Laparoscopically-assisted resection rectopexy for rectal prolapse: Ten years' experience

PURPOSE: This study has been undertaken to audit a single-center experience with laparoscopically-assisted resection rectopexy for full-thickness rectal prolapse. The clinical Outcomes and long-term results were evaluated. METHODS: The data were prospectively collected for the duration of the operation, time to passage of flatus postoperatively, hospital stay, morbidity, and mortality. For follow-up, patients received a questionnaire or were contacted. The data were divided into quartiles over the study period, and the differences in operating time and length of hospital stay were tested using the Kruskal-Wallis test. RESULTS: Between March 1992 and October 2003, a total of 117 patients underwent laparoscopic resection rectopexy for rectal prolapse. The median operating time during the first quartile (representing the early experience) was 180 minutes compared with 110 minutes for the fourth quartile (Kruskal-Wallis test for operating time = 35.523, 3 df, P < 0.0001). Overall morbidity was 9 percent (ten patients), with one death (< 1 percent). One patient had a ureteric injury requiring conversion. One minor anastomotic leak Occurred, necessitating laparoscopic evacuation of a pelvic abscess. Altogether, 77 patients were available for follow-up. The median follow-up was 62 months. Eighty percent of the patients reported alleviation of their symptoms after the operation. Sixty-nine percent of the constipated patients experienced an improvement in bowel frequency. No patient had new or worsening symptoms of constipation after Surgery. Two (2.5 percent) patients had full-thickness rectal prolapse recurrence. Mucosal prolapse recurred in 14 (18 percent) patients. Anastomotic dilation was performed for stricture in five (4 percent) patients. CONCLUSIONS: Laparoscopically-assisted resection rectopexy for rectal prolapse provides a favorable functional outcome and low recurrence rate. Shorter operating time is achieved with experience. The minimally invasive technique benefits should be considered when offering rectal prolapse patients a transabdominal approach for repair, and emphasis should now be on advanced training in the laparoscopic approach.

Effect of initial disturbance amplitude in gravity affected jet break-up

The initial disturbance amplitude has an effect on stretching jets that is not observed for capillary jet instability where gravitational acceleration is not significant. For inviscid and viscous fluids, gravity diminishes the effect that the initial amplitude has on jet length and its ability to prevent satellite formation. In stretching jets, not only the dimensionless frequency of the disturbance but also its initial amplitude must be known to properly study their satellite forming nature. Indirect methods of relating the applied disturbance energy to an initial velocity perturbation are not simple when the gravity parameter G is changing. When G A 0, the optimum disturbance frequency Omega(opt) and the initial disturbance amplitude are related, with Omega(opt) proportional to f (G) x In(1 /epsilon(nu)). Results from numerical simulations and experiments are presented here. (c) 2005 Elsevier Ltd. All rights reserved.

Effects of the build-up and resetting of auditory stream segregation on temporal discrimination

The tendency to hear a tone sequence as 2 or more streams (segregated) builds up, but a sudden change in properties can reset the percept to 1 stream (integrated). This effect has not hitherto been explored using an objective measure of streaming. Stimuli comprised a 2.0-s fixed-frequency inducer followed by a 0.6-s test sequence of alternating pure tones (3 low [L]-high [H] cycles). Listeners compared intervals for which the test sequence was either isochronous or the H tones were slightly delayed. Resetting of segregation should make identifying the anisochronous interval easier. The HL frequency separation was varied (0-12 semitones), and properties of the inducer and test sequence were set to the same or different values. Inducer properties manipulated were frequency, number of onsets (several short bursts vs. one continuous tone), tone:silence ratio (short vs. extended bursts), level, and lateralization. All differences between the inducer and the L tones reduced temporal discrimination thresholds toward those for the no-inducer case, including properties shown previously not to affect segregation greatly. Overall, it is concluded that abrupt changes in a sequence cause resetting and improve subsequent temporal discrimination. (PsycINFO Database Record © 2009 APA, all rights reserved)

Surface acoustic wave devices with low loss and high frequency operation

This thesis describes an industrial research project carried out in collaboration with STC Components, Harlow, Essex. Technical and market trends in the use of surface acoustic wave (SAW) devices are reviewed. As a result, three areas not previously addressed by STC were identified: lower insertion loss designs, higher operating frequencies and improved temperature dependent stability. A review of the temperature performance of alternative lower insertion loss designs,shows that greater use could be made of the on-site quartz growing plant. Data is presented for quartz cuts in the ST-AT range. This data is used to modify the temperature performance of a SAW filter. Several recently identified quartz orientations have been tested. These are SST, LST and X33. Problems associated with each cut are described and devices demonstrated. LST quartz, although sensitive to accuracy of cut, is shown to have an improved temperature coefficient over the normal ST orientation. Results show that its use is restricted due to insertion loss variations with temperature. Effects associated with split-finger transducers on LST-quartz are described. Two low-loss options are studied, coupled resonator filters for very narrow bandwidth applications and single phase unidirectional transducers (SPUDT) for fractional bandwidths up to about 1%. Both designs can be implemented with one quarter wavelength transducer geometries at operating frequencies up to 1GHz. The SPUDT design utilised an existing impulse response model to provide analysis of ladder or rung transducers. A coupled resonator filter at 400MHz is demonstrated with a matched insertion loss of less than 3.5dB and bandwidth of 0.05%. A SPUDT device is designed as a re-timing filter for timing extraction in a long haul PCM transmission system. Filters operating at 565MHz are demonstrated with insertion losses of less than 6dB. This basic SPUDT design is extended to a maximally distributed version and demonstrated at 450MHz with 9.8dB insertion loss.

Correlations between the morphology of diffuse and primitive beta-amyloid (A beta) deposits and the frequency of associated cells in Down's syndrome

Correlations between the morphology of beta-amyloid (A beta) deposits and the frequency with which they are associated with neurons and glial cells were studied in Down's syndrome. The diameter of diffuse deposits was positively correlated with the frequency of large (> 25 microns) neuronal cell bodies in the isocortex and with glial cells in the hippocampus. Diameters of primitive deposits were positively correlated with glial cells in the hippocampus and with glial cells and neurons in the isocortex. Staining intensity was positively correlated with glial cells especially in the hippocampus. The data suggest that: (i) diffuse deposits develop from neurons and primitive deposits from glia; (ii) the size of A beta deposits depends on the numbers of neurons and glia; (iii) glial cells are also involved in the conversion of A beta to amyloid; and (iv) the increased density of primitive deposits in the hippocampus is determined by the high density of glial cells.

Build-up of the tendency to segregate auditory streams:resetting effects of single deviant tones

The tendency to hear a sequence of alternating low (L) and high (H) frequency tones as two streams can be increased by a preceding induction sequence, even one composed only of same-frequency tones. Four experiments used such an induction sequence (10 identical L tones) to promote segregation in a shorter test sequence comprising L and H tones. Previous studies have shown that the build-up of stream segregation is usually reduced greatly when a sudden change in acoustic properties distinguishes all of the induction tones from their test-sequence counterparts. Experiment 1 showed that a single deviant tone, created by altering the final inducer (in frequency, level, duration, or replacement with silence) reduced reported segregation, often substantially. Experiment 2 partially replicated this finding, using changes in temporal discrimination as a measure of streaming. Experiments 3 and 4 varied the size of a frequency change applied to the deviant tone; the extent of resetting varied with size only gradually. The results suggest that resetting begins to occur once the change is large enough to be noticeable. Since the prior inducers always remained unaltered in the deviant-tone conditions, it is proposed that a single change actively resets the build-up evoked by the induction sequence.

Build-up and resetting of auditory stream segregation in quiet and in complex-tone backgrounds

Thirteen experiments investigated the dynamics of stream segregation. Experiments 1-6b used a similar method, where a same-frequency induction sequence (usually 10 repetitions of an identical pure tone) promoted segregation in a subsequent, briefer test sequence (of alternating low- and high-frequency tones). Experiments 1-2 measured streaming using a direct report of perception and a temporal-discrimination task, respectively. Creating a single deviant by altering the final inducer (e.g. in level or replacement with silence) reduced segregation, often substantially. As the prior inducers remained unaltered, it is proposed that the single change actively reset build-up. The extent of resetting varied gradually with the size of a frequency change, once noticeable (experiments 3a-3b). By manipulating the serial position of a change, experiments 4a-4b demonstrated that resetting only occurred when the final inducer was replaced with silence, as build-up is very rapid during a same-frequency induction sequence. Therefore, the observed resetting cannot be explained by fewer inducers being presented. Experiment 5 showed that resetting caused by a single deviant did not increase when prior inducers were made unpredictable in frequency (four-semitone range). Experiments 6a-6b demonstrated that actual and perceived continuity have a similar effect on subsequent streaming judgements promoting either integration or segregation, depending on listening context. Experiment 7 found that same-frequency inducers were considerably more effective at promoting segregation than an alternating-frequency inducer, and that a trend for deviant-tone resetting was only apparent for the same-frequency case. Using temporal-order judgments, experiments 8-9 demonstrated the stream segregation of pure-tone-like percepts, evoked by sudden changes in amplitude or interaural time difference for individual components of a complex tone, Active resetting was observed when a deviant was inserted into a sequence of these percepts (Experiment 10). Overall, these experiments offer new insight into the segregation-promotIng effect of induction sequences, and the factors which can reset this effect.

Pain response and follow-up of patients undergoing panretinal laser photocoagulation with reduced exposure times

Purpose - We performed a study of laser panretinal photocoagulation in 20 patients with proliferative retinopathy. We compared short exposure, high-energy laser settings with conventional settings, using a 532?nm, frequency doubled, Neodymium–Yag laser and assessed the patients in terms of pain experienced and effectiveness of treatment. Methods - Twenty patients having panretinal photocoagulation for the first time underwent random allocation to treatment of the superior and inferior hemi-retina. Treatment A used ‘conventional’ parameters: exposure time 0.1?s, power sufficient to produce a visible grey-white burns, spot size 300?µm. The other hemi- retina was treated with treatment B using exposure 0.02?s, 300?µm and sufficient power to have similar endpoint. All patients were asked to evaluate severity of pain on a visual analogue scale. (0=no pain, 10=most severe pain). All patients were masked as to the type of treatment and the order of carrying out the treatment on each patient was randomised. Patients underwent fundus photography and were followed up for 6–45 months. Results - Seventeen patients had proliferative diabetic retinopathy, two had ischaemic central retinal vein occlusion and one had ocular ischaemic syndrome. The mean response to treatment A was 5.11, compared to 1.40 treatment B, on the visual analogue scale, which was statistically significant (P=0.001). All patients preferred treatment B. Further treatments, if required, were performed with treatment B parameters and long-term follow-up has shown no evidence of undertreatment. Conclusions - Shortening exposure time of retinal laser is significantly less painful but equally effective as conventional parameters.

Broadly tunable CW green-to-red laser source based on frequency doubling of a quantum-dot external cavity diode laser in a PPKTP waveguide

Here we present a compact tunable all-room-temperature frequency-doubling scheme, using a periodically poled potassium titanyl phosphate (PPKTP) waveguide and a QD-ECDL. A broad wavelength tunability of the second harmonic generated light (SHG) in the spectral region between 567.7 and 629.1 nm was achieved, with maximum conversion efficiencies in range of 0.34%-7.9%. The maximum output power for the SHG light was 4.11 mW at 591.5 nm, achieved for 52 mW of launched pump power at 1183 nm, resulting in a conversion efficiency of 7.9%.

Orange light generation from a PPKTP waveguide end pumped by a cw quantum-dot tunable laser diode

A compact all-room-temperature frequency-doubling scheme generating cw orange light with a periodically poled potassium titanyl phosphate waveguide and a quantum-dot external cavity diode laser is demonstrated. A frequency-doubled power of up to 4.3 mW at the wavelength of 612.9 nm with a conversion efficiency exceeding 10% is reported. Second harmonic wavelength tuning between 612.9 nm and 616.3 nm by changing the temperature of the crystal is also demonstrated. © Springer-Verlag 2010.

Orange-to-red tunable picosecond pulses by frequency doubling in a diode-pumped PPKTP waveguide

A compact picosecond all-room-temperature orange-to-red tunable laser source in the spectral region between 600 and 627 nm is demonstrated. The tunable radiation is obtained by second-harmonic generation in a periodically poled potassium titanyl phosphate (PPKTP) multimode waveguide using a tunable quantum-dot external-cavity mode-locked laser. The maximum second-harmonic output peak power of 3.91 mW at 613 nm is achieved for 85.94 mW of launched pump peak power at 1226 nm, resulting in conversion efficiency of 4.55%. © 2013 Optical Society of America.

Efficient generation of orange light by frequency-doubling of a quantum-dot laser radiation in a PPKTP waveguide

Orange light with maximum conversion efficiency exceeding 10% and CW output power of 12.04 mW, 10.45 mW and 6.24 mW has been generated at 606, 608, and 611 nm, respectively, from a frequency-doubled InAs/GaAs quantum-dot external-cavity diode laser by use of a periodically-poled KTP waveguides with different cross-sectional areas. The wider waveguide with the cross-sectional area of 4×4 μm demonstrated better results in comparison with the narrower waveguides (3×5 μm and 2×6 μm) which corresponded to lower coupling efficiency. Additional tuning of second harmonic light (between 606 and 614 nm) with similar conversion efficiency was possible by changing the crystal temperature. © 2014 Copyright SPIE.

Generation of tunable visible picosecond pulses by frequency-doubling of a quantum-dot laser in a PPKTP waveguide

We demonstrate a compact all-room-temperature picosecond laser source broadly tunable in the visible spectral region between 600 nm and 627 nm. The tunable radiation is obtained by frequency-doubling of a tunable quantum-dot external-cavity mode-locked laser in a periodically-poled KTP multimode waveguide. In this case, utilization of a significant difference in the effective refractive indices of the high- and low-order modes enables to match the period of poling in a very broad wavelength range. The maximum achieved second harmonic output peak power is 3.25 mW at 613 nm for 71.43 mW of launched pump peak power at 1226 nm, resulting in conversion efficiency of 4.55%. © 2013 Copyright SPIE.

An agent approach to improving radio frequency identification enabled Returnable Transport Equipment

Returnable transport equipment (RTE) such as pallets form an integral part of the supply chain and poor management leads to costly losses. Companies often address this matter by outsourcing the management of RTE to logistics service providers (LSPs). LSPs are faced with the task to provide logistical expertise to reduce RTE related waste, whilst differentiating their own services to remain competitive. In the current challenging economic climate, the role of the LSP to deliver innovative ways to achieve competitive advantage has never been so important. It is reported that radio frequency identification (RFID) application to RTE enables LSPs such as DHL to gain competitive advantage and offer clients improvements such as loss reduction, process efficiency improvement and effective security. However, the increased visibility and functionality of RFID enabled RTE requires further investigation in regards to decision‐making. The distributed nature of the RTE network favours a decentralised decision‐making format. Agents are an effective way to represent objects from the bottom‐up, capturing the behaviour and enabling localised decision‐making. Therefore, an agent based system is proposed to represent the RTE network and utilise the visibility and data gathered from RFID tags. Two types of agents are developed in order to represent the trucks and RTE, which have bespoke rules and algorithms in order to facilitate negotiations. The aim is to create schedules, which integrate RTE pick‐ups as the trucks go back to the depot. The findings assert that: - agent based modelling provides an autonomous tool, which is effective in modelling RFID enabled RTE in a decentralised utilising the real‐time data facility. ‐ the RFID enabled RTE model developed enables autonomous agent interaction, which leads to a feasible schedule integrating both forward and reverse flows for each RTE batch. ‐ the RTE agent scheduling algorithm developed promotes the utilisation of RTE by including an automatic return flow for each batch of RTE, whilst considering the fleet costs andutilisation rates. ‐ the research conducted contributes an agent based platform, which LSPs can use in order to assess the most appropriate strategies to implement for RTE network improvement for each of their clients.

Thermo-chemical conversion of straw:Haloclean : a performance enhanced low temperature pyrolysis

Haloclean a performance enhanced low temperature pyrolysis for biomass developed by Forschungszentrum Karlsruhe and Sea Marconi Is closing the gap between classical and fast pyrolysis approaches. For pyrolysis of straw (chaffed-, finely ground and pellets) temperature ranges between 320 to 420°C and residence times of only 1 to 5 minutes can be realized. Liquid yields of up to 45 wt-% and 35 wt-% of solids are possible. Solid yields can be increased up to 73 wt-% while loosing 4.5 % of the feed energy by pyrolysis gases only. Toxicity tests of the fractions do not show relevant numbers.