New perioperative fluid and pharmacologic management protocol results in reduced blood loss, faster return of bowel function, and overall recovery.

Cystectomy and urinary diversion have high morbidity, and strategies to reduce complications are of utmost importance. Epidural analgesia and optimized fluid management are considered key factors contributing to successful enhanced recovery after surgery. In colorectal surgery, there is strong evidence that an intraoperative fluid management aiming for a postoperative zero fluid balance results in lower morbidity including a faster return of bowel function. Recently, a randomized clinical trial focusing on radical cystectomy demonstrated that a restrictive intraoperative hydration combined with a concomitant administration of norepinephrine reduced intraoperative blood loss, the need for blood transfusion and morbidity. The purpose of this review is to highlight specific anesthesiological aspects which have been shown to improve outcome after RC with urinary diversion.

An emotional father and son reunion that sometimes is at a loss for words [Review]

DRAMA often develops around the idea of a return: a return to events of the past, memories of the past, or people from the past...

Loss reduction planning in electric distribution networks of IRAN until 2025

In this paper, a loss reduction planning in electric distribution networks is presented based on the successful experiences in distribution utilities of IRAN and some developed countries. The necessary technical and economical parameters of planning are calculated from related projects in IRAN. Cost, time, and benefits of every sub-program including seven loss reduction approaches are determined. Finally, the loss reduction program, the benefit per cost, and the return of investment in optimistic and pessimistic conditions are introduced.

Maximum Loss Calculation using Scenario Analysis, Heavy Tails and Implied Volatility Patterns

The objective of this paper is to improve option risk monitoring by examining the information content of implied volatility and by introducing the calculation of a single-sum expected risk exposure similar to the Value-at-Risk. The figure is calculated in two steps. First, there is a need to estimate the value of a portfolio of options for a number of different market scenarios, while the second step is to summarize the information content of the estimated scenarios into a single-sum risk measure. This involves the use of probability theory and return distributions, which confronts the user with the problems of non-normality in the return distribution of the underlying asset. Here the hyperbolic distribution is used to describe one alternative for dealing with heavy tails. Results indicate that the information content of implied volatility is useful when predicting future large returns in the underlying asset. Further, the hyperbolic distribution provides a good fit to historical returns enabling a more accurate definition of statistical intervals and extreme events.

A 4 GHz non-resonant clock driver with inductor-assisted energy return to power grid

Power consumption of a multi-GHz local clock driver is reduced by returning energy stored in the clock-tree load capacitance back to the on-chip power-distribution grid. We call this type of return energy recycling. To achieve a nearly square clock waveform, the energy is transferred in a non-resonant way using an on-chip inductor in a configuration resembling a full-bridge DC-DC converter. A zero-voltage switching technique is implemented in the clock driver to reduce dynamic power loss associated with the high switching frequencies. A prototype implemented in 90 nm CMOS shows a power savings of 35% at 4 GHz. The area needed for the inductor in this new clock driver is about 6% of a local clock region. © 2006 IEEE.

Attitudes of consultant ophthalmologists in the UK to initial management of glaucoma patients presenting with severe visual field loss: a national survey

BACKGROUND: Recent National Institute of Clinical Excellence guidance suggests primary surgery should be offered to patients presenting with glaucoma with severe visual field loss. We undertook a survey of UK consultant ophthalmologists to determine if this represents current practice and explore attitudes towards managing patients with advanced glaucoma at presentation.

DESIGN: Questionnaire evaluation study.

PARTICIPANTS: All consultant ophthalmologists currently practicing in the UK.

METHODS: A single-page questionnaire was posted to all consultants (n = 910) currently practicing in the UK along with a pre-paid return envelope. A second questionnaire was sent to non-responders (n = 459).

MAIN OUTCOME MEASURES: Questionnaire responses.

RESULTS: 626 responses were received representing 68.8% of the population surveyed. 152 (24%) volunteered a specialist interest in glaucoma. Consensus opinion for both glaucoma specialists (64.9%) and non-glaucoma specialists (62.4%) was to start with primary medical therapy, most commonly citing surgical risk as the primary reason (23% and 22%, respectively) for this approach. Most felt the highest intraocular pressure measurement during follow up (measured in clinic) was the most important variable for prevention of further visual loss (60% of glaucoma specialists and 55% of non-glaucoma specialists). Eighty-three per cent of all responders suggested they would change their practice if evidence supporting primary surgery as a safe and more effective approach existed.

CONCLUSIONS: Recent National Institute of Clinical Excellence guidance does not reflect the current management approach of UK ophthalmologists. The primary concern was related to potential complications of surgery although most practitioners would be willing to change their practice if evidence existed supporting primary surgery in patients presenting with advanced glaucoma.

Integrated Low-Loss Passive SiGe Power Splitter and Combiner Operating Across 78-86 GHz Band

This paper describes the design, implementation, and characterization of a new type of passive power splitting and combining structure for use in a differential four-way power-combining amplifier operating at E-band. In order to achieve lowest insertion loss, input and output coils inductances are resonated with shunt capacitances. Simple C-L-C and L-C networks are proposed in order to compensate inductive loading due to routing line that would otherwise introduce mismatch and increase loss. Across 78-86 GHz band, measured insertion loss is about 7 dB. Measured return losses are >10 dB from 73 GHz to 94 GHz at the input port and >9 dB from 60 GHz to 94 GHz at the output port. When integrated with driver and power amplifier cells, the simulated complete circuit exhibits 18.2 dB gain and 20.3 dBm saturated output power.

Loss potentials associated with European windstorms under future climate conditions

Possible changes in the frequency and intensity of windstorms under future climate conditions during the 21st century are investigated based on an ECHAM5 GCM multi-scenario ensemble. The intensity of a storm is quantified by the associated estimated loss derived with using an empirical model. The geographical focus is ‘Core Europe’, which comprises countries of Western Europe. Possible changes of losses are analysed by comparing ECHAM5 GCM data for recent (20C, 1960 to 2000) and future climate conditions (B1, A1B, A2; 2060 to 2100), each with 3 ensemble members. Changes are quantified using both rank statistics and return periods (RP) estimated by fitting an extreme value distribution using the peak over threshold method to potential storm losses. The estimated losses for ECHAM5 20C and reanalysis events show similar statistical features in terms of return periods. Under future climate conditions, all climate scenarios show an increase in both frequency and magnitude of potential losses caused by windstorms for Core Europe. Future losses that are double the highest ECHAM5 20C loss are identified for some countries. While positive changes of ranking are significant for many countries and multiple scenarios, significantly shorter RPs are mostly found under the A2 scenario for return levels correspondent to 20 yr losses or less. The emergence time of the statistically significant changes in loss varies from 2027 to 2100. These results imply an increased risk of occurrence of windstorm-associated losses, which can be largely attributed to changes in the meteorological severity of the events. Additionally, factors such as changes in the cyclone paths and in the location of the wind signatures relative to highly populated areas are also important to explain the changes in estimated losses.

On the clustering of winter storm loss events over Germany

During the last decades, several windstorm series hit Europe leading to large aggregated losses. Such storm series are examples of serial clustering of extreme cyclones, presenting a considerable risk for the insurance industry. Clustering of events and return periods of storm series for Germany are quantified based on potential losses using empirical models. Two reanalysis data sets and observations from German weather stations are considered for 30 winters. Histograms of events exceeding selected return levels (1-, 2- and 5-year) are derived. Return periods of historical storm series are estimated based on the Poisson and the negative binomial distributions. Over 4000 years of general circulation model (GCM) simulations forced with current climate conditions are analysed to provide a better assessment of historical return periods. Estimations differ between distributions, for example 40 to 65 years for the 1990 series. For such less frequent series, estimates obtained with the Poisson distribution clearly deviate from empirical data. The negative binomial distribution provides better estimates, even though a sensitivity to return level and data set is identified. The consideration of GCM data permits a strong reduction of uncertainties. The present results support the importance of considering explicitly clustering of losses for an adequate risk assessment for economical applications.

Widespread supplementary feeding in domestic gardens explains the return of reintroduced Red Kites Milvus milvus to an urban area

Reintroductions are used worldwide to mitigate biodiversity loss. One prominent case is a charismatic raptor of conservation concern, the Red Kite Milvus milvus. This species has been reintroduced across the UK over the last 25 years following its near extinction after centuries of persecution. The species was not expected to recolonize urban areas; its historical association with human settlements is attributed to scavenging on human waste and refuse, a resource now greatly reduced on the streets of modern Western cities. However, the species has become a common day-time visitor to a large conurbation centred on the town of Reading, southern England, approximately 20 km from the first English reintroduction site. Given a near-absence of breeding and roost sites, we investigated foraging opportunities and habitat associations that might explain use by Red Kites of this urban area. Surveys of discarded human foods and road-kill suggested that these could support at most 13−29 kites/day. Face-to-face surveys of a cross-section of residents revealed that 4.5% (equivalent to 4349 households) provided supplementary food for kites. Using estimates of per-household resource provision from another study, we calculated that this level is potentially sufficient to provision 142−320 kites, a substantial proportion of the total estimated to visit the conurbation each day (between 140 and 440). Road transects found positive associations between Red Kites and residential areas. We therefore suggest that the decision made by thousands of individuals to provide supplementary food for Red Kites is the primary factor explaining their day-time abundance in this urban area.

Return periods of losses associated with European windstorm series in a changing climate

Possible future changes of clustering and return periods (RPs) of European storm series with high potential losses are quantified. Historical storm series are identified using 40 winters of reanalysis. Time series of top events (1, 2 or 5 year return levels (RLs)) are used to assess RPs of storm series both empirically and theoretically. Additionally, 800 winters of general circulation model simulations for present (1960–2000) and future (2060–2100) climate conditions are investigated. Clustering is identified for most countries, and estimated RPs are similar for reanalysis and present day simulations. Future changes of RPs are estimated for fixed RLs and fixed loss index thresholds. For the former, shorter RPs are found for Western Europe, but changes are small and spatially heterogeneous. For the latter, which combines the effects of clustering and event ranking shifts, shorter RPs are found everywhere except for Mediterranean countries. These changes are generally not statistically significant between recent and future climate. However, the RPs for the fixed loss index approach are mostly beyond the range of pre-industrial natural climate variability. This is not true for fixed RLs. The quantification of losses associated with storm series permits a more adequate windstorm risk assessment in a changing climate.

CT-guided infiltration saves surgical intervention and fastens return to work compared to anatomical landmark-guided infiltration in patients with lumbosciatica

BACKGROUND Infiltration procedures are a common treatment of lumbar radiculopathy. There is a wide variety of infiltration techniques without an established gold standard. Therefore, we compared the effectiveness of CT-guided transforaminal infiltrations versus anatomical landmark-guided transforaminal infiltrations at the lower lumbar spine in case of acute sciatica at L3-L5. METHODS A retrospective chart review was conducted of 107 outpatients treated between 2009 and 2011. All patients were diagnosed with lumbar radiculopathic pain secondary to disc herniation in L3-L5. A total of 52 patients received CT-guided transforaminal infiltrations; 55 patients received non-imaging-guided nerve root infiltrations. The therapeutic success was evaluated regarding number of physician contacts, duration of treatment, type of analgesics used and loss of work days. Defined endpoint was surgery at the lower lumbar spine. RESULTS In the CT group, patients needed significantly less oral analgesics (p < 0.001). Overall treatment duration and physician contacts were significantly lower in the CT group (p < 0.001 and 0.002) either. In the CT group, patients lost significant fewer work days due to incapacity (p < 0.001). Surgery had to be performed in 18.2 % of the non-imaging group patients (CT group: 1.9 %; p = 0.008). CONCLUSION This study shows that CT-guided periradicular infiltration in lumbosciatica caused by intervertebral disc herniation is significantly superior to non-imaging, anatomical landmark-guided infiltration, regarding the parameters investigated. The high number of treatment failures in the non-imaging group underlines the inferiority of this treatment concept.

Treatment of maternal syphilis in rural South Africa: effect of multiple doses of benzathine penicillin on pregnancy loss

OBJECTIVES Despite few data, the treatment of syphilis in pregnant women using a single dose of benzathine penicillin is the standard of care in many resource-poor settings. We examined the effect of various doses of benzathine penicillin on pregnancy loss among women with a positive Rapid Plasma Reagin (RPR) test result in a rural South African district. METHODS All pregnant women making their first antenatal care visit during pregnancy were screened for syphilis using the RPR test. Those testing positive were counselled to receive three weekly doses of benzathine penicillin, and received a partner notification card. Pregnancy outcomes were determined from facility records or home visits where necessary. RESULTS Of 8917 women screened, 1043 (12%) had reactive syphilis serology; of those with titre data available, 30% had titres of 1:8 or greater. While 41% (n = 430) of women received all three doses as counselled, 30% (n = 312) received only one dose, and 20% (n = 207) did not return to the clinic to receive treatment. Among the 947 women with pregnancy outcome data available, there were 17 miscarriages and 48 perinatal deaths observed. There was a strong trend towards reduced risk of pregnancy loss among women receiving multiple doses of penicillin (adjusted OR for perinatal mortality for each additional dose received, 0.63; 95% CI, 0.48-0.84). CONCLUSIONS While this association requires further investigation, these results suggest that there may be substantial benefit to providing multiple doses of benzathine penicillin to treat maternal syphilis in this setting.