The development of a parallel implementation of non-contact surface measurement

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Drug discovery and treatment paradigms in nonalcoholic steatohepatitis

10.1002/edm2.105EndocrinologyDiabetes and Metabolism34e0010

Proceedings of the Workshop on Geothermal Reservoir Engineering

A three dimensional, multiphase, numerical simulation model of the Cerro Prieto field was developed and used to verify that the present installed capacity (620 MW) can be sustained for 30 years and to evaluate the impact of an 80 MW addition to the installed capacity in the NE-E of the field on the present production areas. Cerro Prieto is the largest known water-dominated geothermal reservoir in the world, with more than 175 wells drilled to date and 17 years of production history. Wells here produce fluids of varying enthalpy, from moderate-temperature water to dry steam. The varying enthalpy and a complex interaction between the reservoir and the surrounding aquifer posed a real simulation challenge. The simulation approach used to reproduce the major features of the initial-state and the production history of the field is discussed in this paper. From this study it was concluded that the field is capable of sustaining its present 620 MW total installed capacity for 30 years and the addition of the proposed 80 MW should have a negligible effect on the present production area

Design considerations for a steam-injection pilot with in-situ foaming

This report reviews the necessary aspects of the planning, operation, evaluation, environmental impact and cost to implement a field pilot of steam injection with in-situ foaming. The Stanford University Petroleum Research Institute (SUPRI) is planning to implement such a pilot in Kern County, California. The cost of the pilot will be shared by the US Department of Energy and an oil company. Some important aspects of drilling and completion programs and their specifications, permits from regulatory bodies, and downhole tools to improve steam stimulation are discussed. The essential surface facilities which include water treatment plant, steam generator, demulsifier and dehydrator are considered. The necessary laboratory research in support of the pilot has been recommended. The formation evaluation and reservoir engineering effort for the pilot has been divided into three phases: reservoir definition, reservoir monitoring and post-pilot study. Appropriate techniques applicable to each phase of the test have been discussed. The environmental impact regulations as related to the steam injection process have been considered. In particular, the environmental problems associated with the burning of crude oil and desulfurization of flue gas have been discussed. Other environmental considerations such as solid and liquid waste disposal, health and safety are also discussed. An estimate of the cost of this field test is presented. Three scenarii (for pilots with high, medium, and low investment potentials, respectively) are presented. Since this report was prepared, a specific site for the supri pilot has been chosen. Appendices G and H present the details on this site

Review article : the Prothrombin Time Test as a Measure of Bleeding Risk and Prognosis in Liver Disease

Background: Prothrombin time (PT)-derived international normalized ratio (INR) is used to assess bleeding risk and prognosis in cirrhosis, and to guide management of associated coagulation disturbances. Recent studies cast doubt on the validity of the assumptions that form the basis for these applications. Aims: To review and critique the use of the PT-INR in cirrhosis. Methods: Search of the literature. Results: In cirrhosis, there is a decrease in both pro- and anti-coagulants. The PT-INR measures only the activity of procoagulants and fails to capture changes in anticoagulants. It is therefore not surprising that the PT does not predict the bleeding risk. The PT-INR provides a robust measure of liver function but recent data showed INR inter-laboratory variability in this setting. This is not surprising as the INR was validated to normalize results for patients on vitamin-K antagonists, not for cirrhosis. This limitation was not appreciated, but the INR is used to construct the model for end-stage liver disease score to prioritize patients for liver transplantation. Reports showed that model for end-stage liver disease is modified by the thromboplastin used for testing. Conclusions: Alternate tests to predict bleeding risk should be developed. The potential for misuse of the PT-INR should drive the development of alternate algorithms for organ allocation

Coagulation disorders and hemostasis in liver disease: pathophysiology and critical assessment of current management.

Normal coagulation has classically been conceptualized as a Y-shaped pathway, with distinct "intrinsic" and "extrinsic" components initiated by factor XII or factor VIIa/tissue factor, respectively, and converging in a "common" pathway at the level of the FXa/FVa (prothrombinase) complex. Until recently, the lack of an established alternative concept of hemostasis has meant that most physicians view the "cascade" as a model of physiology. This view has been reinforced by the fact that screening coagulation tests (APTT, prothrombin time - INR) are often used as though they are generally predictive of clinical bleeding. The shortcomings of this older model of normal coagulation are nowhere more apparent than in its clinical application to the complex coagulation disorders of acute and chronic liver disease. In this condition, the clotting cascade is heavily influenced by numerous currents and counter-currents resulting in a mixture of pro- and anticoagulant forces that are themselves further subject to change with altered physiological stress such as super-imposed infection or renal failure. This report represents a summary of a recent multidisciplinary symposium held in Charlottesville, VA. We present an overview of the coagulation system in liver disease with emphasis on the limitations of the current clinical paradigm and the need for a critical re-evaluation of the current tenets governing clinical practice. With the realization that there is often limited or conflicting data, we have attempted to represent diverse opinion and experience from the perspectives of both hepatology and hematology beginning with a brief update on the physiology of normal coagulation