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The most effective dissection technique for raising the flap in abdominoplasty is still controversial, particularly in high-risk massive-weight-loss patients. LigaSure ImpactPatients underwent primary abdominoplasty after massive weight loss at a single center from 1 January 2008 to 31 May 2015 and were retrospectively reviewed. A total of 94 patients eligible for the study were divided into two groups on basis of the dissection technique: LigaSure Impact group (29 patients) and the conventional technique group (65 patients). Total intraoperative blood loss was the primary endpoint. Duration of the operation, perioperative complications and re-operation were recorded as secondary endpoints.Baseline characteristics were well balanced between the groups. Significant differences were found in intraoperative blood loss favoring LigaSure Impact group (259.6 ± 198.8 mL vs 377.9 ± 190.0 mL, p = 0.004) and blood transfusion rates (13.8% vs 35.4%, p = 0.047). In contrast, operative time was significantly longer in LigaSure Impact group (168.6 ± 121.2 vs 179.7 ± 57.6 min, p = 0.005), while a tendency to shorter hospital stay was found in LigaSure Impact group (3.6 ± 1.1 days vs 4.6 ± 3.2 days, p = 0.081). Overall complications occurrence, Clavien-Dindo grade II (24.1% vs 55.4%) and grade III (13.8% vs 30.8%) complications were significantly lower in LigaSure Impact group (respectively, p = 0.005, p = 0.007, p = 0.016). Late (30 days) re-operation rate was significantly lower in the LigaSure Impact group (6.9% vs 27.70%, p = 0.0028). Specific wound complications showed no significant difference.LigaSure Impact vessel-sealing system may be beneficial in improving abdominoplasty outcomes in massive-weight-loss patients because it might reduce blood loss, need for transfusions, complications, and re-operations.

In the early summers of 1895 and 1896 Gustav Mahler left behind his obligations as an operatic conductor and traveled from Hamburg through Vienna to the countryside, where he composed his Third Symphony. By situating Mahler's Third Symphony in the context of his summer travels, this article proposes that the symphony's construction of natural spaces is thoroughly bound up with that of urban spaces, especially Vienna. Heeding Mahler's suggestion that the programs for his symphonies be used as “signposts and milestones” on the listener's journey, my hermeneutic method explores the resonances between the symphony, its programs, the preexisting material it references, and Mahler's personal experience of Vienna and the Austrian countryside. The use of marches and the programmatic reference to a mob in the first movement to depict the arrival of summer resonates with the political crisis surrounding Karl Lueger's struggle to be confirmed as mayor of Vienna. Similarly, the portrayal of birds as musical entertainers in “Ablösung im Sommer,” the song on which the third movement is based, paired with a posthorn signaling the arrival of mail echoes Mahler's frustration with the business of opera and his desire to be called to a new position in Vienna.

“You must have had the experience of burying someone dear to you,” wrote Gustav Mahler in a letter explaining his Second Symphony to the music critic Max Marschalk, suggesting that the critic's own experiences with death might help him better understand the symphony. Inversely, if listeners bring personal losses to bear on the piece, Mahler's Second Symphony offers one possible model for coping with death. If we take the distinction that Sigmund Freud draws between two responses to loss—melancholia and mourning—as a discursive frame, Mahler's Second Symphony may be heard as an attempt to come to terms with the death of a loved one by moving gradually from melancholia to mourning. According to Freud, a melancholic subject cannot truly cope with the traumatic experience and instead reenacts it, but someone who mourns truly remembers the loss and thus commemorates the dead, allowing them to live on, if only in memory. Framed in such a way, the early movements of Mahler's Second Symphony—characterized by the alternation between halting sections that dissolve almost as soon as they begin and long-breathed melodies that seem to unfold effortlessly—suggest the melancholic subject's struggle between despair in the face of abject meaninglessness and a manic euphoria, neither of which addresses the loss. By contrast, the text in the symphony's final movement, adapted by Mahler from Friedrich Klopstock's chorale on the resurrection of the dead, encourages true remembrance of the deceased as a figure beyond death. Heard as a musical enactment of mourning, the final movement suggests that the dead who are mourned are resurrected through remembrance. Forcing us to acknowledge Mahler's death on some level, the final movement completes the work of mourning by engendering the composer's own resurrection in our memories as we witness each performance of his Second Symphony.

According to the critical consensus on Gustav Mahler's Fourth Symphony, Mahler seems, through both his orchestration and musical material, to be evoking both the composers who preceded him and childhood. Many scholars have claimed to hear specific allusions in the first movement to pieces composed in a classical style, and Mahler's use of simple themes with ornamented melodies in the Fourth Symphony also seems to suggest a classical style.At the same time, however, most writers hear a disparity in the movement between Mahler's nominal late romantic compositional style and his use of simpler or more naive-sounding materials. Nostalgia – defined here as a simultaneous acknowledgment of and rebellion against the irreversibility of time – offers one way of examining Mahler's juxtaposition of traits of music from the past and present. Using nostalgia as a theoretical frame, we can examine how music might be able to suggest a relation between the past and present akin to memory.In the first movement, Mahler's late romantic treatment of ‘classical’ materials seems to depict an unsuccessful attempt to recapture an idealized past, and the fourth movement‘s depiction of heaven in childlike terms set predominantly in the style of a lullaby suggests the irretrievable – perhaps even non-existent – past in which the soothing tones of a mother's voice hold the promise of calming all worry.

Aims Expanded indications for neuromodulation are continually being explored. We evaluated secondary changes in bowel function after successful neuromodulation for voiding symptoms. Methods Patients in our prospective neuromodulation database study with comorbid irritable bowel syndrome (IBS), constipation and/or diarrhea, or fecal incontinence (FI) at baseline were evaluated. Pre- and 3, 6, and 12 months post-operative measures included Interstitial Cystitis Symptom Index and Problem Index (ICSI-PI), bowel diaries (assessing bowel movement frequency; constipation, diarrhea, and FI episodes), and scaled global response assessments (GRA) (“markedly worse” to “markedly improved” bowel function). Results Most patients reporting secondary bowel problems (128/199; 64.3%) were female (89%; mean age 56 ± 15.4 years). Primary voiding complaints were urgency/frequency (U/F) with or without urinary incontinence (n = 74), interstitial cystitis/painful bladder syndrome (IC/PBS; n = 43), and urinary retention (n = 11). Secondary bowel complaints included constipation and/or diarrhea (49%), IBS (27%), and FI (23%). Urinary (ICSI-PI) scores improved after treatment (P

The effect of water and NaOH was studied on the hydrogenation of 2-ethylanthraquinone (eAQ) over alumina supported 2% Pd/Al2O3-A and 1.2% Pd/Al2O3-B catalysts. The hydrogenation was performed in a fixed-bed reactor by circulating the eAQ solution (the concentration of eAQ was 60 g/dm3) at 50 °C and 5 bar hydrogen pressure. The egg-shell catalysts were prepared by the precipitation of palladium hydroxide onto the support A (activated alumina, preimpregnated with NaH2PO4) or support B (alumina containing 10% SiO2, and preimpregnated with Na2SiO3). Prior to the hydrogenation, the catalysts were dried and pre-treated with water vapour or NaOH solution. The effect of water and NaOH on the amount of active quinones (eAQ and 2-ethyl-5,6,7,8-tetrahydroanthraquinone, H4eAQ) and in particular the role of such reagents in the consumption of aromatic hydroquinone eAQH2, the primary product of the quinone system of eAQ reduction was examined. The saturation of the phenyl rings in eAQH2 produces H4eAQH2, which is a reactive compound and the hydrogenolysis of the C−O bond in the tautomerized eAQH2 leads to other degradation products. Water and NaOH influence the hydrogenation of C O and the hydrogenolysis of C−O bond but have no effect on the hydrogenation of the aromatic rings. The increase in activity in the former C O to C−OH reduction did not depend of alumina A and B as well as the type of reagent (NaH2PO4 or Na2SiO3) introduced to alumina during the catalyst preparation. These reagents however, influenced the course of degradation processes. Water when introduced to the catalyst exhibited unprofitable effect on maintenance the activity of catalyst during the hydrogenation run. Such an unprofitable role is related to influence of water on the course of reactions yielding degradation products.

Hydrogenation of 2-ethylanthraquinone (eAQ) in the fixed-bed reactor was studied in the “Anthra” (AQ) and “All-Tetra” systems on egg-shell palladium profile catalysts (0.7–2 wt.% Pd). Alumina modified with Na 2 SiO 3 solution was used as a support. Solution of active quinones (eAQ and 2-ethyltetrahydroanthraquinone H 4 eAQ) was saturated with hydrogen and circulated through the catalyst bed at the temperature 50 °C and the pressure 5 bar. The concentrations of eAQ, H 4 eAQ and degradation product were analysed by the GC method. Modification of the starting support with Na 2 SiO 3 was performed with three Sh, Lg and Vc procedures differing in the method of support drying and the time of support contacting with the Na 2 SiO 3 solution. Efficiency of modification was studied by specific surface area, porosity and Pd concentration profile. Procedure of support modification did not influence appreciably the rate of the main reaction eAQ to eAQH 2 reduction, while evidently affected the course of side reactions consuming desirable eAQH 2 and producing H 4 eAQ and degradation products. Performance of the catalysts in terms of their ability towards hydrogenolytic reactions producing degradation products and decrease in the activity during the hydrogenation run have been correlated with the efficiency of support modification with Si species. The better this efficiency, as in Vc procedure, the better maintenance of catalysts activity during the hydrogenation experiment.

Right heart catheterization (RHC) is commonly used in the diagnosis and management of acute lung injury (ALI). However, controversy exists regarding RHC. We examined RHC use during the first 3 d of ALI in an observational study of 135 patients defined by American-European Consensus Conference criteria. Study parameters examined for association with RHC included the Acute Physiology and Chronic Health Evaluation (APACHE) III score, lung injury score (LIS), and 20 additional epidemiologic, clinical, and laboratory parameters. RHC was performed in 70 patients (52%) within the first 3 d of ALI. RHC was positively associated (p < 0.05) with a diagnosis of sepsis, APACHE III score, blood urea nitrogen (BUN), creatinine, net fluid balance, and positive end-expiratory pressure. RHC was negatively associated (p < 0.05) with mean arterial pressure (Pa) and PaO2/FIO2. Logistic regression identified four predictors for RHC placement: sepsis, PaO2/FIO2, BUN, and Pa. Initial right atrial and pulmonary artery occlusion pressure measurements demonstrated a moderately strong correlation (r = 0.72). Use of RHC was associated with a change in one or more therapeutic interventions (intravascular fluids, vasopressors, diuretics) in 78% of patients. In summary, patients receiving RHC during the first 3 d of ALI were more severely ill than those who did not receive RHC, and RHC was associated with a change in therapy in most patients.

Our study objective was to assess health-related quality of life in survivors of acute lung injury (ALI) and to supplement generic and disease-specific questionnaires with findings from a focus group of ALI survivors. Six patients participated in the focus group, which revealed patient concerns with amnesia, depressed mood, avoidance behaviors, and a prolonged recovery period. Using a cross-sectional study design, 24 patients completed a questionnaire 6 to 41 mo after their lung injury. A total of 43% of the patients with ALI met criteria for depression; 43% had self-reported significant functional limitations, although 39% had minimal or no limitations. Significant respiratory and psychologic symptoms were reported in a quarter to a third of patients. There were large decrements in all domains of the SF-36 (a generic health-related quality-of-life instrument) in our sample compared with norms previously established for the general population. In addition, our patients had similar physical difficulties compared with previously studied patients with chronic medical illnesses but had more deficits in the social functioning and mental health domains. We conclude that long after lung injury, survivors have significantly lower health-related quality of life than the general population and are likely to have pulmonary and psychologic symptoms.

The objective of this work is to explore the consequences of using present-time-only data for infrared signature predictions on tracked vehicles, and to quantify the error that is introduced by this steady state analysis approach. The paper will focus on the effects of three independent variables; spectral reflectance, thermal capacitance and the time of day that the simulation takes place. The error analysis will be deconstructed to the basic elements of sensor prediction; thermal and radiance analysis. The study was conducted parametrically in order to capture a range of applicability for tracked vehicles. The outcome of the study is a set of guidelines, outlining the period of time necessary to rid a model of equilibrium error.

The effects of the type of support and Pd concentration profile in alumina and silica supported egg-shell catalysts and their performance in the hydrogenation of 2-ethylanthraquinone (eAQ) were studied in 'Anthra' (AQ) and 'All-Tetra' systems. The activity and deactivation of catalysts were determined in the fixed-bed reactor. Solution saturated with hydrogen, (concentration of active quinones 60g/dm3, eAQ in the AQ system, 30% of eAQ and 70% of H4eAQ–2-ethlytetrahydroanthraquinone, in the All-Tetra system) was circulated through the catalyst bed at temperature 50°C and pressure 5bar. The contents of eAQ, active quinones, H4eAQ and degradation products were determined in the course of hydrogenation by GC method. The egg-shell palladium catalysts (1–2wt% Pd) prepared by the precipitation of palladium hydroxide onto alumina and silica supports pre-impregnated with various alkaline (NaHCO3, NaH2PO4, Na2SiO3) solutions were used in the hydrogenation experiments. Pd concentration profile inside the grains of catalysts was characterized by scanning electron microscopy. A difference between alumina and silica carriers with respect to the course of side reactions producing degradation products was found. Degradation of quinones in the hydrogenolytic reactions predominated on alumina supported catalysts, while the catalysts with silica favoured the hydrogenation of aromatic rings resulting in H4eAQ-active quinone. As a crucial factor for the decrease in the activity during the hydrogenation run, the reactivity of catalyst in the hydrogenolytic reactions was established. Alumina supported catalysts exhibited much higher deactivation than those of silica supported ones. Silica carrier as well as silica species introduced onto alumina under pre-impregnation with Na2SiO3 exhibited an advantageous role in the catalyst performance, in terms of activity and deactivation.

Leadframe packages utilize SnPb plating on terminals to protect the base metal from corrosion and to provide a solderable surface. However, customers are moving to environmentally conscious products establishing a need to develop alternative Pb free plating finishes for terminals. The most promising solution is Sn-based electroplating. Several Sn-based plating chemistries are commercially available at comparable costs to SnPb. However, Sn-based plating finishes are not free of issues. Whisker growth can cause a component to electrically short. In addition, there is little data on solderability and solder joint reliability for Pb free terminal finishes with Pb free solders, as well as, SnPb solders. Sn, SnCu, SnBi, and SnAg plating finishes were evaluated for whisker growth, solderability, and solder joint reliability. For the packages SnBi out-performed the other Sn-based finishes in terms of whisker free life, needle length, and quantity. Solderability for the Pb free finishes was poor in comparison to the SnPb finish, which passed all solderability preconditioning and test methods. Lastly, solder joint reliability appears to be comparable for all Pb free finishes to the SnPb finish.