The microsurgical treatment of large and giant aneurysms of the internal carotid artery located parasphenoidally

Internal carotid aneurysms in the ophthalmic area presents a challenge in cerebrovascular neurosurgery. The study was undertaken to provide evidence for the application of intravascular aspiration during direct surgical interventions and to outline their variants used at the N. N. Burdenko Institute of Neurosurgery. The study included 4 (3 females and 1 male) patients with large and giant internal carotid aneurysms of parasphenoidal site who were treated at the Institute. Clipping of the aneurysmal neck was made by employing intravascular blood aspiration from the aneurysm. The technique proved to be effective in proximal monitoring the carotid artery at surgery. It substantially reduced aneurysmal blood flow and wall tension, thus favouring aneurysmal dissection to make clipping.     

Experimental-morphological and clinical basis of preventive methods for the intraoperative complications of the amputation of the lower extremity at the thigh level]

Using total quality management principles within a shared governance framework, this case study discusses how to design and implement a plan to achieve independent nursing practice when an employee has unique needs. This experience demonstrates the importance of looking at root causes, separating ability and compliance issues, using all available resources creatively, and planning for success.     

Signal-adaptive discrete evolutionary transform as a sparse time–frequency representation

Discrete evolutionary transform (DET) has usually been applied to signals in a blind-way without using any parameters to characterize the signal. For this reason, it is not optimal and needs improvement by using some information about the signal. In this paper, we propose an improvement for the discrete evolutionary transform in order to obtain a sparse representation and redefine the generalized time-bandwidth product optimal short-time Fourier transform as a special case of it. In case of linear FM-type signals, the optimized kernel function of the transform is determined according to signal parameters including the instantaneous frequency. The performance of the adaptive-DET is illustrated on three distinct cases. In case of multi-component LFM signals, when the concentration of the proposed distribution is compared to the ordinary sinusoidal-DET, the improvement is computed as 28% in terms of the ratio of norms. Furthermore we define a new and a general class of distribution functions named as the short-time generalized discrete Fourier transform (ST-GDFT) which is a larger set of signal representations including the adaptive-DET.     

Green and Ampt infiltration model extended beyond rain duration

A simple method requiring only hand calculations is presented in this study that enables the use of the Green and Ampt infiltration model beyond the rain duration. The method takes into account that the runoff and infiltration processes continue for some period of time after the rain stops. Both the ground surface and subsurface characteristics are considered. A conjunctive overland flow‐infiltration mathematical model is employed for this purpose. A kinematic‐wave approach is used to model the overland flow, and the Green and Ampt equations are employed to calculate the infiltration rates. The governing equations are expressed and solved in terms of dimensionless parameters to enable the generalization of the results based on the principle of hydrologic similarity. A four‐point finite difference scheme is used to solve the governing equations. The results are presented in chart form. An example application of the proposed method is included.     

Hydrologic design aid for urban grass filter strips

A set of generalised charts are presented in this article as a design aid for hydrologic sizing of grass filter strips. The charts express the volume of runoff and the peak flow rate from a grass strip and the residence time in terms of the size and surface and subsurface characteristics of the grass strip as well as the size and surface characteristics of the area draining to the filter strip. These charts are developed by using a mathematical model based on a kinematic‐wave formulation of overland flow and Green‐and‐Ampt formulation for infiltration. The results are obtained in terms of dimensionless parameters and generalised through the principle of hydrologic similarity. An example is included to demonstrate the use of the charts in a practical design problem.     

Performance of Transport Protocols for Multimedia Communications in Wireless Sensor Networks

Many wireless sensor network (WSN) applications require efficient multimedia communication capabilities. However, the existing communication protocols in the literature mainly aim to achieve energy efficiency and reliability objectives and do not address multimedia communication challenges in WSN. In this paper, comprehensive performance evaluation of the existing transport protocols is performed for multimedia communication in WSN. Performance metrics such as packet delivery rate, end-to-end packet delay, bandwidth and energy efficiency, frame peak signal-to-noise ratio (PSNR), delay-bounded frame PSNR, frame delivery probability, frame end-to-end delay and jitter are investigated. The results clearly show that the existing transport protocols are far from satisfying the requirements of multimedia communication in WSN and hence there is a need for new effective multimedia delivery protocols for WSN.     

Perioperative risk factors affecting hospital stay and hospital costs in open heart surgery for patients > or = 65 years old

OBJECTIVE: Demographic changes, associated with increased demands for open heart surgery in the elderly, place increased burden on financial resources. To evaluate perioperative risk factors affecting incidence of hospital events and estimation of hospital charges, 2577 patients > or = 65 years (range 65-91), operated on from January 1991 to December 1994, were compared with a concurrent cohort of 2642 younger patients. METHODS: Statistical analysis, by surgical procedure, focused on hospital mortality, key postoperative complications affecting length of hospital stay and hospital charges. RESULTS: Overall hospital mortality was 4.7%, 3.5% in younger patients versus 6.1% in the older group (P < 0.01). Mortality was significantly lower in patients less than 65 years undergoing coronary artery bypass grafting (3% versus 5%, P < 0.01) and valve replacement (4% versus 9%, P = 0.01). Significant risk factors for hospital death in the elderly: diabetes (P < 0.01), hypertension (P < 0.01), myocardial infarction (P < 0.01) and congestive heart failure (P < 0.01). Significant postoperative events, more common in older patients, included prolonged ventilation (P < 0.01), congestive heart failure (P < 0.01), infection (P < 0.01), cerebrovascular accident (P < 0.01), and intra aortic balloon pump (P < 0.01). Incremental risk factors for morbidity in the elderly were: higher New York Heart Association class, congestive heart failure, emergent operation, and female gender. Mean length of hospital stay for the < 65 group was 15.3 versus > 19.5 days for the > 65 group (P < 0.01). Length of stay over 18 days positively correlated with increased morbidity in both age groups. For patients > or = 65 years of age, the average hospital charge for open heart surgery was 172% higher for patients with a length of stay greater than 18 days compared with 165% for patients less than 65 years of age. CONCLUSIONS: Higher operative mortality and longer length of stay in elderly patients, resulting in increased health care costs, was associated with more co-morbidities. These results suggest interventions designed to reduce congestive heart failure and other co-morbidities may improve patient's recovery and reduce costs.     

Performance of TCP protocols in deep space communication networks

The communication requirements for space missions necessitate to address the problems due to deep space communication networks. In this letter, the effects of slow start algorithm, propagation delay and the link errors on the throughput performance of transport layer protocols are investigated in deep space communication networks. The objective of this letter is to demonstrate through experimental results that existing TCP protocols are far from satisfying the deep space communication requirements and point out the urgent need for new TCP solutions.