Extended resection for thyroid disease has less operative morbidity than limited resection

BACKGROUND: Theodor Kocher, surgeon and Nobel laureate, has influenced thyroid surgery all over the world: his treatment for multinodular goiter-subtotal thyroidectomy-has been the "Gold Standard" for more than a century. However, based on a new understanding of molecular growth mechanisms in goitrogenesis, we set out to evaluate if a more extended resection yields better results. METHODS: Four thousand three hundred and ninety-four thyroid gland operations with 5,785 "nerves at risk" were prospectively analyzed between 1972 and 2002. From 1972 to 1990, the limited Kocher resections were performed, and from 1991 to 2002 a more radical resection involving at least a hemithyroidectomy was performed. RESULTS: The incidence of postoperative nerve palsy was 3.6%; in the first study period and 0.9%; in the second (P < 0.001, Fisher's exact). Postoperative hypoparathyroidism decreased from 3.2%; in the first period to 0.64%; in the second (P < 0.01). The rate of reoperation for recurrent disease was 11.1%; from 1972 to 1990 and 8.5%; from 1991 to 2002 (P < 0.01). CONCLUSIONS: Extended resection for multinodular goiter not only significantly reduced morbidity, but also decreased the incidence of operations for recurrent disease. Our findings in a large cohort corroborate the suggestions that Kocher's approach should be replaced by a more radical resection, which actually was his original intention more than 130 years ago.

Thermographie zur Temperaturmessung beim Laser-Sintern – ein Beitrag zur Qualitätssicherung?

Beim Laser-Sintern wird das Pulverbett durch Heizstrahler vorgeheizt, um an der Pulveroberfläche eine Temperatur knapp unterhalb des Materialschmelzpunktes zu erzielen. Dabei soll die Temperaturverteilung auf der Oberfläche möglichst homogen sein, um gleiche Bauteileigenschaften im gesamten Bauraum zu erzielen und den Bauteilverzug gering zu halten. Erfahrungen zeigen jedoch sehr inhomogene Temperaturverteilungen, weshalb oftmals die Integration von neuen oder optimierten Prozessüberwachungssystemen in die Anlagen gefordert wird. Ein potentiell einsetzbares System sind Thermographiekameras, welche die flächige Aufnahme von Oberflächentemperaturen und somit Aussagen über die Temperaturen an der Pulverbettoberfläche erlauben. Dadurch lassen sich kalte Bereiche auf der Oberfläche identifizieren und bei der Prozessvorbereitung berücksichtigen. Gleichzeitig ermöglicht die Thermografie eine Beobachtung der Temperaturen beim Lasereingriff und somit das Ableiten von Zusammenhängen zwischen Prozessparametern und Schmelzetemperaturen. Im Rahmen der durchgeführten Untersuchungen wurde ein IR-Kamerasystem erfolgreich als Festeinbau in eine Laser-Sinteranlage integriert und Lösungen für die hierbei auftretenden Probleme erarbeitet. Anschließend wurden Untersuchungen zur Temperaturverteilung auf der Pulverbettoberfläche sowie zu den Einflussfaktoren auf deren Homogenität durchgeführt. In weiteren Untersuchungen wurden die Schmelzetemperaturen in Abhängigkeit verschiedener Prozessparameter ermittelt. Auf Basis dieser Messergebnisse wurden Aussagen über erforderliche Optimierungen getroffen und die Nutzbarkeit der Thermografie beim Laser-Sintern zur Prozessüberwachung, -regelung sowie zur Anlagenwartung als erster Zwischenstand der Untersuchungen bewertet.

Fukushima Effects on Media Coverage and Attitudes in Germany

The paper examines the question, in how far Fukushima caused changes in the media coverage and the public opinion about nuclear power in Germany. To answer this question we used two methods, content analysis and survey. Firstly we analysed data from a quantitative content analyses to examine changes in the media coverage about nuclear power between 2010 and 2011. The first investigation period lasted from 10.07.2010 to 04.09.2010, immediately before the German Bundestag vote for the lifetime extension of nuclear power stations. The second investigation period covered the first two months of media coverage after Fukushima from 12.03.2011 to 16.5.2011. Secondly our data consist of a representative telephone panel survey (n=341). As the first wave was carried out from 16.8.2010 to 06.9.2010 and the second wave from 15.5.2011 to 04.06.2011 these data set gives us the unique possibility to investigate attitude changes about nuclear power on the individual level.

Impact of Team Familiarity in the Operating Room on Surgical Complications

BACKGROUND: The quality of surgical performance depends on the technical skills of the surgical team as well as on non-technical skills, including teamwork. The present study evaluated the impact of familiarity among members of the surgical team on morbidity in patients undergoing elective open abdominal surgery. METHODS: A retrospective analysis was performed to compare the surgical outcomes of patients who underwent major abdominal operations between the first month (period I) and the last month (period II) of a 6-month period of continuous teamwork (stable dyads of one senior and one junior surgeon formed every 6 months). Of 117 patients, 59 and 58 patients underwent operations during period I and period II, respectively, between January 2010 and June 2012. Team performance was assessed via questionnaire by specialized work psychologists; in addition, intraoperative sound levels were measured. RESULTS: The incidence of overall complications was significantly higher in period I than in period II (54.2 vs. 34.5 %; P = 0.041). Postoperative complications grade <3 were significantly more frequently diagnosed in patients who had operations during period I (39.0 vs. 15.5 %; P = 0.007), whereas no between-group differences in grade ≥3 complications were found (15.3 vs. 19.0 %; P = 0.807). Concentration scores from senior surgeons were significantly higher in period II than in period I (P = 0.033). Sound levels during the middle third part of the operations were significantly higher in period I (median above the baseline 8.85 dB [range 4.5-11.3 dB] vs. 7.17 dB [5.24-9.43 dB]; P < 0.001). CONCLUSIONS: Team familiarity improves team performance and reduces morbidity in patients undergoing abdominal surgery.

The impact of a register on the management of neonatal cooling in Switzerland.

BACKGROUND Therapeutic hypothermia following hypoxic ischaemic encephalopathy in term infants was introduced into Switzerland in 2005. Initial documentation of perinatal and resuscitation details was poor and neuromonitoring insufficient. In 2011, a National Asphyxia and Cooling Register was introduced. AIMS To compare management of cooled infants before and after introduction of the register concerning documentation, neuromonitoring, cooling methods and evaluation of temperature variability between cooling methods. STUDY DESIGN Data of cooled infants before the register was in place (first time period: 2005-2010) and afterwards (second time period: 2011-2012) was collected with a case report form. RESULTS 150 infants were cooled during the first time period and 97 during the second time period. Most infants were cooled passively or passively with gel packs during both time periods (82% in 2005-2010 vs 70% in 2011-2012), however more infants were cooled actively during the second time period (18% versus 30%). Overall there was a significant reduction in temperature variability (p < 0.001) comparing the two time periods. A significantly higher proportion of temperature measurements within target temperature range (72% versus 77%, p < 0.001), fewer temperature measurements above (24% versus 7%, p < 0.001) and more temperatures below target range (4% versus 16%, p < 0.001) were recorded during the second time period. Neuromonitoring improved after introduction of the cooling register. CONCLUSION Management of infants with HIE improved since introducing the register. Temperature variability was reduced, more temperature measurements in the target range and fewer temperature measurements above target range were observed. Neuromonitoring has improved, however imaging should be performed more often.

Seawater carbonate chemistry and MgCO3 concentration in bryozoan Myriapora truncata branches during experiments, 2011

There are serious concerns that ocean acidification will combine with the effects of global warming to cause major shifts in marine ecosystems, but there is a lack of field data on the combined ecological effects of these changes due to the difficulty of creating large-scale, long-term exposures to elevated CO2 and temperature. Here we report the first coastal transplant experiment designed to investigate the effects of naturally acidified seawater on the rates of net calcification and dissolution of the branched calcitic bryozoan Myriapora truncata (Pallas, 1766). Colonies were transplanted to normal (pH 8.1), high (mean pH 7.66, minimum value 7.33) and extremely high CO2 conditions (mean pH 7.43, minimum value 6.83) at gas vents off Ischia Island (Tyrrhenian Sea, Italy). The net calcification rates of live colonies and the dissolution rates of dead colonies were estimated by weighing after 45 days (May-June 2008) and after 128 days (July-October) to examine the hypothesis that high CO2 levels affect bryozoan growth and survival differently during moderate and warm water conditions. In the first observation period, seawater temperatures ranged from 19 to 24 °C; dead M. truncata colonies dissolved at high CO2 levels (pH 7.66), whereas live specimens maintained the same net calcification rate as those growing at normal pH. In extremely high CO2 conditions (mean pH 7.43), the live bryozoans calcified significantly less than those at normal pH. Therefore, established colonies of M. truncata seem well able to withstand the levels of ocean acidification predicted in the next 200 years, possibly because the soft tissues protect the skeleton from an external decrease in pH. However, during the second period of observation a prolonged period of high seawater temperatures (25-28 °C) halted calcification both in controls and at high CO2, and all transplants died when high temperatures were combined with extremely high CO2 levels. Clearly, attempts to predict the future response of organisms to ocean acidification need to consider the effects of concurrent changes such as the Mediterranean trend for increased summer temperatures in surface waters. Although M. truncata was resilient to short-term exposure to high levels of ocean acidification at normal temperatures, our field transplants showed that its ability to calcify at higher temperatures was compromised, adding it to the growing list of species now potentially threatened by global warming.

Long-term eddy-covariance measurements from FINO2 platform above the Baltic Sea

The estimation of the carbon dioxide (CO2) fluxes above the open ocean plays an important role for the determination of the global carbon cycle. A frequently used method therefore is the eddy-covariance technique, which is based on the theory of the Prandl-layer with height-constant fluxes in the atmospheric boundary layer. To test the assumption of the constant flux layer, in 2008 measurements of turbulent heat and CO2 fluxes were started within the project Surface Ocean Processes in the Anthropocene (SOPRAN) at the research platform FINO2. The FINO2 platform is situated in the South-west of the Baltic Sea, in the tri-border region between Germany, Denmark, and Sweden. In the frame of the Research project SOPRAN, the platform was equipped with additional sensors in June 2008. A combination of 3-component sonic anemometers (USA-1) and open-path infrared gas analyzers for absolute humidity (H2O) and CO2 (LICOR 7500) were installed at a 9m long boom directed southward of the platform in two heights, at 6.8 and 13.8m above sea surface. Additionally slow temperature and humidity sensors were installed at each height. The gas analyzer systems were calibrated before the installation and worked permanently without any calibration during the first measurement period of one and a half years. The comparison with the measurements of the slow sensors showed for both instruments no significant long-term drift in H2O and CO2. Drifts on smaller time scales (in the order of days) due to the contamination with sea salt, were cleaned naturally by rain. The drift of both quantities had no influence on the fluctuation, which, in contrast to the mean values, are important for the flux estimation. All data were filtered due to spikes, rain, and the influence of the mast. The data set includes the measurements of all sensors as average over 30 minutes each for one and a half years, June 2008 to December 2009, and 10 month from November 2011 to August 2012. Additionally derived quantities for 30 minutes intervals each, like the variances for the fast-sensor variables, as well as the momentum, sensible and latent heat, and CO2 flux are presented.

Dinoflagellate cyst counts of ODP Site 1081, Benguela Upwelling, Miocene-Pliocene

Using the Late Miocene to Pliocene organic-walled dinoflagellate cyst record of ODP Site 1081 we reconstruct and discuss the early upwelling history over the Walvis Ridge with a special focus on the movement of the Angola-Benguela Front (ABF). We suggest that during the Late Miocene the Angola Current flowed southwards over the Walvis Ridge more frequently than today because the ABF was probably located further south as a result of a weaker meridional temperature gradient. A possible strengthening of the meridional gradient during the latest Miocene to early Pliocene in combination with uplift of south-western Africa intensified the upwelling along the coast and increased the upwelling's filaments over the Walvis Ridge. An intermediate period from 6.2 to 5.5 Ma is shown by the dominance of Habibacysta tectata, cysts of a cool-tolerant dinoflagellate known from the northern Atlantic, indicating changing oceanic conditions contemporaneous with the Messinian Salinity Crisis. From 4.3 Ma on, the upwelling signal got stronger again and waters were well-mixed and nutrient-rich. Our results indicate a northward migration of the ABF as early as 7 Ma and the initial stepwise intensification of the BUS.

Growth data from a field trial of Quercus suber plants regenerated from selected trees and their half-sib progenies by somatic embryogenesis

The development of reliable clonal propagation technologies is a requisite for performing Multi-Varietal Forestry (MVF). Somatic embryogenesis is considered the tissue culture based method more suitable for operational breeding of forest trees. Vegetative propagation is very difficult when tissues are taken from mature donors, making clonal propagation of selected trees almost impossible. We have been able to induce somatic embryogenesis in leaves taken from mature oak trees, including cork oak (Quercus suber). This important species of the Mediterranean ecosystem produces cork regularly, conferring to this species a significant economic value. In a previous paper we reported the establishment of a field trial to compare the growth of plants of somatic origin vs zygotic origin, and somatic plants from mature trees vs somatic plants from juvenile seedlings. For that purpose somatic seedlings were regenerated from five selected cork oak trees and from young plants of their half-sib progenies by somatic embryogenesis. They were planted in the field together with acorn-derived plants of the same families. After the first growth period, seedlings of zygotic origin doubled the height of somatic seedlings, showing somatic plants of adult and juvenile origin similar growth. Here we provide data on height and diameter increases after two additional growth periods. In the second one, growth parameters of zygotic seedlings were also significantly higher than those of somatic ones, but there were not significant differences in height increase between seedlings and somatic plants of mature origin. In the third growth period, height and diameter increases of somatic seedlings cloned from the selected trees did not differ from those of zygotic seedlings, which were still higher than data from plants obtained from somatic embryos from the sexual progeny. Therefore, somatic seedlings from mature origin seem not to be influenced by a possible ageing effect, and plants from somatic embryos tend to minimize the initial advantage of plants from acorns

Analysis of advanced European nuclear fuel cycle scenarios including transmutation and economic estimates

Four European fuel cycle scenarios involving transmutation options (in coherence with PATEROS and CPESFR EU projects) have been addressed from a point of view of resources utilization and economic estimates. Scenarios include: (i) the current fleet using Light Water Reactor (LWR) technology and open fuel cycle, (ii) full replacement of the initial fleet with Fast Reactors (FR) burning U?Pu MOX fuel, (iii) closed fuel cycle with Minor Actinide (MA) transmutation in a fraction of the FR fleet, and (iv) closed fuel cycle with MA transmutation in dedicated Accelerator Driven Systems (ADS). All scenarios consider an intermediate period of GEN-III+ LWR deployment and they extend for 200 years, looking for long term equilibrium mass flow achievement. The simulations were made using the TR_EVOL code, capable to assess the management of the nuclear mass streams in the scenario as well as economics for the estimation of the levelized cost of electricity (LCOE) and other costs. Results reveal that all scenarios are feasible according to nuclear resources demand (natural and depleted U, and Pu). Additionally, we have found as expected that the FR scenario reduces considerably the Pu inventory in repositories compared to the reference scenario. The elimination of the LWR MA legacy requires a maximum of 55% fraction (i.e., a peak value of 44 FR units) of the FR fleet dedicated to transmutation (MA in MOX fuel, homogeneous transmutation) or an average of 28 units of ADS plants (i.e., a peak value of 51 ADS units). Regarding the economic analysis, the main usefulness of the provided economic results is for relative comparison of scenarios and breakdown of LCOE contributors rather than provision of absolute values, as technological readiness levels are low for most of the advanced fuel cycle stages. The obtained estimations show an increase of LCOE ? averaged over the whole period ? with respect to the reference open cycle scenario of 20% for Pu management scenario and around 35% for both transmutation scenarios. The main contribution to LCOE is the capital costs of new facilities, quantified between 60% and 69% depending on the scenario. An uncertainty analysis is provided around assumed low and high values of processes and technologies.

Carbon Market Opportunities in Southern Mediterranean Countries. MEDPRO Technical Report No. 8/March 2012

To date, Southern Mediterranean countries have hosted a limited number of projects under the Clean Development Mechanism (CDM). There are three challenges to the participation of middleincome countries in future carbon markets: the limited size of future demand for offsets or credits; restrictions on the use of CDM credits in Phase III of the EU Emissions Trading Scheme; and the lack of prompt preparation for the start of new market-based mechanisms. This study examines existing and emerging activities in Southern Mediterranean countries that could fit into new market based mechanisms. It explores options for the evolution of mechanisms and discusses the merits of post-2012 carbon funds in bridging the gap between the end of the first commitment period of the Kyoto Protocol and the entry into force of a new international agreement.

Laws of New Hampshire : including public and private acts and resolves and the royal commissions and instructions, with historical and descriptive notes, and an appendix.

Vol. 4 : with an appendix embracing the journal of the committee of study.

Digenean trematodes infecting the tropical abalone Haliotis asinina have species-specific cercarial emergence patterns that follow daily or semilunar spawning cycles

Approximately 1-2% of the tropical abalone Haliotis asinina inhabiting Heron Island Reef are infected with opecoelid digeneans. These largely inhabit the haemocoel surrounding the cerebral ganglia and digestive gland-gonad complex, and infected abalone typically have significantly reduced or ablated gonads. Observations of infected abalone reveal two distinct cercarial emergence patterns, one which correlates tightly with the abalone's highly regular and synchronous fortnightly spawning cycle, and the other which occurs in a circadian pattern. The former appears to be a novel emergence strategy not previously observed in digeneans. While the cercariae in all abalone are morphologically indistinguishable, comparison of sequences from the internal transcribed spacer 2 (ITS 2) region of the ribosomal DNA reveals a 5.7% difference between cercariae displaying different emergence patterns, indicating these are two distinct species that probably belong to the same genus. The ITS 2 sequences of the species with the daily emergence pattern are identical to that of an undescribed adult opecoelid from the gut of the barramundi cod, Cromileptes altivelis. Combined molecular, morphological and emergence data suggest that while these opecoelid cercariae use the same first intermediate host and are closely related species-members of the genus Allopodocotyle-they fill different ecological niches that are likely to include different definitive hosts.

Erosion-corrosion of mild steel in hot caustic. Part II: The effect of acid cleaning

Corrosion rates of 1020 steel in 2.75 M NaOH solution at a temperature of 160 degrees C and velocities of 0.32 and 2.5 m/s were studied. The focus was on the effect of the acid cleaning which was performed by using strong, inhibited sulphuric acid in between the exposures to caustic. In situ electrochemical methods were used to measure the corrosion rate such as the potentiodynamic sweep and the polarization resistance method. Also used were the weight-loss method and scanning electron microscopy (SEM). Eight electrodes/coupons were used to monitor the metal loss rate, four were placed at the low velocity section, while the other four were placed in the high velocity section of a high temperature flow. The first three coupons in each section were placed within the disturbed flow region, while the fourth was placed in a fully developed flow region. During the exposure of mild steel to the inhibited acid, following the first caustic period, the corrosion rate increased significantly to between 3 and 10mm/y with a few electrodes experiencing as high as 50 mm/y. The second caustic period following the acidic period typically started with very high corrosion rates (20-80 mm/y). The length of this corrosion period was typically 2-3 h with a few exceptions when the high corrosion period lasted 7-10 h. Following the very high corrosion rates experienced at the beginning of the second caustic period, the corrosion rates were reduced sharply (as the corrosion potential increased) to nearly the same levels as those observed during the passive part of the first caustic period. (c) 2005 Elsevier Ltd. All rights reserved.

Seawater carbonate chemistry and biological processes duirng experiments with bryozoan Myriapora truncata, 2010

There are serious concerns that ocean acidification will combine with the effects of global warming to cause major shifts in marine ecosystems, but there is a lack of field data on the combined ecological effects of these changes due to the difficulty of creating large-scale, long-term exposures to elevated CO2 and temperature. Here we report the first coastal transplant experiment designed to investigate the effects of naturally acidified seawater on the rates of net calcification and dissolution of the branched calcitic bryozoan Myriapora truncata (Pallas, 1766). Colonies were transplanted to normal (pH 8.1), high (mean pH 7.66, minimum value 7.33) and extremely high CO2 conditions (mean pH 7.43, minimum value 6.83) at gas vents off Ischia Island (Tyrrhenian Sea, Italy). The net calcification rates of live colonies and the dissolution rates of dead colonies were estimated by weighing after 45 days (May-June 2008) and after 128 days (July-October) to examine the hypothesis that high CO2 levels affect bryozoan growth and survival differently during moderate and warm water conditions. In the first observation period, seawater temperatures ranged from 19 to 24 °C; dead M. truncata colonies dissolved at high CO2 levels (pH 7.66), whereas live specimens maintained the same net calcification rate as those growing at normal pH. In extremely high CO2 conditions (mean pH 7.43), the live bryozoans calcified significantly less than those at normal pH. Therefore, established colonies of M. truncata seem well able to withstand the levels of ocean acidification predicted in the next 200 years, possibly because the soft tissues protect the skeleton from an external decrease in pH. However, during the second period of observation a prolonged period of high seawater temperatures (25-28 °C) halted calcification both in controls and at high CO2, and all transplants died when high temperatures were combined with extremely high CO2 levels. Clearly, attempts to predict the future response of organisms to ocean acidification need to consider the effects of concurrent changes such as the Mediterranean trend for increased summer temperatures in surface waters. Although M. truncata was resilient to short-term exposure to high levels of ocean acidification at normal temperatures, our field transplants showed that its ability to calcify at higher temperatures was compromised, adding it to the growing list of species now potentially threatened by global warming.