The "first generation" of endovascular stent-grafts for patients with aneurysms of the descending thoracic aorta

OBJECTIVE: Our goal was to determine whether endovascular stent-grafting is feasible and effective for patients with aneurysms of the descending thoracic aorta. METHODS: Starting in July 1992, we conducted a prospective, uncontrolled clinical trial in 103 patients (mean age 69 years [range 34-89 years]) who underwent endovascular treatment of aneurysms of the descending thoracic aorta using a custom-fabricated, self-expanding stent-graft device. Follow-up was 100% complete and averaged 22 months. Sixty-two patients (60%) were judged not to be reasonable candidates for a conventional "open" surgical procedure. RESULTS: Complete thrombosis of the aneurysm was ultimately achieved in 86 (83%) patients. The early mortality rate was 9% +/- 3% (+/- 70% CL). Multivariable analysis revealed that myocardial infarction or stroke was linked with a higher likelihood of early death (P = .001). Early serious complications included paraplegia in 3% +/- 2% and stroke in 7% +/- 3%. Actuarial survival estimates at 1 year and 2 years were 81% +/- 4% and 73% +/- 5% (+/- 1 SE), respectively; being judged not to be a surgical candidate portended a higher probability of death (P = .003). According to the intent-to-treat principle, "treatment failure" (including all late sudden unexplained deaths) occurred in 38 patients; 53% +/- 10% of patients were free from treatment failure at 3.7 years. Stent-graft related complications occurred commonly and were linked with several anatomic, technical, and patient-related risk factors. CONCLUSIONS: This 5-year clinical trial involving use of a "first generation" device indicates that endovascular stent-grafting of descending thoracic aortic aneurysms is feasible with acceptable medium-term results. More refined, commercially developed devices available today offer less traumatic and more precise stent-graft deployment; these major technical advantages, coupled with important lessons we have learned over time and better patient selection, should be associated with more salutary clinical results in the future.     

Isoseparation curves: a mechanism for optimizing off-axis dose homogeneity of intact breast irradiation

The purpose of this paper is to determine whether using off-axis isoseparation curves to optimize the collimator rotation angle improves dose homogeneity. Eleven intact breast irradiation patients underwent computerized tomography (CT) treatment planning with 1 cm abutting slices. Central plane treatment planning, using 6 MV photons, tissue inhomogeneity corrections, and isocentric opposed tangent treatment fields, was performed. Collimators were rotated to match chest wall slope through the use of a beam's-eye-view setting. Patient separations were measured from the apex of the breast to the posterior field border on each axial CT slice. Sagittal-plane isoseparation curves were constructed from these measurements. Using these curves, the collimator rotation that minimized off-axis separation differences was determined. A comparison of off-axis dose inhomogeneity was performed for patients with a > or =10 degrees difference between this optimized collimator angle and the angle determined by chest wall slope. These comparative treatment plans differed only with respect to collimator angle rotation. The mean optimal collimator rotation angle differed significantly from the mean rotation angle which matched the chest wall slope (5.4 degrees vs. 11 degrees, respectively, P < 0.001). Four of the 11 patients had rotation angle differences of 10 degrees. In these patients, the optimization of collimator angle reduced the percentage of breast volume to "that" received > or =110% of the prescribed dose. For the patient with the largest breast size to the patient with the smallest breast size the decreases were, respectively, 5% (15% to 10%), 3% (24% to 21%), 1% (4% to 3%), and 1% (0.9% to 0%). The mean reduction in dose inhomogeneity was greatest in the inferior breast quadrants. At 6 cm and 4 cm off axis, the mean reductions in the percentages of the breast tissue to "that" received 110% of the prescribed dose were respectively 15.1% and 5.3 %. Optimizing the collimator angle through the use of isoseparation curves decreases dose inhomogeneity. The greatest improvements are in the inferior quadrants of the intact breast. The improved dose homogeneity may have clinical relevance in the treatment of patients with large breast sizes.     

National quality of care activities in Germany

The burn nursing Delphi study identified pain management as the most important area of burn nursing research. The question, "What is the best method to measure the pain of the patient with burns?" ranked in the top 10% of the nursing research priorities and is the research question of this study. The most commonly used pain assessment tools were determined in a 1994 survey of burn centers. Of those that responded, 67% used the Visual Analog Scale and 43% used an adjective scale. Forty patients were enrolled in this prospective, multicenter study. Visual analog and color scales were used during a 3-day cycle and word and faces scales were used during another 3-day cycle. Pain levels were assessed twice each day, once during a quiet time and then again immediately after a painful activity. At the end of each 3-day cycle the patient was asked which tool he or she preferred. At the completion of the study period the patient was asked to select the overall most preferred tool for pain assessment. Although this study indicates that patients prefer the faces and color scales to the most commonly used visual analog and adjective scales, further research is needed to determine the potential impact of preferred tools on pain intervention. The results may also lead burn centers to re-evaluate current selection of pain assessment tools.     

Nutrition support for patients after cardiopulmonary bypass: required modifications of the TPN solution

Background electrolyte (BGE) systems with two coions are frequently used in capillary zone electrophoresis (CZE), especially in cases where indirect optical detection is employed. This study investigates the behavior of analytes, which possess mobilities intermediate to those of the BGE coions used. Besides the expected behavior, where the analytes provide either tailing or fronting zones, unusual behavior with extraordinary zone broadening is also observed in some cases. The explanation for this effect is that binary BGE systems involve, as a physico-chemical rule, a region where the analytes are forced by one coion to give tailing zones and simultaneously by the other coion to give fronting zones. The result of this "schizophrenic" situation is extraordinary zone broadening and deterioration of the detection record. A series of experiments is presented showing in a telling way the electromigration behavior of the discussed type of zones as well as the ways to remedy the deterioration of the peak shape by a mere slight changing of the quantitative composition of the BGE used.     

Ice-crystal absorption: a comparison between theory and implications for remote sensing

The problem of the disagreement between cirrus crystal sizes determined remotely and by in situ measurements is shown to be due to inappropriate application of Mie theory. We retrieved the absorption optical depth at 8.3 and 11.1 mum from 11 tropical anvil cirrus clouds, using data from the High Resolution Infrared Radiation Sounder (HIRS). We related the absorption optical depth ratio between the two wavelengths to crystal size (the size was defined in terms of the crystal median mass dimension) by assuming Mie theory applied to ice spheres and anomalous diffraction theory (ADT) applied to hexagonal columns, hexagonal plates, bullet rosettes, and aggregates (polycrystals). The application of Mie theory to retrievals yielded crystal sizes approximately one third those obtained with ADT. The retrievals of crystal size by use of HIRS data are compared with measurements of habit and crystal size obtained from in situ measurements of tropical anvil cirrus particles. The results of the comparison show that ADT provides the more realistic retrieval. Moreover, we demonstrate that at infrared wavelengths retrieval of crystal size depends on assumed habit. The reason why Mie theory predicts smaller sizes than ADT is shown to result from particle geometry and enhanced absorption owing to the capture of photons from above the edge of the particle (tunneling). The contribution of particle geometry to absorption is three times greater than from tunneling, but this process enhances absorption by a further 35%. The complex angular momentum and T-matrix methods are used to show that the contribution to absorption by tunneling is diminished as the asphericity of spheroidal particles is increased. At an aspect ratio of 6 the contribution to the absorption that is due to tunneling is substantially reduced for oblate particles, whereas for prolate particles the tunneling contribution is reduced by 50% relative to the sphere.     

Interaction of guided light in rib polymer waveguides with dielectrophoretically controlled nanoparticles

This work demonstrates an optofluidic system, where dielectrophoretically controlled suspended nanoparticles are used to manipulate the properties of an optical waveguide. This optofluidic device is composed of a multimode polymeric rib waveguide and a microfluidic channel as its upper cladding. This channel integrates dielectrophoretic (DEP) microelectrodes and is infiltrated with suspended silica and tungsten trioxide nanoparticles. By applying electrical signals with various intensities and frequencies to the DEP microelectrodes, the nanoparticles can be concentrated close to the waveguide surface significantly altering the optical properties in this region. Depending on the particle refractive indices, concentrations, positions and dimensions, the light remains confined or is scattered into the surrounding media in the microfluidic channel.     

A scalable approach to mapping annual land cover at 250 m using MODIS time series data: A case study in the Dry Chaco ecoregion of South America

Land use and land cover (LULC) maps from remote sensing are vital for monitoring, understanding and predicting the effects of complex human-nature interactions that span local, regional and global scales. We present a method to map annual LULC at a regional spatial scale with source data and processing techniques that permit scaling to broader spatial and temporal scales, while maintaining a consistent classification scheme and accuracy. Using the Dry Chaco ecoregion in Argentina, Bolivia and Paraguay as a test site, we derived a suite of predictor variables from 2001 to 2007 from the MODIS 250 m vegetation index product (MOD13Q1). These variables included: annual statistics of red, near infrared, and enhanced vegetation index (EVI), phenological metrics derived from EVI time series data, and slope and elevation. For reference data, we visually interpreted percent cover of eight classes at locations with high-resolution QuickBird imagery in Google Earth. An adjustable majority cover threshold was used to assign samples to a dominant class. When compared to field data, we found this imagery to have georeferencing error < 5% the length of a MODIS pixel, while most class interpretation error was related to confusion between agriculture and herbaceous vegetation. We used the Random Forests classifier to identify the best sets of predictor variables and percent cover thresholds for discriminating our LULC classes. The best variable set included all predictor variables and a cover threshold of 80%. This optimal Random Forests was used to map LULC for each year between 2001 and 2007, followed by a per-pixel, 3-year temporal filter to remove disallowed LULC transitions. Our sequence of maps had an overall accuracy of 79.3%, producer accuracy from 51.4% (plantation) to 95.8% (woody vegetation), and user accuracy from 58.9% (herbaceous vegetation) to 100.0% (water). We attributed map class confusion to limited spectral information, sub-pixel spectral mixing, georeferencing error and human error in interpreting reference samples. We used our maps to assess woody vegetation change in the Dry Chaco from 2002 to 2006, which was characterized by rapid deforestation related to soybean and planted pasture expansion. This method can be easily applied to other regions or continents to produce spatially and temporally consistent information on annual LULC.     

Interactive video technology: Enhancing professional learning in initial teacher education

The University of Sussex In-School Teacher Education Project (InSTEP) uses interactive video technologies to enhance initial teacher education programmes for science trainee teachers. With four Internet Protocol cameras and mounted microphones in both school laboratories and the university teaching room, trainees and their tutors have access to live interaction with schools. This paper presents some of the findings of a 2 year evaluation of InSTEP aimed at identifying the benefits for trainee teachers. There has been an increase in the use of video material for teacher training purposes, however, trainee teachers are often intimidated by carefully selected extracts featuring experienced teachers. InSTEP activities are live and capitalise on all the opportunities associated with normal classroom practice. Literature points to InSTEP-type activities having the potential to enhance the development of trainees’ observation skills, develop reflective thinking, to provide authentic illustrations of classroom practice, enable remote observation and facilitate the coaching of trainees by mentors. A fourth generation model of evaluation was undertaken with data generated by semi-structured interviews with university tutors and mentors supported by a questionnaire and group interviews with the trainees. Our main findings point to InSTEP enhancing and accelerating the growth of trainee teachers’ professional knowledge through enabling reflective practice, facilitating collaborative learning and supporting the development of the language of pedagogy.     

A scalable delay based analytical framework for CSMA/CA wireless mesh networks

We present an analytical framework for the performance analysis of CSMA/CA based wireless mesh networks. This framework can provide an accurate throughput-delay evaluation for both saturated and unsaturated cases. An efficient algorithm that determines the collision domain for each node based on both the interference range and routing in the network is presented. As another important application of this framework, we develop an analytic model that enables us to obtain closed form expressions for delay in terms of multipath routing variables. A flow-deviation algorithm is used to derive the optimal flow over a given set of routes for any number of classes. The model takes into account the effects of neighbor interference and hidden terminals, and tools are provided to make it feasible for the performance analysis and optimization of large-scale networks. Numerical results are presented for different network topologies and compared with simulation studies.