Impact of restrictive intravenous fluid replacement and combined epidural analgesia on perioperative volume balance and renal function within a Fast Track program.

BACKGROUND AND OBJECTIVE: Key factors of Fast Track (FT) programs are fluid restriction and epidural analgesia (EDA). We aimed to challenge the preconception that the combination of fluid restriction and EDA might induce hypotension and renal dysfunction. METHODS: A recent randomized trial (NCT00556790) showed reduced complications after colectomy in FT patients compared with standard care (SC). Patients with an effective EDA were compared with regard to hemodynamics and renal function. RESULTS: 61/76 FT patients and 59/75 patients in the SC group had an effective EDA. Both groups were comparable regarding demographics and surgery-related characteristics. FT patients received significantly less i.v. fluids intraoperatively (1900 mL [range 1100-4100] versus 2900 mL [1600-5900], P < 0.0001) and postoperatively (700 mL [400-1500] versus 2300 mL [1800-3800], P < 0.0001). Intraoperatively, 30 FT compared with 19 SC patients needed colloids or vasopressors, but this was statistically not significant (P = 0.066). Postoperative requirements were low in both groups (3 versus 5 patients; P = 0.487). Pre- and postoperative values for creatinine, hematocrit, sodium, and potassium were similar, and no patient developed renal dysfunction in either group. Only one of 82 patients having an EDA without a bladder catheter had urinary retention. Overall, FT patients had fewer postoperative complications (6 versus 20 patients; P = 0.002) and a shorter median hospital stay (5 [2-30] versus 9 d [6-30]; P< 0.0001) compared with the SC group. CONCLUSIONS: Fluid restriction and EDA in FT programs are not associated with clinically relevant hemodynamic instability or renal dysfunction.

Bond Contribution to Whitetopping Performance on Low Volume Roads, Construction Report, HR-341, 1993

This research was initiated in 1991 as a part of a whitetopping project to study the effectiveness of various techniques to enhance bond strength between a new Portland cement concrete (PCC) overlay and an existing asphalt cement concrete (ACC) pavement surface. A 1,676 m (5,500 ft) section of county road R16 in Dallas County, Iowa was divided into 12 test sections. The various techniques used to enhance bond were power brooming, power brooming with air blast, milling, cement and water grout, and emulsion tack coat. As a part of these bonding techniques, two pavement thicknesses were placed; two different concrete proportions were used; and two sections were planed to a uniform cross-slope.

Hector Fiéramosca, ou le Défi de Barletta. Volume 1 / , roman historique, par d'Azéglio, gendre de Manzoni, traduit de l'italien, avec une notice sur ces deux écrivains, par A.-L. Blanchard,... précédé d'un Essai sur les romans historiques et du moyen âge, par Paulin Paris,...

Comprend : Essai sur les romans historiques et du moyen âge...

Development of Evaluation, Rehabilitation, and Strengthening Concepts for Low Volume Bridges, Phase I Progress Report, HR-323, 1990

The primary objective of this project is to develop a design manual that would aid the county or municipal engineer in making structurally sound bridge strengthening or replacement decisions. The contents of this progress report are related only to Phase I of the study and deal primarily with defining the extent of the bridge problem in Iowa. In addition, the types of bridges to which the manual should be directed have been defined.

Surgical safety and hospital volume across a wide range of interventions

OBJECTIVES:: For certain major operations, inpatient mortality risk is lower in high-volume hospitals than those in low-volume hospitals. Extending the analysis to a broader range of interventions and outcomes is necessary before adopting policies based on minimum volume thresholds. METHODS:: Using the United States 2004 Nationwide Inpatient Sample, we assessed the effect of intervention-specific and overall hospital volume on surgical complications, potentially avoidable reoperations, and deaths across 1.4 million interventions in 353 hospitals. Outcome variations across hospitals were analyzed through a 3-level hierarchical logistic regression model (patients, surgical interventions, and hospitals), which took into account interventions on multiple organs, 144 intervention categories, and structural hospital characteristics. Discriminative performance and calibration were good. RESULTS:: Hospitals with more experience in a given intervention had similar reoperation rates but lower mortality and complication rates: odds ratio per volume deciles 0.93 and 0.97. However, the benefit was limited to heart surgery and a small number of other operations. Risks were higher for hospitals that performed more interventions overall: odds ratio per 1000 for each event was approximately 1.02. Even after adjustment for specific volume, mortality varied substantially across both high- and low-volume hospitals. CONCLUSION:: Although the link between specific volume and certain inpatient outcomes suggests that specialization might help improve surgical safety, the variable magnitude of this link and the heterogeneity of hospital effect do not support the systematic use of volume-based referrals. It may be more efficient to monitor risk-adjusted postoperative outcomes and to investigate facilities with worse than expected outcomes.

Trabecular Bone Score (TBS)--A Novel Method to Evaluate Bone Microarchitectural Texture in Patients With Primary Hyperparathyroidism.

Context: In the milder form of primary hyperparathyroidism (PHPT), cancellous bone, represented by areal bone mineral density at the lumbar spine by dual-energy x-ray absorptiometry (DXA), is preserved. This finding is in contrast to high-resolution peripheral quantitative computed tomography (HRpQCT) results of abnormal trabecular microstructure and epidemiological evidence for increased overall fracture risk in PHPT. Because DXA does not directly measure trabecular bone and HRpQCT is not widely available, we used trabecular bone score (TBS), a novel gray-level textural analysis applied to spine DXA images, to estimate indirectly trabecular microarchitecture. Objective: The purpose of this study was to assess TBS from spine DXA images in relation to HRpQCT indices and bone stiffness in radius and tibia in PHPT. Design and Setting: This was a cross-sectional study conducted in a referral center. Patients: Participants were 22 postmenopausal women with PHPT. Main Outcome Measures: Outcomes measured were areal bone mineral density by DXA, TBS indices derived from DXA images, HRpQCT standard measures, and bone stiffness assessed by finite element analysis at distal radius and tibia. Results: TBS in PHPT was low at 1.24, representing abnormal trabecular microstructure (normal ≥1.35). TBS was correlated with whole bone stiffness and all HRpQCT indices, except for trabecular thickness and trabecular stiffness at the radius. At the tibia, correlations were observed between TBS and volumetric densities, cortical thickness, trabecular bone volume, and whole bone stiffness. TBS correlated with all indices of trabecular microarchitecture, except trabecular thickness, after adjustment for body weight. Conclusion: TBS, a measurement technology readily available by DXA, shows promise in the clinical assessment of trabecular microstructure in PHPT.

Development of Rouble Exchange Rate in Russia

This 45th volume deals with the development of the Russian rouble, which suffered a severe depreciation crisis in 1998. In the aftermath of this event, a strong investment boom started in Russia. The new devalued rouble exchange rate gave price competitiveness to local industry. In addition to that, increasing export prices of Russian oil and natural gas deliveries have contributed to economic growth lately. Amid this boom period, inflationary pressure has remained high. Price increases have been higher than in the EU, Russia’s main trading partner. However, rouble/euro exchange rate has remained nominally rather stable in the current decade. This means, that rouble appreciates against euro in real terms, which is weakening Russia’s international competitiveness.

Determinação do volume de madeira em povoamento de eucalipto por escâner a laser aerotransportado

O objetivo deste trabalho foi avaliar a possibilidade de se estimar o diâmetro à altura do peito (DAP) com os dados de altura e de número de árvores derivados do escâner a laser aerotransportado (LiDAR, "light detection and ranging"), e determinar o volume de madeira de talhão de Eucalyptus sp. a partir dessas variáveis. O número total de árvores detectadas foi obtido com uso da filtragem de máxima local. A altura de plantas estimada pelo LiDAR apresentou tendência não significativa à subestimativa. A estimativa do DAP foi coerente com os valores encontrados no inventário florestal; porém, também mostrou tendência à subestimativa, em razão do comportamento observado quanto à altura. A variável número de fustes apresentou valores próximos aos observados nas parcelas do inventário. O LiDAR subestimou o volume total de madeira do talhão em 11,4%, em comparação ao volume posto na fábrica. A tendência de subestimação da altura das árvores (em média, cerca de 5%) impactou a estimativa do volume individual de árvores e, consequentemente, a do volume do talhão. No entanto, é possível gerar equações de regressão que estimam o DAP com boa precisão, a partir de dados de altura de plantas obtidos pelo LiDAR. O modelo parabólico é o que possibilita as melhores estimativas da produção volumétrica dos talhões de eucalipto.

Computer-aided volume measurement of posttraumatic orbits reconstructed with AO titanium mesh plates: accuracy and reliability

PURPOSE: To prospectively evaluate the accuracy and reliability of "freehand" posttraumatic orbital wall reconstruction with AO (Arbeitsgemeinschaft Osteosynthese) titanium mesh plates by using computer-aided volumetric measurement of the bony orbits. METHODS: Bony orbital volume was measured in 12 patients from coronal CT scan slices using OsiriX Medical Image software. After defining the volumetric limits of the orbit, the segmentation of the bony orbital region of interest of each single slice was performed. At the end of the segmentation process, all regions of interest were grouped and the volume was computed. The same procedure was performed on both orbits, and thereafter the volume of the contralateral uninjured orbit was used as a control for comparison. RESULTS: In all patients, the volume data of the reconstructed orbit fitted that of the contralateral uninjured orbit with accuracy to within 1.85 cm3 (7%). CONCLUSIONS: This preliminary study has demonstrated that posttraumatic orbital wall reconstruction using "freehand" bending and placement of AO titanium mesh plates results in a high success rate in re-establishing preoperative bony volume, which closely approximates that of the contralateral uninjured orbit.

Redes neurais artificiais para a modelagem do volume de madeira e biomassa do cerradão com dados de satélite

Resumo:O objetivo deste trabalho foi avaliar a eficácia da aplicação de modelos de análise de regressão e redes neurais artificiais (RNAs) na predição do volume de madeira e da biomassa acima do solo, da vegetação arbórea em área de cerradão. Volume de madeira e biomassa foram estimados com equações alométricas desenvolvidas para a área de estudo. Os índices de vegetação, como variáveis preditoras, foram estimados a partir de imagens do sensor LISS-III, e a área basal foi determinada por medições na floresta. A precisão das equações foi verificada pela correlação entre os valores estimados e observados (r), erro-padrão da estimativa (Syx) e gráfico residual. As equações de regressão para o volume de madeira total e do fuste (0,96 e 0,97 para r, e 11,92 e 9,72% para Syx, respectivamente) e para a biomassa (0,91 e 0,92 para r, e 22,73 e 16,80% para Syx, respectivamente) apresentaram bons ajustes. As redes neurais também apresentaram bom ajuste com o volume de madeira (0,99 e 0,99 para r, e 4,93 e 4,83% para Syx) e a biomassa (0,97 e 0,98 r, e 8,92 e 7,96% para Syx, respectivamente). A área basal e os índices de vegetação foram eficazes na estimativa do volume de madeira e biomassa para o cerradão. Os valores reais de volume de madeira e biomassa não diferiram estatisticamente dos valores estimados pelos modelos de regressão e redes neurais (χ2ns); contudo, as RNAs são mais acuradas.