Measures to prevent surgical site infections: what surgeons (should) do.

BACKGROUND: The present study was designed to evaluate surgeons' strategies and adherence to preventive measures against surgical site infections (SSIs). MATERIALS AND METHODS: All surgeons participating in a prospective Swiss multicentric surveillance program for SSIs received a questionnaire developed from the 2008 National (United Kingdom) Institute for Health and Clinical Excellence (NICE) clinical guidelines on prevention and treatment of SSIs. We focused on perioperative management and surgical technique in hernia surgery, cholecystectomy, appendectomy, and colon surgery (COL). RESULTS: Forty-five of 50 surgeons contacted (90%) responded. Smoking cessation and nutritional screening are regularly propagated by 1/3 and 1/2 of surgeons, respectively. Thirty-eight percent practice bowel preparation before COL. Preoperative hair removal is routinely (90%) performed in the operating room with electric clippers. About 50% administer antibiotic prophylaxis within 30 min before incision. Intra-abdominal drains are common after COL (43%). Two thirds of respondents apply nonocclusive wound dressings that are manipulated after hand disinfection (87%). Dressings are usually changed on postoperative day (POD) 2 (75%), and wounds remain undressed on POD 2-3 or 4-5 (36% each). CONCLUSIONS: Surgeons' strategies to prevent SSIs still differ widely. The adherence to the current NICE guidelines is low for many procedures regardless of the available level of evidence. Further research should provide convincing data in order to justify standardization of perioperative management.

Spiral CT aortography: an efficient technique for the diagnosis of traumatic aortic injury.

The objective of this study was to assess the efficiency of spiral CT (SCT) aortography for diagnosing acute aortic lesions in blunt thoracic trauma patients. Between October 1992 and June 1997, 487 SCT scans of the chest were performed on blunt thoracic trauma patients. To assess aortic injury, the following SCT criteria were considered: hemomediastinum, peri-aortic hematoma, irregular aspect of the aortic wall, aortic pseudodiverticulum, intimal flap and traumatic dissection. Aortic injury was diagnosed on 14 SCT examinations (2.9 %), five of the patients having had an additional digital aortography that confirmed the aortic trauma. Twelve subjects underwent surgical repair of the thoracic aorta, which in all but one case confirmed the aortic injury. Two patients died before surgery from severe brain lesions. The aortic blunt lesions were confirmed at autopsy. According to the follow-up of the other 473 patients, we are aware of no false-negative SCT examination. Our limited series shows a sensitivity of 100 % and specificity of 99.8 % of SCT aortography in the diagnosis of aortic injury. It is concluded that SCT aortagraphy is an accurate diagnostic method for the assessment of aortic injury in blunt thoracic trauma patients.

Removal of unusual, large high-velocity metallic maxillary sinus foreign bodies by a modified free bone flap technique.

Metallic foreign bodies are rarely found in the maxillary sinus, and usually they have a dental origin.Potential complications related to foreign bodies include recurrent sinusitis, rhinolith formation, cutaneous fistula,chemical poisoning, facial neuralgic pain and even malignancies.Two main surgical approaches are currently used for the removal of foreign bodies in the maxillary sinus: the bone flap and the endoscopic sinus techniques. We are reporting two unusual cases of large high-velocity foreign bodies removed by a modified maxillary lateral antrotomy,with free bone flap repositioning and fixation with a titanium miniplate.

Via-configurable transistor array: a regular design technique to improve ICs yield

Process variations are a major bottleneck for digital CMOS integrated circuits manufacturability and yield. That iswhy regular techniques with different degrees of regularity are emerging as possible solutions. Our proposal is a new regular layout design technique called Via-Configurable Transistors Array (VCTA) that pushes to the limit circuit layout regularity for devices and interconnects in order to maximize regularity benefits. VCTA is predicted to perform worse than the Standard Cell approach designs for a certain technology node but it will allow the use of a future technology on an earlier time. Ourobjective is to optimize VCTA for it to be comparable to the Standard Cell design in an older technology. Simulations for the first unoptimized version of our VCTA of delay and energy consumption for a Full Adder circuit in the 90 nm technology node are presented and also the extrapolation for Carry-RippleAdders from 4 bits to 64 bits.

Impingement jet cooling of end windings in a high-speed electric machine

The rotational speed of high-speed electric machines is over 15 000 rpm. These machines are compact in size when compared to the power rate. As a consequence, the heat fluxes are at a high level and the adequacy of cooling becomes an important design criterion. In the high-speed machines, the air gap between the stator and rotor is a narrow flow channel. The cooling air is produced with a fan and the flow is then directed to the air gap. The flow in the gap does not provide sufficient cooling for the stator end windings, and therefore additional cooling is required. This study investigates the heat transfer and flow fields around the coil end windings when cooling jets are used. As a result, an innovative and new assembly is introduced for the cooling jets, with the benefits of a reduced amount of hot spots, a lower pressure drop, and hence a lower power need for the cooling fan. The gained information can also be applied to improve the cooling of electric machines through geometry modifications. The objective of the research is to determine the locations of the hot spots and to find out induced pressure losses with different jet alternatives. Several possibilities to arrange the extra cooling are considered. In the suggested approach cooling is provided by using a row of air jets. The air jets have three main tasks: to cool the coils effectively by direct impingement jets, to increase and cool down the flow that enters the coil end space through the air gap, and to ensure the correct distribution of the flow by forming an air curtain with additional jets. One important aim of this study is the arrangement of cooling jets in such manner that hot spots can be avoided to wide extent. This enables higher power density in high-speed motors. This cooling system can also be applied to the ordinary electric machines when efficient cooling is needed. The numerical calculations have been performed using a commercial Computational Fluid Dynamics software. Two geometries have been generated: cylindrical for the studied machine and Cartesian for the experimental model. The main parameters include the positions, arrangements and number of jets, the jet diameters, and the jet velocities. The investigated cases have been tested with two widely used turbulence models and using a computational grid of over 500 000 cells. The experimental tests have been made by using a simplified model for the end winding space with cooling jets. In the experiments, an emphasis has been given to flow visualisation. The computational analysis shows good agreement with the experimental results. Modelling of the cooling jet arrangement enables also a better understanding of the complex system of heat transfer at end winding space.

Mulching as an alternative technique for weed management in mandarine orchard tree rows

Peer reviewed

Four-corner bone arthrodesis with dorsal rectangular plate: series and personal technique.

Controversy exists about the best method to achieve bone fusion in four-corner arthrodesis. Thirty-five patients who underwent this procedure by our technique were included in the study. Surgical indications were stage II-III SLAC wrist, stage II SNAC wrist and severe traumatic midcarpal joint injury. Mean follow-up was 4.6 years. Mean active flexion and extension were 34 degrees and 30 degrees respectively; grip strength recovery was 79%. Radiological consolidation was achieved in all cases. The mean DASH score was 23 and the postoperative pain improvement by visual analogue scale was statistically significant. Return to work was possible at 4 months for the average patient. Complications were a capitate fracture in one patient and the need for hardware removal in four cases. Four-corner bone wrist arthrodesis by dorsal rectangular plating achieves an acceptable preservation of range of motion with good pain relief, an excellent consolidation rate and minimal complications.

Use of anisotropic modelling in electrical impedance tomography: description of method and preliminary assessment of utility in imaging brain function in the adult human head.

Electrical Impedance Tomography (EIT) is an imaging method which enables a volume conductivity map of a subject to be produced from multiple impedance measurements. It has the potential to become a portable non-invasive imaging technique of particular use in imaging brain function. Accurate numerical forward models may be used to improve image reconstruction but, until now, have employed an assumption of isotropic tissue conductivity. This may be expected to introduce inaccuracy, as body tissues, especially those such as white matter and the skull in head imaging, are highly anisotropic. The purpose of this study was, for the first time, to develop a method for incorporating anisotropy in a forward numerical model for EIT of the head and assess the resulting improvement in image quality in the case of linear reconstruction of one example of the human head. A realistic Finite Element Model (FEM) of an adult human head with segments for the scalp, skull, CSF, and brain was produced from a structural MRI. Anisotropy of the brain was estimated from a diffusion tensor-MRI of the same subject and anisotropy of the skull was approximated from the structural information. A method for incorporation of anisotropy in the forward model and its use in image reconstruction was produced. The improvement in reconstructed image quality was assessed in computer simulation by producing forward data, and then linear reconstruction using a sensitivity matrix approach. The mean boundary data difference between anisotropic and isotropic forward models for a reference conductivity was 50%. Use of the correct anisotropic FEM in image reconstruction, as opposed to an isotropic one, corrected an error of 24 mm in imaging a 10% conductivity decrease located in the hippocampus, improved localisation for conductivity changes deep in the brain and due to epilepsy by 4-17 mm, and, overall, led to a substantial improvement on image quality. This suggests that incorporation of anisotropy in numerical models used for image reconstruction is likely to improve EIT image quality.

An Image Enhancement Technique using MTF of Human eye

Image filtering is a highly demanded approach of image enhancement in digital imaging systems design. It is widely used in television and camera design technologies to improve the quality of an output image to avoid various problems such as image blurring problem thatgains importance in design of displays of large sizes and design of digital cameras. This thesis proposes a new image filtering method basedon visual characteristics of human eye such as MTF. In contrast to the traditional filtering methods based on human visual characteristics this thesis takes into account the anisotropy of the human eye vision. The proposed method is based on laboratory measurements of the human eye MTF and takes into account degradation of the image by the latter. This method improves an image in the way it will be degraded by human eye MTF to give perception of the original image quality. This thesis gives a basic understanding of an image filtering approach and the concept of MTF and describes an algorithm to perform an image enhancement based on MTF of human eye. Performed experiments have shown quite good results according to human evaluation. Suggestions to improve the algorithm are also given for the future improvements.

A case for hornblende dominated fractionation of arc magmas: the Chelan Complex (Washington Cascades)

Amphibole fractionation in the deep roots of subduction-related magmatic arcs is a fundamental process for the generation of the continental crust. Field relations and geochemical data of exposed lower crustal igneous rocks can be used to better constrain these processes. The Chelan Complex in the western U. S. forms the lowest level of a 40-km thick exposed crustal section of the North Cascades and is composed of olivine websterite, pyroxenite, hornblendite, and dominantly by hornblende gabbro and tonalite. Magmatic breccias, comb layers and intrusive contacts suggest that the Chelan Complex was build by igneous processes. Phase equilibria, textural observations and mineral chemistry yield emplacement pressures of similar to 1.0 GPa followed by isobaric cooling to 700 degrees C. The widespread occurrence of idiomorphic hornblende and interstitial plagioclase together with the lack of Eu anomalies in bulk rock compositions indicate that the differentiation is largely dominated by amphibole. Major and trace element modeling constrained by field observations and bulk chemistry demonstrate that peraluminous tonalite could be derived by removing successively 3% of olivine websterite, 12% of pyroxene hornblendite, 33% of pyroxene hornblendite, 19% of gabbros, 15% of diorite and 2% tonalite. Peraluminous tonalite with high Sr/Y that are worldwide associated with active margin settings can be derived from a parental basaltic melt by crystal fractionation at high pressure provided that amphibole dominates the fractionation process. Crustal assimilation during fractionation is thus not required to generate peraluminous tonalite.

Electric bicycles as a new active transportation modality to promote health.

GOJANOVIC, B., J. WELKER, K. IGLESIAS, C. DAUCOURT, and G. GREMION. Electric Bicycles as a New Active Transportation Modality to Promote Health. Med. Sci. Sports Exerc., Vol. 43, No. 11, pp. 2204-2210, 2011. Electrically assisted bicycles (EAB) are an emerging transportation modality favored for environmental reasons. Some physical effort is required to activate the supporting engine, making it a potential active commuting option. Purpose: We hypothesized that using an EAB in a hilly city allows sedentary subjects to commute comfortably, while providing a sufficient effort for health-enhancing purposes. Methods: Sedentary subjects performed four different trips at a self-selected pace: walking 1.7 km uphill from the train station to the hospital (WALK), biking 5.1 km from the lower part of town to the hospital with a regular bike (BIKE), or EAB at two different power assistance settings (EAB(high), EAB(std)). HR, oxygen consumption, and need to shower were recorded. Results: Eighteen sedentary subjects (12 female, 6 male) age 36 +/- 10 yr were included, with (V) over dotO(2max) of 39.4 +/- 5.4 mL.min(-1).kg(-1). Time to complete the course was 22 (WALK), 19 (EAB(high)), 21 (EAB(std)), and 30 (BIKE) min. Mean %(V) over dotO(2max) was 59.0%, 54.9%, 65.7%, and 72.8%. Mean%HR(max) was 71.5%, 74.5%, 80.3%, and 84.0%. There was no significant difference between WALK and EAB(high), but all other comparisons were different (P < 0.05). Two subjects needed to shower after EAB(high), 3 needed to shower after WALK, 8 needed to shower after EAB(std), and all 18 needed to shower after BIKE. WALK and EAB(high) elicited 6.5 and 6.1 METs (no difference), whereas it was 7.3 and 8.2 for EAB(std) and BIKE. Conclusions: EAB is a comfortable and ecological transportation modality, helping sedentary people commute to work and meet physical activity guidelines. Subjects appreciated ease of use and mild effort needed to activate the engine support climbing hills, without the need to shower at work. EAB can be promoted in a challenging urban environment to promote physical activity and mitigate pollution issues.

Histoire des religions et constructivisme. La religion comme 'technique'

(Résumé de l'ouvrage) Qu'est-ce qui justifie l'emploi de rituels dans de nombreuses civilisations, anciennes ou contemporaines ? Sur quoi repose l'efficacité des rites ? Pour répondre à ces questions, ce livre propose une approche transdisciplinaire novatrice, qui rompt avec le cloisonnement en champs scientifiques étanches prévalant trop souvent dans l'exploration des pratiques rituelles. La réflexion autour des frontières et interactions entre les sphères socioculturelle, psychique et physiologique fait ressortir le caractère plastique et dynamique de celles-ci. Il s'agit notamment de souligner l'importance, dans de nombreuses cultures et à des épo-ques différentes, de techniques ou « orthopratiques » corporelles, psychologiques et sociales utilisées en vue de résultats pratiques spécifiques. Par ailleurs, les discours et les « représentations » propres aux systèmes institutionnels (science, médecine, philosophie, théologie) sur lesquels repose notre culture moderne se révèlent à même d'effectuer la « construction-réalisation » des objets mêmes qu'ils prétendent décrire. Ainsi, tant les « orthopratiques » appliquées, traitées dans la première partie du volume, que les pratiques émanant de nos systèmes institutionnels, traitées dans la seconde partie, tendent vers des objectifs transformationnels et opératoires. Alors que les unes opèrent dans un cadre magico-religieux, thérapeutique ou pédagogique, les autres se situent dans le contexte de la modernité. Mais elles se rejoignent en une dynamique dont les contribu-tions réunies ici viennent éclairer la nature et l'homme aux niveaux organique, psychique et historico-social. Ce qui revient, du même coup, à relancer l'interrogation philosophique qui porte sur la notion même de « réalité ».