Bronchoscopic Advances in the Management of Aerodigestive Fistulas

Malignant aerodigestive fistula (ADF) is an uncommon condition complicating thoracic malignancies. It results in increased morbidity and mortality and warrants therapeutic intervention. The management approach depends on symptoms, configuration, location, and extent of the fistula. This article will discuss the therapeutic considerations in the management of ADF

A Bimorph Multi-layer Piezoelectric Vibration Energy Harvester

This paper reports a bimorph piezoelectric vibration energy harvester incorporating multiple PZT layers. The advantage of a multi-layer generator is that it produces a higher power than a single-layer generator having the same total thickness. In addition, a lower voltage is required to polarize a multi-layer generator reducing the risk of breakdown during polarization. Moreover, the optimum resistive load of a multi-layer generator is much lower than that of a single-layer generator, which makes it easier to couple to the electrical domain. In this work, it was found, experimentally, that a double-layer generator produces 41.5% and 19.4% more power than a singlelayer generator with the same total thickness of PZT and resonant frequency. This was verified theoretically. The generators have been fabricated by screen printing which is attractive for low cost mass production

Physical therapies for reducing and controlling lymphoedema of the limbs.

Background Lymphoedema is the accumulation of excess fluid in the body caused by obstruction of the lymphatic drainage mechanisms. Management involves decongesting the reduced lymphatic pathways in order to reduce the size of the limb. There is a great deal of debate as to which components of a physical treatment programme are the most crucial. Objectives To assess the effect of physical treatment programmes on: volume, shape, condition and long-term control of oedema in lymphoedematous limbs; psycho-social benefits. Search strategy We searched the Cochrane Breast Cancer Group trials register (October 2007), the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 1, 2008), MEDLINE, EMBASE, CINAHL and the National Research Register (February 2008) and UnCover, PASCAL, SIGLE, reference lists produced by The British Lymphology Society and The International Society of Lymphology congress proceedings (September 2003). Selection criteria Randomised controlled clinical trials that tested physical therapies with a follow-up period of at least six months. Data collection and analysis Two blinded reviewers independently assessed trial quality and extracted data . Meta-analysis was not performed due to the poor quality of the trials. Main results Only three studies involving 150 randomised patients were included. Since none studied the same intervention it was not possible to combine the data. One crossover study of manual lymph drainage (MLD) followed by self-administered massage versus no treatment, concluded that improvements seen in both groups were attributable to the use of compression sleeves and that MLD provided no extra benefit at any point during the trial. Another trial looked at hosiery versus no treatment and had a very high dropout rate, with only 3 out of 14 participants in the intervention group finishing the trial and only 1 out of 11 in the control group. The authors concluded that wearing a compression sleeve is beneficial. The bandage plus hosiery versus hosiery alone trial, concluded that in this mixed group of participants bandage plus hosiery resulted in a greater reduction in excess limb volume than hosiery alone and this difference in reduction was maintained long-term. Authors' conclusions All three trials have their limitations and have yet to be replicated, so their results must be viewed with caution. There is a clear need for well-designed, randomised trials of the whole range of physical therapies if the best approach to managing lymphoedema is to be determined

NASA/JSC ISSLive!

Just 150 miles above us, the International Space Station (ISS) is orbiting. Each day, the astronauts on board perform a variety of activities from exercise, science experiments, and maintenance. Yet, many on the ground do not know about these daily activities. National Aeronautics Space Agency/ Johnson Space Center (NASA/JSC) innovation creation ISSLive! - an education project - is working to bridge this knowledge gap with traditional education channels such as schools, but also non-traditional channels with the non-technical everyday public. ISSLive! provides a website that seamlessly integrates planning and telemetry data, video feeds, 3D models, and iOS and android applications. Through the site, users are able to view astronauts daily schedules, in plain English alongside the original data. As an example, when an astronaut is working with a science experiment, a user will be able to read about the activity and for more detailed activities follow provided links to view more information all integrated into the same site. Live telemetry data from a predefined set can also be provided alongside the activities. For users to learn more, 3D models of the external and internal parts of the ISS are available, allowing users to explore the station and even select sensors, such as temperature, and view a real-time chart of the data. Even ground operations are modeled with a 3D mission control center, providing users information on the various flight control disciplines and showing live data that they would be monitoring. Some unique activities are also highlighted and have dedicated spaces to explore in more detail. Education is the focus of ISSLive!, even from the beginning when university students participated in the development process as part of their master s projects. Focus groups at a Houston school showed interest in the project and excitement towards including ISSLive! in their classroom. Through this inclusion, students' knowledge can be assessed with projects, oral presentations, and other assignments. For the public citizens outside of the traditional education system, ISSLive! provides a single, interactive, and engaging experience to learn about the ISS and its role in space exploration, international collaboration, and science. While traditional students are using ISSLive! in the classroom, their parents, grandparents, and friends are using it at home. ISSLive! truly brings the daily operations of the ISS into the daily lives of the public from every generation

Globally Convergent Adaptive Tracking of Angular Velocity and Inertia Identification for a 3-DOF Rigid Body

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/57820/1/AdaptiveTrackingTCST2006.pd

Co-located Heroin Assisted Treatment within primary care: A preliminary analysis of the implications for healthcare access, cost, and treatment delivery in the UK.

The UK is experiencing its highest rate of drug related deaths in 25 years. Poor and inconsistent access to healthcare negatively impacts health outcomes for people who use drugs. Innovation in models of care which promote access and availability of physical treatment is fundamental. Heroin Assisted Treatment (HAT) is a treatment modality targeted at the most marginalised people who use drugs, at high risk of mortality and morbidity. The first service-provider initiated HAT service in the UK ran between October 2019 and November 2022 in Middlesbrough, England. The service was co-located within a specialist primary care facility offering acute healthcare treatment alongside injectable diamorphine. Analysis of anonymised health records for healthcare costs (not including drug treatment) took place using descriptive statistics prior and during engagement with HAT, at both three (n=15) and six (n=12) months. Primary outcome measures were incidents of wound care, skin and soft tissue infections (SSTIs), overdose (OD) events, unplanned overnight stays in hospital, treatment engagement (general and within hospital care settings) and ambulance incidents. Secondary outcome measures were costs associated with these events. A shift in healthcare access for participants during HAT engagement was observed. HAT service attendance appeared to support health promoting preventative care, and reduce reactive reliance on emergency healthcare systems. At three and six months, engagement for preventative wound care and treatment for SSTIs increased at the practice. Unplanned emergency healthcare interactions for ODs, overnight hospital stays, serious SSTIs, and ambulance incidents reduced, and there was an increase in treatment engagement (i.e. a reduction in appointments which were not engaged with). There was a decrease in treatment engagement in hospital settings. Changes in healthcare utilisation during HAT translated to a reduction in healthcare costs of 58% within six months compared to the same timeframe from the period directly prior to commencing HAT. This exploratory study highlights the potential for innovative harm reduction interventions such as HAT, co-located with primary care services, to improve healthcare access and engagement for a high-risk population. Increased uptake of primary healthcare services translated to reductions in emergency healthcare use and associated costs. Although costs of HAT provision are substantial, the notable cost-savings in health care should be an important consideration in service implementation planning. [Abstract copyright: Copyright © 2024. Published by Elsevier B.V.

Comparison of post-dural puncture headache incidence among patients undergoing spinal anaesthesia for elective caesarean section by using quincke 25-G and 29-G spinal needles

Background: Multiple complications including hypotension, nausea, vomiting, urinary retention, transient neurological symptoms and headache have been associated with spinal anaesthesia. Importantly, post dural puncture headache (PDPH) varies with the type and size of spinal needle employed for inducing anaesthesia. Here, we aimed to compare the frequency of PDPH in patients underwent spinal anaesthesia for elective caesarean section using 25-gauge (G) and 29-G Quincke spinal needle.Methods: We designed a randomized control trial at Obstetrics and Gynecology Operation Theatres, Jinnah Hospital, Lahore. A total of 152 patients having age 30.28±8.21 years were enrolled in the study and divided into two groups each comprising of 76 patients. In group 1, spinal anaesthesia was performed using 25-G Quincke spinal needle while in group 2 spinal anaesthesia was administered employing 29-G Quincke spinal needle. A standard dose of 10.5-12.0 mg (1.4-1.6 ml) of 0.75% bupivacaine is infiltrated in subarachnoid space at lumber region L3-L4 or L4-L5 following aseptic measures. The patients were evaluated for PDPH during the follow up period.Results: The previous history of PDPH was observed in 20.39% patients. The comparative study showed that the PDPH was observed in 12 (15.7%) patients in group 1 while the group 2 revealed PDPH in only 2 (2.6%) patients.Conclusions: Thus 29-G spinal needle can be regarded as a better option to reduce PDPH in patients subjected to spinal anaesthesia for elective cesarean in contrast to the use of 25-G Quincke spinal needle

Computational Methods for Failure Analysis and Life Prediction

This conference publication contains the presentations and discussions from the joint UVA/NASA Workshop on Computational Methods for Failure Analysis and Life Prediction held at NASA Langley Research Center 14-15 Oct. 1992. The presentations focused on damage failure and life predictions of polymer-matrix composite structures. They covered some of the research activities at NASA Langley, NASA Lewis, Southwest Research Institute, industry, and universities. Both airframes and propulsion systems were considered