Endoscopic and Open Release Similarly Safe for the Treatment of Carpal Tunnel Syndrome. A Systematic Review and Meta-Analysis.

BACKGROUND The Endoscopic Release of Carpal Tunnel Syndrome (ECTR) is a minimal invasive approach for the treatment of Carpal Tunnel Syndrome. There is scepticism regarding the safety of this technique, based on the assumption that this is a rather "blind" procedure and on the high number of severe complications that have been reported in the literature. PURPOSE To evaluate whether there is evidence supporting a higher risk after ECTR in comparison to the conventional open release. METHODS We searched MEDLINE (January 1966 to November 2013), EMBASE (January 1980 to November 2013), the Cochrane Neuromuscular Disease Group Specialized Register (November 2013) and CENTRAL (2013, issue 11 in The Cochrane Library). We hand-searched reference lists of included studies. We included all randomized or quasi-randomized controlled trials (e.g. study using alternation, date of birth, or case record number) that compare any ECTR with any OCTR technique. Safety was assessed by the incidence of major, minor and total number of complications, recurrences, and re-operations.The total time needed before return to work or to return to daily activities was also assessed. We synthesized data using a random-effects meta-analysis in STATA. We conducted a sensitivity analysis for rare events using binomial likelihood. We judged the conclusiveness of meta-analysis calculating the conditional power of meta-analysis. CONCLUSIONS ECTR is associated with less time off work or with daily activities. The assessment of major complications, reoperations and recurrence of symptoms does not favor either of the interventions. There is an uncertain advantage of ECTR with respect to total minor complications (more transient paresthesia but fewer skin-related complications). Future studies are unlikely to alter these findings because of the rarity of the outcome. The effect of a learning curve might be responsible for reduced recurrences and reoperations with ECTR in studies that are more recent, although formal statistical analysis failed to provide evidence for such an association. LEVEL OF EVIDENCE I.

A review of economic analysis in the vaccination program; decision making and governance: Adivisory Committee on Immunization Practices (ACIP)

The Advisory Committee on Immunization Practices (ACIP) develops written recommendations for the routine administration of vaccines to children and adults in the U.S. civilian population. The ACIP is the only entity in the federal government that makes such recommendations. ACIP elaborates on selection of its members and rules out concerns regarding its integrity, but fails to provide information about the importance of economic analysis in vaccine selection. ACIP recommendations can have large health and economic consequences. Emphasis on economic evaluation in health is a likely response to severe pressures of the federal and state health budget. This study describes the economic aspects considered by the ACIP while sanctioning a vaccine, and reviews the economic evaluations (our economic data) provided for vaccine deliberations. A five year study period from 2004 to 2009 is adopted. Publicly available data from ACIP web database is used. Drummond et al. (2005) checklist serves as a guide to assess the quality of economic evaluations presented. Drummond et al.'s checklist is a comprehensive hence it is unrealistic to expect every ACIP deliberation to meet all of their criteria. For practical purposes we have selected seven criteria that we judge to be significant criteria provided by Drummond et al. Twenty-four data points were obtained in a five year period. Our results show that out of the total twenty-four data point‘s (economic evaluations) only five data points received a score of six; that is six items on the list of seven were met. None of the data points received a perfect score of seven. Seven of the twenty-four data points received a score of five. A minimum of a two score was received by only one of the economic analyses. The type of economic evaluation along with the model criteria and ICER/QALY criteria met at 0.875 (87.5%). These three criteria were met at the highest rate among the seven criteria studied. Our study findings demonstrate that the perspective criteria met at 0.583 (58.3%) followed by source and sensitivity analysis criteria both tied at 0.541 (54.1%). The discount factor was met at 0.250 (25.0%).^ Economic analysis is not a novel concept to the ACIP. It has been practiced and presented at these meetings on a regular basis for more than five years. ACIP‘s stated goal is to utilize good quality epidemiologic, clinical and economic analyses to help policy makers choose among alternatives presented and thus achieve a better informed decision. As seen in our study the economic analyses over the years are inconsistent. The large variability coupled with lack of a standardized format may compromise the utility of the economic information for decision-making. While making recommendations, the ACIP takes into account all available information about a vaccine. Thus it is vital that standardized high quality economic information is provided at the ACIP meetings. Our study may provide a call for the ACIP to further investigate deficiencies within the system and thereby to improve economic evaluation data presented. ^

Analysis of 238Pu and 56Fe Evaluated Data for Use in MYRRHA

A sensitivity analysis on the multiplication factor, keffkeff, to the cross section data has been carried out for the MYRRHA critical configuration in order to show the most relevant reactions. With these results, a further analysis on the 238Pu and 56Fe cross sections has been performed, comparing the evaluations provided in the JEFF-3.1.2 and ENDF/B-VII.1 libraries for these nuclides. Then, the effect in MYRRHA of the differences between evaluations are analysed, presenting the source of the differences. With these results, recommendations for the 56Fe and 238Pu evaluations are suggested. These calculations have been performed with SCALE6.1 and MCNPX-2.7e.

Uncertainty Analysis in New Seismic Hazard Study of Spain Aimed at the Revision of the Spanish Building Code.

In this paper we present a global overview of the recent study carried out in Spain for the new hazard map, which final goal is the revision of the Building Code in our country (NCSE-02). The study was carried our for a working group joining experts from The Instituto Geografico Nacional (IGN) and the Technical University of Madrid (UPM) , being the different phases of the work supervised by an expert Committee integrated by national experts from public institutions involved in subject of seismic hazard. The PSHA method (Probabilistic Seismic Hazard Assessment) has been followed, quantifying the epistemic uncertainties through a logic tree and the aleatory ones linked to variability of parameters by means of probability density functions and Monte Carlo simulations. In a first phase, the inputs have been prepared, which essentially are: 1) a project catalogue update and homogenization at Mw 2) proposal of zoning models and source characterization 3) calibration of Ground Motion Prediction Equations (GMPE’s) with actual data and development of a local model with data collected in Spain for Mw < 5.5. In a second phase, a sensitivity analysis of the different input options on hazard results has been carried out in order to have criteria for defining the branches of the logic tree and their weights. Finally, the hazard estimation was done with the logic tree shown in figure 1, including nodes for quantifying uncertainties corresponding to: 1) method for estimation of hazard (zoning and zoneless); 2) zoning models, 3) GMPE combinations used and 4) regression method for estimation of source parameters. In addition, the aleatory uncertainties corresponding to the magnitude of the events, recurrence parameters and maximum magnitude for each zone have been also considered including probability density functions and Monte Carlo simulations The main conclusions of the study are presented here, together with the obtained results in terms of PGA and other spectral accelerations SA (T) for return periods of 475, 975 and 2475 years. The map of the coefficient of variation (COV) are also represented to give an idea of the zones where the dispersion among results are the highest and the zones where the results are robust.

Limits of the frequency response for the analysis of ripple-based controllers

Advanced control techniques like V2, Vout hysteresis or V2Ic can strongly reduce the required output capacitance in PowerSoC converters. Techniques to analyze power converters based on the analysis of the frequency response are not suitable for ripple-based controllers that use fast-scale dynamics to control the power stage. This paper proves that the use of discrete modeling together with Floquet theory is a very powerful tool to model the system and derive stable region diagrams for sensitivity analysis. It is applied to V 2Ic control, validating experimentally that Floquet theory predicts accurately subharmonic oscillations. This method is applied to several ripplebased controllers, providing higher accuracy when it is compared with other techniques based on the frequency response. The paper experimentally validates the usefulness of the discrete modeling and the Floquet theory on a 5 MHz Buck converter with a V 2Ic control.

Design and analysis of ripple-based controls based on the discrete modeling and Floquet theory

Ripple-based controls can strongly reduce the required output capacitance in PowerSoC converter thanks to a very fast dynamic response. Unfortunately, these controls are prone to sub-harmonic oscillations and several parameters affect the stability of these systems. This paper derives and validates a simulation-based modeling and stability analysis of a closed-loop V 2Ic control applied to a 5 MHz Buck converter using discrete modeling and Floquet theory to predict stability. This allows the derivation of sensitivity analysis to design robust systems. The work is extended to different V 2 architectures using the same methodology.

Analysis and validation of a multiple output series resonant converter

In this paper a novel bidirectional multiple port dc/dc transformer topology is presented. The novel concept for dc/dc transformer is based on the Series Resonant Converter (SRC) topology operated at its resonant frequency point. This allows for higher switching frequency to be adopted and enables high efficiency/high power density operation. The feasibility of the proposed concept is verified on a 300W, 700 kHz three port prototype with 390V input voltage and 48V and 12V output voltages. A peak overall efficiency of 93% is measured at full load. A very good load and cross regulation characteristic of the converter is observed in the whole load range, from full load to open circuit. The sensitivity analysis of the resonant capacitance is also performed showing very slight deterioration in the converter performances when a resonant capacitor is changed ±30% of its nominal value.

Analysis of the railway track as a spatially periodic structure

This article presents a new and computationally efficient method of analysis of a railway track modelled as a continuous beam of 2N spans supported by elastic vertical springs. The main feature of this method is its important reduction in computational effort with respect to standard matrix methods of structural analysis. In this article, the whole structure is considered to be a repetition of a single one. The analysis presented is applied to a simple railway track model, i.e. to a repetitive beam supported on vertical springs (sleepers). The proposed method of analysis is based on the general theory of spatially periodic structures. The main feature of this theory is the possibility to apply Discrete Fourier Transform (DFT) in order to reduce a large system of q(2N + 1) linear stiffness equilibrium equations to a set of 2N + 1 uncoupled systems of q equations each. In this way, a dramatic reduction of the computational effort of solving the large system of equations is achieved. This fact is particularly important in the analysis of railway track structures, in which N is a very large number (around several thousands), and q = 2, the vertical displacement and rotation, is very small. The proposed method allows us to easily obtain the exact solution given by Samartín [1], i.e. the continuous beam railway track response. The comparison between the proposed method and other methods of analysis of railway tracks, such as Lorente de Nó and Zimmermann-Timoshenko, clearly shows the accuracy of the obtained results for the proposed method, even for low values of N. In addition, identical results between the proposed and the Lorente methods have been found, although the proposed method seems to be of simpler application and computationally more efficient than the Lorente one. Small but significative differences occur between these two methods and the one developed by Zimmermann-Timoshenko. This article also presents a detailed sensitivity analysis of the vertical displacement of the sleepers. Although standard matrix methods of structural analysis can handle this railway model, one of the objectives of this article is to show the efficiency of DFT method with respect to standard matrix structural analysis. A comparative analysis between standard matrix structural analysis and the proposed method (DFT), in terms of computational time, input, output and also software programming, will be carried out. Finally, a URL link to a MatLab computer program list, based on the proposed method, is given

A nonlinear analysis of laying a floating pipeline on the seabed

In this article, a model for the determination of displacements, strains, and stresses of a submarine pipeline during its construction is presented. Typically, polyethylene outfall pipelines are the ones treated by this model. The process is carried out from an initial floating situation to the final laying position on the seabed. The following control variables are considered in the laying process: the axial load in the pipe, the flooded inner length, and the distance of the control barge from the coast. External loads such as self-weight, dead loads, and forces due to currents and small waves are also taken into account.This paper describes both the conceptual framework for the proposed model and its practical application in a real engineering situation. The authors also consider how the model might be used as a tool to study how sensitive the behavior of the pipeline is to small changes in the values of the control variables. A detailed description of the actions is considered, especially the ones related to the marine environment such as buoyancy, current, and sea waves. The structural behavior of the pipeline is simulated in the framework of a geometrically nonlinear dynamic analysis. The pipeline is assumed to be a two-dimensional Navier_Bernoulli beam. In the nonlinear analysis an updated Lagrangian formulation is used, and special care is taken regarding the numerical aspects of sea bed contact, follower forces due to external water pressures, and dynamic actions. The paper concludes by describing the implementation of the proposed techniques, using the ANSYS computer program with a number of subroutines developed by the authors. This implementation permits simulation of the two-dimensional structural pipe behavior of the whole construction process. A sensitivity analysis of the bending moments, axial forces, and stresses for different values of the control variables is carried out. Using the techniques described, the engineer may optimize the construction steps in the pipe laying process

Numerical methods in Nonlinear Analysis of shell structures

The design of shell and spatial structures represents an important challenge even with the use of the modern computer technology.If we concentrate in the concrete shell structures many problems must be faced,such as the conceptual and structural disposition, optimal shape design, analysis, construction methods, details etc. and all these problems are interconnected among them. As an example the shape optimization requires the use of several disciplines like structural analysis, sensitivity analysis, optimization strategies and geometrical design concepts. Similar comments can be applied to other space structures such as steel trusses with single or double shape and tension structures. In relation to the analysis the Finite Element Method appears to be the most extended and versatile technique used in the practice. In the application of this method several issues arise. First the derivation of the pertinent shell theory or alternatively the degenerated 3-D solid approach should be chosen. According to the previous election the suitable FE model has to be adopted i.e. the displacement,stress or mixed formulated element. The good behavior of the shell structures under dead loads that are carried out towards the supports by mainly compressive stresses is impaired by the high imperfection sensitivity usually exhibited by these structures. This last effect is important particularly if large deformation and material nonlinearities of the shell may interact unfavorably, as can be the case for thin reinforced shells. In this respect the study of the stability of the shell represents a compulsory step in the analysis. Therefore there are currently very active fields of research such as the different descriptions of consistent nonlinear shell models given by Simo, Fox and Rifai, Mantzenmiller and Buchter and Ramm among others, the consistent formulation of efficient tangent stiffness as the one presented by Ortiz and Schweizerhof and Wringgers, with application to concrete shells exhibiting creep behavior given by Scordelis and coworkers; and finally the development of numerical techniques needed to trace the nonlinear response of the structure. The objective of this paper is concentrated in the last research aspect i.e. in the presentation of a state-of-the-art on the existing solution techniques for nonlinear analysis of structures. In this presentation the following excellent reviews on this subject will be mainly used.

Deposition reactors for solar grade silicon: a comparative thermal analysis of a Siemens reactor and a fluidized bed reactor

Polysilicon production costs contribute approximately to 25-33% of the overall cost of the solar panels and a similar fraction of the total energy invested in their fabrication. Understanding the energy losses and the behaviour of process temperature is an essential requirement as one moves forward to design and build large scale polysilicon manufacturing plants. In this paper we present thermal models for two processes for poly production, viz., the Siemens process using trichlorosilane (TCS) as precursor and the fluid bed process using silane (monosilane, MS).We validate the models with some experimental measurements on prototype laboratory reactors relating the temperature profiles to product quality. A model sensitivity analysis is also performed, and the efects of some key parameters such as reactor wall emissivity, gas distributor temperature, etc., on temperature distribution and product quality are examined. The information presented in this paper is useful for further understanding of the strengths and weaknesses of both deposition technologies, and will help in optimal temperature profiling of these systems aiming at lowering production costs without compromising the solar cell quality.

Global instability analysis and control of three-dimensional long open cavity flow

The three-dimensional wall-bounded open cavity may be considered as a simplified geometry found in industrial applications such as leading gear or slotted flats on the airplane. Understanding the three-dimensional complex flow structure that surrounds this particular geometry is therefore of major industrial interest. At the light of the remarkable former investigations in this kind of flows, enough evidences suggest that the lateral walls have a great influence on the flow features and hence on their instability modes. Nevertheless, even though there is a large body of literature on cavity flows, most of them are based on the assumption that the flow is two-dimensional and spanwise-periodic. The flow over realistic open cavity should be considered. This thesis presents an investigation of three-dimensional wall-bounded open cavity with geometric ratio 6:2:1. To this aim, three-dimensional Direct Numerical Simulation (DNS) and global linear instability have been performed. Linear instability analysis reveals that the onset of the first instability in this open cavity is around Recr 1080. The three-dimensional shear layer mode with a complex structure is shown to be the most unstable mode. I t is noteworthy that the flow pattern of this high-frequency shear layer mode is similar to the observed unstable oscillations in supercritical unstable case. DNS of the cavity flow carried out at different Reynolds number from steady state until a nonlinear saturated state is obtained. The comparison of time histories of kinetic energy presents a clearly dominant energetic mode which shifts between low-frequency and highfrequency oscillation. A complete flow patterns from subcritical cases to supercritical case has been put in evidence. The flow structure at the supercritical case Re=1100 resembles typical wake-shedding instability oscillations with a lateral motion existed in the subcritical cases. Also, This flow pattern is similar to the observations in experiments. In order to validate the linear instability analysis results, the topology of the composite flow fields reconstructed by linear superposition of a three-dimensional base flow and its leading three-dimensional global eigenmodes has been studied. The instantaneous wall streamlines of those composited flows display distinguish influence region of each eigenmode. Attention has been focused on the leading high-frequency shear layer mode; the composite flow fields have been fully recognized with respect to the downstream wave shedding. The three-dimensional shear layer mode is shown to give rise to a typical wake-shedding instability with a lateral motions occurring downstream which is in good agreement with the experiment results. Moreover, the spanwise-periodic, open cavity with the same length to depth ratio has been also studied. The most unstable linear mode is different from the real three-dimensional cavity flow, because of the existence of the side walls. Structure sensitivity of the unstable global mode is analyzed in the flow control context. The adjoint-based sensitivity analysis has been employed to localized the receptivity region, where the flow is more sensible to momentum forcing and mass injection. Because of the non-normality of the linearized Navier-Stokes equations, the direct and adjoint field has a large spatial separation. The strongest sensitivity region is locate in the upstream lip of the three-dimensional cavity. This numerical finding is in agreement with experimental observations. Finally, a prototype of passive flow control strategy is applied.

Accurate Analysis of Subharmonic Oscillations of V^2 and V^2Ic Controls Applied to Buck Converter

V2Ic control provides very fast dynamic performance to the Buck converter both under load steps and under voltage reference steps. However, the design of this control is complex since it is prone to subharmonic oscillations and several parameters affect the stability of the system. This paper derives and validates a very accurate modeling and stability analysis of a closed-loop V2Ic control using the Floquet theory. This allows the derivation of sensitivity analysis to design a robust converter. The proposed methodology is validated on a 5-MHz Buck converter. The work is also extended to V2 control using the same methodology, showing high accuracy and robustness. The paper also demonstrates, on the V2 control, that even a low bandwidth-linear controller can affect the stability of a ripple-based control.

Profitability analysis of a femtosecond laser system for cataract surgery using a fuzzy logic approach

AIM: To define the financial and management conditions required to introduce a femtosecond laser system for cataract surgery in a clinic using a fuzzy logic approach. METHODS: In the simulation performed in the current study, the costs associated to the acquisition and use of a commercially available femtosecond laser platform for cataract surgery (VICTUS, TECHNOLAS Perfect Vision GmbH, Bausch & Lomb, Munich, Germany) during a period of 5y were considered. A sensitivity analysis was performed considering such costs and the countable amortization of the system during this 5y period. Furthermore, a fuzzy logic analysis was used to obtain an estimation of the money income associated to each femtosecond laser-assisted cataract surgery (G). RESULTS: According to the sensitivity analysis, the femtosecond laser system under evaluation can be profitable if 1400 cataract surgeries are performed per year and if each surgery can be invoiced more than $500. In contrast, the fuzzy logic analysis confirmed that the patient had to pay more per surgery, between $661.8 and $667.4 per surgery, without considering the cost of the intraocular lens (IOL). CONCLUSION: A profitability of femtosecond laser systems for cataract surgery can be obtained after a detailed financial analysis, especially in those centers with large volumes of patients. The cost of the surgery for patients should be adapted to the real flow of patients with the ability of paying a reasonable range of cost.

Cost-Effectiveness Analysis of Adaptive Monitoring Strategies for Depression Treatment

Thesis (Master's)--University of Washington, 2016-06