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Abstract Background Emergency abdominal surgery carries a 15% to 20% short-term mortality rate. Postoperative medical complications are strongly associated with increased mortality. Recent research suggests that timely recognition and effective management of complications may reduce mortality. The aim of the present trial is to evaluate the effect of postoperative intermediate care following emergency major abdominal surgery in high-risk patients. Methods and design The InCare trial is a randomised, parallel-group, non-blinded clinical trial with 1:1 allocation. Patients undergoing emergency laparotomy or laparoscopic surgery with a perioperative Acute Physiology and Chronic Health Evaluation II score of 10 or above, who are ready to be transferred to the surgical ward within 24 h of surgery are allocated to either intermediate care for 48 h, or surgical ward care. The primary outcome measure is all-cause 30-day mortality. We aim to enrol 400 patients in seven Danish hospitals. The sample size allows us to detect or refute a 34% relative risk reduction of mortality with 80% power. Discussion This trial evaluates the benefits and possible harm of intermediate care. The results may potentially influence the survival of many high-risk surgical patients. As a pioneer trial in the area, it will provide important data on the feasibility of future large-scale randomised clinical trials evaluating different levels of postoperative care. Trial registration Clinicaltrials.gov identifier: NCT01209663

Presents information about the Eulerian model for acid deposition over Europe. Chemicals used as input for the model; Comparison of daily concentration of SO[sub2] and SO[sub4] at selected locations in Europe.

As a part of EMEP, MSC-W in Oslo has the task to compute atmospherictransport and deposition of sulfur and nitrogen species over Europe.To perform this task, a three-dimensional Eulerian multilayer model was developed at MSC-W. This model has a 50 km horizontal resolution with 20 vertical layers, of which 10 are below 2 km level. Meteorological input, from a dedicated weather prediction model, is updated at 6-hour intervals. Emission inventories for NOx (NO+NO2), NH3 (and SO2), submitted officially by the individual countries, are used as input data. In the model, NOx may be converted to PAN by the CH3COO2 radical, or to nitrate (as HNO3 in the gas phase and ammonium nitrate as particulate matter). The oxidation of NOx is assumed to proceed either by the OH radical in the gas phase, or as a night-time reaction via N2O5 on deliquescent particles. Both OH and CH3COO2 are prescribed as a function of solar zenith angle and cloud cover. Furthermore,ammonium sulfate is formed by NH3 and sulfate. Excess NH3 may react with HNO3, forming ammonium nitrate in an equilibrium reaction. Nitrogen is removed from the atmosphere by dry and wet deposition. A description of the model, as well as the model results, are presented and discussed. We also present a comparison of calculated concentrations and deposition fields for nitrogen with available measurements of concentrations and wet deposition for 1992. [ABSTRACT FROM AUTHOR]

The objective of this work is to compare mass- and mole based diffusion flux models, convection, fluid velocity and pore structure models for methanol synthesis process. Steady-state models have been derived and solved using leastsquares spectral method (LSM) to describe the evolution of species composition, pressure, velocity, total concentration and diffusion fluxes in porous pellets for methanol synthesis. Mass diffusion fluxes are described according to the rigorous Maxwell Stefan model, dusty gas model and the more simple Wilke model. These fluxes are defined with respect to molar- and mass averaged velocities. The different effects of choosing the random- and parallel pore models have been investigated. The effects of Knudsen diffusion have been investigated. The result varies significantly in the dusty gas model. The effectiveness factors have been calculated for the methanol synthesis process for both mass- and mole based pellet models. The values of effectiveness factors for both mass- and mole based pellet models do not vary so much. The effect of Wilke-, Maxwell-Stefan- and dusty gas mass diffusion fluxes on the reactor performance have been studied. Steady-state heterogeneous fixed bed reactor model is derived where the intra-particle mass diffusion fluxes in the voids of the pellet are described by Wilke-, Maxwell-Stefan- and dusty gas models. Furthermore, the total computational efficiency of the heterogeneous fixed bed reactor model is calculated with several closures for the intra-particle mass diffusion fluxes. The model evaluations revealed that: - The mass- and mole based pellet models are not completely consistent. However, the small deviation (less than 2%) between mass- and mole based pellet models is due to the model equations are not fully consistent. If one pellet model is to be chosen for the methanol synthesis process, the optimal diffusion flux model is the Maxwell-Stefan model. - The parallel pore model is deviating from the random pore model for the methanol synthesis process. The results of both the parallel-and random pore models have been compared with experimental data available in the literature. It is found that the result of the parallel pore model is well agreement with experimental data. - A small but significant differences in the mole fraction profiles of methanol along the reactor axis where the diffusion fluxes are described according to the Wilke-, Maxwell-Stefan- and dusty gas models. - The consistent models are about 20 and 60% more computationally expensive than the simplified and not always consistent Wilke model. It is recommended to use the consistent models instead of Wilke approach. [ABSTRACT FROM AUTHOR]

Objective: To assess the precision of three different automatic calculation methods in real-time bladder volume measurement. Material and Methods: Bladders from 34 medical staff volunteers were examined. Two examinations of each subject were performed independently by 2 examiners using 2 identical ultrasound scanners with no delay between the examinations. Three different automatic calculation algorithms, available as software in the ultrasound scanner, were applied on the frozen ultrasound pictures. After registration of the voided volume with an uroflowmeter, the subjects were scanned again in order to assure complete emptying. Results: Voided volumes ranged from 45 ml to 508 ml. The precision of each method was equal but the LWH method measured significantly lower values than the ELLIPSOID and AREA method. Errors in the range of -56.1% to +58.8% for all volumes and methods were found. Data for voided volumes greater than 150 ml (n = 29) were investigated separately, but no significant improvement in accuracy for any of the methods was found. Conclusions: Ultrasound bladder volume calculation is an easy method for estimation of bladder volume. The prolate ellipsoid method (LWH) is recommended as the standard calculation method because it is fast and easy. Unacceptable large measure errors are found and too rigid conclusions based on ultrasound measurements of bladder volume should be avoided. [ABSTRACT FROM AUTHOR]

The article focuses on the plagioselmis prolonga is the haploid form of the diploid T. amphioxeia and describe the seasonal dynamics of these two life stages. It mentions that diploid T. amphioxeia dominates during periods of high dissolved inorganic nitrogen (DIN) and low irradiance, temperature, and grazing. It also mentions that dimorphic sexual life cycles might explain the success of this species by fostering high genetic diversity and enabling endurance in adverse conditions.

Background: It is assumed that conventional laparoscopy (LAP) and robotic‐assisted laparoscopic surgery (RALS) differ in terms of the surgeon's comfort. This study compared muscle workload, work posture and perceived physical exertion of surgeons performing LAP or RALS. Methods: Colorectal surgeons with experience in advanced LAP and RALS performed one of each operation. Bipolar surface electromyography (EMG) recordings were made from forearm, shoulder and neck muscles, and expressed relative to EMG maximum (%EMGmax). The static, median and peak levels of muscle activity were calculated, and an exposure variation analysis undertaken. Postural observations were carried out every 10 min, and ratings of perceived physical exertion before and after surgery were recorded. Results: The study included 13 surgeons. Surgeons performing LAP showed higher static, median, and peak forearm muscle activity than those undertaking RALS. Muscle activity at peak level was higher during RALS than LAP. Exposure variation analysis demonstrated long‐lasting periods of low‐level intensity muscle activity in the shoulders for LAP, in the forearms for RALS, and in the neck for both procedures. Postural observations revealed a greater need for a change in work posture when performing LAP compared with RALS. Perceived physical exertion was no different between the surgical modalities. Conclusion: Minimally invasive surgery requires long‐term static muscle activity with a high physical workload for surgeons. RALS is less demanding on posture. [ABSTRACT FROM AUTHOR]

Background Emergency abdominal surgery carries a considerable risk of death and postoperative complications. Early detection and timely management of complications may reduce mortality. The aim was to evaluate the effect and feasibility of intermediate care compared with standard ward care in patients who had emergency abdominal surgery. Methods This was a randomized clinical trial carried out in seven Danish hospitals. Eligible for inclusion were patients with an Acute Physiology And Chronic Health Evaluation ( APACHE) II score of at least 10 who were ready to be transferred to the surgical ward within 24 h of emergency abdominal surgery. Participants were randomized to either intermediate care or standard surgical ward care after surgery. The primary outcome was 30-day mortality. Results In total, 286 patients were included in the modified intention-to-treat analysis. The trial was terminated after the interim analysis owing to slow recruitment and a lower than expected mortality rate. Eleven (7·6 per cent) of 144 patients assigned to intermediate care and 12 (8·5 per cent) of 142 patients assigned to ward care died within 30 days of surgery (odds ratio 0·91, 95 per cent c.i. 0·38 to 2·16; P = 0·828). Thirty (20·8 per cent) of 144 patients assigned to intermediate care and 37 (26·1 per cent) of 142 assigned to ward care died within the total observation period (hazard ratio 0·78, 95 per cent c.i. 0·48 to 1·26; P = 0·310). Conclusion Postoperative intermediate care had no statistically significant effect on 30-day mortality after emergency abdominal surgery, nor any effect on secondary outcomes. The trial was stopped prematurely owing to slow recruitment and a much lower than expected mortality rate among the enrolled patients. Registration number: NCT01209663 (). [ABSTRACT FROM AUTHOR]