How does endoscopic sclerotherapy alter splanchnic hemodynamics?

Endoscopic sclerotherapy is widely employed for esophageal variceal hemorrhage. However it has side effects and can aggravate portal hypertension by suppression of portosystemic shunt. The purpose of the present investigation was to study the effect of variceal thrombosis on hepatic venous pressure gradient and azygos blood flow. Eight alcoholic cirrhotic patients with a first variceal hemorrhage were included. According to Child Pugh's classification, 4 patients were group A, 2 group B and 2 group C. At each session 40 to 60 ml of 1 p. 100 polidocanol were injected into the varices. A hemodynamic study was performed in each patient before and about 1 week after variceal obliteration (mean 3.3 procedures). Mean value of hepatic venous pressure gradient was 16.6 ± 5.5 mm Hg and 17.0 ± 3.8, respectively, before sclerotherapy and after eradication of varices; azygos blood flow 663 ± 506 ml/min before and 682 ± 522 after; cardiac output was 6.5 ± 0.7 ml/min before and 6.5 ± 0.8 after. None of these differences were significant. These results suggest that endoscopic sclerotherapy using polidocanol does not change hepatic venous pressure gradient and azygos blood flow, and does not lower blood flow through the gastroesophageal collaterals draining into the azygos vein. This is consistent with the hypothesis that thrombosis remains localized.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/38353/1/1840130337_ftp.pd

Coordination Between the HEU Transparency Program and the Material Protection, Control and Accountability Program

DOE sponsored programs such as Material Protection Control and Accountability (MPC&A) and implementation of the Highly-Enriched Uranium (HEU) Transparency Program send US personnel into Russian nuclear facilities and receive Russian representatives from these programs. While there is overlap in the Russian nuclear facilities visited by these two programs, there had not been any formal mechanism to share information between them. Recently, an MPC&A/HEU Working Group was developed to facilitate the sharing of appropriate information and to address concerns expressed by Minatom and Russian facility personnel such as US visit scheduling conflicts. This paper discusses the goals of the Working Group and ways it has helped to allow the programs to work more efficiently with the Russian facilities

Effective board governance of safe care: a (theoretically underpinned) cross-sectioned examination of the breadth and depth of relationships through national quantitative surveys and in-depth qualitative case studies

Background: Recent high-profile reports into serious failings in the quality of hospital care in the NHS raise concerns over the ability of trust boards to discharge their duties effectively. Objectives: Our study aimed to generate theoretically grounded empirical evidence on the associations between board governance, patient safety processes and patient-centred outcomes. The specific aims were as follows: (1) to identify the types of governance activities undertaken by hospital trust boards in the English NHS with regard to ensuring safe care in their organisation; (2) in foundation trusts, to explore the role of boards and boards of governors with regards to the oversight of patient safety in their organisation; (3) to assess the association between particular hospital trust board oversight activities and patient safety processes and clinical outcomes; (4) to identify the facilitators and barriers to developing effective hospital trust board governance of safe care; and (5) to assess the impact of external commissioning arrangements and incentives on hospital trust board oversight of patient safety. Methods: The study comprised three distinct but interlocking strands: (1) a narrative systematic review in order to describe, interpret and synthesise key findings and debates concerning board oversight of patient safety; (2) in-depth mixed-methods case studies in four organisations to assess the impact of hospital board governance and external incentives on patient safety processes and outcomes; and (3) two national surveys exploring board management in NHS acute and specialist hospital trusts in England, and relating board characteristics to whole-organisation outcomes. Results: A very high proportion of trust boards reported the kinds of desirable characteristics and board-related processes that research says may be associated with higher performance. Our analysis of the symbolic aspects of board activities highlights the role and differences in local processes of organising the governance of patient safety. Most boards do allocate considerable amount of time to discussing patient safety and quality-related issues and were using a wide range of hard performance metrics and soft intelligence to monitor its organisation with regard to patient safety. Although the board of governors is generally perceived to be well-meaning, they were also considered to be being largely ineffective in helping to promote and deliver safer care for their organisations. We did not find any statistically significant relationship between board attributes (self-reported) and processes and any patient safety outcome measures. However, we did find a significant relationship between two dimensions of the Board Self-Assessment Questionnaire and two specific-and-related national staff survey organisational ‘process’ measures: (1) staff feeling safe to raise concerns about errors, near-misses and incidents and (2) staff feeling confident that their organisation would address their concerns, if raised. We also found that contracting and external financial incentives appeared to play only a relatively minor role in incentivising quality and safety improvement. Conclusions: Our research is the first large-scale mixed-methods study of hospital board activity and behaviour related to the oversight of patient safety in the English NHS and the key findings should be used to influence the design of future governance arrangements as well as the training and support of board. Funding: The National Institute for Health Research Health Services and Delivery Research programme

Sintesis Dimensi Mekanisme Empat Batang untuk Peralatan Bongkar Muat pada Mobil Pickup

Pada penelitian tugas akhir ini, dibahas rancangan peralatan untuk bongkar muat yang dipasangkan pada bagian belakan dari mobil pickup. Peralatan dirancang dengan mempertahankan kondisi bidang kerja tempat peletakan benda tidak mengalami perubahan orientasi selama melakukan proses bongkar muat. Digunakan mekanisme empat batang hubung sebagai rangkaian untuk mendukung gerak dari peralatan yang dirancang. Konstanta kinematik dari mekanisme empat batang hubung disintesis berdasarkan motion generation. Dilakukan perancangan dengan menggunakan dua tahapan untuk mendapatkan hasil rancangan peralatan. Tahapan pertama yang dilakukan adalah proses sintesis dimensi yang merupakan tahapan untuk memperoleh konstanta kinematik dari mekanisme empat batang hubung seperti, posisi sambungan dan jarak dari sambungan. Proses sintesis dimensi dilakukan berdasarkan tiga posisi eksak yang merupakan tiga posisi pergerakan dari tempat peletakan benda. tahapan kedua adalah untuk menentukan ukuran atau dimensi dari komponen dari peralatan berdasarkan analisis statik. Mekanisme peralatan dirancang terdiri atas tiga pengelompokan komponen, yaitu komponen yang digerakkan, komponen penopang gerakan dan komponen penggerak. Komponen yang digerakkan pada rancangan adalah platform yang merupakan tempat peletakan benda dan sebagai coupler pada mekanisme empat batang. Komponen penopang penggerak merupakan komponen yang mengontrol gerakan dari komponen yang digerakkan. Pada rancangan ini, komponen penopang gerakan adalah crank. Sedangkan komponen penggerak merupakan komponen sebagai penggerak dari peralatan. Rancangan peralatan bongkar muat memiliki spesifikasi dapat mengangkat benda dengan massa 250 kg, dengan perpindahan ketinggian platform sebesar 684 mm. Dari rancangan, penggerak menggunakan sistem 10 pulley dan dua roda gigi untuk mengurangi besar daya yang dibutuhkan untuk mengoperasikan peralatan. sebagai hasilnya didapat mekanisme saat menerima beratnya 250 kg, dibutuhkan daya untuk mengoperasikan peralatan sebesar 28,99N

Radiosity for Large Vegetation Scenes

Calculating radiosity solutions for large scenes containing multiple plants is all but impossible using the radiosity method in its original form. With the introduction of sophisticated hierarchical and clustering algorithms radiosity for vegetation scenes becomes a solvable challenge. The precomputation of the diffuse light distribution in leaf canopies of forests and other plants can be used to calculate realistic images, but also for agricultural planning purposes. This state of the art report gives an overview of the methods that can, and have been, used to calculate global illumination in vegetation scenes, including hierarchical methods, statistical methods based on simplifications, and specialized methods that have been optimized to handle scenes with a dense, non-isotropic distribution of objects such as canopies. 1. Introduction Radiosity belongs to the global illumination methods for generating photorealistic images by computer graphics. The physical foundation of radiosity ..

Implementation of U.S. transparency monitoring under the U.S./Russian HEU purchase agreement

During the past three years US monitoring at Russian nuclear facilities, subject to the HEU Purchase Agreement, has evolved as MINATOM and DOE negotiators worked to improve transparency rights and as additional Russian facilities began processing HEU. The number of Russian nuclear facilities subject to US monitoring has increased from two in 1996 to the current four. In that time, physical monitoring, which only permitted visual inspections and access to process forms is being supplemented by instrumentation which detects U-235 enrichment of material in containers and instrumentation which is used to confirm that blending of HEU into LEU at the blending facilities is taking place. This paper summarizes the US HEU Transparency monitoring activities performed in Russian facilities. It then summarizes the process used to certify the Blend Down Monitoring System (BDMS) that is currently in use at one of these facilities