116 research outputs found
Wall slip, shear banding, and instability in the flow of a triblock copolymer micellar solution
The shear flow of a triblock copolymer micellar solution (PEO--PPO--PEO
Pluronic P84 in brine) is investigated using simultaneous rheological and
velocity profile measurements in the concentric cylinder geometry. We focus on
two different temperatures below and above the transition temperature
which was previously associated with the apparition of a stress plateau in the
flow curve. (i) At C , the bulk flow remains homogeneous
and Newtonian-like, although significant wall slip is measured at the rotor
that can be linked to an inflexion point in the flow curve. (ii) At
C , the stress plateau is shown to correspond to stationary
shear-banded states characterized by two high shear rate bands close to the
walls and a very weakly sheared central band, together with large slip
velocities at the rotor. In both cases, the high shear branch of the flow curve
is characterized by flow instability. Interpretations of wall slip, three-band
structure, and instability are proposed in light of recent theoretical models
and experiments.Comment: 13 pages, 13 figure
Education Human Excellence
In line with the logic of ecology and the philosophy of Existentialism, the existence of one thing is always in the company of one or more of other things. This, to give a correct idea or to avoid misunderstandings of the use of the predicate ahead as in terms like seeds, superior schools, excellent products of education, and others, it is morally imperative for the users of such terms to provide the terms with Reviews their Contexts to Determine Whether a superior means \u27prime\u27, \u27superior\u27, \u27competitive\u27, or any other. Instances of such Contexts can be of appearance or performance, of a long or short term, of the current objectives or future goals, of individuals or the community, of individual or social needs, of national or International needs, of inclusive or exclusive purposes, and others. Even now, the writer is still of the belief that the USAge of the aforementioned Reviews those terms in the field of education in Indonesia is still more as jargon rather than basic concepts. Indeed very rarely or even never does the public, particularly subject to Reviews those who are very much concerned with the development of education in Indonesia, to get a thorough explanation of Reviews those terms Mentioned. This article tries to build a kind of "second opinion" as a balance to the existence of that jargon Mentioned
Prophylactic fixation of donor site in radial forearm osteocutaneous free flaps using locking reconstruction plate augmented with mineral cement
National Vascular Registry: 2015 Annual Report.
The National Vascular Registry is commissioned by the Healthcare Quality Improvement
Partnership (HQIP) to measure the quality and outcomes of care for patients who undergo
major vascular surgery in NHS hospitals in England and Wales. It aims to provide
comparative information on the performance of NHS vascular units and thereby support
local quality improvement as well as inform patients about major vascular interventions
delivered in the NHS. As such, all NHS hospitals in England, Wales, Scotland and Northern
Ireland are encouraged to participate in the Registry.
The measures used to describe the patterns and outcomes of care are drawn from various
national guidelines including: the “Provision of Services for Patients with Vascular Disease”
document and the Quality Improvement Frameworks published by the Vascular Society, and
the National Institute for Health and Care Excellence (NICE) guidelines on stroke and
peripheral arterial disease.
This report provides a description of the care provided by NHS vascular units, and contains
information on the process and outcomes of care for: (i) patients undergoing abdominal
aortic aneurysm (AAA) repair, (ii) patients undergoing carotid endarterectomy, (iii) patients
undergoing a revascularisation procedure (angioplasty/stent or bypass) or major
amputation for lower-limb peripheral arterial disease (PAD). In addition, the report
presents the findings of an organisational audit conducted in August 2015
National Vascular Registry: 2014 Progress Report.
The National Vascular Registry is commissioned by the Healthcare Quality Improvement
Partnership (HQIP) to measure the quality and outcomes of care for patients who undergo
major vascular surgery in NHS hospitals in England and Wales. It aims to provide
comparative information on the performance of NHS hospitals and thereby support local
quality improvement as well as inform patients about the care delivered in the NHS. As
such, all NHS hospitals in England, Wales, Scotland and Northern Ireland are encouraged to
participate in the Registry.
The measures used to describe the patterns and outcomes of care are drawn from various
national guidelines including: the “2014 The Provision of Services for Patients with Vascular
Disease” and the Quality Improvement Frameworks published by the Vascular Society, and
the National Institute for Health and Care Excellence (NICE) guidelines on stroke and
peripheral arterial disease.
In 2014, the Registry published NHS trust and surgeon-level information for elective infrarenal
Abdominal Aortic Aneurysm (AAA) repair and carotid endarterectomy on the Registry
website. From 28 October, information on both procedures has been available on the
www.vsqip.org.uk website for all UK NHS trusts that currently perform them. For English
NHS trusts, the same information was published for individual consultants, as part of NHS
England’s “Everyone Counts: Planning for Patients 2013/4” initiative. Consultant-level
information was also published for NHS hospitals in Wales, Scotland and Northern Ireland
for consenting surgeons.
This progress report aims to complement that information by (1) providing an overview of
care delivered by the NHS at a national level, and (2) describing various developments
within the National Vascular Registry. The Registry will publish its next annual report on
major vascular surgery in November 2015
Editor's Choice - Delays to Surgery and Procedural Risks Following Carotid Endarterectomy in the UK National Vascular Registry.
OBJECTIVE: Guidelines recommend that patients suffering an ischaemic transient ischaemic attack (TIA) or stroke caused by carotid artery stenosis should undergo carotid endarterectomy (CEA) within 14 days. METHOD: The degree to which UK vascular units met this standard was examined and whether rapid interventions were associated with procedural risks. The study analysed patients undergoing CEA between January 2009 and December 2014 from 100 UK NHS hospitals. Data were collected on patient characteristics, intervals of time from symptoms to surgery, and 30-day postoperative outcomes. The relationship between outcomes and time from symptom to surgery was evaluated using multilevel multivariable logistic regression. RESULTS: In 23,235 patients, the median time from TIA/stroke to CEA decreased over time, from 22 days (IQR 10-56) in 2009 to 12 days (IQR 7-26) in 2014. The proportion of patients treated within 14 days increased from 37% to 58%. This improvement was produced by shorter times across the care pathway: symptoms to referral, from medical review to being seen by a vascular surgeon, and then to surgery. The spread of the median time from symptom to surgery among NHS hospitals shrank between 2009 and 2013 but then grew slightly. Low-, medium-, and high-volume NHS hospitals all improved their performance similarly. Performing CEA within 48 h of symptom onset was associated with a small increase in the 30-day stroke and death rate: 3.1% (0-2 days) compared with 2.0% (3-7 days); adjusted odds ratio 1.64 (95% CI 1.04-2.59) but not with longer delays. CONCLUSIONS: The delay from symptom to CEA in symptomatic patients with ipsilateral 50-99% carotid stenoses has reduced substantially, although 42% of patients underwent CEA after the recommended 14 days. The risk of stroke after CEA was low, but there may be a small increase in risk during the first 48 h after symptoms
Improving 1-Year Outcomes of Infrainguinal Limb Revascularization: Population-Based Cohort Study of 104 000 Patients in England.
BACKGROUND: The availability and diversity of lower limb revascularization procedures have increased in England in the past decade. We investigated whether these developments in care have translated to improvements in patient pathways and outcomes. METHODS: Individual-patient records from Hospital Episode Statistics were used to identify 103 934 patients who underwent endovascular (angioplasty) or surgical (endarterectomy, profundaplasty, or bypass) lower limb revascularization for infrainguinal peripheral artery disease in England between January 2006 and December 2015. Major lower limb amputations and deaths within 1 year after revascularization were ascertained from Hospital Episode Statistics and Office for National Statistics mortality records. Competing risks regression was used to estimate the cumulative incidence of major amputation and death, adjusted for patient age, sex, comorbidity score, indication for the intervention (intermittent claudication, severe limb ischemia without record of tissue loss, severe limb ischemia with a record of ulceration, severe limb ischemia with a record of gangrene/osteomyelitis), and comorbid diabetes mellitus. RESULTS: The estimated 1-year risk of major amputation decreased from 5.7% (in 2006-2007) to 3.9% (in 2014-2015) following endovascular revascularization, and from 11.2% (2006-2007) to 6.6% (2014-2015) following surgical procedures. The risk of death after both types of revascularization also decreased. These trends were observed for all indication categories, with the largest reductions found in patients with severe limb ischemia with ulceration or gangrene. Overall, morbidity increased over the study period, and a larger proportion of patients was treated for the severe end of the peripheral artery disease spectrum using less invasive procedures. CONCLUSIONS: Our findings show that from 2006 to 2015, the overall survival increased and the risk of major lower limb amputation decreased following revascularization. These observations suggest that patient outcomes after lower limb revascularization have improved during a period of centralization and specialization of vascular services in the United Kingdom
Volumetric versus single slice measurements of core abdominal muscle for Sarcopenia
Objectives:
We investigated whether total psoas muscle area (TPMA) was representative of the total psoas muscle volume (TPMV). Secondly, we assessed whether there was a relationship between the two commonly used single slice measurements of sarcopenia, TPMA and total abdominal muscle area (TAMA).
Methods:
Pre-operative CT imaging of 110 patients undergoing elective endovascular aneurysm repair were analysed by two trained independent observers. TPMA was measured at individual vertebral levels between the second lumbar vertebrae and sacrum. TPMV was also estimated between the second lumbar vertebrae and sacrum. TAMA was measured at the third lumbar vertebrae (L3). Observer differences were assessed using Bland-Altman plots. Associations between the different measures were assessed using linear regression and Pearson's correlation.
Results:
We found single slice measurements of the TPMA to be representative of the TPMV at individual levels between L2 to the sacrum. The strongest association was seen at L3 (adjusted regression coefficient 16.7, 95% CI 12.1 to 21.4, p < 0.001). There was no association between TPMA and TAMA (adjusted regression coefficient - 0.7, 95% CI - 4.1 to 2.8, p = 0.710).
Conclusions:
We demonstrate that measurements of the TPMA between L2 to the sacrum are representative of the TPMV, with the greatest association at the third lumbar vertebrae. There was no association between the TPMA and TAMA.
Advances in Knowledge:
We demonstrate that a single slice measurement of TPMA at L3 is representative of the muscle volume, contrary to previous criticism. Future sarcopenia studies can continue to measure TPMA which is representative of the TPMV
Association of neighbourhood deprivation with risks of major amputation and death following lower limb revascularisation.
BACKGROUND AND AIMS: Individual-level socioeconomic deprivation is associated with an increased risk of adverse patient outcomes following cardiovascular disease interventions, but the role of area-level socioeconomic circumstances as a predictor for treatment outcomes is unclear. We have examined the association of neighbourhood socioeconomic deprivation with risks of major lower limb amputation and death following surgical and endovascular lower limb revascularisation due to peripheral artery disease (PAD). METHODS: Patients aged 50+ years who underwent surgical or endovascular lower limb revascularisation for PAD were identified from Hospital Episode Statistics, a nationwide hospital data warehouse in England. Major amputations and deaths within a year of revascularisation were ascertained from HES and national mortality register, respectively. Index of Multiple Deprivation (IMD) was used to measure neighbourhood deprivation. Flexible parametric competing risks models were used to estimate sub-distribution hazard ratios (SHRs) for amputation and death. RESULTS: In all, 65,806 patients underwent endovascular and 20,072 underwent surgical revascularisation. The covariate-adjusted 1-year risk of major amputation was higher among patients from the most deprived compared to least deprived neighbourhoods following endovascular revascularisation (SHR: 1.24, 95% confidence interval, CI:1.10 to 1.38) and surgical revascularisation (SHR:1.28, 95% CI: 1.09 to 1.51). The risk of death was higher in most deprived compared to the least deprived neighbourhoods following both procedures. CONCLUSIONS: We found a consistent association between neighbourhood deprivation and amputation and death outcomes following lower limb revascularisation for PAD. These findings suggest there may be opportunities for targeted interventions to improve care of PAD patients in deprived neighbourhoods
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