984 resultados para 26-256
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2009
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2010
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2010
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2010
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2009
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http://www.archive.org/details/worldwideevangel00unknuoft
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Objective: To evaluate the practice of laparoscopic appendectomy (LA) in Italy. Methods: On behalf of the Italian Society of Young Surgeons (SPIGC), an audit of LA was carried out through a written questionnaire sent to 800 institutions in Italy. The questions concerned the diffusion of laparoscopic surgery and LA over the period 1990 through 2001, surgery-related morbidity and mortality rates, indications for LA, the diagnostic algorithm adopted prior to surgery, and use of LA among young surgeons (<40 years). Results: A total of 182 institutions (22.7%) participated in the current audit, and accounted for a total number of 26863 LA. Laparoscopic surgery is performed in 173 (95%) institutions, with 144 (83.2%) routinely performing LA. The mean interval from introduction of laparoscopic surgery to inception of LA was 3.4 ± 2.5 years. There was an emergent basis for 8809 (32.8%) LA procedures (<6 hours of admission); 10314 (38.4%) procedures were performed on an urgent basis (<24 hours of admission); while 7740 (28.8%) procedures were elective. The conversion rate was 2.1% (561 cases) and was due to intraoperative complications in 197 cases (35.1%). Intraoperative complications ranged as high as 0.32%, while postoperative complications were reported in 1.2% of successfully completed LA. The mean hospital stay for successfully completed LA was 2.5 ± 1.05 days. The highest rate of intraoperative complications was reported as occurring during the learning curve phase of their experience (in their first 10 procedures) by 39.7% of the surgeons. LA was indicated for every case of suspected acute appendiceal disease by 51.8% of surgeons, and 44.8% order abdominal ultrasound (US) prior to surgery. A gynecologic counseling is deemed necessary only by 34.5% surgeons, while an abdominal CT scan is required only by 1.5%. The procedure is completed laparoscopically in the absence of gross appendiceal inflammation by 83%; 79.8% try to complete the procedure laparoscopically in the presence of concomitant disease; while 10.4% convert to open surgery in cases of suspected malignancy. Of responding surgeons aged under 40, 76.3% can perform LA, compared to 47.3% surgeons of all age categories. Conclusions: The low response rate of the present survey does not allow us to assess the diffusion of LA in Italy, but rather to appraise its practice in centers routinely performing laparoscopic surgery. In the hands of experienced surgeons, LA has morbidity rates comparable to those of international series. The higher diagnostic yield of laparoscopy makes it an invaluable tool in the management algorithm of women of childbearing age; its advantages in the presence of severe peritonitis are less clear-cut. Surgeons remain the main limiting factor preventing a wider diffusion of LA in our country, since only 47.3% of surgeons from the audited institutions can perform LA on a routine basis.
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Su mirada recorrió los lomos del estante inferior y se detuvo en un título que le llamó la atención. Lo liberó de la hilera que lo aprisionaba y lo abrió al azar. Al menos eso era lo que pretendía, aunque el libro se abrió por una página señalada con un pliegue en la esquina superior. Quien lo practicó quería señalar un punto con una indicación perenne. Seguro que era cosa de su abuelo, fallecido hacía ya unos cuantos años. Fue precisamente el recuerdo de su muerte lo que le animó a entrar en la biblioteca. No sabía porqué, pero de repente le había venido a la mente la imagen del anciano leyendo ensimismado en aquel sillón antiguo, rodeado de incontables volúmenes, páginas, frases, palabras, letras.
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The most common parallelisation strategy for many Computational Mechanics (CM) (typified by Computational Fluid Dynamics (CFD) applications) which use structured meshes, involves a 1D partition based upon slabs of cells. However, many CFD codes employ pipeline operations in their solution procedure. For parallelised versions of such codes to scale well they must employ two (or more) dimensional partitions. This paper describes an algorithmic approach to the multi-dimensional mesh partitioning in code parallelisation, its implementation in a toolkit for almost automatically transforming scalar codes to parallel form, and its testing on a range of ‘real-world’ FORTRAN codes. The concept of multi-dimensional partitioning is straightforward, but non-trivial to represent as a sufficiently generic algorithm so that it can be embedded in a code transformation tool. The results of the tests on fine real-world codes demonstrate clear improvements in parallel performance and scalability (over a 1D partition). This is matched by a huge reduction in the time required to develop the parallel versions when hand coded – from weeks/months down to hours/days.
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Seasonal changes in altimeter data are derived for the North Atlantic Ocean. Altimeter data are then used to examine annually propagating structure along 26 degree N. By averaging the altimeter data into monthly values or by Fourier analysis, a positive anomaly can be followed from 17 degree W to similar to 50 degree W along similar to 26 degree N. The methods give a westward travel speed of 1 degree of longitude a month and a half-life of one year for the average decaying structure. At similar to 50 degree W 26 degree N, the average structure is about 2.8 years old with an elevation signal of similar to 1 cm, having gravelled similar to 3300 km westward. The mean positive anomaly results from the formation of anticyclonic eddies which are generally formed annually south of the Canary Islands by late summer and which then travel westward near 26 degree N. Individual eddy structure along 26 degree N is examined and related to in situ measurements and anomalies in the annual seasonal concentration cycle of SeaWiFS chlorophyll-a.