Percutaneous gastrostomy: troubleshooting complications

Percutaneous endoscopic gastrostomy was first described in 1980 (Gauderer et al, 1980), superseding surgical gastrostomy as a means of providing long-term enteral nutrition. Despite the commonality of this procedure, its associated morbidity and mortality rates are significant, with directly attributable rates of 1:30 and 1:150 respectively. Poor patient selection and poor management are the principal factors contributing to adverse outcomes. The 2004 National Confidential Enquiry into Patient Outcome and Death recorded that 19% of percutaneous endoscopic gastrostomy procedures performed were ‘futile or not indicated at all’. This article provides a practical approach to avoiding and treating complications associated with percutaneous endoscopic gastrostomy feeding

Metamodeling and metaquerying in OWL 2 QL

OWL 2 QL is a standard profile of the OWL 2 ontology language, specifically tailored to Ontology-Based Data Management. Inspired by recent work on higher-order Description Logics, in this paper we present a new semantics for OWL 2 QL ontologies, called Metamodeling Semantics (MS), and show that, in contrast to the official Direct Semantics (DS) for OWL 2, it allows exploiting the metamodeling capabilities natively offered by the OWL 2 punning. We then extend unions of conjunctive queries with both metavariables, and the possibility of using TBox atoms, with the purpose of expressing meaningful metalevel queries. We first show that under MS both satisfiability checking and answering queries including only ABox atoms, have the same complexity as under DS. Second, we investigate the problem of answering general metaqueries, and single out a new source of complexity coming from the combined presence of a specific type of incompleteness in the ontology, and of TBox axioms among the query atoms. Then we focus on a specific class of ontologies, called TBox-complete, where there is no incompleteness in the TBox axioms, and show that general metaquery answering in this case has again the same complexity as under DS. Finally, we move to general ontologies and show that answering general metaqueries is coNP-complete with respect to ontology complexity, Π2p-complete with respect to combined complexity, and remains AC0 with respect to ABox complexity

Optical characterization of homogeneous and heterogeneous intralipid-based samples

Different scattering processes take place when photons propagate inside turbid media. Many powerful experimental techniques exploiting these processes have been developed and applied over the years in a large variety of situations from fundamental and applied research to industrial applications. In the present paper, we intend to take advantage of Static Light Scattering (SLS), Dynamic Light Scattering (DLS), and Time-Resolved Transmittance (TRT) for investigating all the different scattering regimes by using scattering suspensions in a very large range of scatterer concentrations. The suspensions were prepared using Intralipid 20%, a material largely employed in studies of the optical properties of turbid media, with concentrations from 10-5% to 50%. By the analysis of the angular and temporal dependence of the scattered light, a more reliable description of the scattering process occurring in these samples can be obtained. TRT measurements allowed us to obtain information on the reduced scattering coefficient, an important parameter largely used in the description of the optical properties of turbid media. TRT was also employed for the detection of inclusions embedded in Intralipid suspensions, by using a properly designed data analysis. The present study allowed us to better elucidate the dependence of scattering properties of Intralipid suspensions in a very large concentration range and the occurrence of the different scattering processes involved in the propagation of light in turbid media for the first time to our knowledge. In so doing, the complementary contribution of SLS, DLS, and TRT in the characterization of turbid media from an optical and structural point of view is strongly evidenced

Kinetic Models of the Prebiotic Replication of dsRNA under Thermal Cycling Conditions

We present computational models for the replication of double stranded RNA (dsRNA) or related macromolecules under thermal cycling conditions that would reflect prebiotic (i.e. non-enzymatic) environments. Two models of the replication of dsRNA are represented as multi-step chemical systems. The objective of this investigation was to better understand the kinetic features of such chemical systems. It is shown that thermal cycling in a chemical system is advantageous (relative to a fixed temperature) if there are two competing reactions, one favored at high temperature and one favored at low temperature. For the prebiotic replication of dsRNA, a high temperature favors formation of the two single stranded RNA (ssRNA) templates and a presumptive catalysis or catalytic surface is active at low temperature at which the ssRNA template is copied. Our models may facilitate understanding possible prebiotic conditions for the replication of dsRNA

Multiple crack propagation in friction stir welded aluminium joints

This paper is concerned with the simulation of crack propagation in friction stir welded butt joints, in order to assess the influence of process induced microstructural alterations and residual stresses on the fatigue behaviour of the assembly. The approach employed is based on the coupled use of the finite element method and the dual boundary element method in order to take advantage of the main capabilities of the two methods. The distribution of the process induced residual stresses has been mapped by means of the contour method. Then, the computed residual stresses field has been superimposed, in a dual boundary element environment, to the stress field as a result of a remote fatigue traction load and the crack growth is simulated. A two-parameter crack growth law, based on the evaluation of two thresholds, for the material being analysed, is used for the crack propagation rate assessment. The stress intensity factors are evaluated using the J-integral technique. Computational results have been compared with experimental data, provided from constant amplitude crack propagation tests on welded samples, showing the subdivision of the overall fatigue life in the two periods of crack initiation and crack propagation

Coupled FEM-DBEM Simulation of 3D Crack Growth under Fatigue Load Spectrum

Abstract Numerical predictions of fatigue crack growth under load spectrum are obtained by coupled FEM-DBEM approach. An initial part-through corner crack, in a pre-notched specimen undergoing a traction fatigue load, propagates becoming through the thickness. A two parameter crack growth law ("Unified Approach") is calibrated by in house made constant amplitude experimental tests and the crack growth retardation after an overload application is reproduced. The residual stresses responsible for such retardation are calculated by a sequence of elastic-plastic static FEM analysis; such stresses are then applied to the crack faces for the propagation simulation in a DBEM environment. A satisfactory agreement between numerical and experimental crack growth rates are displayed, for both part-through crack and through the thickness crack. This approach provide general modeling capabilities, with allowance for general crack front shape and fully automatic propagation

Corporate governance and sustainability in water utilities. The effects of decorporatisation in the city of Naples, Italy

The recent economic literature has largely investigated sustainability in the provision of public utilities, highlighting the role of governance models in the determination of economic results. Little attention however has been devoted to the social and environmental dimensions of sustainability. In Italy, a long‐lasting debate on governance structures in the water sector has been fuelled by scholars and policymakers for more than 30 years, whereas the first (and unique) experiment involving the return of full public management in water provision is taking place in the city of Naples. The present work analyses this peculiar case study, aiming to assess the effects of a major governance shift that occurred in the early 2010s—that is, decorporatisation—in terms of economic, social and environmental sustainability. We resort to a bundle of qualitative and quantitative techniques to address the research question and our exploratory results suggest that decorporatisation was overall beneficial: Although little changed in terms of economic sustainability, the social and environmental dimensions benefitted from the shift in governance