A New Use for the Amplatzer Duct Occluder Device

We report a case in which the Amplatzer device for percutaneous occlusion of ductus arteriosus was successfully used for occluding a large systemic-pulmonary collateral vessel in a patient who had previously undergone surgery for correction of pulmonary atresia and ventricular septal defect (Rastelli technique), and was awaiting the change of a cardiac tube. In the first attempt, the device embolized to the distal pulmonary bed and, after being rescued with a Bitome, it was appropriately repositioned with no complications and with total occlusion of the vessel.

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Musculoskeletal disorders (MSD) are the most prevalent pain disorders in industrialized countries, and their costs can represent up to 2% of gross national product. MSD are often work associated and recurrent and may lead to disability. In occupational health we are interested in the opposite process : in the return to work (RTW). Different models of disability and RTW exist with different conceptions of psychosocial factors. We therefore propose to analyze the influence of factors from work, patient, health care providers, and broader societal domains along the different phases of the MSD process, adopting a biopsychosocial approach. The analysis of risk factors for the different phases of MSD indicate that work stress factors have an impact on the occurrence of MSD and RTW with MSD, but their effect is low to moderate and nonspecific. Physical work demands, work place adaptation, and pain experience are much stronger predictors of RTW. Lack of modified or adapted work is one of the major factors that hinder RTW. The longer the pain lasts, the longer the patient is out of work, the more personal factors and broader context factors become dominant. There is a clear lack of RTW studies concerning neck and upper limb pain. MSD and especially chronic MSD should be viewed as public health concerns, implying a wider socio-economic and insurance and disability problem. Adequate medical support tailored to the different dimensions and phases of MSD must be on offer, and work accommodations must be promoted and supported.

Nosocomial Outbreak of Infection With Pan-Drug-Resistant Acinetobacter baumannii in a Tertiary Care University Hospital

OBJECTIVE To describe what is, to our knowledge, the first nosocomial outbreak of infection with pan-drug-resistant (including colistin-resistant) Acinetobacter baumannii, to determine the risk factors associated with these types of infections, and to determine their clinical impact. DESIGN Nested case-control cohort study and a clinical-microbiological study. SETTING A 1,521-bed tertiary care university hospital in Seville, Spain. PATIENTS Case patients were inpatients who had a pan-drug-resistant A. baumannii isolate recovered from a clinical or surveillance sample obtained at least 48 hours after admission to an intensive care unit (ICU) during the time of the epidemic outbreak. Control patients were patients who were admitted to any of the "boxes" (ie, rooms that partition off a distinct area for a patient's bed and the equipment needed to care for the patient) of an ICU for at least 48 hours during the time of the epidemic outbreak. RESULTS All the clinical isolates had similar antibiotic susceptibility patterns (ie, they were resistant to all the antibiotics tested, including colistin), and, on the basis of repetitive extragenic palindromic-polymerase chain reaction, it was determined that all of them were of the same clone. The previous use of quinolones and glycopeptides and an ICU stay were associated with the acquisition of infection or colonization with pan-drug-resistant A. baumannii. To control this outbreak, we implemented the following multicomponent intervention program: the performance of environmental decontamination of the ICUs involved, an environmental survey, a revision of cleaning protocols, active surveillance for colonization with pan-drug-resistant A. baumannii, educational programs for the staff, and the display of posters that illustrate contact isolation measures and antimicrobial use recommendations. CONCLUSIONS We were not able to identify the common source for these cases of infection, but the adopted measures have proven to be effective at controlling the outbreak.

Evolution of a debris flow channel monitored using a 3D terrestrial laser scanner

Like numerous torrents in mountainous regions, the Illgraben creek (canton of Wallis, SW Switzerland) produces almost every year several debris flows. The total area of the active catchment is only 4.7 km², but large events ranging from 50'000 to 400'000 m³ are common (Zimmermann 2000). Consequently, the pathway of the main channel often changes suddenly. One single event can for instance fill the whole river bed and dig new several-meters-deep channels somewhere else (Bardou et al. 2003). The quantification of both, the rhythm and the magnitude of these changes, is very important to assess the variability of the bed's cross section and long profile. These parameters are indispensable for numerical modelling, as they should be considered as initial conditions. To monitor the channel evolution an Optech ILRIS 3D terrestrial laser scanner (LIDAR) was used. LIDAR permits to make a complete high precision 3D model of the channel and its surroundings by scanning it from different view points. The 3D data are treated and interpreted with the software Polyworks from Innovmetric Software Inc. Sequential 3D models allow for the determination of the variation in the bed's cross section and long profile. These data will afterwards be used to quantify the erosion and the deposition in the torrent reaches. To complete the chronological evolution of the landforms, precise digital terrain models, obtained by high resolution photogrammetry based on old aerial photographs, will be used. A 500 m long section of the Illgraben channel was scanned on 18th of August 2005 and on 7th of April 2006. These two data sets permit identifying the changes of the channel that occurred during the winter season. An upcoming scanning campaign in September 2006 will allow for the determination of the changes during this summer. Preliminary results show huge variations in the pathway of the Illgraben channel, as well as important vertical and lateral erosion of the river bed. Here we present the results of a river bank on the left (north-western) flank of the channel (Figure 1). For the August 2005 model the scans from 3 viewpoints were superposed, whereas the April 2006 3D image was obtained by combining 5 separate scans. The bank was eroded. The bank got eroded essentially on its left part (up to 6.3 m), where it is hit by the river and the debris flows (Figures 2 and 3). A debris cone has also formed (Figure 3), which suggests that a part of the bank erosion is due to shallow landslides. They probably occur when the river erosion creates an undercut slope. These geometrical data allow for the monitoring of the alluvial dynamics (i.e. aggradation and degradation) on different time scales and the influence of debris flows occurrence on these changes. Finally, the resistance against erosion of the bed's cross section and long profile will be analysed to assess the variability of these two key parameters. This information may then be used in debris flow simulation.

La réhabilitation psychosociale a l'aube du XXIème siècle. I: Principes, population cible et pathologie en cause

The relatively recent development of the psychosocial rehabilitation has its origins mainly in the progress of modern psychopharmacology, the assertion of the rights of the patients and the result of the studies showing that the evolution of persons suffering from severe and persistent mental illnesses can prove to be positive in many cases. In spite of the heterogeneity of the experiences and of the theoretical references, the core principles of the psychosocial rehabilitation imposed themselves. These principles can be classified according to three levels, that of relational ethics, that of the method of intervention and that of the institutional device. A recent study showed that 2.4@1000 of the general adult population of the Canton of Vaud live in sociotherapeutic and rehabilitation accommodations. In this sample, there is a important percentage of relatively young persons (55.3% are under 40). In institutional accommodation there is a majority of patients suffering from major personality disorders and addiction (40.6%), followed by psychotic disorders (37.2%), persistent mood disorders (12.3%), neurotic disorders (6.6%) and psycho-organic disorders (3.3%). In home based rehabilitation, the ratio of patients with psychotic disorders is more important (53.1%). This difference would indicate that people with schizophrenia would have a better social outcome than personality disorders with addiction

Postmortem whole-body CT angiography: evaluation of two contrast media solutions.

OBJECTIVE: The objective of our study was to establish a standardized procedure for postmortem whole-body CT-based angiography with lipophilic and hydrophilic contrast media solutions and to compare the results of these two methods. MATERIALS AND METHODS: Minimally invasive postmortem CT angiography was performed on 10 human cadavers via access to the femoral blood vessels. Separate perfusion of the arterial and venous systems was established with a modified heart-lung machine using a mixture of an oily contrast medium and paraffin (five cases) and a mixture of a water-soluble contrast medium with polyethylene glycol (PEG) 200 in the other five cases. Imaging was executed with an MDCT scanner. RESULTS: The minimally invasive femoral approach to the vascular system provided a good depiction of lesions of the complete vascular system down to the level of the small supplying vessels. Because of the enhancement of well-vascularized tissues, angiography with the PEG-mixed contrast medium allowed the detection of tissue lesions and the depiction of vascular abnormalities such as pulmonary embolisms or ruptures of the vessel wall. CONCLUSION: The angiographic method with a water-soluble contrast medium and PEG as a contrast-agent dissolver showed a clearly superior quality due to the lack of extravasation through the gastrointestinal vascular bed and the enhancement of soft tissues (cerebral cortex, myocardium, and parenchymal abdominal organs). The diagnostic possibilities of these findings in cases of antemortem ischemia of these tissues are not yet fully understood.

Iowa Canoe Trips, 1971.

Describes several canoe trips available in Iowa on streams and rivers classed as non-meandered waterways, meaning the stream bed and all adjacent lands to these waterways are the property of landowners whose land the water flows.

Aportació a l'estudi dels herbassars higronitròfils (Al. Sylibo-Urticion) dels trams finals dels rius Besòs i Llobregat

Artemisio annuae-Conietum maculati ass. nova is described from the lower valley of Llobregat and Besòs rivers. Communities of this association, which is included into the Silybo-Urticion Sissingh 1950 alliance, are hygronitrophilous meadows up to 3 m high and more than 80% of vegetation cover. They are commonly restricted to the river bed and are made up almost exclussively by therophytes and hemicryptophytes. However, the mostcharacteristic trend of these herbaceous communities is the abundance of neophytes, which stand for 20% of the species but close to 50% of vegetation cover. Several widespread neophytes such as Aster squamatus, Conyza spp., Xanthium spp. are commonly found in these communities, and other rare aliens such as Artemisia annua, Rumex cristatus and R. palustris have recently been recorded. Ecological implications of the neophyte abundance in these communities are discussed in relation to the role of human disturbance and population biology of alien species in general.

Flow resistance equations for mountain rivers

Three models of flow resistance (a Keulegan-type logarithmic law and two models developed for large-scale roughness conditions: the full logarithmic law and a model based on an inflectional velocity profile) were calibrated, validated and compared using an extensive database (N = 1,533) from rivers and flumes, representative of a wide hydraulic and geomorphologic range in the field of gravel-bed and mountain channels. It is preferable to apply the model based on an inflectional velocity profile in the relative submergence (y/d90) interval between 0.5 and 15, while the full logarithmic law is preferable for values below 0.5. For high relative submergence, above 15, either the logarithmic law or the full logarithmic law can be applied. The models fitted to the coarser percentiles are preferable to those fitted to the median diameter, owing to the higher explanatory power achieved by setting a model, the smaller difference in the goodness-of-fit between the different models and the lower influence of the origin of the data (river or flume).

Kuplivan leijukerroksen poltto- ja lämpötekninen tarkastelu

Työn tavoitteena oli luoda menetelmä leijukerroskattilan petin lämpötilojen ja toiminta-alueen arvioimiseksi annetuilla lähtötiedoilla. Toimintatapana oli tutkia polttoaineen ominaisuuksien ja kattilan geometrian vaikutuksia petin energiataseeseen ja tätä kautta petin lämpötilaan kattilan ajotapa huomioiden. Työn teoriaosassa esitellään aluksi biopolttoaineiden ominaisuuksia ja leijukerroskattilan toimintaa petin toimintaympäristön selvittämiseksi. Teoriaosan lopussa käsitellään perusteellisesti petin hydrodynamiikkaa ja reaktiokinettikkaa sekä petin alueen mekaanista mitoitusta. Lisäksi polttoaineen syöttötapa ja palaminen petissä tuodaan esille. Tutkimusosassa selvitetään petin energiatasemallin määrittämistä teoriaan ja diplomityön aikana eri kattiloilla suoritettuihin mittauksiin perustuen. Mittauksista on erillinen selvitys seitsemännessä kappaleessa. Lopuksi kuvaillaan petin energiatasetta mallintavan menetelmän toimintaa sekä siihen syötettäviä lähtötietoja. Tuloksena on saatu suppealla alueella toimiva laajennettavissa oleva petin energiataseen malli. Menetelmän testaamiseen käytetään mittaustietoa kahdelta kattilalta, joita ei olla käytetty petin energiatasemallin virityksessä.

Using computational fluid dynamics to predict head losses in the auxiliary elements of a microirrigation sand filter

It is often assumed that total head losses in a sand filter are solely due to the filtration media and that there are analytical solutions, such as the Ergun equation, to compute them. However, total head losses are also due to auxiliary elements (inlet and outlet pipes and filter nozzles), which produce undesirable head losses because they increase energy requirements without contributing to the filtration process. In this study, ANSYS Fluent version 6.3, a commercial computational fluid dynamics (CFD) software program, was used to compute head losses in different parts of a sand filter. Six different numerical filter models of varying complexities were used to understand the hydraulic behavior of the several filter elements and their importance in total head losses. The simulation results show that 84.6% of these were caused by the sand bed and 15.4% were due to auxiliary elements (4.4% in the outlet and inlet pipes, and 11.0% in the perforated plate and nozzles). Simulation results with different models show the important role of the nozzles in the hydraulic behavior of the sand filter. The relationship between the passing area through the nozzles and the passing area through the perforated plate is an important design parameter for the reduction of total head losses. A reduced relationship caused by nozzle clogging would disproportionately increase the total head losses in the sand filter

Los domos graníticos de la Cuenca del Ridaura (Girona)

Se describen los domos graníticos de la cuenca del río Ridaura. Sus caraterísticas geométricas se relacionan estrechamente con la disposición de las fracturas. Su génesis deriva de una fase subsuperficial, bajo un manto de alteración, presumiblemente desarrollada durante el Plioceno, y una fase de exhumación torrencial, que comprende desde el Plioceno terminal hasta la actualidad

Muutosilmiöt soodakattilakeossa

Soodakattilan sulakeon epästationaarinen käyttäytyminen sekä keon pitkä jäähtymisaika alasajon jälkeen ovat aiheuttaneet ongelmia kattilan taloudellisessa käytettävyydessä. Keon käyttäytymisestä on luotu CFD-malleja, joiden tavoitteena on havainnollistaa keon lämpötilajakaumaa ja rakennetta. Mallien ongelmana on se, että niissä huomioidaan vain keon aktiivinen pintakerros. Keon sisäosan rakennetta ja siinä tapahtuvia prosesseja ei toistaiseksi tunneta kunnolla luotettavan, koko keon kattavan mallin luomiseen. Tässä työssä tutkittiin sulakeon käytön aikana havaittuja muutosilmiöitä, jotka vaikuttavat keon rakenteeseen ja ominaisuuksiin sekä tutkittiin ilmiöiden taustalla olevia tekijöitä. Näitä tekijöitä ovat keon sisässä tapahtuvat kemialliset ja fyysiset prosessit, jotka aiheuttavat muutoksia niin lämpöteknisesti kuin fyysisesti sekä ulkoapäin tulevat tekijät, jotka aiheutuvat ajotilanteiden seurauksena tapahtuvista muutoksista. Työn kokeellisena osana luotiin sulakeon jäähtymismalli käyttäen 1-dimensionaalista ADL-mallia. Mallin pohjana käytettiin StoraEnso Oy:ltä Oulun soodakattilan sulakeosta saatua mittausraporttia. ADL-mallin avulla luotiin keon jäähtymiskäyrät lämpötilan ja syvyyden funktiona. Saadut käyrät täsmäsivät hyvin mittausraportin tuloksiin. Mallin avulla keolle saatiin muodostettua energiatase, jonka tuloksena keosta 12 tunnin aikana poistuva lämpövirta pinnalla oli noin 9.8kW/m2 ja pinnan lämmönsiirtokerroin 58.3W/m²°C. Pohjan poistuvaksi lämpövirraksi saatiin 14.1kW/m2 ja lämmönsiirtokertoimeksi 75.4W/m²°C. Termiseksi diffuusiokertoimeksi saatiin 3.9•10-7m²/s.

Diagnostiikkamenetelmät höyrykattilan leijukerroksen tilan ja käytettävyysongelmien tunnistamiseksi

Diplomityön tavoitteena oli tutkia höyrykattiloiden leijukerrosten käytettävyysongelmia ja kirjallisuudesta löytyvien diagnostiikkamenetelmien toimivuutta leijukerroksen tilan ja käytettävyysongelmien tunnistamiseksi. Diagnostiikkamenetelmien toimivuutta testattiin VTT:n kiertoleijukoelaitteen prosessimittauksiin perustuen. Analysoinnissa käytettiin prosessimittauksia, jotka ovat yleisesti käytössä energiantuotannon leijukerroskattiloissa. Analysoitavina koeajotapauksina olivat kylmäkokeet partikkelikokojakaumaltaan vaihtelevalle leijutusmateriaalille, tuhkapartikkelien aiheuttama petimateriaalin karkeneminen ja agglomeroituminen, sekä vaihtelevien ajoarvojen vaikutus leijukerroksen hydrodynaamiseen käyttäytymiseen. Kokeellisesta osiosta saaduista tuloksista selvisi leijutusilman tilavuusvirran, petimassan ja partikkelikoon vaikutus analysoitavaan prosessimittaukseen. Tuloksista oli havaittavissa myös kiertävän petimateriaalin ja pohjapedin osuuksien vaikutus mitattuun painesignaaliin. Petipartikkelien agglomeroitumisen ja karkenemisen todettiin lisäävän kiertoleijukoelaitteistossa nousuputken pohjapedin määrää suhteessa kiertävään petimateriaaliin, mikä voitiin havaita painemittauksista.

Model based analysis of the post-combustion calcium looping process for carbon dioxide capture

This thesis presents a one-dimensional, semi-empirical dynamic model for the simulation and analysis of a calcium looping process for post-combustion CO2 capture. Reduction of greenhouse emissions from fossil fuel power production requires rapid actions including the development of efficient carbon capture and sequestration technologies. The development of new carbon capture technologies can be expedited by using modelling tools. Techno-economical evaluation of new capture processes can be done quickly and cost-effectively with computational models before building expensive pilot plants. Post-combustion calcium looping is a developing carbon capture process which utilizes fluidized bed technology with lime as a sorbent. The main objective of this work was to analyse the technological feasibility of the calcium looping process at different scales with a computational model. A one-dimensional dynamic model was applied to the calcium looping process, simulating the behaviour of the interconnected circulating fluidized bed reactors. The model incorporates fundamental mass and energy balance solvers to semi-empirical models describing solid behaviour in a circulating fluidized bed and chemical reactions occurring in the calcium loop. In addition, fluidized bed combustion, heat transfer and core-wall layer effects were modelled. The calcium looping model framework was successfully applied to a 30 kWth laboratory scale and a pilot scale unit 1.7 MWth and used to design a conceptual 250 MWth industrial scale unit. Valuable information was gathered from the behaviour of a small scale laboratory device. In addition, the interconnected behaviour of pilot plant reactors and the effect of solid fluidization on the thermal and carbon dioxide balances of the system were analysed. The scale-up study provided practical information on the thermal design of an industrial sized unit, selection of particle size and operability in different load scenarios.