Increased rates of ENT surgery among young children: Have clinical guidelines made a difference?

Objectives: To examine the association between introduction of paediatric ear, nose and throat (ENT) surgery guidelines and population procedure rates. To determine changes in children's risk of undergoing ENT surgery. Methods: Trend analysis of incidence of myringotomy, tonsillectomy and adenoidectomy among New South Wales (NSW) children aged 0-14 between 1981 and mid 1999. Poisson regression models were used to estimate annual rates of change pre and postguidelines introduction and age/gender specific rates, and lifetable methods to determine risk of undergoing an ENT procedure by age 15. Results: ENT surgery rates increased by 21% over the study period. Children's risk of surgery increased from 17.9% in 1981 to 20.2% in 1998/99. Guideline introduction was associated with moderate short-term decreases in rates. For tonsillectomy, rates decreased between 1981 and 1983, but then rose continually until the introduction of myringotomy guidelines in 1993, when they fell, only to recommence rising until the end of the study period. For myringotomy, rates rose annually from 1981 to 1992/93 and fell in the 3 years following guideline introduction, after which they rose again. Increases were almost exclusively restricted to children aged 0-4 and correspond with increased use of formal childcare. The prevalence of myringotomy by the age of 5 years rose from 5.6% of children born in 1988/89 to 6.4% of those born in 1994/95, and the prevalence of tonsillectomy from 2.4% to 2.7%. Conclusions: The risk of young Australian children undergoing ENT surgery increased significantly over the last two decades despite the introduction of guidelines and no evidence of an increase in otitis media, one condition prompting surgery. Surgery increased most among the very young. We hypothesize this is related to increasing use of childcare.

Effectiveness Of The Endotracheal Tube Cuff On The Trachea: Physical And Mechanical Aspects.

The inflation pressure of the endotracheal tube cuff can cause ischemia of the tracheal mucosa at high pressures; thus, it can cause important tracheal morbidity and tracheal microaspiration of the oropharyngeal secretion, or it can even cause pneumonia associated with mechanical ventilation if the pressure of the cuff is insufficient. In order to investigate the effectiveness of the RUSCH® 7.5 mm endotracheal tube cuff, this study was designed to investigate the physical and mechanical aspects of the cuff in contact with the trachea. For this end, we developed an in vitro experimental model to assess the flow of dye (methylene blue) by the inflated cuff on the wall of the artificial material. We also designed an in vivo study with 12 Large White pigs under endotracheal intubation. We instilled the same dye in the oral cavity of the animals, and we analyzed the presence or not of leakage in the trachea after the region of the cuff after their deaths (animal sacrifice). All cuffs were inflated at the pressure of 30 cmH2O. We observed the passage of fluids through the cuff in all in vitro and in vivo experimental models. We conclude that, as well as several other cuff models in the literature, the RUSCH® 7.5 mm tube cuffs are also not able to completely seal the trachea and thus prevent aspiration of oropharyngeal secretions. Other prevention measures should be taken.

Human fallopian tube: a new source of multipotent adult mesenchymal stem cells discarded in surgical procedures

Background: The possibility of using stem cells for regenerative medicine has opened a new field of investigation. The search for sources to obtain multipotent stem cells from discarded tissues or through non-invasive procedures is of great interest. It has been shown that mesenchymal stem cells (MSCs) obtained from umbilical cords, dental pulp and adipose tissue, which are all biological discards, are able to differentiate into muscle, fat, bone and cartilage cell lineages. The aim of this study was to isolate, expand, characterize and assess the differentiation potential of MSCs from human fallopian tubes (hFTs). Methods: Lineages of hFTs were expanded, had their karyotype analyzed, were characterized by flow cytometry and underwent in vitro adipogenic, chondrogenic, osteogenic, and myogenic differentiation. Results: Here we show for the first time that hFTs, which are discarded after some gynecological procedures, are a rich additional source of MSCs, which we designated as human tube MSCs (htMSCs). Conclusion: Human tube MSCs can be easily isolated, expanded in vitro, present a mesenchymal profile and are able to differentiate into muscle, fat, cartilage and bone in vitro.

Flow boiling heat transfer of R134a and R245fa in a 2.3 mm tube

This paper presents new experimental flow boiling heat transfer results in micro-scale tubes. The experimental data were obtained in a horizontal 2.3 mm I.D stainless steel tube with heating length of 464 mm, R134a and R245fa as working fluids, mass velocities ranging from 50 to 700 kg m(-2) s(-1), heat flux from 5 to 55 kW m(-2), exit saturation temperatures of 22, 31 and 41 degrees C, and vapor qualities ranging from 0.05 to 0.99. Flow pattern characterization was also performed from images obtained by high-speed filming. Heat transfer coefficient results from 1 to 14 kW m(-2) K(-1) were measured. It was found that the heat transfer coefficient is a strong function of heat flux, mass velocity and vapor quality. The experimental data were compared against ten flow boiling predictive methods from the literature. Liu and Winterton [3], Zhang et al. [5] and Saitoh et al. [6] worked best for both fluids, capturing most of the experimental heat transfer trends. (C) 2010 Elsevier Ltd. All rights reserved.

Evaluation of the performance of biodiesel from waste vegetable oil in a flame tube furnace

This work presents a theoretical and experimental study of the biodiesel (ethyl ester from a waste vegetable oil) performance in a flame tube furnace. The heat transfer rate was analysed in several sections along the furnace and the performance of the biodiesel was compared to that of diesel oil. The flow of heat from the burn of each fuel in the direction of the walls of the combustion chamber was evaluated under the same fuel injection pressure. The peak of the heat transfer occurred around 0.45 m far from the fuel injection nozzle in a 0.305 m inner diameter combustion chamber. The diesel oil showed a higher heat transfer rate in most parts exposed to the flame. In the region where the body of the flame is not present, the heat transfer of biodiesel becomes higher. (C) 2008 Elsevier Ltd. All rights reserved.

Hybrid modeling of convective laminar flow in a permeable tube associated with the cross-flow process

The confined flows in tubes with permeable surfaces arc associated to tangential filtration processes (microfiltration or ultrafiltration). The complexity of the phenomena do not allow for the development of exact analytical solutions, however, approximate solutions are of great interest for the calculation of the transmembrane outflow and estimate of the concentration, polarization phenomenon. In the present work, the generalized integral transform technique (GITT) was employed in solving the laminar and permanent flow in permeable tubes of Newtonian and incompressible fluid. The mathematical formulation employed the parabolic differential equation of chemical species conservation (convective-diffusive equation). The velocity profiles for the entrance region flow, which are found in the connective terms of the equation, were assessed by solutions obtained from literature. The velocity at the permeable wall was considered uniform, with the concentration at the tube wall regarded as variable with an axial position. A computational methodology using global error control was applied to determine the concentration in the wall and concentration boundary layer thickness. The results obtained for the local transmembrane flux and the concentration boundary layer thickness were compared against others in literature. (C) 2007 Elsevier B.V. All rights reserved.

Characterization of the cold ductility degradation after aging in centrifugally cast 20Cr32Ni+Nb alloy tube

The mechanical properties (yield stress, ultimate tensile stress and elongation) of alloy 20Cr32Ni + Nb subject to isochronal aging at temperatures between 670 and 820 degrees C for 200 h were investigated using samples extracted from a centrifugally cast tube. The results confirm the occurrence of embrittlement in the aged samples, with maximum embrittlement observed around 770 degrees C without significant gain in strength. (C) 2008 Elsevier Ltd. All rights reserved.

Cracking of 2.25Cr-1.0Mo steel tube/stationary tube-sheet weldment of a heat-exchanger

The premature failure of a horizontal heat-exchanger, which occurred after service exposure at 580 degrees C for 50,000 h, revealed the occurrence of extensive through-thickness cracking in approximately 40% of the tube/stationary tube-sheet welds. Additionally, the internal surface of the welded joint featured intensive secondary intergranular cracking (up to 250 mu m deep), preferential formation of a 150 mu m thick layer of (Fe, Cr)(3)O-4 and internal intergranular oxidation (40 mu m deep). The welded region also showed intense carbon pick-up and, as consequence, severe precipitation of intergranular M7C3 and M23C6 carbides. The fracture surface was composed of two distinct regions: a ""planar"" region of 250 mu m, formed due to the stable crack growth along by the intergranular oxidation; and a slant region with radial marks, formed by the fast crack growth along the network of intergranular carbides. The association of intergranular oxidation pre-cracks with microstructural embrittlement promoted the premature failure, which took place by an overload mechanism, probably due to the jamming of the floating tube-sheet during the maintenance halt (cooling operation). (C) 2007 Elsevier Ltd. All rights reserved.

FLOW PROPERTIES AND TUBE FRICTION FACTOR OF MILK CREAM: INFLUENCE OF TEMPERATURE AND FAT CONTENT

The rheological behavior of milk cream was studied for different fat contents (0.10 to 0.31) and for a wide temperature range (2 and 87C) using a rotational rheometer. Newtonian behavior was observed, except for fat content between 0.20 and 0.31 and temperature between 2 and 33C, where viscoplastic behavior was remarkable. The rheological parameters (Newtonian viscosity, plastic viscosity and yield stress) and density were well correlated to temperature and fat content. Tube friction factor during flow of cream was experimentally obtained at various flow rates, temperatures and tube diameters (86 < Re < 2.3 x 104, 38 < Re(B) < 8.8 x 103, 1.1 x 103 < He < 6.7 x 103). The proposed correlations for density and rheological parameters were applied for the prediction of friction factor for laminar and turbulent flow of cream using well-known equations for Newtonian and viscoplastic flow. The good agreement between experimental and predicted values confirms the reliability of the proposed correlations for describing the flow behavior of cream. PRACTICAL APPLICATIONS This paper presents correlations for the calculation of density and rheological parameters (Newtonian viscosity, Bingham plastic viscosity and yield stress) of milk cream as functions of temperature (2-87C) and fat content (0.10-0.31). Because of the large temperature range, the proposed correlations are useful for process design and optimization in dairy processing. An example of practical application is presented in the text, where the correlations were applied for the prediction of friction factor for laminar and turbulent tube flow of cream using well-known equations for Newtonian and viscoplastic flow, which are summarized in the text. The comparison with experimental data obtained at various flow rates, temperatures and tube diameters showed a good agreement, which confirms the reliability of the proposed correlations.

Nonlinear Interactions in a Piezoceramic Bar Transducer Powered by a Vacuum Tube Generated by a Nonideal Source

Interactions between the oscillations of piezoceramic transducer and the mechanism of as excitation-the generator of the electric current of limited power-supply-are analyzed in this paper In practical situations, the dynamics of the forcing function on a vibrating system cannot be considered as given a priori, and it must be taken as a consequence of the dynamics of the whole system. In other words, the forcing source has limited power as that provided by a dc motor for an example, and thus its own dynamics is influenced by that of the vibrating system being forced. This increases the number of degrees of freedom of the problem, and it is called a nonideal problem. In this work, we present certain phenomena as Sommerfeld effect, jump, saturation, and stability, through the influences of the parameters of the governing equations motion. [DOI: 10.1115/1.3007909]

DRYING OF HERBAL EXTRACT IN A DRAFT-TUBE SPOUTED BED

This work evaluates the feasibility of the draft-tube spouted bed for drying of herbal extract. Drying runs were carried out according to a central composite design in a conical-cylindrical draft-tube spouted bed. The variables studied were the percentage of the drying aid (ADJ), the drying gas flow rate relative to gas flow at minimum spouting (Q/Q(ms)), and the flow rate of extract fed to the system relative to the spouting gas flow rate W(s)/W(g)). Colloidal silicon dioxide was the drying aid used in order to improve drying performance. Statistical analysis of the effects of processing parameters on product recovery, product accumulation in the bed, and product properties permitted the identification of parameters presenting significant effects on drying. Optimized drying conditions were related to experimental parameters as follow: high levels of the percentage of drying adjuvant (ADJ), high airflow rate relative to minimum spouting (Q/Q(ms)), and low values of the feed flow rate of the extract relative to the gas flow rate (W(s)/W(g)).

Optical study of a light diaphragm rupture process in an expansion tube

Rupture of a light cellophane diaphragm in an expansion tube has been studied by an optical method. The influence of the light diaphragm on test flow generation has long been recognised, however the diaphragm rupture mechanism is less well known. It has been previously postulated that the diaphragm ruptures around its periphery due to the dynamic pressure loading of the shock wave, with the diaphragm material at some stage being removed from the flow to allow the shock to accelerate to the measured speeds downstream. The images obtained in this series of experiments are the first to show the mechanism of diaphragm rupture and mass removal in an expansion tube. A light diaphragm was impulsively loaded via a shock wave and a series of images was recorded holographically throughout the rupture process, showing gradual destruction of the diaphragm. Features such as the diaphragm material, the interface between gases, and a reflected shock were clearly visualised. Both qualitative and quantitative aspects of the rupture dynamics were derived from the images and compared with existing one-dimensional theory.

Entropy generation for forced convection in a porous saturated circular tube with uniform wall temperature

A numerical study is reported to investigate both the First and the Second Law of Thermodynamics for thermally developing forced convection in a circular tube filled by a saturated porous medium, with uniform wall temperature, and with the effects of viscous dissipation included. A theoretical analysis is also presented to study the problem for the asymptotic region applying the perturbation solution of the Brinkman momentum equation reported by Hooman and Kani [1]. Expressions are reported for the temperature profile, the Nusselt number, the Bejan number, and the dimensionless entropy generation rate in the asymptotic region. Numerical results are found to be in good agreement with theoretical counterparts.

Emission and holographic interferometry measurements in a superorbital expansion tube

Free-piston-driven expansion tubes are capable of generating flaw conditions over a wide range of enthalpies ranging from orbital up to superorbital velocities. Initial optical measurements aimed at investigating the flow in such a facility are presented. Emission studies were used to identify impurities in the how and to investigate spectral regions that are accessible by optical techniques. At moderate enthalpies, it was found that significant radiation resulted from metallic contaminants. At high enthalpies, the spectrum consisted of a number of atomic lines together with a broadband background component indicative of the presence of electrons. The presence of this radiation may limit the applicability of optical techniques that require spectral regions free from the influence of atomic transitions or background radiation. Emission spectroscopy (through Stark broadened hydrogen lines) and two-wavelength holographic interferometry were used to measure the electron number density behind a bow shock on a blunt body at conditions where significant ionization was observed. They yielded average concentrations of (3 +/- 1) x 10(17) cm(-3) from the emission measurements and (3.8 +/- 0.6) x 10(17) cm(-3) from the interferometry.

In-tube solid-phase microextraction coupled to liquid chromatography (in-tube SPME/LC) analysis of nontricyclic antidepressants in human plasma

A sensitive, selective, and reproducible in-tube solid-phase microextraction and liquid chromatographic (in-tube SPME/LC-UV) method for simultaneous determination of mirrazapine, citalopram, paroxetine, duloxetine, fluoxetine, and sertraline in human plasma was developed, validated and further applied to the analysis of plasma samples from elderly patients undergoing therapy with antidepressants. Important factors in the optimization of in-tube SPME efficiency are discussed, including the sample draw/eject volume, draw/eject cycle number, draw/eject flow-rate, sample pH, and influence of plasma proteins. The quantification limits of the in-tube SPME/LC method varied between 20 and 50 ng/mL, with a coefficient of variation lower than 10%. The response of the in-tube SPME/LC method for most of the drugs was linear over a dynamic range from 50 to 500 ng/mL, with correlation coefficients higher than 0.9985. The in-tube SPME/LC can be successfully used to analyze plasma samples from ageing patients undergoing therapy with nontricyclic antidepressants. (c) 2007 Elsevier B.V. All rights reserved.