) and visual outcome in patients undergoing surgery for idiopathic full-thickness macular hole. Retrospective observational study of a consecutive cohort of patients undergoing vitrectomy to treat macular hole. The greatest vertical height of the central ELM above the retinal pigment epithelium (ELM height) was measured on spectral domain optical coherence tomography preoperatively. The relationship of ELM height to other preoperative and postoperative variables, including macular hole width and height, and visual acuity was analyzed. Data from 91 eyes of 91 patients who had undergone successful hole closure were included. The mean ELM height was 220 μm (range 100-394). There were significant correlations between the ELM height and the diameter of the hole, hole height, and worsening preoperative visual acuity. For holes less than 400 μm in width, better postoperative visual acuity was significantly predicted by a lower ELM height. The ELM height varies widely in idiopathic macular hole. It is higher in eyes where the hole is wider and also when the hole itself is higher. For holes of less than 400 μm in width, a lower ELM height is a strong independent predictor of a good postoperative outcome.

Osteo-odonto-keratoprosthesis - a maxillofacial perspective.

PubMed

Narayanan, Vinod; Nirvikalpa, Natarajan; Rao, Srinivas K

2012-12-01

The OOKP (osteo-odonto-keratoprosthesis) is the treatment of choice for conditions like Stevens-Johnson syndrome, ocular cicatricial pemphigoid, trachoma, multiple failed grafts and chemical burns which are not amenable to penetrating keratoplasty. The OOKP is an autograft which replaces the cornea with a polymethacrylate cylinder mounted on a tooth-bone complex. The aim of this paper was to retrospectively analyze the records in 26 patients undergoing OOKP surgery between 2007 and 2011. The paper describes our experience with the procedure, with emphasis on its oral and maxillofacial aspects and management of associated complications. The aetiology of blindness in 23 patients was Stevens-Johnson's syndrome and chemical burns in three. Twenty-two patients had their maxillary canines, two had mandibular canines and two had maxillary first premolars as the choice of donor tooth. An oroantral fistula developed in four patients. One patient needed to undergo a surgical procedure for closure of the same. Roots of adjacent teeth were exposed in 12 patients. Twenty-four patients underwent both stages of the procedure with 19 being visually rehabilitated successfully. There was no improvement in the vision of four patients. One patient was lost to follow-up. Two patients have yet to undergo Stage 2. Copyright © 2012 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Radiation exposure and contrast agent use related to radial versus femoral arterial access during percutaneous coronary intervention (PCI)-Results of the FERARI study.

PubMed

Becher, Tobias; Behnes, Michael; Ünsal, Melike; Baumann, Stefan; El-Battrawy, Ibrahim; Fastner, Christian; Kuschyk, Jürgen; Papavassiliu, Theano; Hoffmann, Ursula; Mashayekhi, Kambis; Borggrefe, Martin; Akin, Ibrahim

2016-12-01

Data regarding radiation exposure related to radial versus femoral arterial access in patients undergoing percutaneous coronary intervention (PCI) remain controversial. This study aims to evaluate patients enrolled in the FERARI study regarding radiation exposure, fluoroscopy time and contrast agent use. The Femoral Closure versus Radial Compression Devices Related to Percutaneous Coronary Interventions (FERARI) study evaluated prospectively 400 patients between February 2014 and May 2015 undergoing PCI either using the radial or femoral access. In these 400 patients, baseline characteristics, procedural data such as procedural duration, fluoroscopy time, dose-area product (DAP) as well as the amount of contrast agent used were documented and analyzed. Median fluoroscopy time was not significantly different in patients undergoing radial versus femoral access (12.2 vs. 9.8min, p=0.507). Furthermore, median DAP (54.5 vs. 52.0 Gycm2, p=0.826), procedural duration (46.0 vs. 45.0min, p=0.363) and contrast agent use (185.5 vs. 199.5ml, p=0.742) were also similar in radial and femoral PCI. There was no difference regarding median fluoroscopy time, procedural duration, radiation dose or contrast agent use between radial versus femoral arterial access in PCI. Copyright © 2016 Elsevier Inc. All rights reserved.

[Combined left atrial appendage percutaneous closure and atrial fibrillation ablation: a single center experience].

PubMed

Pelissero, Elisa; Giuggia, Marco; Todaro, Maria Chiara; Trapani, Giuseppe; Giordano, Benedetta; Senatore, Gaetano

2017-12-01

We evaluated long-term safety and efficacy of concomitant left atrial appendage (LAA) closure and atrial fibrillation (AF) ablation. From February 2013 to June 2017, all patients referred for AF ablation and LAA closure (group 1) were enrolled in the study and compared with a matched control group undergoing AF ablation only (group 2). Pulmonary vein isolation was achieved in all cases with radiofrequency or cryoballoon. LAA was occluded with Watchman or Amplatzer Cardiac Plug or Amulet (ACP) devices. All patients were treated with oral anticoagulation therapy for at least 3 months after the procedure ("blanking period"), and then switched to dual antiplatelet therapy with aspirin and clopidogrel for other 3 months, and then to single antiplatelet therapy with aspirin in case of LAA closure, while group 2 was treated with long-term oral anticoagulation therapy according to CHA2DS2-VASc score. Follow-up was performed with transesophageal echocardiography and clinical visit at 3, 6 and 12 months after the procedure. AF burden was evaluated by loop recorder or pacemaker interrogation in all patients. Overall, 42 patients were enrolled, 21 in each group. Mean age was 66.86 ± 10.35 years in group 1 vs 68.42 ± 10.61 in group 2 (p=NS); mean CHA2DS2-VASc score was 2.8 ± 1.22 in group 1 vs 2.01 ± 0.93 in group 2 (p=NS), mean HAS-BLED score was 3.2 ± 0.83 in group 1 vs 3.1 ± 0.95 in group 2 (p=NS). Persistent AF was present in 80% of patients in group 1 and in 85% in group 2. LAA closure was successful in all cases (14 Watchman, 7 ACP devices). Procedural and fluoroscopy times were shorter in group 2 (68 ± 17 vs 52 ± 15 min, p <0.05; 23 ± 5 vs 18 ± 3 min, p <0.05, respectively). No procedural complications were observed in group 2, while in group 1 one case of self-terminating pericardial effusion and one arteriovenous fistula were observed. At a mean follow-up of 14.93 ± 10.05 months, complete seal of LAA was documented in all patients, with neither dislocations nor thromboembolic events. Similarly, no long-term complications were observed in group 2. Maintenance of sinus rhythm was overlapping, with an AF relapse rate of 36% in group 1 vs 38% in group 2 (p=NS). Combined LAA percutaneous closure and AF ablation appears to be feasible in high-risk patients.

Some possibilities of a closure degree increase and matter turnover intensification in the bioregenerative life support system BIOS-3

NASA Astrophysics Data System (ADS)

Tikhomirov, A. A.; Ushakova, S. A.; Velichko, V. V.; Degermendzhy, Á. G.; Lasseur, Ch.; Lamaze, B.

The problems of scientific-technical substantiation of perspective joint IBP-ESA works on imitation of functioning of stationary bioregenerative life support systems BLSS on Moon and or Mars are discussed With this purpose the possibilities of matter turnover intensification and closure degree increase which can be achieved after modernization of the BIOS-3 BLSS designed and constructed at Institute of Biophysics Siberian Branch of Russian Academy of Sciences IBP SB RAS Russia are considered These works are performed in the frame of INTAS IA project under the joint SB RAS-ESA financial support Specifically at the expense of intensity increase of photosynthetic active radiation from 150 to 250 Wt m 2 the productivity of photosynthesizing unit on oxygen and biomass is supposed to increase on 50 on average The given substantiation is based upon analysis of carried out preliminary experiments in a laboratory environment and in the BIOS-3 facility and also on series of experiments carried out at present time The results of technical reconstruction of lighting and thermoregulation systems demonstrating practical possibility of these plans implementation are produced On the grounds of mass exchange processes intensification the problems of a crew supply with vegetarian food and oxygen under a smaller photosynthesizing unit size are considered Some possibilities of the humans wastes utilization under combination of physicochemical and biological methods and necessary technical decisions allowing closure increase of matter turnover are

Supporting Displaced Workers for Successful Retraining.

ERIC Educational Resources Information Center

Bugler, Helen; Newhook, Brenda

In response to the closure and down-sizing of fish plants in Newfoundland, Cabot College (CC) established a Student Support Services Unit (SSSU) to offer special counseling and advising services to the more than 100 students expected to undertake vocational retraining at CC under the province's Fisheries Adjustment Program. The SSSU hired two…

40 CFR 267.111 - What general standards must I meet when I stop operating the unit?

Code of Federal Regulations, 2011 CFR

2011-07-01

... to protect human health and the environment, post-closure escape of hazardous waste, hazardous constituents, leachate, contaminated run-off, or hazardous waste decomposition products to the ground or... PROTECTION AGENCY (CONTINUED) SOLID WASTES (CONTINUED) STANDARDS FOR OWNERS AND OPERATORS OF HAZARDOUS WASTE...

40 CFR 267.111 - What general standards must I meet when I stop operating the unit?

Code of Federal Regulations, 2010 CFR

2010-07-01

... to protect human health and the environment, post-closure escape of hazardous waste, hazardous constituents, leachate, contaminated run-off, or hazardous waste decomposition products to the ground or... PROTECTION AGENCY (CONTINUED) SOLID WASTES (CONTINUED) STANDARDS FOR OWNERS AND OPERATORS OF HAZARDOUS WASTE...

WHAT ARE THE BEST MEANS TO ASSESS SITES AND MOVE TOWARD CLOSURE, USING APPROPRIATE SITE SPECIFIC RISK EVALUATIONS?

EPA Science Inventory

To facilitate evaluation of existing site characterization data, ORD has developed on-line tools and models that integrate data and models into innovative applications. Forty calculators have been developed in four groups: parameter estimators, models, scientific demos and unit ...

The Income Losses of Displaced Workers

ERIC Educational Resources Information Center

Hijzen, Alexander; Upward, Richard; Wright, Peter W.

2010-01-01

We use a new, matched worker-firm dataset for the United Kingdom to estimate the income loss resulting from firm closure and mass layoffs. We track workers for up to nine years after the displacement event, and the availability of predisplacement characteristics allows us to implement difference-in-differences estimators using propensity score…

MEETING IN MEXICO: NOWCASTING AND FORECASTING BEACH BACTERIA CONCENTRATION USING EPA'S VIRTUAL BEACH SOFTWARE

EPA Science Inventory

Beaches in the United States of (North) America are subject to closure when bacterial counts exceed water quality criteria. Many authorities base these decisions on water samples that typically require at least 18 hours to analyze. This persistence approach, or model, often leads...

76 FR 66260 - Fisheries of the Northeastern United States; Atlantic Mackerel, Squid, and Butterfish Fisheries...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-10-26

... number of management measures, such as closure thresholds, gear restrictions, and possession limits. The... recommended zero JVP because U.S. shoreside processing capacity for mackerel has expanded. The Council... personal identifying information (e.g., name, address, etc.) submitted voluntarily by the sender will be...

Joining Forces: The Case of Alliant International University

ERIC Educational Resources Information Center

Leslie, Heather

2013-01-01

Mergers and acquisitions are a prevalent force in higher education as more colleges and universities are joining forces to expand resources, enhance missions, or prevent closures. This study examines the merger of Alliant University (formerly California School of Professional Psychology) with United States International University to create what…

50 CFR 648.55 - Framework adjustments to management measures.

Code of Federal Regulations, 2010 CFR

2010-10-01

... criteria. Rotational Closures should be considered where projected annual change in scallop biomass is... annual change in scallop biomass is less than 15 percent. (b) The preparation of the SAFE Report shall... calculate the stock biomass and fishing mortality for the entire unit stock and consider all sources of...

21 CFR 212.50 - What production and process controls must I have?

Code of Federal Regulations, 2010 CFR

2010-04-01

... containers, closures, and packaging materials, including a specimen or copy of each label and all other..., the name and radioactivity or other measurement of each active pharmaceutical ingredient and each... active pharmaceutical ingredient and each inactive ingredient per batch or per unit of radioactivity or...

21 CFR 212.50 - What production and process controls must I have?

Code of Federal Regulations, 2011 CFR

2011-04-01

... containers, closures, and packaging materials, including a specimen or copy of each label and all other... radioactivity or other measurement of each active pharmaceutical ingredient and each inactive ingredient per... active pharmaceutical ingredient and each inactive ingredient per batch or per unit of radioactivity or...

Investigations of turbulent scalar fields using probability density function approach

NASA Technical Reports Server (NTRS)

Gao, Feng

1991-01-01

Scalar fields undergoing random advection have attracted much attention from researchers in both the theoretical and practical sectors. Research interest spans from the study of the small scale structures of turbulent scalar fields to the modeling and simulations of turbulent reacting flows. The probability density function (PDF) method is an effective tool in the study of turbulent scalar fields, especially for those which involve chemical reactions. It has been argued that a one-point, joint PDF approach is the one to choose from among many simulation and closure methods for turbulent combustion and chemically reacting flows based on its practical feasibility in the foreseeable future for multiple reactants. Instead of the multi-point PDF, the joint PDF of a scalar and its gradient which represents the roles of both scalar and scalar diffusion is introduced. A proper closure model for the molecular diffusion term in the PDF equation is investigated. Another direction in this research is to study the mapping closure method that has been recently proposed to deal with the PDF's in turbulent fields. This method seems to have captured the physics correctly when applied to diffusion problems. However, if the turbulent stretching is included, the amplitude mapping has to be supplemented by either adjusting the parameters representing turbulent stretching at each time step or by introducing the coordinate mapping. This technique is still under development and seems to be quite promising. The final objective of this project is to understand some fundamental properties of the turbulent scalar fields and to develop practical numerical schemes that are capable of handling turbulent reacting flows.

Functional analysis of cellulose and xyloglucan in the walls of stomatal guard cells of Arabidopsis thaliana

DOE PAGES

Rui, Yue; Anderson, Charles T.

2016-01-04

Here, stomatal guard cells are pairs of specialized epidermal cells that control water and CO 2 exchange between the plant and the environment. To fulfill the functions of stomatal opening and closure that are driven by changes in turgor pressure, guard cell walls must be both strong and flexible, but how the structure and dynamics of guard cell walls enable stomatal function remains poorly understood. To address this question, we applied cell biological and genetic analyses to investigate guard cell walls and their relationship to stomatal function in Arabidopsis ( Arabidopsis thaliana). Using live-cell spinning disk confocal microscopy, we measuredmore » the motility of cellulose synthase (CESA)-containing complexes labeled by green fluorescent protein (GFP)-CESA3 and observed a reduced proportion of GFP-CESA3 particles colocalizing with microtubules upon stomatal closure. Imaging cellulose organization in guard cells revealed a relatively uniform distribution of cellulose in the open state and a more fibrillar pattern in the closed state, indicating that cellulose microfibrils undergo dynamic reorganization during stomatal movements. In cesa3 je5 mutants defective in cellulose synthesis and xxt1 xxt2 mutants lacking the hemicellulose xyloglucan, stomatal apertures, changes in guard cell length, and cellulose reorganization were aberrant during fusicoccin-induced stomatal opening or abscisic acid-induced stomatal closure, indicating that sufficient cellulose and xyloglucan are required for normal guard cell dynamics. Together, these results provide new insights into how guard cell walls allow stomata to function as responsive mediators of gas exchange at the plant surface.« less

Functional Analysis of Cellulose and Xyloglucan in the Walls of Stomatal Guard Cells of Arabidopsis1[OPEN

PubMed Central

Rui, Yue; Anderson, Charles T.

2016-01-01

Stomatal guard cells are pairs of specialized epidermal cells that control water and CO2 exchange between the plant and the environment. To fulfill the functions of stomatal opening and closure that are driven by changes in turgor pressure, guard cell walls must be both strong and flexible, but how the structure and dynamics of guard cell walls enable stomatal function remains poorly understood. To address this question, we applied cell biological and genetic analyses to investigate guard cell walls and their relationship to stomatal function in Arabidopsis (Arabidopsis thaliana). Using live-cell spinning disk confocal microscopy, we measured the motility of cellulose synthase (CESA)-containing complexes labeled by green fluorescent protein (GFP)-CESA3 and observed a reduced proportion of GFP-CESA3 particles colocalizing with microtubules upon stomatal closure. Imaging cellulose organization in guard cells revealed a relatively uniform distribution of cellulose in the open state and a more fibrillar pattern in the closed state, indicating that cellulose microfibrils undergo dynamic reorganization during stomatal movements. In cesa3je5 mutants defective in cellulose synthesis and xxt1 xxt2 mutants lacking the hemicellulose xyloglucan, stomatal apertures, changes in guard cell length, and cellulose reorganization were aberrant during fusicoccin-induced stomatal opening or abscisic acid-induced stomatal closure, indicating that sufficient cellulose and xyloglucan are required for normal guard cell dynamics. Together, these results provide new insights into how guard cell walls allow stomata to function as responsive mediators of gas exchange at the plant surface. PMID:26729799

Malthusian overfishing and efforts to overcome it on Kenyan coral reefs.

PubMed

McClanahan, Tim R; Hicks, Christina C; Darling, Emily S

2008-09-01

This study examined trends along a gradient of fishing intensity in an artisanal coral reef fishery over a 10-year period along 75 km of Kenya's most populated coastline. As predicted by Malthusian scenarios, catch per unit effort (CPUE), mean trophic level, the functional diversity of fished taxa, and the diversity of gear declined, while total annual catch and catch variability increased along the fishing pressure gradient. The fishery was able to sustain high (approximately 16 Mg x km(-2) x yr(-1)) but variable yields at high fishing pressure due to the dominance of a few productive herbivorous fish species in the catch. The effect of two separate management strategies to overcome this Malthusian pattern was investigated: fisheries area closure and elimination of the dominant and most "competitive" gear. We found that sites within 5 km of the enforced closure showed significantly lower total catch and CPUE, but increased yield stability and trophic level of catch than predicted by regression models normalized for fishing effort. Sites that had excluded illegal beach seine use through active gear management exhibited increased total catch and CPUE. There was a strong interaction between closure and gear management, which indicates that, for closures to be effective at increasing catch, there must be simultaneous efforts at gear management around the periphery of the closures. We propose that Malthusian effects are responsible for the variation in gear and catch and that active management through reduced effort and reductions in the most competitive gear have the greatest potential to increase the functional and trophic diversity and per-person productivity.

Spontaneous Closure of Patent Ductus Arteriosus in Infants ≤1500 g.

PubMed

Semberova, Jana; Sirc, Jan; Miletin, Jan; Kucera, Jachym; Berka, Ivan; Sebkova, Sylva; O'Sullivan, Sinead; Franklin, Orla; Stranak, Zbynek

2017-08-01

Patent ductus arteriosus (PDA) remains a challenging issue in very low birth weight (VLBW) infants, and its management varies widely. Our aim in this study was to document the natural course of ductus arteriosus in a cohort of VLBW infants who underwent conservative PDA management with no medical or surgical intervention. A retrospective cohort study conducted in 2 European level-3 neonatal units. A total of 368 VLBW infants were born within the study period. Two hundred and ninety-seven infants were free of congenital malformations or heart defects and survived to hospital discharge. Out of those, 280 infants received truly conservative PDA management. In 237 (85%) of nontreated infants, the PDA closed before hospital discharge. The Kaplan-Meier model was used to document the incidence proportion of PDA closure over time for different gestational age groups. The median time to ductal closure was 71, 13, 8, and 6 days in <26+0, 26+0 to 27+6, 28+0 to 29+6, and ≥30 weeks, respectively. For different birth weight groups, the median was 48, 22, 9, and 8 days in infants weighing <750, 750 to 999, 1000 to 1249, and 1250 to 1500 g, respectively. No statistically significant relationship was found between PDA closure before hospital discharge and neonatal morbidities. The likelihood of PDA spontaneous closure in VLBW infants is extremely high. We provide in our findings a platform for future placebo-controlled trials focused on the smallest and youngest infants. Copyright © 2017 by the American Academy of Pediatrics.

Results of the combined U.S. Multicenter Pivotal Study and the Continuing Access Study of the Nit-Occlud PDA device for percutaneous closure of patent ductus arteriosus.

PubMed

Moore, John W; Greene, Jessica; Palomares, Salvadore; Javois, Alexander; Owada, Carl Y; Cheatham, John P; Hoyer, Mark H; Jones, Thomas K; Levi, Daniel S

2014-12-01

This study aimed to compare the efficacy and safety of the Nit-Occlud PDA device (PFM Medical, Cologne, Germany) to benchmarks designed as objective performance criteria (OPC). The Nit-Occlud PDA is a nitinol coil-type patent ductus arteriosus (PDA) occluder with a reverse cone configuration, which is implanted using a controlled delivery system. Patients with <4-mm minimum diameter PDA were prospectively enrolled in the Pivotal and the Continuing Access Studies from 15 sites in the United States and were followed up for 12 months post-procedure. Investigator-reported outcomes were compared to OPC including a composite success criterion, efficacy criteria of successful closure (clinical and echocardiographic), and safety criteria incidence of adverse events (serious and of total). The Pivotal Study enrolled patients between November 1, 2002 and October 31, 2005, and the Continuing Access Study enrolled additional patients between September 1, 2006 and October 31, 2007. A total of 357 patients were enrolled, and 347 had successful device implantations. After 12 months, 96.8% had complete echocardiographic closure (OPC = 85%) and 98.1% had clinical closure (OPC = 95%). There were no deaths or serious adverse events (OPC = 1%). The total adverse event rate was 4.7% (OPC = 6%). Composite success was 95.1% in the study patients (OPC = 80%). Closure of small- and medium-sized PDA with the Nit-Occlud PDA is effective and safe when compared with OPC. Copyright © 2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Corrective Action Decision Document for Corrective Action Unit 428: Area 3 Septic Waste Systems 1 and 5, Tonopah Test Range, Nevada

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

U.S. Department of Energy, Nevada Operations Office

2000-02-08

This Corrective Action Decision Document identifies and rationalizes the US Department of Energy, Nevada Operations Office's selection of a recommended corrective action alternative (CAA) appropriate to facilitate the closure of Corrective Action Unit (CAU) 428, Septic Waste Systems 1 and 5, under the Federal Facility Agreement and Consent Order. Located in Area 3 at the Tonopah Test Range (TTR) in Nevada, CAU 428 is comprised of two Corrective Action Sites (CASs): (1) CAS 03-05-002-SW01, Septic Waste System 1 and (2) CAS 03-05-002- SW05, Septic Waste System 5. A corrective action investigation performed in 1999 detected analyte concentrations that exceeded preliminarymore » action levels; specifically, contaminants of concern (COCs) included benzo(a) pyrene in a septic tank integrity sample associated with Septic Tank 33-1A of Septic Waste System 1, and arsenic in a soil sample associated with Septic Waste System 5. During this investigation, three Corrective Action Objectives (CAOs) were identified to prevent or mitigate exposure to contents of the septic tanks and distribution box, to subsurface soil containing COCs, and the spread of COCs beyond the CAU. Based on these CAOs, a review of existing data, future use, and current operations in Area 3 of the TTR, three CAAs were developed for consideration: Alternative 1 - No Further Action; Alternative 2 - Closure in Place with Administrative Controls; and Alternative 3 - Clean Closure by Excavation and Disposal. These alternatives were evaluated based on four general corrective action standards and five remedy selection decision factors. Based on the results of the evaluation, the preferred CAA was Alternative 3. This alternative meets all applicable state and federal regulations for closure of the site and will eliminate potential future exposure pathways to the contaminated soils at the Area 3 Septic Waste Systems 1 and 5.« less

CLOSURE REPORT FOR CORRECTIVE ACTION UNIT 204: STORAGE BUNKERS, NEVADA TEST SITE, NEVADA

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

NONE

Corrective Action Unit (CAU) 330 consists of four Corrective Action Sites (CASs) located in Areas 6, 22, and 23 of the Nevada Test Site (NTS). The unit is listed in the Federal Facility Agreement and Consent Order (FFACO, 1996) as CAU 330: Areas 6, 22, and 23 Tanks and Spill Sites. CAU 330 consists of the following CASs: CAS 06-02-04, Underground Storage Tank (UST) and Piping CAS 22-99-06, Fuel Spill CAS 23-01-02, Large Aboveground Storage Tank (AST) Farm CAS 23-25-05, Asphalt Oil Spill/Tar Release

First astronomical unit scale image of the GW Orionis triple system. Direct detection of a new stellar companion

NASA Astrophysics Data System (ADS)

Berger, J.-P.; Monnier, J. D.; Millan-Gabet, R.; Renard, S.; Pedretti, E.; Traub, W.; Bechet, C.; Benisty, M.; Carleton, N.; Haguenauer, P.; Kern, P.; Labeye, P.; Longa, F.; Lacasse, M.; Malbet, F.; Perraut, K.; Ragland, S.; Schloerb, P.; Schuller, P. A.; Thiébaut, E.

2011-05-01

Context. Young and close multiple systems are unique laboratories to probe the initial dynamical interactions between forming stellar systems and their dust and gas environment. Their study is a key building block to understanding the high frequency of main-sequence multiple systems. However, the number of detected spectroscopic young multiple systems that allow dynamical studies is limited. GW Orionis is one such system. It is one of the brightest young T Tauri stars and is surrounded by a massive disk. Aims: Our goal is to probe the GW Orionis multiplicity at angular scales at which we can spatially resolve the orbit. Methods: We used the IOTA/IONIC3 interferometer to probe the environment of GW Orionis with an astronomical unit resolution in 2003, 2004, and 2005. By measuring squared visibilities and closure phases with a good UV coverage we carry out the first image reconstruction of GW Ori from infrared long-baseline interferometry. Results.We obtained the first infrared image of a T Tauri multiple system with astronomical unit resolution. We show that GW Orionis is a triple system, resolve for the first time the previously known inner pair (separation ρ ~ 1.4 AU) and reveal a new more distant component (GW Ori C) with a projected separation of ~ 8 AU with direct evidence of motion. Furthermore, the nearly equal (2:1) H-band flux ratio of the inner components suggests that either GW Ori B is undergoing a preferential accretion event that increases its disk luminosity or that the estimate of the masses has to be revisited in favour of a more equal mass-ratio system that is seen at lower inclination. Conclusions: Accretion disk models of GW Ori will need to be completely reconsidered because of this outer companion C and the unexpected brightness of companion B.

Associate Directorate Environmental Management Infrastructure Plan for Area G and Area L Domes

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

Stevens, Patrice Ann; Baumer, Andrew Ronald

Technical Area 54, at Los Alamos National Laboratory (LANL) is situated in the east-central portion of the Laboratory on the Mesita del Buey between Pajarito Canyon to the south and Cañada del Buey to the north. TA-54 includes four MDAs designated as G, H, J, and L; a waste characterization, container storage, and transfer facility; active TRU waste and MLLW waste storage and low-level waste (LLW) disposal operations at Area G; active hazardous and mixed low-level (MLLW) waste storage operations at Area L; and administrative and support areas. MDA J has previously under-gone closure. Area G is a waste managementmore » and disposal area, used for the disposal and storage of radioactive wastes since 1957. Since August 2015, Area G has been in warm standby and provides minimal operations to support safety, compliance, and nitrate salt remediation. Located within Area G, MDA G covers 63-acres. MDA G contains 334 active and inactive waste management units, which include 36 pits, 294 shafts, and 4 trenches. In 1971, Area G began use for the retrievable storage of TRU waste. There are two pits, four trenches and 60 shafts that contain retrievable TRU waste. Thirty-three of the shafts contain TRU waste that may present unique problems for retrieval. In 1986, segregation of MLLW was initiated at Area G for treatment and temporary storage or for off-site disposal. Area G is the only active LLW disposal facility at the Laboratory. Current operations at Area G include storage and characterization of TRU and mixed TRU waste destined for off-site disposal at the Waste Isolation Pilot Plant (WIPP) in southeastern New Mexico and the storage of MLLW destined for off-site treatment and/or disposal. Several above-ground container storage units (CSUs) are currently used for storage of containerized MLLW and/or mixed TRU wastes. These consist of asphalt pads and associated fabric domes or other structures. As defined by the Consent Order, MDA G contains 229 of the 334 subsurface waste management units at Area G. These MDA G disposal units include 32 pits, 193 shafts, and 4 trenches and contain LLW, MLLW and TRU waste. The remaining 105 solid waste management units (SWMUs) include RCRA-regulated landfill and storage units and DOE-regulated LLW disposal units. The TA-54 closure project must ensure that continuing waste operations at Area G and their transition to an interim or enduring facility are coordinated with closure activities.« less

Vaginal Migration of Ventriculoperitoneal Shunt Catheter and Cerebrospinal Fluid Leak as a Complication of Hysterectomy.

PubMed

Houten, John K; Smith, Shiela; Schwartz, Amit Y

2017-08-01

Ventriculoperitoneal (VP) shunting is a common neurosurgical procedure to treat hydrocephalus that diverts cerebrospinal fluid from the cerebral ventricles to the peritoneal cavity for reabsorption. The distal catheter may potentially migrate through any potential or iatrogenic opening in the peritoneal cavity. Increasingly successfully management of childhood hydrocephalus and adult-onset conditions leading to hydrocephalus, such as subarachnoid hemorrhage, is leading many adult female patients harboring VP shunts needing to undergo hysterectomy. Hysterectomy creates a potential defect though which a VP shunt catheter may migrate. It is not known whether the hysterectomy cuff closure technique may affect the likelihood of distal catheter migration though the repair site. We report the case of a 38-year-old woman with a VP shunt who underwent laparoscopic hysterectomy via an open vaginal cuff technique who subsequently presented with vaginal cerebrospinal fluid leakage secondary to migration of the distal shunt catheter through the hysterectomy cuff. Vaginal migration of the distal VP shunt catheter is a possible complication of hysterectomy. The authors postulate that an open cuff hysterectomy closure technique may increase the risk of catheter migration, an issue that may be better understood with further investigation. Copyright © 2017 Elsevier Inc. All rights reserved.

Radiation pressure driving of a dusty atmosphere

NASA Astrophysics Data System (ADS)

Tsang, Benny T.-H.; Milosavljević, Miloš

2015-10-01

Radiation pressure can be dynamically important in star-forming environments such as ultra-luminous infrared and submillimetre galaxies. Whether and how radiation drives turbulence and bulk outflows in star formation sites is still unclear. The uncertainty in part reflects the limitations of direct numerical schemes that are currently used to simulate radiation transfer and radiation-gas coupling. An idealized setup in which radiation is introduced at the base of a dusty atmosphere in a gravitational field has recently become the standard test for radiation-hydrodynamics methods in the context of star formation. To a series of treatments featuring the flux-limited diffusion approximation as well as a short-characteristics tracing and M1 closure for the variable Eddington tensor approximation, we here add another treatment that is based on the implicit Monte Carlo radiation transfer scheme. Consistent with all previous treatments, the atmosphere undergoes Rayleigh-Taylor instability and readjusts to a near-Eddington-limited state. We detect late-time net acceleration in which the turbulent velocity dispersion matches that reported previously with the short-characteristics-based radiation transport closure, the most accurate of the three preceding treatments. Our technical result demonstrates the importance of accurate radiation transfer in simulations of radiative feedback.

Role of Groundwater Monitoring for Closure of Underground Nuclear Tests on the Nevada Test Site

NASA Astrophysics Data System (ADS)

Chapman, J. B.; Pohlmann, K.; Pohll, G.; Russell, C.

2009-12-01

Over 800 underground nuclear tests were conducted at the Nevada Test Site in a variety of hydrogeologic environments. As of the 1996 Environmental Impact Statement for the site, more than 100 million curies of radioactivity remained in the subsurface from these tests, much of it near or below the water table. The U.S. Department of Energy Environmental Management program is implementing a closure strategy for these sites that anticipates closure-in-place, natural attenuation, and institutional controls. Groundwater monitoring is a key component of this strategy, but its role is significantly evolved from that of a detection- or compliance-based monitoring concept. Indeed, monitoring is part of the integrated closure process itself, not an activity confined to a static post-closure period. The reasons for this evolution derive from the complex hydrogeologic conditions, the long time-frames of concern, and recognition that a significant degree of uncertainty is irreducible. The hundreds of test locations are grouped into Corrective Action Units that measure over 100 km2 in area and extend to depths in excess of 1000 m. Despite concerted data collection efforts, the technical basis for closure of these large regions relies heavily on complex numerical models of flow and transport. The inherent uncertainties in these models present challenges for reaching regulatory acceptance of closure, and challenges for confidently locating monitoring wells. The solution now being pursued for the NTS is to integrate model evaluation and monitoring. In addition to standard goals of contaminant detection and protection of human health, an explicit monitoring objective is to increase confidence in model results by assessing the reliability of model forecasts. The initial monitoring network is expected to eventually transition to a long-term closure design, with less emphasis on confidence-building as uncertainty in forecasts is reduced. The methodology for this iterative process of monitoring and model refinement will incorporate expert-judgment and Bayesian updating of model input parameters to provide a cost-beneficial monitoring network that is expected to reduce model prediction uncertainty. This approach to monitoring for these large and complex contaminant areas is consistent with the underlying reliance on model predictions and will ensure that water quality samples are collected in a manner and location that is consistent with the current understanding of contaminant flowpaths.

Transcatheter closure of large patent ductus arteriosus with severe pulmonary arterial hypertension in adults: immediate and two-year follow-up results.

PubMed

Zhang, Cao-Jin; Huang, Yi-Gao; Huang, Xin-Sheng; Huang, Tao; Huang, Wen-Hui; Xia, Chun-Li; Mo, Yu-Jing

2012-11-01

Transcatheter closure of patent ductus arteriosus (PDA) is a well established procedure and an accepted treatment modality for small to moderate-sized PDA. This study aimed to evaluate the immediate and follow-up results of transcatheter closure of large PDAs with severe pulmonary arterial hypertension (PAH) in adults. After a complete hemodynamic evaluation differentiating from the reversibility of severe PAH, transcatheter closure of PDA was performed. Patients were followed up clinically and echocardiographically at 24 hours, 1 month, 3 months, 6 months, 12 months and 24 months after occlusion. Twenty-nine patients had successful occlusion, pulmonary artery pressure (PAP), left ventricular ejection fraction (LVEF) and fractional shortening (FS) significantly decreased immediately after occlusion ((106 ± 25) mmHg vs. (50 ± 14) mmHg, P < 0.01; (63.7 ± 7.2)% vs. (51.4 ± 10.1)%, P < 0.01 and (36.9 ± 8.2)% vs. (28.9 ± 8.6)%, P < 0.05, respectively). At 1 month after PDA closure, the signs and symptoms improved markedly in all 29 patients, and PDAs were completely closed and remained closed during the follow-up. Eighteen patients having different degrees of dyspnea were treated with angiotensin converting enzyme inhibitor (ACEI) and/or digoxin after occlusion. Nine patients whose pulmonary vascular resistence (PVR) > 6 Wood units accepted targeted PAH therapy. After 1 to 3 months of peroral drug therapy, their exercise tolerance improved from New York Heart Association (NYHA) class III-IV to NYHA class I. During follow-up, no latent arrhythmias were found, the left atrial diameter (LAD), left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD), left ventricular mass index (LVMI) and pulmonary artery systolic pressure (PASP) decreased significantly (P < 0.05), and FS and LVEF recovered compared to the immediate postclosure state. However, FS and LVEF remained low compared to the preclosure state. Transcatheter closure of large PDA with severe PAH is feasible, effective, and safe in adults. Significant left ventricular systolic changes may occur after closure of large PDA, and left ventricular function usually recovers within a few months.

Outcomes and costs of left atrial appendage closure from randomized controlled trial and real-world experience relative to oral anticoagulation.

PubMed

Panikker, Sandeep; Lord, Joanne; Jarman, Julian W E; Armstrong, Shannon; Jones, David G; Haldar, Shouvik; Butcher, Charles; Khan, Habib; Mantziari, Lilian; Nicol, Edward; Hussain, Wajid; Clague, Jonathan R; Foran, John P; Markides, Vias; Wong, Tom

2016-12-07

The aim of this study was to analyse randomized controlled study and real-world outcomes of patients with non-valvular atrial fibrillation (NVAF) undergoing left atrial appendage closure (LAAC) with the Watchman device and to compare costs with available antithrombotic therapies. Registry data of LAAC from two centres were prospectively collected from 110 patients with NVAF at risk of stroke, suitable and unsuitable for long-term anticoagulation (age 71.3 ± 9.2 years, CHADS 2 2.8 ± 1.2, CHA 2 DS 2 -VASc 4.5 ± 1.6, and HAS-BLED 3.8 ± 1.1). Outcomes from PROTECT AF and registry study LAAC were compared with warfarin, dabigatran, rivaroxaban, apixaban, aspirin, and no treatment using a network meta-analysis. Costs were estimated over a 10-year horizon. Uncertainty was assessed using sensitivity analyses. The procedural success rate was 92% (103/112). Follow-up was 24.1 ± 4.6 months, during which annual rates of stroke, major bleeding, and all-cause mortality were 0.9% (2/223 patient-years), 0.9% (2/223 patient-years), and 1.8% (4/223 patient-years), respectively. Anticoagulant therapy was successfully stopped in 91.2% (93/102) of implanted patients by 12 months. Registry study LAAC stroke and major bleeding rates were significantly lower than PROTECT AF results: mean absolute difference of stroke, 0.89% (P = 0.02) and major bleeding, 5.48% (P < 0.001). Left atrial appendage closure achieved cost parity between 4.9 years vs. dabigatran 110 mg and 8.4 years vs. warfarin. At 10 years, LAAC was cost-saving against all therapies (range £1162-£7194). Left atrial appendage closure in NVAF in a real-world setting may result in lower stroke and major bleeding rates than reported in LAAC clinical trials. Left atrial appendage closure in both settings achieves cost parity in a relatively short period of time and may offer substantial savings compared with current therapies. Savings are most pronounced among higher risk patients and those unsuitable for anticoagulation. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2016. For permissions please email: journals.permissions@oup.com.

Platelet dysfunction detected at high shear in patients with heart valve disease.

PubMed

Francis, J L

2000-05-01

Whether patients with valvular heart disease have a defect of platelet function has been unclear. Despite evidence that these individuals have an abnormality detectable only under conditions of high shear stress, no methods have been widely available to adequately assess platelet function under such conditions. The Platelet Function Analyzer (PFA)-100 measures platelet function in a high shear environment and is well suited to the detection of platelet dysfunction in the clinical laboratory. The instrument records the time for platelets to occlude a membrane coated with collagen and either epinephrine (CEPI) or ADP (CADP). We studied the PFA-100 in 398 patients before open heart surgery; 308 for coronary artery bypass grafting (CABG) and 90 for aortic or mitral valve replacement (VR). Patients were classified as normal (CEPI < or = 153 s); 'aspirin effect' (CEPI > 153 s but CADP < or = 109 s) or abnormal (CEPI > 153 s and CADP > 109 s). In the CABG group, 41.2% were classified as normal, 43.2% as 'aspirin effect' and 15.6% as abnormal. In contrast, in patients undergoing VR, these values were 6.7, 11.1 and 82.4%, respectively. Patients with valvular disease had significantly longer closure times for both CEPI and CADP tests (P < 0.001). In addition, the valvular disease group had a significantly higher proportion of patients with markedly prolonged (> 150 s) closure times in the CADP cartridge (43.3 vs. 3.6%, respectively). Only one (0.3%) patient in the CABG group had non-closure (> 300 s) in the CADP test compared to seven (7.8%) in the valvular disease group. Three of six patients in the latter group bled excessively during surgery. We conclude that abnormal CADP closure is much more frequent among patients with aortic or mitral valve disease compared to those with coronary artery disease. This may reflect pre-existing high-shear damage to platelets that renders them refractory to subsequent shear activation and aggregation in the PFA-100 system. Further studies are needed to more precisely define the platelet defect in these patients. Markedly prolonged CADP closure in patients with valvular disease may indicate an increased likelihood of intra-operative bleeding, although an appropriately designed prospective study is needed to adequately address this hypothesis.

Interim Closure Activities at Corrective Action Unit 114: Area 25 EMAD Facility, Nevada National Security Site, Nevada

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

Boehlecke, R. F.

This letter report documents interim activities that have been completed at CAU 114 to support ongoing access and generate information necessary to plan future closure activities. General housekeeping and cleanup of debris was conducted in the EMAD yard, cold bays, support areas of Building 3900, and postmortem cell tunnel area of the hot bay. All non-asbestos ceiling tiles and loose and broken non-friable asbestos floor tiles were removed from support galleries and office areas. Non-radiologically contaminated piping and equipment in the cold areas of the building and in the two 120-ton locomotives in the yard were tapped, characterized, drained, andmore » verified free of contents.« less

Post-Closure Inspection Report for the Tonopah Test Range, Nevada, For Calendar Year 2011

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

NSTec Environmental Restoration

This report provides the results of the annual post-closure inspections conducted at the closed Corrective Action Units (CAUs) located on the Tonopah Test Range (TTR), Nevada. This report covers calendar year 2011 and includes inspection and repair activities completed at the following CAUs: (1) CAU 400: Bomblet Pit and Five Points Landfill (TTR); (2) CAU 407: Roller Coaster RadSafe Area (TTR); (3) CAU 424: Area 3 Landfill Complexes (TTR); (4) CAU 453: Area 9 UXO Landfill (TTR); and (5) CAU 487: Thunderwell Site (TTR) Inspections were conducted according to the post-closure plans in the approved Closure Reports. The post-closure inspectionmore » plan for each CAU is included in Appendix B. The inspection checklists are included in Appendix C, field notes are included in Appendix D, and photographs taken during inspections are included in Appendix E. The annual post-closure inspections were conducted May 3 and 4, 2011. Maintenance was performed at CAU 424, CAU 453, and CAU 487. At CAU 424, two surface grade monuments at Landfill Cell A3-3 could not be located during the inspection. The two monuments were located and marked with lava rock on July 13, 2011. At CAU 453, there was evidence of animal burrowing. Animal burrows were backfilled on July 13, 2011. At CAU 487, one use restriction warning sign was missing, and wording was faded on the remaining signs. A large animal burrow was also present. The signs were replaced, and the animal burrow was backfilled on July 12, 2011. As a best management practice, the use restriction warning signs at CAU 407 were replaced with standard Federal Facility Agreement and Consent Order signs on July 13, 2011. Vegetation monitoring was performed at the CAU 400 Five Points Landfill and CAU 407 in June 2011, and the vegetation monitoring report is included in Appendix F.« less

Corrective Action Decision Document/Closure Report for Corrective Action Unit 365: Baneberry Contamination Area, Nevada National Security Site, Nevada, Revision 0

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

Patrick Matthews

2011-09-01

Corrective Action Unit 365 comprises one corrective action site (CAS), CAS 08-23-02, U-8d Contamination Area. The purpose of this CADD/CR is to provide justification and documentation supporting the recommendation that no further corrective action is needed for CAU 365 based on the implementation of the corrective action of closure in place with a use restriction (UR). Corrective action investigation (CAI) activities were performed from January 18, 2011, through August 2, 2011, as set forth in the Corrective Action Investigation Plan for Corrective Action Unit 365: Baneberry Contamination Area. The purpose of the CAI was to fulfill data needs as definedmore » during the data quality objective (DQO) process. The CAU 365 dataset of investigation results was evaluated based on a data quality assessment. This assessment demonstrated the dataset is complete and acceptable for use in supporting the DQO decisions. Investigation results were evaluated against final action levels (FALs) established in this document. A radiological dose FAL of 25 millirem per year was established based on the Remote Work Area exposure scenario (336 hours of annual exposure). Radiological doses exceeding the FAL were found to be present to the southwest of the Baneberry crater. It was also assumed that radionuclide levels present within the crater and fissure exceed the FAL. Corrective actions were undertaken that consisted of establishing a UR and posting warning signs for the crater, fissure, and the area located to the southwest of the crater where soil concentrations exceeded the FAL. These URs were recorded in the FFACO database; the U.S. Department of Energy, National Nuclear Security Administration Nevada Site Office (NNSA/NSO) Facility Information Management System; and the NNSA/NSO CAU/CAS files. Therefore, NNSA/NSO provides the following recommendations: (1) No further corrective actions beyond what are described in this document are necessary for CAU 365. (2) A Notice of Completion to NNSA/NSO is requested from the Nevada Division of Environmental Protection for closure of CAU 365. (3) Corrective Action Unit 365 should be moved from Appendix III to Appendix IV of the FFACO.« less

Treatment Strategies in 135 Consecutive Patients with Enterocutaneous Fistulas

PubMed Central

Visschers, Ruben G. J.; Damink, Steven W. M. Olde; Winkens, Bjorn; Soeters, Peter B.

2008-01-01

Background Enterocutaneous fistulas (ECF) pose a major challenge to every gastrointestinal (GI) surgeon. Based on earlier studies, a standardized treatment guideline was implemented. The focus of the present study was to assess that guideline and determine prognostic factors for outcome of patients with ECF, and to define a more detailed therapeutic approach including the convalescence time before restorative surgery. Methods All patients with ECF treated between 1990 and 2005 were included. Management consisted of controlling Sepsis, Optimization of nutritional state, Wound care, assessment of fistula Anatomy, Timing of surgery, and Surgical strategy (the SOWATS guideline). Prognostic factors were assessed by way of multiple logistic regression analysis. Results A total of 135 patients were treated at our unit. Overall closure was achieved in 118 patients (87.4%). Restorative operations for fistula closure were performed after a median of 53 days (range: 4–270 days). Restorative operations were successful in 97/107 patients (90.7%). Thirteen patients (9.6%) died. An abdominal wall defect was the most predominant negative prognostic factor for spontaneous closure (odds ratio [OR] = 0.195, confidence interval [CI] 0.052–0.726, p = 0.015). A strong relation was found between preoperative albumin level and surgical closure (p < 0.001) and mortality (p < 0.001). Conclusions Application of the SOWATS guideline allowed a favorable outcome after a short convalescence period. Abdominal wall defects and preoperative hypoalbuminemia are important prognostic variables. PMID:18175171

Treatment strategies in 135 consecutive patients with enterocutaneous fistulas.

PubMed

Visschers, Ruben G J; Olde Damink, Steven W M; Winkens, Bjorn; Soeters, Peter B; van Gemert, Wim G

2008-03-01

Enterocutaneous fistulas (ECF) pose a major challenge to every gastrointestinal (GI) surgeon. Based on earlier studies, a standardized treatment guideline was implemented. The focus of the present study was to assess that guideline and determine prognostic factors for outcome of patients with ECF, and to define a more detailed therapeutic approach including the convalescence time before restorative surgery. All patients with ECF treated between 1990 and 2005 were included. Management consisted of controlling Sepsis, Optimization of nutritional state, Wound care, assessment of fistula Anatomy, Timing of surgery, and Surgical strategy (the SOWATS guideline). Prognostic factors were assessed by way of multiple logistic regression analysis. A total of 135 patients were treated at our unit. Overall closure was achieved in 118 patients (87.4%). Restorative operations for fistula closure were performed after a median of 53 days (range: 4-270 days). Restorative operations were successful in 97/107 patients (90.7%). Thirteen patients (9.6%) died. An abdominal wall defect was the most predominant negative prognostic factor for spontaneous closure (odds ratio [OR]=0.195, confidence interval [CI] 0.052-0.726, p=0.015). A strong relation was found between preoperative albumin level and surgical closure (p<0.001) and mortality (p<0.001). Application of the SOWATS guideline allowed a favorable outcome after a short convalescence period. Abdominal wall defects and preoperative hypoalbuminemia are important prognostic variables.

Strategic Planning: Renewal and Redesign during Turbulent Times

ERIC Educational Resources Information Center

Cherrey, Cynthia; Clark, Evette Castillo

2010-01-01

In August 2005, Hurricane Katrina, the worst natural disaster in the history of the United States, forced the fall semester closure of Tulane University in New Orleans, Louisiana. In the aftermath of this unprecedented storm, the Tulane leadership set forth a plan for renewal to secure the survival, recovery, and sustainability of the institution,…

50 CFR 665.252 - Harvest limitation program.

Code of Federal Regulations, 2013 CFR

2013-10-01

... Grounds for Permit Area 1 will be set annually for the calendar year and shall: (1) Apply to the total... the overall harvest guideline for Crustacean Permit Area 1 will be reached; (ii) Closure date after... Permit Area 1 is prohibited by any permitted vessel that is not operating a VMS unit certified by NMFS...

50 CFR 665.252 - Harvest limitation program.

Code of Federal Regulations, 2014 CFR

2014-10-01

... Grounds for Permit Area 1 will be set annually for the calendar year and shall: (1) Apply to the total... the overall harvest guideline for Crustacean Permit Area 1 will be reached; (ii) Closure date after... Permit Area 1 is prohibited by any permitted vessel that is not operating a VMS unit certified by NMFS...

50 CFR 665.252 - Harvest limitation program.

Code of Federal Regulations, 2012 CFR

2012-10-01

... Grounds for Permit Area 1 will be set annually for the calendar year and shall: (1) Apply to the total... the overall harvest guideline for Crustacean Permit Area 1 will be reached; (ii) Closure date after... Permit Area 1 is prohibited by any permitted vessel that is not operating a VMS unit certified by NMFS...

40 CFR 258.60 - Closure criteria.

Code of Federal Regulations, 2011 CFR

2011-07-01

... operators of all MSWLF units must install a final cover system that is designed to minimize infiltration and... greater than 1×10−5 cm/sec, whichever is less, and (2) Minimize infiltration through the closed MSWLF by the use of an infiltration layer that contains a minimum 18-inches of earthen material, and (3...

40 CFR 258.60 - Closure criteria.

Code of Federal Regulations, 2010 CFR

2010-07-01

... operators of all MSWLF units must install a final cover system that is designed to minimize infiltration and... greater than 1×10−5 cm/sec, whichever is less, and (2) Minimize infiltration through the closed MSWLF by the use of an infiltration layer that contains a minimum 18-inches of earthen material, and (3...

40 CFR 258.60 - Closure criteria.

Code of Federal Regulations, 2013 CFR

2013-07-01

... operators of all MSWLF units must install a final cover system that is designed to minimize infiltration and... greater than 1×10−5 cm/sec, whichever is less, and (2) Minimize infiltration through the closed MSWLF by the use of an infiltration layer that contains a minimum 18-inches of earthen material, and (3...

40 CFR 258.60 - Closure criteria.

Code of Federal Regulations, 2012 CFR

2012-07-01

... of all MSWLF units must install a final cover system that is designed to minimize infiltration and... greater than 1×10−5 cm/sec, whichever is less, and (2) Minimize infiltration through the closed MSWLF by the use of an infiltration layer that contains a minimum 18-inches of earthen material, and (3...

40 CFR 258.60 - Closure criteria.

Code of Federal Regulations, 2014 CFR

2014-07-01

... operators of all MSWLF units must install a final cover system that is designed to minimize infiltration and... greater than 1×10−5 cm/sec, whichever is less, and (2) Minimize infiltration through the closed MSWLF by the use of an infiltration layer that contains a minimum 18-inches of earthen material, and (3...

Casting the Spirit: A Handmade Legacy

ERIC Educational Resources Information Center

Rutenberg, Mona

2008-01-01

This article discusses how an art therapist working in a hospital palliative care unit has incorporated a ritual of hand casting to help bring closure to dying patients and family members who are grieving as death approaches. The finished hand sculptures depict the hands of the patients and, sometimes, of their loved ones. They are faithful and…

Hibbing Community College's Community Computer Center.

ERIC Educational Resources Information Center

Regional Technology Strategies, Inc., Carrboro, NC.

This paper reports on the development of the Community Computer Center (CCC) at Hibbing Community College (HCC) in Minnesota. HCC is located in the largest U.S. iron mining area in the United States. Closures of steel-producing plants are affecting the Hibbing area. Outmigration, particularly of younger workers and their families, has been…

50 CFR 648.262 - Accountability measures for red crab limited access vessels.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 50 Wildlife and Fisheries 10 2011-10-01 2011-10-01 false Accountability measures for red crab... UNITED STATES Management Measures for the Atlantic Deep-Sea Red Crab Fishery § 648.262 Accountability measures for red crab limited access vessels. (a) Closure authority. NMFS shall close the EEZ to fishing...

Prediction and measurement of direct-normal solar irradiance: A closure experiment

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

Halthore, R.N.; Schwartz, S.E.; Michalsky, J.J.

1997-03-01

Direct-normal solar irradiance (DNSI), the total energy in the solar spectrum incident on a plane perpendicular to the Sun`s direction on a unit area at the earth`s surface in unit time, depends only on the atmospheric extinction of sunlight without regard to the details of extinction--whether absorption or scattering. Here the authors describe a set of closure experiments performed in north-central Oklahoma, wherein measured atmospheric composition is input to a radiative transfer model, MODTRAN-3, to predict DNSI, which is then compared to measured values. Thirty six independent comparisons are presented; the agreement between predicted and measured values falls within themore » combined uncertainties in the prediction (2%) and measurement (0.2%) albeit with a slight bias ({approximately} 1% overprediction) that is independent of the solar zenith angle. Thus these results establish the adequacy of current knowledge of the solar spectrum and atmospheric extinction as embodied in MODTRAN-3 for use in climate models. An important consequence is the overwhelming likelihood that the atmospheric clear-sky absorption is accurately described to within comparable uncertainties.« less

Prediction and measurement of direct-normal solar irradiance: A closure experiment

NASA Technical Reports Server (NTRS)

Halthore, R. N.; Schwartz, S. E.; Michalsky, J. J.; Anderson, G. P.; Ferrare, R. A.; Ten Brink, H. M.

1997-01-01

Direct-Normal Solar Irradiance (DNSI), the total energy in the solar spectrum incident on a plane perpendicular to the Sun's direction on a unit area at the earth's surface in unit time, depends only on the atmospheric extinction of sunlight without regard to the details of extinction-whether absorption or scattering. Here the authors describe a set of closure experiments performed in north-central Oklahoma, wherein measured atmospheric composition is input to a radiative transfer model, MODTRAN-3, to predict DNSI, which is then compared to measured values. Thirty six independent comparisons are presented; the agreement between predicted and measured values falls within the combined uncertainties in the prediction (2%) and measurement (0.2%) albeit with a slight bias ((approximately) 1% overprediction) that is independent of the solar zenith angle. Thus these results establish the adequacy of current knowledge of the solar spectrum and atmospheric extinction as embodied in MODTRAN-3 for use in climate models. An important consequence is the overwhelming likelihood that the atmospheric clear-sky absorption is accurately described to within comparable uncertainties.

Frequency of Dehiscence in Hand-Sutured and Stapled Intestinal Anastomoses in Dogs.

PubMed

Duell, Jason R; Thieman Mankin, Kelley M; Rochat, Mark C; Regier, Penny J; Singh, Ameet; Luther, Jill K; Mison, Michael B; Leeman, Jessica J; Budke, Christine M

2016-01-01

To determine the frequency of dehiscence of hand-sutured and stapled intestinal anastomoses in the dog and compare the surgery duration for the methods of anastomosis. Historical cohort study. Two hundred fourteen client-owned dogs undergoing hand-sutured (n = 142) or stapled (n = 72) intestinal anastomoses. Medical records from 5 referral institutions were searched for dogs undergoing intestinal resection and anastomosis between March 2006 and February 2014. Demographic data, presence of septic peritonitis before surgery, surgical technique (hand-sutured or stapled), surgery duration, surgeon (resident versus faculty member), indication for surgical intervention, anatomic location of resection and anastomosis, and if dehiscence was noted postoperatively were retrieved. Estimated frequencies were summarized and presented as proportions and 95% confidence intervals (CI) and continuous outcomes as mean (95% CI). Comparisons were made across methods of anastomosis. Overall, 29/205 dogs (0.14, 95% CI 0.10-00.19) had dehiscence, including 21/134 dogs (0.16, 0.11-0.23) undergoing hand-sutured anastomosis and 8/71 dogs (0.11, 0.06-0.21) undergoing stapled anastomosis. There was no significant difference in the frequency of dehiscence across anastomosis methods (χ(2), P = .389). The mean (95% CI) surgery duration of 140 minutes (132-147) for hand- sutured anastomoses and 108 minutes (99-119) for stapled anastomoses was significantly different (t-test, P < .001). No significant difference in frequency of dehiscence was noted between hand- sutured and stapled anastomoses in dogs but surgery duration is significantly reduced by the use of staples for intestinal closure. © Copyright 2015 by The American College of Veterinary Surgeons.

Chronic Traumatic Giant Macular Hole Repair with Autologous Platelets.

PubMed

Coca, Mircea; Makkouk, Fuad; Picciani, Renata; Godley, Bernard; Elkeeb, Ahmed

2017-01-05

We report on the closure of a chronic posttraumatic giant macular hole. The patient presented with decreased vision in the left eye following blunt trauma 20 years prior. His dilated fundus examination revealed a 3000 um base-diameter full thickness macular hole. Surgical repair was performed with pars plana vitrectomy (PPV), internal limiting membrane peeling and autologous platelet concentrate (APC) injected over the macular hole. At one month follow-up, the macular hole had closed on exam and optical coherence tomography (OCT), and the patient reported subjective visual improvement. To our knowledge, this report presents the first case of a chronic giant macular hole successfully closed after undergoing surgery with adjuvant platelets therapy.

Pseudoephedrine-Directed Asymmetric α-Arylation of α-Amino Acid Derivatives.

PubMed

Atkinson, Rachel C; Fernández-Nieto, Fernando; Mas Roselló, Josep; Clayden, Jonathan

2015-07-27

Available α-amino acids undergo arylation at their α position in an enantioselective manner on treatment with base of N'-aryl urea derivatives ligated to pseudoephedrine as a chiral auxiliary. In situ silylation and enolization induces diastereoselective migration of the N'-aryl group to the α position of the amino acid, followed by ring closure to a hydantoin with concomitant explulsion of the recyclable auxiliary. The hydrolysis of the hydantoin products provides derivatives of quaternary amino acids. The arylation avoids the use of heavy-metal additives, and is successful with a range of amino acids and with aryl rings of varying electronic character. © 2015 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Riding pontic: a tool to keep patients smiling.

PubMed

Sharma, Narendra Shriram

2013-05-01

All patients expect a beautiful smile at the completion of orthodontic treatment, but some patients show concern regarding their appearance while undergoing treatment. The appearance of a gap from a missing tooth can be a concern, especially if it is in the display zone of a patient's smile. If the treatment plan includes prosthetic replacement of the missing tooth rather then space closure, then space maintenance is also an issue. In an appearance conscious patient use of riding pontic as space maintainers is a good option during treatment. How to cite this article: Sharma NS. Riding Pontic: A Tool to Keep Patients Smiling. Int J Clin Pediatr Dent 2013;6(2): 127-131.

Chronic Traumatic Giant Macular Hole Repair with Autologous Platelets

PubMed Central

Makkouk, Fuad; Picciani, Renata; Godley, Bernard; Elkeeb, Ahmed

2017-01-01

We report on the closure of a chronic posttraumatic giant macular hole. The patient presented with decreased vision in the left eye following blunt trauma 20 years prior. His dilated fundus examination revealed a 3000 um base-diameter full thickness macular hole. Surgical repair was performed with pars plana vitrectomy (PPV), internal limiting membrane peeling and autologous platelet concentrate (APC) injected over the macular hole. At one month follow-up, the macular hole had closed on exam and optical coherence tomography (OCT), and the patient reported subjective visual improvement. To our knowledge, this report presents the first case of a chronic giant macular hole successfully closed after undergoing surgery with adjuvant platelets therapy. PMID:28168133

Geologic controls on gas hydrate occurrence in the Mount Elbert prospect, Alaska North Slope

USGS Publications Warehouse

Boswell, R.; Rose, K.; Collett, T.S.; Lee, M.; Winters, W.; Lewis, K.A.; Agena, W.

2011-01-01

Data acquired at the BPXA-DOE-USGS Mount Elbert Gas Hydrate Stratigraphic Test Well, drilled in the Milne Point area of the Alaska North Slope in February, 2007, indicates two zones of high gas hydrate saturation within the Eocene Sagavanirktok Formation. Gas hydrate is observed in two separate sand reservoirs (the D and C units), in the stratigraphically highest portions of those sands, and is not detected in non-sand lithologies. In the younger D unit, gas hydrate appears to fill much of the available reservoir space at the top of the unit. The degree of vertical fill with the D unit is closely related to the unit reservoir quality. A thick, low-permeability clay-dominated unit serves as an upper seal, whereas a subtle transition to more clay-rich, and interbedded sand, silt, and clay units is associated with the base of gas hydrate occurrence. In the underlying C unit, the reservoir is similarly capped by a clay-dominated section, with gas hydrate filling the relatively lower-quality sands at the top of the unit leaving an underlying thick section of high-reservoir quality sands devoid of gas hydrate. Evaluation of well log, core, and seismic data indicate that the gas hydrate occurs within complex combination stratigraphic/structural traps. Structural trapping is provided by a four-way fold closure augmented by a large western bounding fault. Lithologic variation is also a likely strong control on lateral extent of the reservoirs, particularly in the D unit accumulation, where gas hydrate appears to extend beyond the limits of the structural closure. Porous and permeable zones within the C unit sand are only partially charged due most likely to limited structural trapping in the reservoir lithofacies during the period of primary charging. The occurrence of the gas hydrate within the sands in the upper portions of both the C and D units and along the crest of the fold is consistent with an interpretation that these deposits are converted free gas accumulations formed prior to the imposition of gas hydrate stability conditions. ?? 2009.