Roux-en-Y Drainage of the Pancreatic Stump Decreases Pancreatic Fistula After Distal Pancreatic Resection

Clinically relevant fistula after distal pancreatic resection occurs in 5-30% of patients, prolonging recovery and considerably increasing in-hospital stay and costs. We tested whether routine drainage of the pancreatic stump into a Roux-en-Y limb after distal pancreatic resection decreased the incidence of fistula. From October 2001, data of all patients undergoing pancreatic distal resection were entered in a prospective database. From June 2003 after resection, the main pancreatic duct and the pancreatic stump were oversewn, and in addition, anastomosed into a jejunal Roux-en-Y limb by a single-layer suture (n = 23). A drain was placed near the anastomosis, and all patients received octreotide for 5-7days postoperatively. The volume of the drained fluid was registered daily, and concentration of amylase was measured and recorded every other day. Patient demographics, hospital stay, pancreatic fistula incidence (≥30ml amylase-rich fluid/day on/after postoperative day 10), perioperative morbidity, and follow-up after discharge were compared with our initial series of patients (treated October 2001-May 2003) who underwent oversewing only (n = 20). Indications, patient demographics, blood loss, and tolerance of an oral diet were similar. There were four (20%) pancreatic fistulas in the "oversewn” group and none in the anastomosis group (p < 0.05). Nonsurgical morbidity, in-hospital stay, and follow-up were comparable in both group

A general lower bound for collaborative tree exploration

We consider collaborative graph exploration with a set of $k$ agents. All agents start at a common vertex of an initially unknown graph and need to collectively visit all other vertices. We assume agents are deterministic, vertices are distinguishable, moves are simultaneous, and we allow agents to communicate globally. For this setting, we give the first non-trivial lower bounds that bridge the gap between small ($k \leq \sqrt n$) and large ($k \geq n$) teams of agents. Remarkably, our bounds tightly connect to existing results in both domains. First, we significantly extend a lower bound of $\Omega(\log k / \log\log k)$ by Dynia et al. on the competitive ratio of a collaborative tree exploration strategy to the range $k \leq n \log^c n$ for any $c \in \mathbb{N}$. Second, we provide a tight lower bound on the number of agents needed for any competitive exploration algorithm. In particular, we show that any collaborative tree exploration algorithm with $k = Dn^{1+o(1)}$ agents has a competitive ratio of $\omega(1)$, while Dereniowski et al. gave an algorithm with $k = Dn^{1+\varepsilon}$ agents and competitive ratio $O(1)$, for any $\varepsilon > 0$ and with $D$ denoting the diameter of the graph. Lastly, we show that, for any exploration algorithm using $k = n$ agents, there exist trees of arbitrarily large height $D$ that require $\Omega(D^2)$ rounds, and we provide a simple algorithm that matches this bound for all trees

Psychological response and quality of life after transplantation: a comparison between heart, lung, liver and kidney recipients

PRINCIPLES: Various non-specific questionnaires were used to measure quality of life and psychological wellbeing of patients after organ transplantation. At present cross-organ studies dealing specifically with the psychological response to a transplanted organ are non-existent in German-speaking countries. METHODS: The Transplant Effects Questionnaire TxEQ-D and the SF-36 Quality of Life Questionnaire were used to examine the psychological response and quality of life of 370 patients after heart, lung, liver or kidney transplantation. The organ groups were compared with regard to psychosocial parameters. RESULTS: 72% of patients develop a feeling of responsibility for the received organ and its function. This feeling is even stronger towards the patient's key relationships i.e. family, friends, the treatment team and the donor. 11.6% worry about the transplanted organ. Heart and lung patients report significantly fewer concerns than liver and kidney patients. Overall, only a minority of patients report feelings of guilt towards the donor (2.7%), problems in disclosing their transplant to others (2.4%), or difficulties in complying with medical orders (3.5%). Lung transplant patients show significantly better adherence. CONCLUSIONS: A feeling of responsibility towards those one is close to and towards the donor is a common psychological phenomenon after transplantation of an organ. Conscious feelings of guilt and shame are harboured by only a minority of patients. The fact that heart and lung patients worry less about their transplant might have primarily to do with the greater medical and psychosocial support in this group

A stochastic method for the energy management in hybrid electric vehicles

There are many approaches addressing the problem of optimal energy management in hybrid electric vehicles; however, most of them optimise the control strategy for particular driving cycles. This paper takes into account that the driving cycle is not a priori known to obtain a near-optimal solution. The proposed method is based on analysing the power demands in a given receding horizon to estimate future driving conditions and minimise the fuel consumption while cancelling the expected battery energy consumption after a defined time horizon. Simulations show that the proposed method allows charge sustainability providing near-optimal results. (C) 2014 Elsevier Ltd. All rights reserved.This research has been partially supported by Ministerio de Ciencia e Innovacion through Project TRA2010-16205 uDiesel and by the Conselleria de Educacio Cultura i Esports de la Generalitat Valenciana through Project GV/2103/044 AECOSPH.Payri González, F.; Guardiola, C.; Plá Moreno, B.; Blanco-Rodriguez, D. (2014). A stochastic method for the energy management in hybrid electric vehicles. Control Engineering Practice. 29:257-265. https://doi.org/10.1016/j.conengprac.2014.01.004S2572652

Roux-en-Y drainage of the pancreatic stump decreases pancreatic fistula after distal pancreatic resection

Clinically relevant fistula after distal pancreatic resection occurs in 5-30% of patients, prolonging recovery and considerably increasing in-hospital stay and costs. We tested whether routine drainage of the pancreatic stump into a Roux-en-Y limb after distal pancreatic resection decreased the incidence of fistula. From October 2001, data of all patients undergoing pancreatic distal resection were entered in a prospective database. From June 2003 after resection, the main pancreatic duct and the pancreatic stump were oversewn, and in addition, anastomosed into a jejunal Roux-en-Y limb by a single-layer suture (n = 23). A drain was placed near the anastomosis, and all patients received octreotide for 5-7 days postoperatively. The volume of the drained fluid was registered daily, and concentration of amylase was measured and recorded every other day. Patient demographics, hospital stay, pancreatic fistula incidence (> or =30 ml amylase-rich fluid/day on/after postoperative day 10), perioperative morbidity, and follow-up after discharge were compared with our initial series of patients (treated October 2001-May 2003) who underwent oversewing only (n = 20). Indications, patient demographics, blood loss, and tolerance of an oral diet were similar. There were four (20%) pancreatic fistulas in the "oversewn" group and none in the anastomosis group (p < 0.05). Nonsurgical morbidity, in-hospital stay, and follow-up were comparable in both groups

Minimum Energy Broadcast and Disk Cover in Grid Wireless Networks

Abstract. The Minimum Energy Broadcast problem consists in finding the minimum-energy range assignment for a given set S of n stations of an ad hoc wireless network that allows a source station to perform broadcast operations over S. We prove a nearly tight asymptotical bound on the optimal cost for the Minimum Energy Broadcast problem on square grids. We emphasize that finding tight bounds for this problem restriction is far to be easy: it involves the Gauss’s Circle problem and the Apollonian Circle Packing. We also derive near-tight bounds for the Bounded-Hop version of this problem. Our results imply that the best-known heuristic, the MST-based one, for the Minimum Energy Broadcast problem is far to achieve optimal solutions (even) on very regular, well-spread instances: its worst-case approximation ratio is about pi and it yields Ω( n) hops. As a by product, we get nearly tight bounds for the Minimum Disk Cover problem and for its restriction in which the allowed disks must have non-constant radius. Finally, we emphasize that our upper bounds are obtained via polynomial time constructions.

Co-located wind and wave energy farms: Uniformly distributed arrays

publisher: Elsevier articletitle: Co-located wind and wave energy farms: Uniformly distributed arrays journaltitle: Energy articlelink: http://dx.doi.org/10.1016/j.energy.2016.07.069 content_type: article copyright: © 2016 Elsevier Ltd. All rights reserved

Projective paternalism

We study experimentally when, why, and how people intervene in others' choices. Choice Architects (CAs) construct opportunity sets containing bundles of time-indexed payments for Choosers. CAs frequently prevent impatient choices despite opportunities to provide advice, believing Choosers benefit. We consider several hypotheses concerning CAs' motives. A conventional behavioral welfarist acts as a correctly informed social planner; a mistakesprojective paternalist removes options she wishes she could reject when choosing for herself; an ideals-projective paternalist seeks to align others' choices with her own aspirations. Idealsprojective paternalism provides the best explanation for interventions in the laboratory and rationalizes support for actual paternalistic policies