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The model Internal Wave Dissipation, Energy and Mixing (IDEMIX) presents a novel way of parameterizing internal gravity waves in the atmosphere. IDEMIX is based on the spectral energy balance of the wave field and has previously been successfully developed as a model for diapycnal diffusivity, induced by internal gravity wave breaking in oceans. Applied here for the first time to atmospheric gravity waves, integration of the energy balance equation for a continuous wave field of a given spectrum, results in prognostic equations for the energy density of eastward and westward gravity waves. It includes their interaction with the mean flow, allowing for an evolving and local description of momentum flux and gravity wave drag. A saturation mechanism maintains the wave field within convective stability limits, and a closure for critical-layer effects controls how much wave flux propagates from the troposphere into the middle atmosphere. Offline comparisons to a traditional parameterization reveal increases in the wave momentum flux in the middle atmosphere due to the mean-flow interaction, resulting in a greater gravity wave drag at lower altitudes. Preliminary validation against observational data show good agreement with momentum fluxes.

UNSTRUCTURED Engaging patients in their treatment and making them experts of their condition has been identified as a high priority across many medical disciplines. Patient empowerment claims to improve compliance, patient safety, and disease outcome. Patient empowerment may help the patient in shared decision making and in becoming an informed partner of the health care professional. We consider patient empowerment to be in jeopardy if written medical information for patients is too complex and confusing. We introduce document-engineering methodology (DEM) as a new tool for the health care industry. DEM tries to implement principles of cognitive science and neuroscience-based concepts of reading and comprehension. It follows the most recent document design techniques. DEM has been used in the aviation, mining, and oil industries. In these very industries, DEM was integrated to improve user performance, prevent harm, and increase safety. We postulate that DEM, applied to written documents in health care, will help patients to quickly navigate through complex written information and thereby enable them to better comprehend the essence of the medical information. DEM aims to empower the patient and help start an informed conversation with their health care professional. The ultimate goals of DEM are to increase adherence and compliance, leading to improved outcomes. Our approach is innovative, as we apply our learning from other industries to health care; we call this cross-industry innovation. In this manuscript, we provide illustrative examples of DEM in three frequent clinical scenarios: (1) explaining a complex diagnosis for the first time, (2) understanding medical leaflet information, and (3) exploring cannabis-based medicine. There is an urgent need to test DEM in larger clinical cohorts and for careful proof-of-concept studies, regarding patient and stakeholder engagement, to be conducted.

Introduction Patient empowerment and shared decision-making has been increasingly recognized as key factors for a favorable prognosis. This is particularly true in complex brain disorders such as psychogenic nonepileptic seizures (PNES) which go along with several challenges. People with PNES (PW-PNES) often feel lost in the healthcare system. Early clear communication is one of the few favorable prognostic variables. Our goal was to design a new ultrashort user-friendly communication tool allowing immediate patient empowerment. Methods We conceptualized a design thinking process with patient engagement of PW-PNES. Together with a larger group of PW-PNES, we developed a comprehensive user-friendly 1-page document summarizing the key features of PNES. We applied document engineering (DE) as a cognitive science-based new methodology. Document engineering is well established in the aviation, oil, and mining industries and measurably reduces comprehension and performance errors. Results The design thinking process encompassed 5 phases (empathize, ideate, define, prototype, and test). A prototype of a 1-page document, the 1-Pager-PNES, was created which contained the essential 7 domains organized in a simple structure such as a promise-question-answer (PQA) format. Information was kept poignant, complete, easy-to-read integrating cognitive principles to optimize navigation. The prototype “1-Pager-PNES” was subsequently tested in a 7-member focus group. All patients expressed significant improvement in understanding their disease and felt immediately empowered. Implementing their specific feedbacks, reiterative testing, and involving PNES experts resulted in the final version of the “1-Pager-PNES”. Conclusion A promising new communication tool reduced to 1-page only is introduced which improves patient guidance and enables better coping mechanisms with this complex disease. The patient/user is empowered quickly through finding answers to pressing questions. Our study is unique for three reasons: 1) it engaged patients in the developing process, 2) it produced a tool for immediate communication for PW-PNES, which follows principles of human behavior and cognitive science, and 3) it used cross-industry thinking. Despite all limitations, we consider our small pilot study an inspiration for future studies with focus on patient empowerment through user-friendly documents.

Engaging patients in their treatment and making them experts of their condition has been identified as a high priority across many medical disciplines. Patient empowerment claims to improve compliance, patient safety, and disease outcome. Patient empowerment may help the patient in shared decision making and in becoming an informed partner of the health care professional. We consider patient empowerment to be in jeopardy if written medical information for patients is too complex and confusing. We introduce document-engineering methodology (DEM) as a new tool for the health care industry. DEM tries to implement principles of cognitive science and neuroscience-based concepts of reading and comprehension. It follows the most recent document design techniques. DEM has been used in the aviation, mining, and oil industries. In these very industries, DEM was integrated to improve user performance, prevent harm, and increase safety. We postulate that DEM, applied to written documents in health care, will help patients to quickly navigate through complex written information and thereby enable them to better comprehend the essence of the medical information. DEM aims to empower the patient and help start an informed conversation with their health care professional. The ultimate goals of DEM are to increase adherence and compliance, leading to improved outcomes. Our approach is innovative, as we apply our learning from other industries to health care; we call this cross-industry innovation. In this manuscript, we provide illustrative examples of DEM in three frequent clinical scenarios: (1) explaining a complex diagnosis for the first time, (2) understanding medical leaflet information, and (3) exploring cannabis-based medicine. There is an urgent need to test DEM in larger clinical cohorts and for careful proof-of-concept studies, regarding patient and stakeholder engagement, to be conducted.

Israel phosphate-bearing rock is shown to contain in addition to calcite another form of carbonate, which dissociates irreversibly below the dissociation temperature of calcite. The phenomenon can be explained on the assumption that the calcium oxide produced on dissociation of the second form becomes an integral part of the apatite lattice. It is therefore plausible to suggest that the second form is either finely dispersed throughout the apatite or itself constitutes part of the apatite lattice.

INTRODUCTION The objective of this study is to report a novel system of ‘mutual mentoring’ that overcomes the limited availability of laparoscopic mentors and allows progression from laboratory and fellowship experience into independent clinical practice. PATIENTS AND METHODS A total of 88 laparoscopic cases were performed during the fellowship. In the first 2 years as consultants, we (AJ and MS) performed 151 cases with mutual mentoring (simple nephrectomy [n = 28], radical nephrectomy [n = 35], nephro-ureterectomy [n = 19], pyeloplasty [n = 31], pelvic LND [n = 21], others [n = 17]). RESULTS Mutual mentoring has resulted in the successful introduction of laparoscopic services to two hospitals, allowing an exposure to an average of two cases a week. Complication rates are acceptable and objective measures such as conversion rates, operative time and blood loss appear to be improving. CONCLUSIONS Mutual mentoring allows for a greater through-put of cases, a high level of assistance, advice with intra-operative decisions and the potential to ‘share’ cases, reducing fatigue and increasing experience. It provides significant moral support in the difficult early days of starting the service. Its disadvantages are that it is time consuming and is geographically restrictive. Mutual mentoring has allowed us to introduce a laparoscopic service at our respective hospitals with high case-load acceptable complication rates.

Rail life is controlled by the balance between wear and fatigue damage due to in service loading. To model and optimise rail life, knowledge of the fatigue crack initiation mechanism is required. This paper reports the effect of in service loading on microstructural changes in the subsurface layer of pearlitic rail steels and observations of early stage (10–50 μm length) fatigue crack formation. Micro and nanohardness measurements are reported, along with microstructural observations, showing differential work hardening in the proeutectoid ferrite and pearlite phases. It is proposed that the differential straining results in ductility exhaustion in the proeutectoid ferrite and therefore fatigue crack initiation and initial growth in the proeutectoid ferrite phase. Observations of short (

Greater experience with urological laparoscopy has lead to increasing interest in its use for reconstructive surgery, such as pyeloplasty.A total of 124 cases of laparoscopic pyeloplasty were performed, of which 11 followed failed primary treatment done elsewhere, namely balloon dilation (3), endopyelotomy (3); open pyeloplasty (3), endopyelotomy plus balloon dilation (1) and open pyeloplasty plus balloon dilation (1). Nine patients had renal calculi. A 4 port, balloon dissecting, extraperitoneal laparoscopic approach was used in all except 1 patient, who had a horseshoe kidney, necessitating a transperitoneal approach.Operative time was 29 minutes longer in the secondary pyeloplasty group compared to primary cases (173.3 vs 144.0 minutes) but the conversion rate (0% vs 1.6%) and duration of postoperative hospitalization (2.8 nights each) were no greater. The complication rate was 3.6% and 9.1%, respectively. The success rate was 98.2% and 90.9% (p = 0.63) at a mean followup of 20.2 and 19.7 months, respectively. In the 9 patients with renal calculi a total of 18 calculi (94.7%) were successfully removed and the ureter was transposed medial to a crossing vessel in 50.0%. Trainee operating did not significantly prolong the procedure vs no training (162.0 vs 143.9 minutes, p = 0.06).Extraperitoneal laparoscopic dismembered pyeloplasty is capable of addressing all causes of ureteropelvic junction obstruction with excellent functional results and low morbidity, and with an operative time similar to that of open pyeloplasty. Secondary laparoscopic pyeloplasty does not increase hospitalization, conversion or complication rates.

The excavation of a 1st century BC cremation cemetery having ring-ditch surrounded interments is reported. One of its two richly accompanied burials included an unparalleled drapery-cast stud/knob – an extraordinary object found within a cemetery with uniquely delineated graves. Given its location on the northern fringe of the distribution of Aylesford-Swarling cremation burials, the site prompts questions of core/periphery interrelationships, regionally and group definition.

The following terminal, carbonyl-conjugated alkynes were reacted with N-bromosuccinimide (NBS) and N-iodosuccinimide (NIS) in MeOH/H2SO4 to give dibromo and diiodo acetals in the indicated yields: ...

The design and implementation of a simplified coupled atmosphere-ocean model over mid and high Southern Hemisphere latitudes are described. The development of the model is motivated by the clear indications of important low-frequency variability of extratropical origin in atmosphere-only models and the crucial role of atmosphere-ocean interaction in altering and shaping the climate variability on decadal and multidecadal time-scales. The basic model consists of an idealized quasi-geostrophic model of Southern Hemisphere's wintertime atmospheric circulation coupled to a general ocean circulation model with simplified physics. Model spin-up is described, some basic descriptors of the model climatology are discussed, and it is argued that the model exhibits skill in reproducing essential features of decadal and multi-decadal climate variability in the extratropical Southern Hemisphere. Notably, 1000 yr long coupled model simulations reveal sea surface temperature fluctuations on the timescale of several decades in the Antarctic Circumpolar Current region.

The increased speed of integrated circuits (ICs) is accompanied by increased power levels and the need to package the IC chips very close together in order to realize that speed at the system level. Combined, these spell very high power densities and severe thermal problems at the package level, which are difficult to deal with satisfactorily using conventional packaging materials. Recently, the promise of major reductions in the price of synthetic diamond has allowed its consideration for use in electronic thermal management applications, such as multichip module (MCM) substrates, requiring many tens of grams of material (e.g. substrates 100 mm square and 1 mm thick). Because of the combination of extremely high thermal conductivity and an electrically insulating nature, diamond is an ideal IC packaging or MCM substrate material, not only for reducing chip temperatures in conventional 2D MCM configurations but also in making it practical to implement advanced 2D package configurations and ultrahigh performance, three-dimensionally interconnected MCM packaging approaches. These advanced packaging concepts are made possible because diamond can cool, through lateral thermal conduction to board edges alone, MCMs with many hundreds of watts of power dissipation and at the same time allow for a high density of vertical via interconnects through the diamond substrate.

The following terminal, carbonyl-conjugated alkynes were reacted with N-bromosuccinimide (NBS) and N-iodosuccinimide (NIS) in MeOH/H2SO4 to give dibromo and diiodo acetals in the indicated yields: ...

This paper deals with the field use of a multi-technique electrochemical corrosion monitoring system, to differentiate between general and localized corrosion activity in a water injection system. The technology was used to identify the corrosion mechanism that resulted in failures in the system, showing benefit over and above 'conventional' corrosion monitoring techniques (e.g. Linear Polarisation Resistance, LPR, and coupons) that had failed to identify the corrosion risk. Subsequent to identifying the type of corrosion in the system, the multi-technique approach aided the identification of a suitable corrosion inhibitor to mitigate the corrosion. The findings from the study have been confirmed by weight loss coupon data and 'conventional' monitoring techniques after implementation of a treatment program using the optimized corrosion inhibitor formulation.

The VISA program has been sponsored by DARPA to enable a significant enhancement in signal conditioning, processing, and digitalization on the focal plane of visible and infrared sensors. The approach being developed builds on the traditional “hybrid” structure of a detector with a 2D array of indium-bump interconnects to a silicon readout. VISA will allow additional layers of silicon processing chips to be connected below the readout to provide more complex functionality. Connections will be fully arrayed two-dimensionally with one or more vias per pixel possible. The structural overview will be presented along with several application candidates that appear to be most promising to exploit this technology. These include active/passive sensors, expanded charge storage capacity for full flux utilization in the LWIR, cameras on a chip, high speed sub-frame collection to defeat pulsed laser interference, together with digital output with greater bit depth than currently possible from analog outputs. An A/D candidate circuit to achieve this performance within each pixel will be described.

There are a number of different techniques capable of being used to measure corrosion within equipment. The most simple, the use of metal coupons, usually causes the process to be shut down, is manpower intensive, and has a time delay in getting the required corrosion information. Electrical Resistance (ER) techniques are often used but their response is very sensitive to temperature and they cannot differentiate between general and localized corrosion. Electrochemical techniques, such as linear polarization resistance (LPR), electrochemical noise (EN), electrochemical impedance spectroscopy (EIS), harmonic distortion analysis (HDA), and electrochemical frequency modulation (EFM), have the capability of solving most of those drawbacks. Electrochemical probes can be mounted permanently in most equipment, give regular measurements of the intensity of corrosion, and some can detect localized corrosion. Of all of the electrochemical techniques, EN has the most potential for being used successfully to measure general and localized corrosion rates of equipment. The EN technique was studied in the late 1970s and early 80s as a means of detecting localized (stochastic) corrosion phenomena, such as occurs with pitting, crevice and cavitation attack. EN measurements are based on fluctuations in electrochemical potential and corrosion current that occur during corrosion. Electrochemical potential is related to the driving force (thermodynamics) of the reaction, while corrosion current is related to the rate of reaction (kinetics) of the reaction. The idea is that random electrochemical events on the surface of a corroding metal will generate noise in the overall potential and current signals. Each type of corrosion (for example general corrosion, pitting corrosion, crevice corrosion, and stress corrosion cracking) will have a characteristic “fingerprint” or “signature” in the signal noise. This “fingerprint” can be used to predict the type and severity of corrosion that is occurring. By comparison, conventional electrochemical techniques such as LPR, EIS, HDA and EFM rely on a steady-state analogy for the determination of general corrosion rates. Early studies were carried out using potential EN measurements, using time domain, statistical and frequency domain analyses to characterise the electrochemical response of systems undergoing localised corrosion. Current EN measurements followed quickly using zero resistance ammetry to study the current noise between two identical electrodes. For general corrosion processes, EN has been demonstrated independently by several workers to provide information similar to LPR. Noise technology has been used to study systems undergoing very low to very high rates of corrosion, for example, coatings performance, passive systems undergoing pit initiation/propagation, condensing systems, systems undergoing stress corrosion cracking, and general corrosion through to the very high corrosion rates experienced during chemical cleaning processes. This review will describe: state of the art methods and probes used to measure EN, data acquisition requirements, theory to analyze the signal and to relate the signal to corrosion rates and types, the results of EN field trials, and laboratory results in environments similar to gaspipelines.

Introduction: The literature-based evidence as to whether or not obesity has any impact on the outcomes of radical prostatectomy is contradictory. This study investigates the effect of obesity on the peri-operative parameters of patients undergoing laparoscopic radical prostatectomy (LRP). Materials and methods: The database entries and case notes of 532 consecutive patients undergoing LRP from March 2000 to August 2005 were retrospectively examined. Complete data were available on 505 (95%) patients, 108 (21%) of whom were obese (BMI ≥ 30 kg/m2). All patients had clinical stage T ≤ 3aN0M0 prostate cancer and had their procedure performed or supervised by the same surgeon. Results: Patients’ PSA, Gleason score, clinical stage and prostate weight were similar. Non-obese and obese patients mean values for operating time = 182 and 197 min (P = 0.01), blood loss = 310 and 350 ml (P = 0.66), hospital stay = 3.0 and 3.3 nights (P = 1.00) complications = 3.5% and 4.6% (P = 0.77), positive margins = 15.4% and 20.6% (P = 0.26) and biochemical recurrence = 3.8 and 3.7% (P = 1.00) at a mean follow-up of 9.7 and 12.0 months, respectively. Conclusion: The operating time was significantly longer for obese patients but this was only by a mean of 15 min. All other parameters were comparable in the two groups. Obese patients can expect a similar outcome to their non-obese counterparts following LRP when operated on be an experienced surgeon.

The rapid increases in IC chip performance have made increasing demands on electronic packaging technology in order to achieve the improvements in system performance that the IC speeds promise. An exciting approach to reducing the signal latency in electronic systems is to go to 3-D packaging, in which closely stacked boards are coupled with large numbers of vertical interconnects distributed over the area of the boards. In part because of a perception that electrical Z interconnect approaches such as `fuzz buttons' would seriously compromise signal performance due to parasitic lumped inductance effects, optical inter-board interconnect approaches have been proposed for this application. This paper examines the capabilities of normal metal electronic interconnects in meeting the requirements for 2-D and 3-D MCM applications, and to elucidate the areas in which more exotic approaches such as superconducting or optical interconnects offer significant potential advantages. It is pointed out that for short interconnects, such as those inside of a 2-D or 3-D MCM, normal metal interconnects can be designed to give excellent performance for digital signal frequencies up to at least 5 GHz.© (1994) COPYRIGHT SPIE--The International Society for Optical Engineering. Downloading of the abstract is permitted for personal use only.

Recently, the promise of major reductions in the price of synthetic diamond has allowed its consideration for use in electronic thermal management applications, such as MCM substrates, requiring many tens of grams of material (e.g., 100 mm square substrates, 1 mm thick). Because of the combination of extremely high thermal conductivity and electrically insulating nature, diamond is an ideal IC packaging or MCM substrate material; diamond can cool, through lateral thermal conduction to board edges alone, MCMs having many hundreds of watts power dissipation, and at the same time allow for a high density of vertical via interconnects through the diamond substrate. This diamond 3-D packaging approach is capable of handling, with a modest temperature rise, a power density of 200 Watts per cubic inch, which corresponds to a potential computational density of over 1300 MFlops per cubic inch or 83 GFlops in a 4" X 4" X 4" cube with current processor technology.

Diamond has been used as a heat sink material in critical device applications for many years. Only recently, however, has the promise of major reductions in the price of diamond allowed its consideration for use in electronic thermal management applications requiring many tens of grams, rather than a milligram or so, of material. It is indeed fortunate that this is the case, since the “new wave” in electronics packaging, multi-chip modules (MCMs), because of their very high densities of high-speed integrated circuit chips, confronts the packaging engineer with power densities very difficult to manage without diamond. Because of the combination of high thermal conductivity and insulating nature, diamond is an ideal MCM substrate material, not only for reducing chip temperatures in conventional 2-D MCM configurations, but in making it practical to implement ultra high performance, 3-dimensionally interconnected MCM packaging approaches.

estimate -2.99, 95%CI -3.45,-2.53) but more anastomotic strictures (OR 1.40, 95%CI 1.04,1.87) and higher rates of salvage therapy (OR 3.67, 95%CI 2.81,4.81). Patients of high-volume MIRP experienced fewer anastomotic strictures (OR 0.93, 95%CI 0.87,0.99) and less salvage therapy (OR 0.92, 95%CI 0.88,0.98). CONCLUSIONS: Men undergoing MIRP vs. open radical prostatectomy have lower risk for perioperative complications and shorter lengths of stay, but are at higher risk for salvage therapy and anastomotic strictures. However, risk for these unfavorable outcomes decreases with increasing MIRP surgical volume.

An advanced, low power, high performance GaAs standard cell library (SC10000) has been developed which is uniquely applicable to signal processing applications. The SC10000 library is based on source-coupled logic (SCL) in order to achieve good noise margin with small voltage swings and optimum speed-power product. The SCL design techniques can simplify complex logic to a single current tree, resulting in faster real-time arithmetic operations. In addition to low power cells, the SC10000 library contains very high performance cells such as input buffers, clock drivers, and flip-flops running at speeds up to 6.5 GHz. The library is supported by an advanced enhancement-depletion mode MESFET technology which has been built around the heart of a proven depletion mode technology. This advanced technology can easily support very large scale integrated circuits of 10000 gate complexity. Furthermore, the library is supported on several CAD/CAE systems to shorten the ASIC design cycle.© (1990) COPYRIGHT SPIE--The International Society for Optical Engineering. Downloading of the abstract is permitted for personal use only.

Introduction: Recent evidence suggests that cavernous nerves run within layers of the lateral prostatic fascia. It has been proposed that a nerve sparing technique should therefore include preservation of this fascial layer in addition to the main bulk of the neurovascular bundle posterolateral to the prostate. Materials and methods: All patients on whom laparoscopic nerve-sparing prostatectomy was performed (potent patients

Large scale digital integrated circuits containing over 6000 active devices (1 μm MESFETs and Schottky diodes) have recently been achieved in GaAs Schottky Diode FET Logic. The planar, ion implanted process used to fabricate these circuits results in very uniform device properties because of the excellent control of critical device interfaces. The present status of LSI GaAs ICs is reviewed, including a description of the performance of an 8×8 bit multiplier LSI circuit. VLSI circuit prospects and the applicability of new high speed GaAs active devices for VLSI application in GaAs are considered.

Combination of numerical simulation, many simultaneous measurements, and a large assortment of statistical tools, employed at all stages, have been found useful in design and evaluation of modification experiments on cumulus clouds. A randomized sample is essential, although non-random controls have supplemented it by providing necessary information on natural distributions.Obstacles to definitive estimates of treatment effects are huge natural variability compounded by the expense and labor involved in obtaining an adequately large data sample. A 26 pair data set from a dynamic seeding experiment on isolated Florida cumuli is used here to illustrate both the problems and the combined approach used to overcome them. In this data set, rain volumes from unmodified single cumuli varied by three orders of magnitude on days screened as suitable. The field phase of the experiment cost above $250,000, requiring instrumented aircraft, calibrated radar, and several radiosondes daily.Numerical simulation o...

A sensitive search has been made in Drosophila melanogaster DNA for short repetitive sequences interspersed with single copy sequences. Five kinds of measurements all yield the conclusion that there are few short repetitive sequences in this genome: 1) Comparison of the kinetics of reassociation of short (360 nucleotide) and long (1,830 nucleotide) fragments of DNA; 2) reassociation kinetics of long fragments (2,200 nucleotide) with an excess of short (390 short nucleotide) fragments; 3) measurement of the size of S1 nuclease resistant reassociated repeated sequences; 4) measurement of the hyperchromicity of reassociated repetitive fragments as a function of length; 5) direct assay by kinetics of reassociation of the amount of single copy sequence present on 1,200 nucleotide long fragments which also contain repetitive sequences.