Laparoscopy in the era of enhanced recovery.

Laparoscopy is one of the cornerstones in the surgical revolution and transformed outcome and recovery for various surgical procedures. Even if these changes were widely accepted for basic interventions, like appendectomies and cholecystectomies, laparoscopy still remains challenged for more advanced operations in many aspects. Despite these discussion, there is an overwhelming acceptance in the surgical community that laparoscopy did transform the recovery for several abdominal procedures. The importance of improved peri-operative patient management and its influence on outcome started to become a focus of attention 20 years ago and is now increasingly spreading, as shown by the incoming volume of data on this topic. The enhanced recovery after surgery (ERAS) concept incorporates simple measures of general management, and requires multidisciplinary collaboration from hospital staff as well as the patient and the relatives. Several studies have demonstrated a significant decrease in postoperative complication rate, length of hospital stay and reduced overall cost. The key elements of success are fluid restriction, a functioning epidural and preoperative carbohydrate intake. With the expansion of laparoscopic techniques, ERAS increasingly incorporates laparoscopic patients, especially in colorectal surgery. However, the precise impact of laparoscopy on ERAS is still not clearly defined. Increasing evidence suggests that laparoscopy itself is an additional ERAS item that should be considered as routine where feasible in order to obtain the best surgical outcomes.

Recovery Risk and Labor Costs in Public-Private Partnerships : Contractual Choice in the US Water industry

We use an ordered logistic model to empirically examine the factors that explain varying degrees of private involvement in the U.S. water sector through public-private partnerships. Our estimates suggest that a variety of factors help explain greater private participation in this sector. We find that the risk to private participants regarding cost recovery is an important driver of private participation. The relative cost of labor is also a key factor in determining the degree of private involvement in the contract choice. When public wages are high relative to private wages, private participation is viewed as a source of cost savings. We thus find two main drivers of greater private involvement: one encouraging private participation by reducing risk, and another encouraging government to seek out private participation in lowering costs.

Electrical machine in a Hybrid Electrical Vehicle

Hybrid electric vehicles (HEV) have attracted very much attention during the latest years. Increasing environmental concern and an increase in fuel prices are key factors for the growing interest towards the HEV. In a hybrid electric vehicle the power train consists of both a mechanical power system and an electric power transmission system. The major subsystems in the mechanical power system are the internal combustion engine which powers the vehicle; electric power transmission including an energy storage, power electronic inverter, hybrid control system; the electric motor drive that runs either in the generating mode or in the motoring mode to process the power flow between the energy storage and the electrical machine. This research includes two advanced electric motors for a parallel hybrid: induction machine and permanent magnets synchronous machine. In the thesis an induction motor and a permanent magnet motor are compared as propulsion motors. Electric energy storages are also studied.

Modern recovery boiler design criteria

Engineering and pricing of large recovery boiler were studied in this work. Engineering was carried out with Anita 4.2 which is an engineering program of Andritz. Key initial values were chosen with previous studies. Primary target of this work was to find out the consequences that furnace dimensions and furnace screen vertical part has to boiler pricing. Boilers that were engineered had different rate of furnace width and depth and different heat transfer plate count. Boiler balances were invariable. Boilers with different vertical screen construction were also calculated. First variation was boiler with vertical screen up to furnace roof. Other variation was to connect vertical screen to Pre-boiler generating bank inlet tubes. Total prices were calculated to engineered boilers. Pricing was sort out to heat transfers, high pressure pipes, steel structures, auxiliary equipments and civil/structural costs. This study did not notice parts of the boiler which costs do not vary with the construction of the boiler. Heat transfers had the largest share of costs. Boiler building had the most significant differences between the boilers. Furnace screen had also significant role especially to costs of the boiler building.

Expressional regulation of key hepatic enzymes of intermediary metabolism in European seabass (Dicentrarchus labrax) during food deprivation and refeeding

We hypothesized that the analysis of mRNA level and activity of key enzymes in amino acid and carbohydrate metabolism in a feeding/fasting/refeeding setting could improve our understanding of how a carnivorous fish, like the European seabass (Dicentrarchus labrax), responds to changes in dietary intake at the hepatic level. To this end cDNA fragments encoding genes for cytosolic and mitochondrial alanine aminotransferase (cALT; mALT), pyruvate kinase (PK), glucose 6-phosphate dehydrogenase (G6PDH) and 6-phosphogluconate dehydrogenase (6PGDH) were cloned and sequenced. Measurement of mRNA levels through quantitative real-time PCR performed in livers of fasted seabass revealed a significant increase in cALT (8.5-fold induction)while promoting a drastic 45-fold down-regulation of PK in relation to the levels found in fed seabass. These observations were corroborated by enzyme activity meaning that during food deprivation an increase in the capacity of pyruvate generation happened via alanine to offset the reduction in pyruvate derived via glycolysis. After a 3-day refeeding period cALT returned to control levels while PK was not able to rebound. No alterations were detected in the expression levels of G6PDH while 6PGDH was revealed to be more sensitive specially to fasting, as confirmed by a significant 5.7-fold decrease in mRNA levels with no recovery after refeeding. Our results indicate that in early stages of refeeding, the liver prioritized the restoration of systemic normoglycemia and replenishment of hepatic glycogen. In a later stage, once regular feeding is re-established, dietary fuel may then be channeled to glycolysis and de novo lipogenesis.

Expressional regulation of key hepatic enzymes of intermediary metabolism in European seabass (Dicentrarchus labrax) during food deprivation and refeeding

We hypothesized that the analysis of mRNA level and activity of key enzymes in amino acid and carbohydrate metabolism in a feeding/fasting/refeeding setting could improve our understanding of how a carnivorous fish, like the European seabass (Dicentrarchus labrax), responds to changes in dietary intake at the hepatic level. To this end cDNA fragments encoding genes for cytosolic and mitochondrial alanine aminotransferase (cALT; mALT), pyruvate kinase (PK), glucose 6-phosphate dehydrogenase (G6PDH) and 6-phosphogluconate dehydrogenase (6PGDH) were cloned and sequenced. Measurement of mRNA levels through quantitative real-time PCR performed in livers of fasted seabass revealed a significant increase in cALT (8.5-fold induction)while promoting a drastic 45-fold down-regulation of PK in relation to the levels found in fed seabass. These observations were corroborated by enzyme activity meaning that during food deprivation an increase in the capacity of pyruvate generation happened via alanine to offset the reduction in pyruvate derived via glycolysis. After a 3-day refeeding period cALT returned to control levels while PK was not able to rebound. No alterations were detected in the expression levels of G6PDH while 6PGDH was revealed to be more sensitive specially to fasting, as confirmed by a significant 5.7-fold decrease in mRNA levels with no recovery after refeeding. Our results indicate that in early stages of refeeding, the liver prioritized the restoration of systemic normoglycemia and replenishment of hepatic glycogen. In a later stage, once regular feeding is re-established, dietary fuel may then be channeled to glycolysis and de novo lipogenesis.

Recovery of biomass-derived valuable compounds using chromatographic and membrane separations

Utilization of biomass-based raw materials for the production of chemicals and materials is gaining an increasing interest. Due to the complex nature of biomass, a major challenge in its refining is the development of efficient fractionation and purification processes. Preparative chromatography and membrane filtration are selective, energy-efficient separation techniques which offer a great potential for biorefinery applications. Both of these techniques have been widely studied. On the other hand, only few process concepts that combine the two methods have been presented in the literature. The aim of this thesis was to find the possible synergetic effects provided by combining chromatographic and membrane separations, with a particular interest in biorefinery separation processes. Such knowledge could be used in the development of new, more efficient separation processes for isolating valuable compounds from complex feed solutions that are typical for the biorefinery environment. Separation techniques can be combined in various ways, from simple sequential coupling arrangements to fully-integrated hybrid processes. In this work, different types of combined separation processes as well as conventional chromatographic separation processes were studied for separating small molecules such as sugars and acids from biomass hydrolysates and spent pulping liquors. The combination of chromatographic and membrane separation was found capable of recovering high-purity products from complex solutions. For example, hydroxy acids of black liquor were successfully recovered using a novel multistep process based on ultrafiltration and size-exclusion chromatography. Unlike any other separation process earlier suggested for this challenging separation task, the new process concept does not require acidification pretreatment, and thus it could be more readily integrated into a pulp-mill biorefinery. In addition to the combined separation processes, steady-state recycling chromatography, which has earlier been studied for small-scale separations of high-value compounds only, was found a promising process alternative for biorefinery applications. In comparison to conventional batch chromatography, recycling chromatography provided higher product purity, increased the production rate and reduced the chemical consumption in the separation of monosaccharides from biomass hydrolysates. In addition, a significant further improvement in the process performance was obtained when a membrane filtration unit was integrated with recycling chromatography. In the light of the results of this work, separation processes based on combining membrane and chromatographic separations could be effectively applied for different biorefinery applications. The main challenge remains in the development of inexpensive separation materials which are resistant towards harsh process conditions and fouling.

Working fluid selection and design of small-scale waste heat recovery systems based on organic Rankine cycles

Demand for the use of energy systems, entailing high efficiency as well as availability to harness renewable energy sources, is a key issue in order to tackling the threat of global warming and saving natural resources. Organic Rankine cycle (ORC) technology has been identified as one of the most promising technologies in recovering low-grade heat sources and in harnessing renewable energy sources that cannot be efficiently utilized by means of more conventional power systems. The ORC is based on the working principle of Rankine process, but an organic working fluid is adopted in the cycle instead of steam. This thesis presents numerical and experimental results of the study on the design of small-scale ORCs. Two main applications were selected for the thesis: waste heat re- covery from small-scale diesel engines concentrating on the utilization of the exhaust gas heat and waste heat recovery in large industrial-scale engine power plants considering the utilization of both the high and low temperature heat sources. The main objective of this work was to identify suitable working fluid candidates and to study the process and turbine design methods that can be applied when power plants based on the use of non-conventional working fluids are considered. The computational work included the use of thermodynamic analysis methods and turbine design methods that were based on the use of highly accurate fluid properties. In addition, the design and loss mechanisms in supersonic ORC turbines were studied by means of computational fluid dynamics. The results indicated that the design of ORC is highly influenced by the selection of the working fluid and cycle operational conditions. The results for the turbine designs in- dicated that the working fluid selection should not be based only on the thermodynamic analysis, but requires also considerations on the turbine design. The turbines tend to be fast rotating, entailing small blade heights at the turbine rotor inlet and highly supersonic flow in the turbine flow passages, especially when power systems with low power outputs are designed. The results indicated that the ORC is a potential solution in utilizing waste heat streams both at high and low temperatures and both in micro and larger scale appli- cations.

Alliance Politics in Hybrid Regimes : Political Stability and Instability since World War II

Cette thèse étudie la stabilité et l’instabilité politique des régimes hybrides. Elle pose la question suivante : dans quelles conditions l’autorité des élites au pouvoir est-elle reconnue ou contestée? Notre réponse s’articule en lien avec le caractère inclusif ou exclusif de la coalition dirigeante : c’est-à-dire, l’alliance stratégique des élites dirigeantes avec les groupes sociaux dominants. L’inclusion de ces derniers favorise le consentement et la stabilité; leur exclusion entraîne l’affrontement et l’instabilité politique. Sa composition dépend (i) du degré de violence organisée extra-légale et (ii) du degré de pénétration de l’État sur le territoire et dans l’économie. La première variable permet d’identifier quel groupe social au sein de l’État (militaires) ou du régime (partis d’opposition) est dominant et influence les formes de communication politique avec les élites dirigeantes. La deuxième variable permet d’identifier quel groupe social au sein de l’État (fonctionnaires) ou de la société (chefs locaux) est dominant et oriente les rapports entre les régions et le pouvoir central. L’apport de la recherche est d’approfondir notre compréhension des institutions politiques dans les régimes hybrides en mettant l’accent sur l’identité des groupes sociaux dominants dans un contexte donné. La thèse propose un modèle simple, flexible et original permettant d’appréhender des relations causales autrement contre-intuitives. En ce sens, la stabilité politique est également possible dans un pays où l’État est faible et/ou aux prises avec des mouvements de rébellion; et l’instabilité dans un contexte inverse. Tout dépend de la composition de la coalition dirigeante. Afin d’illustrer les liens logiques formulés et d’exposer les nuances de notre théorie, nous employons une analyse historique comparative de la coalition dirigeante en Malaisie (1957-2010), en Indonésie (1945-1998), au Sénégal (1960-2010) et au Paraguay (1945-2008). La principale conclusion est que les deux variables sont incontournables. L’une sans l’autre offre nécessairement une explication incomplète des alliances politiques qui forgent les conditions de stabilité et d'instabilité dans les régimes hybrides.

Dynamic magnetic resonance spectroscopy of phosphate energetics during muscle exercise and recovery

Entailing of phosphorus exchanges in most bio-chemicals as a key factor in disease, increases researcher’s interest to develop the technologies capable of detecting this metabolite. Phosphorus magnetic resonance spectroscopy is able to detect key metabolites in a non-invasive manner. Particularly, it offers the ability to measure the dynamic rate of phosphocreatine(PCr) degeneration through the exercise and recovery. This metric as a valid indication of mitochondrial oxidative metabolism in muscle, differentiate between normal and pathological state. To do magnetic resonance imaging and spectroscopy, clinical research tools provide a wide variety of anatomical and functional contrasts, however they are typically restricted to the tissues containing water or hydrogen atoms and they are still blind to the biochemicals of other atoms of interests. Through this project we intended to obtain the phosphorus spectrum in human body – specificadenerativelly in muscle – using 31P spectroscopy. To do so a double loop RF surface coil, tuned to phosphorus frequency, is designed and fabricated using bench work facilities and then validated through in vitro spectroscopy using 3 Tesla Siemens scanner. We acquired in vitro as well as in vivo phosphorus spectrum in a 100 mM potassium phosphate phantom and human calf muscle in rest-exercise-recovery phase in a 3T MR scanner. The spectrum demonstrates the main constituent in high-energy phosphate metabolism. We also observed the dynamic variation of PCr for five young healthy subjects who performed planter flexions using resistance band during exercise and recovery. The took steps in this project pave the way for future application of spectroscopic quantification of phosphate metabolism in patients affected by carotid artery disease as well as in age-matched control subjects.

A Novel Fast Hybrid Cryptographic System: MARS4

A novel and fast technique for cryptographic applications is designed and developed using the symmetric key algorithm “MAJE4” and the popular asymmetric key algorithm “RSA”. The MAJE4 algorithm is used for encryption / decryption of files since it is much faster and occupies less memory than RSA. The RSA algorithm is used to solve the problem of key exchange as well as to accomplish scalability and message authentication. The focus is to develop a new hybrid system called MARS4 by combining the two cryptographic methods with an aim to get the advantages of both. The performance evaluation of MARS4 is done in comparison with MAJE4 and RSA.

Economics of Hybrid Photovoltaic Power Plants

The global power supply stability is faced to several severe and fundamental threats, in particular steadily increasing power demand, diminishing and degrading fossil and nuclear energy resources, very harmful greenhouse gas emissions, significant energy injustice and a structurally misbalanced ecological footprint. Photovoltaic (PV) power systems are analysed in various aspects focusing on economic and technical considerations of supplemental and substitutional power supply to the constraint conventional power system. To infer the most relevant system approach for PV power plants several solar resources available for PV systems are compared. By combining the different solar resources and respective economics, two major PV systems are identified to be very competitive in almost all regions in the world. The experience curve concept is used as a key technique for the development of scenario assumptions on economic projections for the decade of the 2010s. Main drivers for cost reductions in PV systems are learning and production growth rate, thus several relevant aspects are discussed such as research and development investments, technical PV market potential, different PV technologies and the energetic sustainability of PV. Three major market segments for PV systems are identified: off-grid PV solutions, decentralised small scale on-grid PV systems (several kWp) and large scale PV power plants (tens of MWp). Mainly by application of ‘grid-parity’ and ‘fuel-parity’ concepts per country, local market and conventional power plant basis, the global economic market potential for all major PV system segments is derived. PV power plant hybridization potential of all relevant power technologies and the global power plant structure are analyzed regarding technical, economical and geographical feasibility. Key success criteria for hybrid PV power plants are discussed and comprehensively analysed for all adequate power plant technologies, i.e. oil, gas and coal fired power plants, wind power, solar thermal power (STEG) and hydro power plants. For the 2010s, detailed global demand curves are derived for hybrid PV-Fossil power plants on a per power plant, per country and per fuel type basis. The fundamental technical and economic potentials for hybrid PV-STEG, hybrid PV-Wind and hybrid PV-Hydro power plants are considered. The global resource availability for PV and wind power plants is excellent, thus knowing the competitive or complementary characteristic of hybrid PV-Wind power plants on a local basis is identified as being of utmost relevance. The complementarity of hybrid PV-Wind power plants is confirmed. As a result of that almost no reduction of the global economic PV market potential need to be expected and more complex power system designs on basis of hybrid PV-Wind power plants are feasible. The final target of implementing renewable power technologies into the global power system is a nearly 100% renewable power supply. Besides balancing facilities, storage options are needed, in particular for seasonal power storage. Renewable power methane (RPM) offers respective options. A comprehensive global and local analysis is performed for analysing a hybrid PV-Wind-RPM combined cycle gas turbine power system. Such a power system design might be competitive and could offer solutions for nearly all current energy system constraints including the heating and transportation sector and even the chemical industry. Summing up, hybrid PV power plants become very attractive and PV power systems will very likely evolve together with wind power to the major and final source of energy for mankind.

Book bands for guided reading : organising key stage one texts for the literacy hour.

Ha sido pensado para ayudar a los profesores a revisar, organizar y completar en las escuelas, las existencias de materiales de lectura para la etapa uno (Key Stage uno). También, proporciona las bases para establecer los procedimientos de lectura guiada en la etapa de alfabetización infantil, y para indicar cómo la lectura guiada encaja dentro de la National Literacy Strategy Framework for Teaching (Estrategia Nacional de Alfabetización Marco para la Enseñanza). Se reunieron casi cuatro mil libros para los niños, que se han agrupado teniendo en cuenta la gradación de dificultad de los textos en diez bloques, desde los más sencillos para los primeros lectores a áquellos utilizados al final de la etapa uno (Key stage uno) para lectores con más fluidez.

Researching and designing GREAT; the extremely condensed hybrid urban block

The fact that the hybrid building is an extremely condensed urban block which increases the city’s density and contributes to the public realm of the city – horizontally as well vertically - forms one of the key interests of this documentation, research and master studio work. The “ground scraper” is not only public because of the character of its plinth facing surrounding streets, but also in regard to its interior space that is partly accessible to public. As such the European hybrid building potentially extends the city’s public domain horizontally and vertically into the building’s interior and links the public domain inside and outside. Notwithstanding, the hybrid building due to its specific and unconventional character represents a truly urban architecture that was unfortunately often rejected in the name of ‘purity’ of form and function during the twentieth century. Or with other words, its rejection demonstrates the domination of the building’s plan opposed to the section. Today, new frameworks for the city, like the “compact city,” ask for innovative interpretations and designs of building types, worthy to be investigated and proposed. The architectural type of the hybrid building, (re)defines and expresses the relation between architecture and the city in a specific manner. To begin with, the city of Rotterdam forms the first test-case of the Hybrid’s project to document and discuss statements, such as “the hybrid building has a long- standing tradition within this ‘modern city”, “it is a machine for urbanity,” “it enlarges the city,” “it innovates because of its ambitiousness but also because of necessity,” “it combines to activate,” “it asks for extraordinary design intelligence and craftsmanship.” A special way of drawing is developed to document, analyse and compare historical and contemporary representatives of the species. The method includes panoply of scales ranging from the morphological arrangement on the scale of the city, the typologies of stacking diverse programs to the architectural features that establish the mutual relationship between the public space of the city and the interior of the building. Basically the features analysed within the series of drawings are also constitutional for (the success of) every future hybrid building.

Hybrid Brains - Biology, Technology Merger

In this paper an attempt has been made to take a look at how the use of implant and electrode technology can now be employed to create biological brains for robots, to enable human enhancement and to diminish the effects of certain neural illnesses. In all cases the end result is to increase the range of abilities of the recipients. An indication is given of a number of areas in which such technology has already had a profound effect, a key element being the need for a clear interface linking the human brain directly with a computer. An overview of some of the latest developments in the field of Brain to Computer Interfacing is also given in order to assess advantages and disadvantages. The emphasis is clearly placed on practical studies that have been and are being undertaken and reported on, as opposed to those speculated, simulated or proposed as future projects. Related areas are discussed briefly only in the context of their contribution to the studies being undertaken. The area of focus is notably the use of invasive implant technology, where a connection is made directly with the cerebral cortex and/or nervous system. Tests and experimentation which do not involve human subjects are invariably carried out a priori to indicate the eventual possibilities before human subjects are themselves involved. Some of the more pertinent animal studies from this area are discussed including our own involving neural growth. The paper goes on to describe human experimentation, in which neural implants have linked the human nervous system bi-directionally with technology and the internet. A view is taken as to the prospects for the future for this implantable computing in terms of both therapy and enhancement.