30 research outputs found

    Security guidelines for field research in complex, remote and hazardous places

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    These guidelines assist researchers in conducting their field-based research or fieldwork in hazardous, remote or complex environments as safely and securely as possible. Fieldwork comes with risks, ranging from the mundane risks of car accidents to more exceptional risks of encountering violence. These risks may affect the security of the researcher and the research outcomes, as well as the security of the respondents, local assistants and interpreters, the home and host organizations, and research sponsors. Taking into account the risk environment should be

    DISCOVER: Dutch Iliac Stent trial: COVERed balloon-expandable versus uncovered balloon-expandable stents in the common iliac artery: Study protocol for a randomized controlled trial

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    Background: Iliac artery atherosclerotic disease may cause intermittent claudication and critical limb ischemia. It can lead to serious complications such as infection, amputation and even death. Revascularization relieves symptoms and prevents these complications. Historically, open surgical repair, in the form of endarterectomy or bypass, was used. Over the last decade, endovascular repair has become the first choice of treatment for iliac arterial occlusive disease. No definitive consensus has emerged about the best endovascular strategy and which type of stent, if any, to use. However, in more advanced disease, that is, long or multiple stenoses or occlusions, literature is most supportive of primary stenting with a balloon-expandable stent in the common iliac artery (Jongkind V et al., J Vasc Surg 52:1376-1383,2010). Recently, a PTFE-covered balloon-expandable stent (Advanta V12, Atrium Medical Inc., Hudson, NH, USA) has been introduced for the iliac artery. Covering stents with PTFE has been shown to lead to less neo-intimal hyperplasia and this might lower restenosis rates (Dolmatch B et al. J Vasc Interv Radiol 18:527-534,2007, Marin ML et al. J Vasc Interv Radiol 7:651-656,1996, Virmani R et al. J Vasc Interv Radiol 10:445-456,1999). However, only one RCT, of mediocre quality has been published on this stent in the common iliac artery (Mwipatayi BP et al. J Vasc Surg 54:1561-1570,2011, Bekken JA et al. J Vasc Surg 55:1545-1546,2012). Our hypothesis is that covered balloon-expandable stents lead to better results when compared to uncovered balloon-expandable stents.Methods/Design: This is a prospective, randomized, controlled, double-blind, multi-center trial. The study population consists of human volunteers aged over 18 years, with symptomatic advanced atherosclerotic disease of the common iliac artery, defined as stenoses longer than 3 cm and occlusions. A total of 174 patients will be included.The control group will undergo endovascular dilatation or revascularization of the common iliac artery, followed by placement of one or more uncovered balloon-expandable stents. The study group will undergo the same treatment, however one or more PTFE-covered balloon-expandable stents will be placed. When necessary, the aorta, external iliac artery, common femoral artery, superficial femoral artery and deep femoral artery will be treated, using the standard treatment.The primary endpoint is absence of binary restenosis rate. Secondary endpoints are reocclusion rate, target-lesion revascularization rate, clinical success, procedural success, hemodynamic success, major amputation rate, complication rate and mortality rate. Main study parameters are age, gender, relevant co-morbidity, and several patient, disease and procedure-related parameters. Trial registration: Dutch Trial Register, NTR3381

    Early diagnosis is associated with improved clinical outcomes in benign esophageal perforation: an individual patient data meta-anal

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    Background: Time of diagnosis (TOD) of benign esophageal perforation is regarded as an important risk factor for clinical outcome, although convincing evidence is lacking. The aim of this study is to assess whether time between onset of perforation and diagnosis is associated with clinical outcome in patients with iatrogenic esophageal perforation (IEP) and Boerhaave’s syndrome (BS). Methods: We searched MEDLINE, Embase and Cochrane library through June 2018 to identify studies. Authors were invited to share individual patient data and a meta-analysis was performed (PROSPERO: CRD42018093473). Patients were subdivided in early (≤ 24 h) and late (> 24 h) TOD and compared with mixed effects multivariable analysis while adjusting age, gender, location of perforation, initial treatment and center. Primary outcome was overall mortality. Secondary outcomes were length of hospital stay, re-interventions and ICU admission. Results: Our meta-analysis included IPD of 25 studies including 576 patients with IEP and 384 with BS. In IEP, early TOD was not associated with overall mortality (8% vs. 13%, OR 2.1, 95% CI 0.8–5.1), but was associated with a 23% decrease in ICU admissions (46% vs. 69%, OR 3.0, 95% CI 1.2–7.2), a 22% decrease in re-interventions (23% vs. 45%, OR 2.8, 95% CI 1.2–6.7) and a 36% decrease in length of hospital stay (14 vs. 22 days, p 24 h) in benign esophageal perforations, particularly in IEP, is associated with improved clinical outcome

    Principles of a novel multistage circulating fluidized bed reactor for biomass gasification

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    In this paper a novel multistage circulating fluidized bed reactor has been introduced. The riser of this multistage circulating fluidized bed consists of several segments (seven in the base-case design) in series each built-up out of two opposite cones. Due to the specific shape, a fluidized bed arises in the bottom cone of each riser segment. Back-mixing of gas and solids between the segments is prevented effectively. The absence of back-mixing combined with the enlarged solids residence time in each segment (each segment is a fluidized bed) creates the opportunity to operate, spatially divided, separate process steps in a single reactor. The benefit of a concept in which different processes are carried out in separate segments of the same reactor has been demonstrated for the specific case of biomass gasification. In the novel reactor it is possible to create oxidation segments in which O2 reacts exclusively with char (carbon). This results in an increased carbon conversion and consequently improved gasification efficiency.\ud \ud Creating an exclusive char combustion zone, aimed at improving both the carbon conversion and the thermal efficiency, has also been applied successfully in a conventional CFB biomass gasifier (ECN's CFB 100 kg wood/h) by building a flow restriction in the riser between the primary air nozzles and the biomass feed point

    Going green: Optimizing GPUs for energy efficiency through model-steered auto-tuning

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    Graphics Processing Units (GPUs) have revolutionized the computing landscape over the past decade. However, the growing energy demands of data centres and computing facilities equipped with GPUs come with significant capital and environmental costs. The energy consumption of GPU applications greatly depend on how well they are optimized. Auto-tuning is an effective and commonly applied technique of finding the optimal combination of algorithm, application, and hardware parameters to optimize performance of a GPU application. In this paper, we introduce new energy monitoring and optimization capabilities in Kernel Tuner, a generic auto-tuning tool for GPU applications. These capabilities enable us to investigate the difference between tuning for execution time and various approaches to improve energy efficiency, and investigate the differences in tuning difficulty. Additionally, our model for GPU power consumption greatly reduces the large tuning search space by providing clock frequencies for which a GPU is likely most energy efficient
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