670 research outputs found

    Joint infection after knee arthroscopy: Medicolegal aspects

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    SummaryIntroductionSeptic knee arthritis following arthroscopy is a rare but dreaded complication: it might compromise patients’ functional prognosis and engage surgeon's liability. This study analyzes the context of such infection occurrences, their management as well as their medicolegal consequences.Patients and methodsTwenty-two cases of knee septic arthritis following arthroscopy were examined during the medicolegal litigation process and collected for assessment from a medical liability specialised insurer. Half of the patients were manual workers who worked on their knees, and seven knees had a previous surgical history. The procedures performed at arthroscopy included seven ligamentoplasties, nine meniscotomies, three arthroscopic lavages, one arthrolysis, one chondroma removal and one plica resection. Seven patients, to some point, received corticosteroids: three preoperative joint injections, three intraoperative injections, and one oral corticotherapy.ResultsClinical signs of septic arthritis appeared after a median interval of 8 days (0–37), twice after a hemarthrosis and once after an articular burn. The median delay before treatment initiation was 4.2 days, and in 10 cases this therapeutic delay exceeded 3 days. On average, 3.5 additional procedures (1–9) were required to treat the infection and its residual sequels. Two total knee prostheses were implanted. Only two patients were free of disabling sequellae, and in five patients these sequels affected their livelihood. The medicolegal consequences were a partially permanent disability averaging 5% (0–20), a total temporary work incapacity of 120 days (40–790), a suffering burden averaging 3 out of 7 (0–4,5) points on the scale conventionally used in France. Twelve of these legal claims led to court ordered patient compensation.DiscussionSome risk factors of articular infection are known and well-identified. They can be linked to the patient's condition (addiction to smoking, surgical history, professional activity) or to medical management (intra-articular corticoid injections, interventions under oral anticoagulants, inadvertently overheated irrigation fluid). When infection is suspected, it is often the needle-aspirated fluid's inappropriate handling (such as absence of bacteriological testing or defective waiting time for the results), which delays the diagnostic or therapeutic management of this complication. All failures of infection diagnosis or treatment heavily contribute to malpractice claims against the surgeon. Early and appropriate management of postoperative infections helps limiting the risk of functional sequellae for the patient and reduces the risk of malpractice litigation for the practitioner.Level of evidenceLevel IV; economic and decision analysis, retrospective study

    Optimum matrix acidizing: How much does it impact the productivity

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    Formation damage is one of the big challenges for oil and gas oilfields development. Several types of formation damage most likely exist during the entire life of producing wells. Formation damage can occur during the drilling or coring operations, well completion, work-over and production. The most important problems that affect formation during drilling operations are mud filtrate and fines invasion. There are different damage mechanisms affect reservoirs for instance pore blocking by solids, clay swelling and dispersion and liquid block which all reduce effective permeability to hydrocarbons. The reduction in production and an excessive build up pressure in injection wells indicate the formation. Many techniques are developed to remove the formation damage and to improve the productivity of wells. Matrix acidizing is one of these method which depend on injecting acids into the formation below fracturing pressure to eliminate the damage around the well. In this study, comprehensive design procedures for the acid treatment have been introduced. The procedures include the determination of the damage type and the mineralogy of the formation. Accordingly, the selection of the appropriate acid for the treatment and the optimum volume of injected acid are explained in the study. Additionally, the research presents several models for the pre-flush volume and the main acid volume based on the radius of the damaged zone and the height of the formation. New technique has been proposed for determining the final permeability improvement ratio based on current and proposed productivity index. It has been found the pre-flush volume increase as the carbonate percentage in the formation increases while the main acid volume conversely proportional with the clay content in the formation

    Internet of Things (IoT) based Energy Tracking and Bill Estimation System

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    Electrical energy is an important form of energy in the present times. For better or worse electricity is indispensable to life as we know it. Although we may not yet be able to produce enough clean energy to power the world, we can reduce environmental damage by learning how to save electricity is becoming a priority for more and more people. The purpose of this project is to design a system which can track and estimate the bill using IOT from anywhere in world. The project design comprises of NodeMCU, four channel relay, OLED display and MIT app Inventor 2  as cloud Interface. Here NodeMCU fetches  average consumption detail of loads from and logs estimated bill to the cloud-hosted database, monitors the duration for which each relay in a 4-channel relay module was switched-on, performs calculations, and transmits real-time results to an IoT cloud interface. 4-channel relay module executes switching instructions on loads sent over the internet via the control unit. This paper provides highlights on cloud-hosted database details, hardware design, IoT cloud interface application design, and working principle with mathematical modeling of the proposed system and tested results of this system are discussed, with the cloud-hosted database and IoT cloud interface

    A comprehensive medical decision–support framework based on a heterogeneous ensemble classifier for diabetes prediction

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    Funding Information: Funding: This work was supported by National Research Foundation of Korea-Grant funded by the Korean Government (Ministry of Science and ICT)-NRF-2017R1A2B2012337). Funding Information: This work was supported by National Research Foundation of Korea-Grant funded by the Korean Government (Ministry of Science and ICT)-NRF-2017R1A2B2012337).Peer reviewe

    Ozone and Tracer Transport Variations in the Summer Northern Hemisphere Stratosphere

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    Constituent observations from the Upper Atmosphere Research Satellite (UARS) in combination with estimates of the residual circulation are used to examine the transport and chemical budgets of HF, CH4 and O3 in the summer Northern Hemisphere. Budget calculations of HF, CH4 and O3 show that the transport tendency due to the residual circulation increases in magnitude and is largely opposed by eddy motions through the summer months. Ozone budget analyses show that between 100 and 31 hPa, the magnitudes of the mean circulation and eddy transport terms increase through the summer months, producing tendencies that are factors of 2 to 3 times larger than the observed ozone change in the stratosphere. Chemical loss dominates the observed ozone decrease only at the highest latitudes, poleward of about 70°N. A comparison of observations from the Total Ozone Mapping Spectrometer with UARS-calculated total ozone suggests that poleward of 50°N, between 35% and 55% of the seasonal ozone decline during the summer occurs at altitudes below 100 hPa. The overall uncertainties, associated primarily with calculations of the residual circulation and eddy transport, are relatively large, and thus prevent accurate and useful constraints on the ozone chemical rate in the lower stratosphere

    A Comparative Genomic Analysis of Putative Pathogenicity Genes in the Host-Specific Sibling Species \u3cem\u3eColletotrichum graminicola\u3c/em\u3e and \u3cem\u3eColletotrichum sublineola\u3c/em\u3e

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    Background: Colletotrichum graminicola and C. sublineola cause anthracnose leaf and stalk diseases of maize and sorghum, respectively. In spite of their close evolutionary relationship, the two species are completely host-specific. Host specificity is often attributed to pathogen virulence factors, including specialized secondary metabolites (SSM), and small-secreted protein (SSP) effectors. Genes relevant to these categories were manually annotated in two co-occurring, contemporaneous strains of C. graminicola and C. sublineola. A comparative genomic and phylogenetic analysis was performed to address the evolutionary relationships among these and other divergent gene families in the two strains. Results: Inoculation of maize with C. sublineola, or of sorghum with C. graminicola, resulted in rapid plant cell death at, or just after, the point of penetration. The two fungal genomes were very similar. More than 50% of the assemblies could be directly aligned, and more than 80% of the gene models were syntenous. More than 90% of the predicted proteins had orthologs in both species. Genes lacking orthologs in the other species (non-conserved genes) included many predicted to encode SSM-associated proteins and SSPs. Other common groups of non-conserved proteins included transporters, transcription factors, and CAZymes. Only 32 SSP genes appeared to be specific to C. graminicola, and 21 to C. sublineola. None of the SSM-associated genes were lineage-specific. Two different strains of C. graminicola, and three strains of C. sublineola, differed in no more than 1% percent of gene sequences from one another. Conclusions: Efficient non-host recognition of C. sublineola by maize, and of C. graminicola by sorghum, was observed in epidermal cells as a rapid deployment of visible resistance responses and plant cell death. Numerous non-conserved SSP and SSM-associated predicted proteins that could play a role in this non-host recognition were identified. Additional categories of genes that were also highly divergent suggested an important role for co-evolutionary adaptation to specific host environmental factors, in addition to aspects of initial recognition, in host specificity. This work provides a foundation for future functional studies aimed at clarifying the roles of these proteins, and the possibility of manipulating them to improve management of these two economically important diseases
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