Laparoscopic vs. open wedge biopsy of the liver

The number of people smoking free-base cocaine, or "crack," has increased dramatically in recent years. Concomitantly, the literature describing complications of such use has grown as well. Adverse pulmonary effects are being increasingly noted, such as respiratory symptoms, pulmonary hemorrhage, pulmonary edema, asthma, and pulmonary barotrauma. These and other pulmonary effects are reviewed.     

After-hours telephone coverage: the application of an area-wide telephone triage and advice system for pediatric practices

BACKGROUND: After-hours telephone calls are a stressful and frustrating aspect of pediatric practice. At the request of private practice pediatricians in Denver, a metropolitan area-wide system was created to manage after-hours pediatric telephone calls and after-hours patient care. This system, the After-Hours Program (AHP), uses specially trained pediatric nurses with standardized protocols to provide after-hours telephone triage and advice for the patients of 92 Denver pediatricians, representing 56 practices. OBJECTIVES: This report describes the AHP, presents data from 4 years' experience with the program, and describes results of our evaluation of the following aspects of the program: subscribing physician satisfaction, parent satisfaction, the accuracy and appropriateness of telephone triage, and program costs. METHODS: After-Hours Program records (including quality assurance data) for all 4 years of operation were retrospectively reviewed, tabulated, and analyzed. The results of two subscribing physician surveys and one parent caller satisfaction survey are presented. A retrospective review of after-hours patient care encounter forms assessed the necessity for after-hours visits triaged by the AHP. An analysis of the total cost of this program to 10 randomly selected subscribing physicians was conducted using current AHP data and a survey of the 10 physicians. RESULTS: In 4 years, 107,938 calls have been successfully managed without an adverse clinical outcome. Minor errors in using protocols occurred in one call out of 1450 after-hours calls. After-hours phoen calls necessitated an after-hours patient visit 20% of the time and generated one after-hours hospital admission out of every 88 calls. Just over half of the patients were managed with home care advice only, and 28% were given home care advice after-hours and seen the next day in the primary physician's office. Of all patients directed by the telephone triage nurses to be seen after hours, 78% were determined to have a condition necessitating after-hours care. Data are presented regarding call volumes by time of day, day of week, patient age, and patient's initial complaint. The 6 most common complaints accounted for more than one half of the calls, and 38 complaints accounted for more than 95% of all after-hours calls. Utilization by subscribing physicians is described. Satisfaction among subscribing pediatricians was 100%, and among parents was 96% to 99% on a variety of issues. The total cost to participating Denver pediatricians (which includes revenues "given up" as a result of not seeing patients after hours) ranged from 1% to 12% of their annual net income, depending on a variety of factors. CONCLUSIONS: Large-scale after-hours telephone coverage systems can be effective and well-received by patients, parents, and primary physicians. Data presented in this report can assist in planning the training of personnel who provide after-hours telephone advice and triage. Controversies associated with this type of program are discussed. Suggestions are made regarding the direction of future programs and research.     

Choroidal neovascular membrane in Best's vitelliform macular dystrophy

The right eye of a 9-year-old white boy with Best's vitelliform macular dystrophy had an intact egg-yolk lesion and a retinal pigment epithelial defect superiorly, suggesting an early pseudohypopyon stage. The disruptive phase of the left eye showed subretinal hemorrhages, a "signet ring," and a subretinal neovascular membrane.     

Tuned limiter for receiver amplifier in a fast-recovery pulsed NMR spectrometer

A simple tuned limiter is described which limits the rf voltage amplitude at the input of the receiver amplifier of a pulsed NMR spectrometer. This device prevents overload of the receiver amplifier during the high-power rf pulse and thereby allows fast recovery of the spectrometer following the pulse. When used with Avantek unit amplifiers at 24 MHz, a recovery time of 2.5 mus is achieved.     

Tribological Characteristics of Aqueous Graphene Oxide,Graphitic Carbon Nitride,and Their Mixed Suspensions

The tribological performance of graphene oxide (GO), graphitic carbon nitride (g-C₃N₄), and their mixed (g-C₃N₄/GO) aqueous suspensions was investigated. The 0.06 wt% GO, 0.06 wt% g-C₃N₄, and 0.06 wt% 1:1 g-C₃N₄/GO suspensions reduced the coefficient of friction (COF) by 37, 26 and 37% and wear mark radius by 19.1, 16.0 and 19.6%, respectively, in comparison with water. Pure g-C₃N₄ and GO suspensions showed unstable lubrication in the tests with relatively high loads and speeds, while the g-C₃N₄/GO mixed suspension had superior tribological performance in all tested conditions. This is because in the mixed suspension g-C₃N₄ agglomerates became smaller, and GO nanosheets exhibited fewer wrinkles and less stacking, which enabled the formation of a layer of tribo-composite film. As a result, the friction, wear and tribo-corrosion were reduced during sliding.     

Solidification of thermoviscoelastic melts. Part 3: Effects of mold surface temperature differences on warpage and residual stresses

The solidification of a molten layer of amorphous thermoplastic between cooled parallel plates is used to model the mechanics of part warpage in the injection-molding process. Flow effects are neglected, and a thermorheologically simple thermoviscoelastic material model is assumed. The model allows material to be added to fill the space created by the pressure applied during solidification so that this model can be used to assess packing-pressure effects in injection molding. Parametric results are presented on the effects of the mold temperatures and the packing pressure—the pressure applied during solidification to counteract the effects of volumetric shrinkage of the thermoplastic—on the in-plane and through-thickness shrinkages, on warpage, and on residual stresses in plaque-like geometries. The packing pressure is shown to have a significant effect on part warpage. While the results are presented in terms of normalized variables based on the properties of bisphenol-A polycarbonate, they can be interpreted for other amorphous thermoplastics, such as modified polyphenylene oxide, polyetherimide, and acrylonitrile-butadiene-styrene.     

Identification of straight-chain fatty acids in coal extracts and their geochemical relation with straight-chain alkanes

Mono-carboxylic, straight-chain fatty acids are present in extracts of lignite and subbituminous coal (0.4–1.0 wt%, daf basis), but not in those of a bituminous coal. They are removed with nearly equal ease by both solvent and supercritical gas (SCG) extraction. Octacosanoic acid is the major constituent, and values of the carbon preference index (even over odd) lie between 2 and 6. Solvent extraction of the coals also removes small quantities (< 0.08 wt%) of straight-chain alkanes which are closely related in composition to the straight-chain fatty acids and are probably derived from them during maturation. However, previous SCG extraction of the coals yielded much larger quantities of straight-chain alkanes (0.3–0.7 wt%). Pyrolysis experiments with a lignite fatty acid fraction and with tetracosanoic acid show that these acids largely survive SCG extraction and, therefore, are not the main source of the relatively large quantity of straight-chain alkanes in these extracts.