Search

There is much controversy regarding enhanced recovery for recipients of liver transplants from deceased and living donors. The objectives of this Review were to summarise current knowledge on individual enhanced recovery elements on short-term outcomes, identify key components for comprehensive pathways, and create internationally accepted guidelines on enhanced recovery for liver-transplant recipients. The ERAS4OLT.org collaborative partnered by the International Liver Transplantation Society performed systematic literature reviews on the effect of 32 relevant enhanced perioperative recovery elements on short-term outcomes, and global specialists prepared expert statements on deceased and living donor liver transplantation. The Grading Recommendations, Assessment, Development and Evaluations approach was used for rating of quality of evidence and grading of recommendations. A virtual international consensus conference was held in January, 2022, in which results were presented, voted on by the audience, and discussed by an independent international jury of eight members, applying the Danish model of consensus. 273 liver transplantation specialists from 30 countries prepared expert statements on elements of enhanced recovery for liver transplantation based on the systematic literature reviews. The consensus conference yielded 80 final recommendations, covering aspects of enhanced recovery for preoperative assessment and optimisation, intraoperative surgical and anaesthetic conduct, and postoperative management for the recipients of liver transplants from both deceased and living donors, and for the living donor. The recommendations represent a comprehensive overview of the relevant elements and areas of enhanced recovery for liver transplantation. These internationally established guidelines could direct the development of enhanced recovery programmes worldwide, allowing adjustments according to local resources and practices.

The Baltimore City government's energy vision includes a future where clean, reliable, and affordable energy fuels all of our city operations and community. To achieve this vision, the Department of Public Works' Office of Sustainable Energy (OSE) created a Strategic Energy Management Plan (Energy Plan). This plan sets long term goals and lays out strategies for a financially healthy and environmentally stable city government. Baltimore is pursuing this strategy with a specialized energy team of project managers, energy auditors, engineers, accountants, and financial analysts, whose projects cut across agencies and finds the right combination of quick return on investment and essential capital investments.OSE's model is distinct for a mid-size city. Funding sources include fees for service to agency customers, grants, and financing with the city's Master Lease program. The fee for service model puts a dollar value on OSE's expertise and ties energy savings to our projects. OSE is involved from pro...

To describe six cases of unknown primary carcinoma of the retroperitoneum that were positive for human papillomavirus (HPV), a surrogate molecular marker for high-risk HPV (p16), or both.Using the MD Anderson pathology database, females with confirmed HPV or p16 expression within retroperitoneal carcinomas of unknown primary were identified. Clinical data were collected by retrospective chart review. One pathologist reviewed all histology. Individuals with known primary were excluded. Data regarding individual demographics, presentation, Pap test history, pathology, HPV and p16 positivity, and outcome were analyzed using descriptive statistics.Six individuals were identified. The median age of the individuals was 43.5 years (range 27-54). Three malignancies (50%) were squamous and three (50%) were undifferentiated. Median follow-up was 12 months (range 6-48 months). Two of the six (33%) individuals had remote histories (more than 10 years) of abnormal Pap test results. All had normal gynecologic examination and Pap test results at diagnosis. Four tumors were HPV-positive (66%) and six were p16-positive (100%). All samples that were HPV-positive were also p16-positive. All individuals underwent treatment with chemotherapy, radiation, or both. One individual underwent initial attempt at resection that was unsuccessful. Two individuals are without evidence of disease, two have had progression of disease, and two have died of their disease.Pelvic masses of unknown primary may be HPV-related despite normal cervical examinations.III.

Multi-needle Langmuir probe is a fairly new instrument technique that has been flown on several recent sounding rockets and is slated to fly on a subset of QB50 CubeSat constellation. This paper takes a fundamental look into the data analysis procedures used for this instrument to derive absolute electron density. Our calculations suggest that while the technique remains promising, the current data analysis procedures could easily result in errors of 50% or more. We present a simple data analysis adjustment that can reduce errors by at least a factor of five in typical operation.

This study investigated the relative acceptance of different avionics implementations that present Flightdeck Interval Management (FIM) speeds and speed deviations to commercial pilots, and for indications of conditions that require action. Results indicate a clear preference for an Avionics condition where target speed information was provided in the primary flight display, relevant traffic information was provided in the navigational display, IM clearance information and conformance information was provided in the Multi-function Control Display Unit (MCDU), and the engine-indicating and crew-alerting system (EICAS) display showed conformance deviation alerts; and a condition in which all this information was presented only in an Electronic Flight Bag (EFB)-like display (with extended functionality) implemented under the side window for both pilots. Other Avionics conditions tested were less desirable. These were conditions in which the EFB was mounted aft of, and below the side window - with and without an auxiliary display that repeated speed target and conformance information in the primary field of view. Results also indicate a preference for aural indications to direct attention to new speed targets, as a reminder to enter these when not done in a timely manner, and to convey when the aircraft has deviated significantly from the calculated FIM speed profile. The aural indications, thresholds for reminders and conformance indications used in this study were found to be appropriate. In general FIM, as implemented in this study, was perceived as having no deleterious effect on workload or crew coordination; and, under some conditions, was reported to have improved situation awareness of arrival speeds and general conditions during approach and descent.

Purpose: Soft tissue sarcoma (STS) is a rare heterogeneous malignancy. Overall survival has been stagnant for decades, primarily because systemic therapies are ineffective versus metastases, the leading cause of STS lethality. Consequently, we examined whether tyrosine kinase receptors active in STS growth signaling might be blockable and whether multireceptor blockade might synergize with low-dose STS chemotherapy by therapeutically affecting STS cells and their associated microenvironment. Experimental Design: Vandetanib (AstraZenca), a tyrosine kinase inhibitor of vascular endothelial growth factor receptor 2 and epidermal growth factor receptor, was evaluated alone and with chemotherapy in vitro and in vivo in three human STS nude mouse xenograft models of different STS locations (muscle, uterus, lung), stages (primary, metastatic), and subtypes (leiomyosarcoma, fibrosarcoma, uterine sarcoma: luciferase-expressing MES-SA human uterine sarcoma cells surgically implanted into uterine muscularis with bioluminescence tumor growth assessment; developed by us). Results: In vitro, human STS cells were sensitive to vandetanib. Vandetanib alone and with chemotherapy statistically significantly inhibited leiomyosarcoma local growth and fibrosarcoma lung metastasis. Direct injection of MES-SA into nude mice uterine muscularis resulted in high tumor take (88%), whereas s.c. injection resulted in no growth, suggesting microenvironmental tumor growth modulation. Vandetanib alone and with chemotherapy statistically significantly inhibited uterine sarcoma growth. In all models, vandetanib induced increased apoptosis, decreased tumor cell proliferation, and decreased angiogenesis. Conclusions: Vandetanib has antitumor effects against human STS subtypes in vitro and in vivo, where it also affects the tumor-associated microenvironment. Given the urgent need for better systemic approaches to STS, clinical trials evaluating vandetanib, perhaps with low-dose chemotherapy, seem warranted.

It has been a goal to develop fiber optic link components that offer high performance and environmental robustness. This paper describes the performance of a lithium niobate modulator, laser sources, and detectors when evaluated against the requirements encountered on airborne platforms. It was shown that the complete fiber optic link provided for high dynamic range operation to 18 GHz under the environmental stresses of the application.

This paper describes integrated optics modulators which meet the requirements introduced by hybrid fiber coax system architectures, and the design criteria and performance data for both the devices and externally modulated systems. Advantages associated with external modulators include high power operation, chirpless operation at 1550 nm, compatibility with optical amplifiers, optimal performance for the distribution of analog signals to optical distribution nodes from head ends/central offices, integral means for SBS suppression, flat frequency and phase response to 1 GHz, high impedance (50 ohm) operation, and stable operating characteristics over a range of environmental conditions.© (1995) COPYRIGHT SPIE--The International Society for Optical Engineering. Downloading of the abstract is permitted for personal use only.

We review current 18 gigahertz optic link technology with a spurious free dynamic range of 110 dB/Hz2/3. The dynamic range of an externally modulated optic link increases with increasing optical power on the photodetector. One of the limiting factors for dynamic range is the amount of optical power that the photodiodes can handle. A method to allow greater optical information sideband power throught the link by filtering out some of the optical carrier will be discussed. The I/O modulator is normally run with an otpcial modulation depth of 4%. It should be possible to increase this by reducing the amount of optical carrier sent to the detector. This increase in the depth of modulation will reduce the RF loss and noise figure of the optic link thereby reducing the preamplifier requirements to obtain maximum dynamic range. This should make possible a spurious free dynamic range of 120 (db/Hz)2/3 with commercially available 18 GHz photodetectors. This technique could also be used to reduce problems caused by stimulated Brillouin scattering in long lengths of SM fiber.© (1995) COPYRIGHT SPIE--The International Society for Optical Engineering. Downloading of the abstract is permitted for personal use only.

This paper describes an externally modulated fiber optic link designed to transmit signals from the face of a phased array antenna to a receiver/signal processor. The architecture used modulator pods and remotely located optical sources which were interconnected by fiber. The size of the modulator pod and its power dissipation were minimized, and operation over a range of environmental conditions was achieved. Perturbations in the operating characteristics of the link due to environmental stressing was minimized through careful design. The RF design considerations were dominated by issues related to beamsteering and null formation, and cancellation ratio data is presented for a pair of links showing a null depth in excess of 60 dB.© (1994) COPYRIGHT SPIE--The International Society for Optical Engineering. Downloading of the abstract is permitted for personal use only.

Fiber optic RF distribution of signals has many attractive features but can be problematic when the combining function of an array is attempted at optical frequencies. A photodiode array is described that permits the simultaneous detection of RF modulation in optical links and the combining of the resultant RF signals in a coherent fashion. A small photodiode array was built and tested in a phased array to demonstrate beam formation.© (1994) COPYRIGHT SPIE--The International Society for Optical Engineering. Downloading of the abstract is permitted for personal use only.

A design analysis is presented for a microwave frequency fiber optic link with minimum figure and large dynamic range for transmission of a satellite downlink signal. The optic link components are briefly characterized, with attention given to optic sources, modulators, optical fiber, and optical detector. The principal parameters of the optic link are derived. These parameters are then cascaded with the parameters of the electrical components (preamplifier and postamplifier) to derive the noise figure and dynamic range of the complete communication system. A schematic diagram of the optic link is included.