Initial Fill Research Articles

The Use of Dermal Autograft as an Adjunct to Breast Reconstruction with Tissue Expanders

Acellular dermal matrices are commonly used in breast reconstruction but add cost to the procedure and have been associated with complications. Dermal autograft may represent a useful alternative to matrices. Sixteen patients (26 breasts) underwent breast reconstruction using tissue expanders and dermal autograft. Their ages ranged from 41 to 66 years (median, 51 years). Autografts were harvested by wide excision of preexisting abdominal scars. Demographic data, clinical history, and harvest and preparation time were recorded. The initial fill volume, number of expansions, and complications were recorded and compared with published data for acellular dermal matrix-assisted reconstruction. Patients rated their satisfaction with scar appearance on a seven-point scale. Follow-up ranged from 6 to 16 months (mean, 10 months). Three patients were smokers. Mean body mass index was 30.5 (range, 19.1 to 48.8). Three patients received chemotherapy between reconstructive stages, and none required irradiation. The mean time of autograft harvest was 38 minutes, the mean initial fill was 190 cc, and the average number of expansions was 3.5. There were no implant losses. There were three minor complications (19 percent). Initial expander fill, number of expansions, and complication rate were equivalent to historical values for matrix-assisted breast reconstruction. Fourteen of 16 patients (88 percent) were "very satisfied" with their scars. The use of dermal autograft in tissue expander breast reconstruction offers the advantages of acellular dermal matrix, without the associated expense. The technique adds minimally to the operative time and morbidity and is associated with a low complication rate. Therapeutic, IV.

Improvement of a-Si:H solar cell performance by SiH4 purging treatment

Amorphous silicon (a-Si:H) thin film solar cells were prepared in a single chamber large area plasma enhanced chemical vapor deposition (PECVD) system. A purging process using silane (SiH4) gas was developed to remove the residual contaminations in the reactor after a nitrogen trifluoride (NF3) plasma dry cleaning process. Such a purging treatment leads to a clear improvement in initial fill factor (FF) and in efficiency of as-prepared a-Si:H solar cells. Secondary ion mass spectroscopy (SIMS) results demonstrate that fluorine impurity concentration [F] at the p-layer as well as p/i interface of solar cells reduces by more than one order of magnitude after this purging process. Additionally, high [F] is accompanied with high oxygen impurity concentration [O] which plays a great role in the solar cell performance. Low degradation rate of open circuit voltage (Voc) and fill factor (FF) of solar cells after a purging process after a 1000 h light soaking further illustrates an improvement in the material properties. Implanting such a purging process in the practical production line, about 2 W in power for a-Si:H solar modules (1.1 m × 1.3 m) are gained and meanwhile the champion solar module (1.1 m × 1.3 m) of stabilized power of 113 W with 160 nm thick intrinsic layer has been achieved.

Acellular Dermal Matrix Slings in Tissue Expander Breast Reconstruction

Acellular dermal matrix (ADM) slings in breast reconstruction are increasingly used but are not yet validated. This study compares immediate, expander-based breast reconstruction with and without the use of inferolateral ADM slings. There were 63 patients (106 breasts) in the ADM group and 42 patients (68 breasts) in the control group. Initial intraoperative fill volumes were significantly greater in the ADM group, median 69% full (250 mL) versus 50% full (180 mL; P < 0.001). However, the number of days to complete expansion between the 2 groups was similar. One less office visit was required to complete the fills in the ADM group (P < 0.01). Drains were removed 3 days later in the ADM group (P < 0.01). Overall complication rate was greater in the ADM group (18.9% vs. 7.4%, P < 0.05), with a slightly higher percentage of expanders requiring removal due to infection in the ADM group (5.7% vs. 4.4%, P = NS). This study suggests inferolateral ADM slings in expander-based breast reconstruction allow for significantly increased initial fill volumes and may offer an aesthetic advantage; however, its use is costly and increases complications.

Use of Fetal Bovine Acellular Dermal Xenograft With Tissue Expansion for Staged Breast Reconstruction

Staged breast reconstruction with implants and human acellular cadaveric dermis offers advantages of precise expander positioning, higher initial expander fill volumes, and improved outcomes. This study reports breast reconstruction using fetal bovine acellular dermal matrix (FBADM). The high type III collagen content of FBADM may allow for more rapid tissue incorporation and healing. A total of 49 breast reconstructions in 28 patients (group A) with FBADM were retrospectively compared with 123 reconstructions in 91 patients operated without FBADM (group B). FBADM sizes ranged from 48 to 100 cm2 (mean size: 70.6 cm2). The mean immediate fill volume in group A was 181.2 ± 148.3 mL and 117.7 ± 66.3 mL in group B (P < 0.001). The duration of drainage was significantly shorter in group A (8.51 ± 3.4 days) as compared with controls (11.07 ± 5.1 days), t-test (P = 0.015). There was no significant difference in the overall complication rate (20.8% in group A, 13.0% in group B). Further subgroup analysis of group A patients with complications and without complications, showed that group with complications had significantly longer drain removal time (9.48 vs. 7.97 days), larger initial fill volumes (238.1 vs. 145.3 mL), and a higher BMI (25.8 vs. 22.6 kg/m2) when compared with the complication-free subgroup. The use of FBADM in breast reconstruction offers results comparable with that of human acellular dermal matrix as reported in the literature. However, FBADM significantly reduced wound drainage time in our study when compared with patients without FBADM.

Sedimentary architecture of abandoned channel fills

ABSTRACTChannel fills are common elements of Holocene river systems and older fluvial sequences, but surprisingly little is known about formation and their sedimentary build‐up. Abandoned channels result from channel shifting processes at various scales, including meander cutoff and channel‐belt avulsion. Channel‐fill sequences are of importance as containers of palaeoenvironmental proxy‐records, can be used to reconstruct palaeochannel dynamics and derive palaeoflood records, and contain materials that allow dating the abandonment. Integrated knowledge on the dynamic nature (geometrical and physical insights) of channel abandonment and resultant sedimentary recording is a necessity for comparing and collating records from a series of abandoned channel fills.This paper intends to make channel‐fill sedimentological sequences more useful recorders of channel abandonment processes and palaeofloods, for which improved understanding is needed of the internal build‐up of channel fills. We review oxbow lake infilling along meandering rivers, and supplement this with highly detailed descriptions of two selected field examples of channel fills from the apex‐region of the Netherlands' Rhine delta. From these examples it becomes clear that regional setting and type of abandonment result in different channel‐fill end‐members; oxbow cutoffs generally produce thick laminated clayey fills as the channel entrance is plugged rapidly, avulsion‐abandoned channels are filled with coarse (proximal) deposits as a result of a maintained open river connection.Field examples of channel fills are integrated with knowledge on channel abandonment dynamics in meander cutoff and bifurcating river situations, including insights from recent numerical modelling. We propose a sedimentary‐architecture descriptive scheme that distinguishes elements from two stages of channel‐fill development; (i) the abandonment stage with initial proximal fill, and (ii) the subsequent fully abandoned palaeochannel that collects distal fill. Copyright © 2011 John Wiley &amp; Sons, Ltd.

Characteristics of stable a-Si:H Schottoky cells fabricated by suppressing cluster deposition

ABSTRACTWe have developed a cluster-eliminating filter which reduces amount of amorphous silicon nanoparticles (clusters) incorporated into a-Si:H films. We have applied the filter to fabricate a-Si:H Schottky solar cells. The cells show a high initial fill factor FF=0.563 and a high stabilized value after light soaking FF=0.552 which light-induced degradation was quite low value of 1.95 %.

Experimental technique for generating fast high-density shock waves with phased linear explosive shock tubes

The sequential detonation of a layer of explosive surrounding a pressurized tube can be used to generate fast, high-density shock waves by means of a piston-like implosive pinch travelling at the detonation velocity of the explosive. A novel technique has been developed to extend the regime of operation to piston velocities greater than the detonation velocity of known explosives. This technique consists of cutting a slit in the tamper of a conventional explosive shock tube and introducing a phased detonation wave into the explosive cladding. Preliminary results indicate that quasi-steady shocks can be generated in helium with velocities between 13–17 km/s for initial fill pressures of 6.9 MPa.

Dynamics of explosively imploded pressurized tubes

The detonation of an explosive layer surrounding a pressurized thin-walled tube causes the formation of a virtual piston that drives a precursor shock wave ahead of the detonation, generating very high temperatures and pressures in the gas contained within the tube. Such a device can be used as the driver for a high energy density shock tube or hypervelocity gas gun. The dynamics of the precursor shock wave were investigated for different tube sizes and initial fill pressures. Shock velocity and standoff distance were found to decrease with increasing fill pressure, mainly due to radial expansion of the tube. Adding a tamper can reduce this effect, but may increase jetting. A simple analytical model based on acoustic wave interactions was developed to calculate pump tube expansion and the resulting effect on the shock velocity and standoff distance. Results from this model agree quite well with experimental data.

Assessment of the dosimetric consequences of prostate movement through rectal distension for patients receiving 3DCRT

AbstractPurpose: To investigate the dosimetric consequences of rectal distension at the time of the planning computed tomography (CT) scan and any resultant prostate movement on the planned dose delivery for patients receiving three-dimensional conformal radiotherapy (3DCRT) to the prostate.Methods and materials: 25 prostate cancer patients whose planning CT scan demonstrated a full rectum were rescanned after following a laxative protocol. Rectal dimensions on the two scans and 3DCRT treatment plans produced on each plan were compared. The dosimetric implications of changes in rectal size on the treatment plans and the delivered dose were determined. Statistical significance was evaluated with the Wilcoxon signed ranks test.Results: Significant differences in rectal size were found between the initial CT scan and the rescan. The corresponding median change in prostate position was 4.7 mm. The use of planning scans with a full rectum, that is unrepresentative of the rectum, during treatment causes significant reductions in planning target volume (PTV) minimum dose (median reduction 33.7%) and coverage by the 95% isodose (median reduction 3.7% of the PTV).Conclusion: Rectal distension on the initial planning scan can lead to significant PTV underdosage. Patients presenting with large initial rectal fillings must be rescanned in order to avoid a systematic underdosing of the PTV.

Mathematical Modeling of Initial Filling Moment of Uphill Teeming Process Considering a Trumpet

The flow pattern in the uphill teeming process has been found to be closely related to the quality of ingots and further affects the yield of ingots production, which is crucial for steel making pr ...

Improvements to Fill Tube Design for Direct-Drive NIF and Fast Ignition Applications

Fill tubes are being implemented to meet direct-drive National Ignition Facility (NIF) target designs and eliminate the need for permeation filling of targets. Significant improvements have been made to the fill tube designs for the NIF-scale CD and fast ignition targets to accommodate fuel-layering experiments at the University of Rochester Laboratory for Laser Energetics. The initial fill tube design had a number of issues that contributed to the nonuniformity of the deuterium (D2) ice layer and low fabrication yield of targets. Redesign of the entire target has significantly improved the D2 ice layering by reducing thermal perturbations. These design changes also made a more robust target that can survive the handling required in fabrication and testing. This paper will detail the target design aspects that were altered, including adjusting the fill tube aspect ratio, removing the thermally conductive support stalk, and adding a thermally conductive coating on the fill tube.

Influence of the initial volume fill ratio of the granulator on melt agglomeration behavior in a high-shear mixer

The purpose of this study was to investigate the effects of different initial volume fill ratios of the granulator on granular agglomeration in a high-shear mixer. Calcium carbonate powders, with mean granule sizes of 75–150 μm were used as the raw material. Polyethylene glycol 6000 (PEG 6000) was used as the melting binder. The initial liquid to solid weight ratio was fixed at 0.15. Four different initial granulator fill ratios were used 11%, 14.7%, 18.4% and 22%. The results showed that the granules that formed during the nucleation stage were a little larger when the initial fill ratio was lower than higher. In the rapid-growth stage, the agglomeration growth rate increased as the initial fill ratio increased. The range in granule size at the end of agglomeration also increased as initial fill ratio increased. SEM images of the surface structure of the granules during the nucleation and final stages are shown.

The Effect of Acellular Dermal Matrix Use on Complication Rates in Tissue Expander/Implant Breast Reconstruction

Tissue expander/implant breast reconstructions by 5 surgeons at a single institution from 2005 to 2008 were retrospectively identified and divided into 2 cohorts: use of acellular dermal matrix (ADM, n = 75) versus standard submuscular placement (n = 52). The ADM group had a statistically significant higher rate of infection (28.9% vs. 12.0%, P = 0.022), reoperation (25.0% vs. 8.0%, P = 0.011), expander explantation (19.2% vs. 5.3%, P = 0.020), and overall complications (46.2% vs. 22.7%, P = 0.007). When stratifying by breast size, a higher complication rate was not observed with the use of ADM in breasts less than 600 g, whereas ADM use in breasts larger than 600 g was associated with a statistically significant higher rate of infection when controlling for the occurrence of skin necrosis. The ADM cohort had a significantly higher mean initial tissue expander fill volume (256 mL vs. 74 mL, P < 0.001) and a significantly higher mean initial tissue expander fill ratio (49% vs. 17%, P < 0.001). Further work is needed to define the ideal patient population for ADM use in tissue expander/implant breast reconstruction.

Provenance of siliciclastic and hybrid turbiditic arenites of the Eocene Hecho Group, Spanish Pyrenees: implications for the tectonic evolution of a foreland basin

ABSTRACTThe Eocene Hecho Group turbidite system of the Aínsa‐Jaca foreland Basin (southcentral Pyrenees) provides an excellent opportunity to constrain compositional variations within the context of spatial and temporal distribution of source rocks during tectonostratigraphic evolution of foreland basins. The complex tectonic setting necessitated the use of petrographic, geochemical and multivariate statistical techniques to achieve this goal. The turbidite deposits comprise four unconformity‐bounded tectonostratigraphic units (TSU), consisting of quartz‐rich and feldspar‐poor sandstones, calclithites rich in extrabasinal carbonates and hybrid arenites dominated by intrabasinal carbonates. The sandstones occur exclusively in TSU‐2, whereas calclithites and hybrid arenites occur in the overlying TSU‐3, TSU‐4 and TSU‐5. The calclithites were deposited at the base of each TSU and hybrid arenites in the uppermost parts. Extrabasinal carbonate sources were derived from the fold‐and‐thrust belt (mainly Cretaceous and Palaeocene limestones). Conversely, intrabasinal carbonate grains were sourced from foramol shelf carbonate factories. This compositional trend is attributed to alternating episodes of uplift and thrust propagation (siliciclastic and extrabasinal carbonates supplies) and subsequent episodes of development of carbonate platforms supplying intrabasinal detrital grains. The quartz‐rich and feldspar‐poor composition of the sandstones suggests derivation from intensely weathered cratonic basement rocks during the initial fill of the foreland basin. Successive sediments (calclithites and hybrid arenites) were derived from older uplifted basement rocks (feldspar‐rich and, to some extent, rock fragments‐rich sandstones), thrust‐and‐fold belt deposits and from coeval carbonate platforms developed at the basin margins. This study demonstrates that the integration of tectono‐stratigraphy, petrology and geochemistry of arenites provides a powerful tool to constrain the spatial and temporal variation in provenance during the tectonic evolution of foreland basins.

Acellular Dermis–Assisted Prosthetic Breast Reconstruction versus Complete Submuscular Coverage: A Head-to-Head Comparison of Outcomes

Complete submuscular tissue expander coverage affords the best protection against implant exposure but restricts lower pole expansion. Techniques using acellular dermis as a pectoralis muscle extension can allow for more rapid fill of the expander and better control of the inframammary fold. This study compares both techniques with regard to relevant outcomes. Results of 100 consecutive breast expander reconstructions performed by two surgeons between 2004 and 2007 were retrospectively reviewed. Patient demographics, expander coverage type, adjuvant treatment, length and characteristics of the expansion, and incidence and types of complications were analyzed. One hundred women underwent breast reconstruction with 172 expanders, in 50 using complete submuscular placement and in 50 using partial subpectoral placement with acellular dermis. The patient groups were similar in terms of demographic data. Mean number of fills to complete reconstruction was 4.31 in the submuscular group and 1.72 in the acellular dermis group (p = 0.0001). Mean intraoperative fill volume was 130 cc in the submuscular group, compared with 412 cc per expander in the acellular dermis group (p = 0.0001). Fisher's exact test demonstrated no significant difference in total complication rate between the two groups (14 percent versus 18 percent; p = 0.79). Acellular dermis allowed for a greater initial fill of saline. This potentially improves cosmetic outcome, as it better capitalizes on preserved mastectomy skin for reconstruction. The authors conclude that acellular dermis-assisted implant breast reconstruction has a safety profile no worse than that of complete submuscular coverage but offers the benefit of fewer expansions and the potential for more predictable secondary revisions.

Breast Reconstruction with Implants, Tissue Expanders and AlloDerm: Predicting Volume and Maximizing the Skin Envelope in Skin Sparing Mastectomies

AlloDerm has been used as a tissue supplement in conjunction with the pectoralis major muscle to provide full coverage over an implant in breast reconstruction. While this method of reconstruction has shown promising results there is little known on the relationship of AlloDerm size and potential immediate expansion volume. A retrospective chart review was completed evaluating all tissue expander or primary implant reconstructions using AlloDerm. Data recorded included: The type/size of implant/expander, dimensions of the AlloDerm used, initial fill volume, number of expansions and time period of expansion. Statistical analysis was completed with a linear regression model. AlloDerm was used on 49 patients (72 reconstructions). Thirty-four patients (50 reconstructions) underwent reconstruction with a tissue expander and 15 patients (22 reconstructions) underwent a single stage reconstruction with a permanent implant. The tissue expander volume filled (cc) could be predicted by 5 x surface area of AlloDerm (cm(2)) - 12 (R(2) = 0.62) and 80 x height of AlloDerm (cm) - 15 (R(2) = 0.59). The tissue expanders could be filled to an average of 75% of total size and required three to four injections in the postoperative period to reach full expansion. Obviously, a requirement for maximal implant expansion is an appropriate skin sparing mastectomy. There is a mathematical relationship between fill volume and surface area as well as height of AlloDerm used in breast reconstruction. This analysis provides a guideline for immediate implant expansion to surgeons using AlloDerm in reconstructive breast surgery.

Provenance of Upper Cretaceous-Paleogene sandstones in the foreland basin system of the Sierra Madre Oriental, northeastern Mexico, and its bearing on fluvial dispersal systems of the Mexican Laramide Province

Sandstone petrography and detrital zircon U-Pb analysis of Upper Cretaceous–Paleogene sandstones in the foreland basin of the Sierra Madre Oriental in northeastern Mexico indicate long-distance sediment transport from arc, basement, and thrust-belt sources lying to the west, northwest, and south. The basin fill, termed the Difunta Group, consists of sublitharenites, litharenites, feldspathic litharenites, and lithic arkoses derived from mixed sources that included sedimentary rocks, magmatic arc rocks, and subordinate basement rocks. Six age populations comprise the detrital zircon content of the sandstones: Proterozoic (1900–900 Ma), early Paleozoic (500–400 Ma), late Paleozoic–Early Triassic (288–235 Ma), Jurassic (180–151 Ma), Early Cretaceous (150–111 Ma), and Late Cretaceous–Paleogene (110–54 Ma). These grains were derived from several arc terranes, ranging in age from Permian to Paleogene, in western Mexico and the southwestern United States, from sedimentary rocks and possibly interbedded tuffs of the Sierra Madre Oriental orogen and from basement sources or their derivative sandstones of the southwestern United States. The petrographic and geochronologic provenance data corroborate existing models for derivation of much foreland detritus from arc sources to the west, identify the Sierra Madre orogen itself as an important source for sediment, and these data modify the Late Cretaceous–Paleogene paleogeography of Mexico to include a long, orogen-parallel fluvial system with headwaters in the southwestern United States. The difference in average ages of the youngest grains in the sandstones and their inferred depositional ages is 10.5 m.y., indicating that the initial coarse fill of the foreland basin was derived from early Laramide uplift and eastward arc migration in northwestern Mexico and the southwestern United States.

Middle Jurassic stromatactis mud-mounds in the Pieniny Klippen Belt (Carpathians) — A possible clue to the origin of stromatactis

Four occurrences of Jurassic stromatactis mud-mounds were found in the Czorsztyn Unit of the Pieniny Klippen Belt (Western Carpathians) — in western Slovakia (Slavnické Podhorie, Babiná), and in the Transcarpathian Ukraine (Priborzhavskoe and Veliky Kamenets). Their stratigraphic range is from Bajocian to Callovian. The mounds consist of micropeloidal mudstones, wackestones to packstones with a fauna including pelecypods, brachiopods, ammonites and crinoids. Spicules and skeletons of siliceous sponges are abundant in every section. All of the mounds contain networks of stromatactis cavities that are partially filled with radiaxial fibrous calcite (RFC) and locally by internal sediments. At Slavnické Podhorie, the sparry masses that fill stromatactis cavities are weathered out and show casts of sponges. Parallel study of the weathered casts and their cross-sections in slabs showed that they bear all the signs of stromatactis (relatively flat bottoms and digitate upper parts, RFC initial fillings and eventual blocky calcite later filling). Almost no original sponge structures were preserved. This strongly supports the possible sponge-related origin for stromatactis cavities.

Psychotropic Medications for Patients With Bipolar Disorder in the United States: Polytherapy and Adherence

Psychotropic Medications for Patients With Bipolar Disorder in the United States: Polytherapy and Adherence

Psychotropic Medications for Patients With Bipolar Disorder in the United States: Polytherapy and Adherence

Because treatments for bipolar disorder include a growing number of psychotropic agents, the authors evaluated psychotropic polytherapy and adherence to treatment among U.S. patients with bipolar disorder. National health plan claims data (2000-2004) were used to identify patients diagnosed as having bipolar disorder who had continuous benefits and had not been prescribed medication for bipolar disorder for six months or more. The study compared drugs dispensed to these patients initially and at one year and characterized patients who were adherent to mood-stabilizers. A total of 7,406 patients had a bipolar disorder: bipolar I (55%), bipolar II (15%), or bipolar disorder not otherwise specified (30%). Women represented 57% of the sample; mean+/-SD age was 35.4+/-12.4 years. Initial prescription fills involved one psychotropic agent in 67% of patients, and two or more psychotropics (polytherapy) in 33%. Initial prescription drug selections involved: antidepressants > anticonvulsants >or= antipsychotics > sedatives > lithium; initial mood stabilizer use ranked: valproate > lithium > carbamazepine or oxcarbazepine > lamotrigine; antipsychotics ranked: olanzapine > quetiapine >or= risperidone > ziprasidone > aripiprazole > clozapine. Rankings were similar at one year, when only 31% of patients received monotherapy (a 2.2-fold decline), 32% received polytherapy, and 37% received no psychotropics. Initially patients received 1.42 psychotropic drugs per person; at one year, patients received 175, and at both times polytherapy was less likely with lithium than with anticonvulsants. In multivariate modeling, one-year mood stabilizer use was greater with the following: older age, type of mood stabilizer (lamotrigine > valproate > carbamazepine or oxcarbazepine > lithium) and was associated with more psychiatric office and emergency visits, clinician type (more common with psychiatrists than with primary care physicians), and nonuse of off-label anticonvulsants. Polytherapy was used by one-third of patients initially and at one year, antidepressant use was highly prevalent initially and later, but lack of treatment was prevalent at one year. Plausible clinical and treatment factors were associated with sustained mood stabilizer adherence.