Interrupted Technique Research Articles

Durability of Electrodeposited Ni-Fe-Co-C Anodes for Alkaline Water Electrolysis

IntroductionWe have been studying more than a quarter of century for supply of renewable energy in the form of methane via electrolytic hydrogen generation using carbon dioxide as the feedstock. Although we created cathodes and anodes for direct seawater electrolysis, the energy efficiency was not sufficient. For immediate industrialization, we are concentrating our current effort on alkaline water electrolysis, creating efficient cathodes and anodes. The present work aimed to determine the composition of active Ni-Fe-Co-C alloy anodes prepared by electrodeposition and to examine the durability for continuous electrolysis at a high current density of 6000 Am-2 in 4.5 M KOH at 90°C. Experimental Procedures The substrate for electrodeposition was a chemically etched Ni plate. Electrodeposition was carried out at a current density of 300 Am-2 for 10 min in 1.14 M NiSO4-0.189 M NiCl2-0.49 M H3BO3-0.104 mM CH3(CH2)11OSO3Na solutions containing various concentrations of FeSO4, CoSO4 and lysine, the pH of which was adjusted at 1.5 by the addition of 18 M H2SO4. Lysine was added as the carbon source. The composition of metallic elements in the electrodes was analyzed by electron probe microanalysis, and carbon was chemically analyzed by combustion infrared absorption method. The solution used for oxygen evolution was 4.5 M KOH at 90oC. The activity of the anodes was evaluated from galvanostatic polarization curves measured by the current density rise every 1 min. The potential rise due to the solution resistance at high current densities was corrected by the current interruption technique. Potentiodynamic polarization curves were also measured at a potential sweep rate of 0.52mV-1 for comparison. Results and Discussion As-deposited alloys were used for examination of oxygen evolution activity. Ni was a stable anode but less active for industrial electrolysis. The addition of Co ion and lysine to the deposition electrolyte containing Ni ion enhanced the oxygen evolution activity, but the activity of Ni-Co-C alloys was not yet sufficiently high. Ni-Fe-Co-C alloys deposited showed significantly high activity for oxygen evolution. An increase in Fe content in the alloy was more effective than the increase in Co content for enhancement of oxygen evolution activity. Thus, an increase in Co concentration in deposition electrolytes did not largely change the activity because the increase in Co content in the alloy resulted in the decrease in the content of Fe. The addition of lysine to the deposition electrolytes containing Ni, Fe and Co ions enhanced the oxygen evolution activity. The highest activity was attained at 0.2 M lysine in the deposition solution, but further increase in lysine concentration was not effective. An increase in lysine concentration led to asymptotic increase in the C content in the Ni-Fe-Co-C alloys up to about 6 at%. The deposition electrolyte to form the most active Ni-Fe-Co-C alloy for oxygen evolution was 1.33M Ni-0.072M Fe-0.018M Co-0.2M lysine solution. When the Ni-Fe-Co-C alloy prepared from this electrolyte was used for oxygen evolution at a current density of 6000 Am-2 for 800 h, the mass loss was about 5 % of the original mass. The galvanostatic polarization potential of as-deposited Ni-Fe-Co-C alloy measured by the current density rise every 1 min was in the active region at lower current densities, but the potential shifed to the oxygen evolution region at higher current densities. Once the specimen was polarized in the oxygen evolution region, the potential was stayed in the oxygen evolution region even when the current density was lowered. After oxygen evolution at 6000 Am-2 for long period of time, the potential stayed in the oxygen evolution region regardless of current densities. In fact, the dissolution current density estimated from the mass loss by polarization at 6000 Am-2 for 800 h even on the assumption of Fe dissolution in the form of Fe6+ as FeO4 2- was only 4.5 x 10-3 Am-2 that is less than one-millionth of oxygen evolution current. Consequently, the active Ni-Fe-Co-C alloy anode thus prepared is sufficiently stable maintaining the passive state in the severe environment for oxygen evolution at 6000 Am-2 in a concentrated KOH solution at 90°C for long period of time. Conclusion The active oxygen evolution anode in alkaline water electrolysis for hydrogen production was created. The addition of Fe, Co and C to Ni enhanced the oxygen evolution efficiency in 4.5 M KOH solution at 90°C. The Ni-Fe-Co-C alloy thus prepared kept the passive state during electrolytic oxygen evolution at 6000 Am-2 for a long period of time.

Initial Resistance of Carina Anastomoses with Increasing Tensile Stress: An ex vivo Model Comparing Different Suture Techniques

Background: After resection of the carina with a length of more than 4 cm, anastomoses often need to be performed under tension despite maximum mobilization. If the patient cannot be extubated, the anastomosis remains under continued stress. Anastomoses of the carina can be constructed using various suture techniques, including single interrupted sutures, back wall running but front wall single interrupted sutures, and complete running suture. This experimental study was designed to determine the most tensile stress-resistant anastomotic suture technique. Materials and Methods: Isolated preparations of tracheobronchial trees were recovered from freshly slaughtered pigs. Resection of the carina was carried out in preparation of the experiments. After blind randomization, anastomoses (n = 15 per group) between the distal trachea and the proximal left main bronchus were performed with PDS 4-0 employing three different suture techniques: (1) single interrupted sutures, (2) back wall running but front wall single interrupted sutures (= mixed technique), and (3) complete running suture. The anastomotic specimen was fixed onto a specially constructed device. The tracheal end was intubated with a tube (CH 8.0) and connected to a respirator. Different weights were attached to the distal end of the preparation via a clamp and guide rollers. Airtightness was investigated at the following tensile loads: 0, 500, 1,000 and 1,500 g. Intrabronchial pressure was increased in 5-mbar steps. In an underwater trial, we analyzed whether anastomoses were airtight at a maximum intrabronchial ventilation pressure of 70 mbar. Results: At an intrabronchial pressure of 25 mbar without tensile stress, all anastomoses were initially airtight. In tensionless anastomoses at 70 mbar, 100% of single interrupted and continuous sutures were airtight, as compared to 80% of sutures in mixed technique. At 70 mbar and tensile loads of 1,500 g, 80% of single interrupted sutures, 60% of sutures in mixed technique and 53% of the running sutures remained competent. Conclusion: If tracheal anastomoses can be performed without tension, the suture technique is not important. With increased tension, anastomoses performed in single interrupted suture technique were clearly superior. Thus, in situations, where high tensile stress is to be expected, single interrupted sutures should be preferred.

Investigation of quench sensitivity of high strength 2219 aluminum alloy by TTP and TTT diagrams

The time-temperature-transformation (TTT) curve and time-temperature-property (TTP) curve of 2219 aluminum alloy were determined by an interrupted quench technique. The results show that the quench sensitivity temperature range of 2219 aluminum alloy is from 300 °C to 480 °C and the nose temperature is about 440 °C. The transmission electron microscopy (TEM) observation indicated that, during isothermal holding at 440 °C, a number of coarse equilibrium rod-shaped θ particles precipitated and grew fast, resulting in loss of solutes and decrease of subsequent ageing hardening effect. In the quench sensitive range, primary precipitating reasons of rod-shaped θ particles are high diffusion rate of solute atoms and large phase transformation driving force. Therefore, for large 2219 aluminum alloy forgings, the quenching cooling rate should be increased as high as possible in the quenching sensitive range (300–480 °C) to obtain high mechanical properties, and decreased properly from the solution temperature to 480°Cin order to reduce the residual stress.

Methods of Airway Resistance Assessment

Airway resistance is the ratio of driving pressure to the rate of the airflow in the airways. The most frequent methods used to measure airway resistance are whole-body plethysmography, the interrupter technique and the forced oscillation technique. All these methods allow to measure resistance during respiration at the level close to tidal volume, they do not require forced breathing manoeuvres or deep breathing during measurement. The most popular method for measuring airway resistance is whole-body plethysmography. The results of plethysmography include among others the following parameters: airway resistance (Raw), airway conductance (Gaw), specific airway resistance (sRaw) and specific airway conductance (sGaw). The interrupter technique is based on the assumption that at the moment of airway occlusion, air pressure in the mouth is equal to the alveolar pressure . In the forced oscillation technique (FOT), airway resistance is calculated basing on the changes in pressure and flow caused by air vibration. The methods for measurement of airway resistance that are described in the present paper seem to be a useful alternative to the most common lung function test — spirometry. The target group in which these methods may be widely used are particularly the patients who are unable to perform spirometry.

Methods of airway resistance assessment.

Airway resistance is the ratio of driving pressure to the rate of the airflow in the airways. The most frequent methods used to measure airway resistance are whole-body plethysmography, the interrupter technique and the forced oscillation technique. All these methods allow to measure resistance during respiration at the level close to tidal volume, they do not require forced breathing manoeuvres or deep breathing during measurement. The most popular method for measuring airway resistance is whole-body plethysmography. The results of plethysmography include among others the following parameters: airway resistance (Raw), airway conductance (Gaw), specific airway resistance (sRaw) and specific airway conductance (sGaw). The interrupter technique is based on the assumption that at the moment of airway occlusion, air pressure in the mouth is equal to the alveolar pressure . In the forced oscillation technique (FOT), airway resistance is calculated basing on the changes in pressure and flow caused by air vibration. The methods for measurement of airway resistance that are described in the present paper seem to be a useful alternative to the most common lung function test - spirometry. The target group in which these methods may be widely used are particularly the patients who are unable to perform spirometry.

Maternal fatty acid levels during pregnancy, childhood lung function and atopic diseases. The Generation R Study.

Maternal fatty acid status during pregnancy might influence foetal immunological development and subsequently the risk of childhood atopic diseases. To examine the associations of maternal fatty acid levels during pregnancy with airway resistance and inflammation, asthma and eczema, in school-age children. This study among 4976 subjects was embedded in a population-based prospective cohort study. We measured maternal plasma glycerophospholipid fatty acid levels by gas chromatography during the second trimester of pregnancy (mean gestational age: 20.7 (± 1.1) weeks). At the age of 6years, airway resistance and inflammation were measured by interrupter technique (Rint) and fractional exhaled nitric oxide (FeNO), and current physician-diagnosed asthma and eczema were assessed by ISAAC-based questionnaires. Multiple linear and logistic regression models were adjusted for socio-demographic, lifestyle and anthropometric factors. We did not observe consistent associations of maternal total polyunsaturated fatty acid (PUFA), total n-6 PUFA, total n-3 PUFA levels and n-6/n-3 PUFA ratio during pregnancy with child's Rint and FeNO. Higher maternal total PUFA and total n-6 PUFA levels were associated with a decreased risk of childhood asthma (odds ratios (95% confidence interval): 0.76 (0.60, 0.97) and 0.71 (0.52, 0.96) per standard deviation score (SDS) increase of total PUFA and total n-6 PUFA levels, respectively) and with an increased risk of childhood eczema (1.16 (1.05, 1.28) and 1.21 (1.07, 1.37)). The observed associations were partly explained by Linoleic acid (LA, C18:2n-6) levels. Maternal total n-3 PUFA levels and n-6/n-3 PUFA ratio were not associated with current asthma and eczema. The observed associations were not explained by child's PUFA intake. Higher maternal total PUFA and total n-6 PUFA levels during pregnancy seem to influence the risk of atopic diseases in childhood. The underlying mechanisms need to be further explored.

Multicentre, propensity-matched study to evaluate long-term impact of implantation technique in isolated aortic valve replacement on mortality and incidence of redo surgery.

Studies suggest that the use of semicontinuous suture (SC) technique increases the risk of redo valve surgery after aortic valve replacement (AVR). The objective of this study was to identify 30-day mortality, rate of redo operation and long-term outcomes after AVR using either a semicontinuous suture or interrupted suture (IS) technique. A total of 1617 patients from 2 cardiothoracic centres, undergoing isolated AVR between April 2005 and August 2013 were included. AVR was performed using SC technique in 765 patients and IS technique in 852 patients. Data were collected prospectively and follow-up was obtained to date for all patients. We compared 30-day mortality, rate of redo operation and long-term mortality in SC and IS groups. One-to-one propensity-matching analysis was performed using IBM SPSS version 22 to evaluate outcomes. Four hundred and eleven patients in the SC group were matched to 411 patients in the IS group (total of 822 patients) using propensity-score matching. The baseline characteristics were similar between SC and IS groups after matching. There were no statistically significant differences in 30-day mortality (3.9 vs 2.7%; P = 0.328), long-term mortality at 9-year follow-up (14.4 vs 15.3%; log-rank = 0.524) or rate of redo surgery (2.9 vs 2.0%; P = 0.320) between SC and IS, respectively. However, shorter cross-clamp time (51.9 ± 15.2 vs 60.9 ± 17.6 min; P < 0.001), bypass time (71.3 ± 23.0 vs 81.3 ± 37.8 min; P < 0.001) and the use of larger valve sizes (23.4 ± 2.1 vs 21.9 ± 2.2 mm; P < 0.001) were observed in SC patients compared with IS patients. Multivariate analysis did not show the suture technique as a significant determinant of redo valve surgery. This multicentre study demonstrates that neither mortality nor the risk of redo surgery was influenced by the choice of implantation technique using semicontinuous vs interrupted suture techniques. The SC technique allowed shorter operations and larger size valves to be utilized.

Associations of maternal and fetal 25-hydroxyvitamin D levels with childhood lung function and asthma: the Generation R Study.

Exposure to low levels of vitamin D in fetal life might be a risk factor for childhood asthma. We examined whether 25-hydroxyvitamin D levels in mid-gestation and at birth were associated with higher airway resistance and inflammation, and increased risks of wheezing and asthma in school-age children. We performed a population-based prospective cohort study among 3130 mothers and their children. Maternal blood samples in mid-gestation and umbilical cord blood samples at birth were used to determine 25-hydroxyvitamin D levels. At age of 6, airway resistance (Rint) was measured by interrupter technique and airway inflammation by fractional exhaled nitric oxide (FENO) using NIOX chemiluminescence analyser. Wheezing and asthma were prospectively assessed by annual questionnaires until age 6. Maternal levels of 25-hydroxyvitamin D in mid-gestation were not associated with Rint, FeNO, wheezing patterns, or asthma. Children in the lowest tertile of 25-hydroxyvitamin D levels at birth had a higher Rint (Z-score (95% confidence interval [95% CI]): -0.42 (-0.84, -0.01), P-value for trend<0.05), compared to those in the highest tertile group. The effect estimate attenuated when child's current 25-hydroxyvitamin D level was taken into account [Z-score (95% CI): -0.55 (-1.08, 0.01)]. Low levels of 25-hydroxyvitamin D at birth were associated with a higher airway resistance in childhood. Additional adjustment for child's current 25-hydroxyvitamin D level reduced the effect size of the association. Further studies are needed to replicate these findings and to examine mechanisms underlying the observed association and the long-term consequences.

Conduction disorders in continuous versus interrupted suturing technique in ventricular septal defect surgical repair

Background: Ventricular septal defects (VSD) is one of the most frequent congenital cardiac malformations and cardiac conduction disorders are still one of the serious postoperative complications in this surgery. Objectives: This study aimed to compare the incidence of conduction disorders with the use of continuous compared to interrupted suturing techniques in VSD surgical repair. Patients and Methods: Previously recorded data of 231 patients who underwent surgical closure of VSD between January 2009 and January 2012 at the Rajaie cardiovascular medical and research center were retrospectively reviewed. VSD surgical repair was performed using continues suturing technique in group A patients (n = 163, 70.6%) and interrupted suturing technique in group B patients (n = 68, 29.4%). Results: The most common concomitant congenital anomalywas Tetralogy of Fallot (27.3%). Twenty-four (10.4%) patients had intraoperative cardiac arrhythmia, including 19 (8.2%) transient and 5 (2.2 %) permanent arrhythmia. During their ICU stay, ventricular arrhythmia and complete heart block were observed in 34 (14.7%) and 5 patients (2.2%), respectively. At the time of the last follow-up, incomplete right bundle branch block (RBBB), complete RBBB, RBBB with left anterior hemi-block, and complete heart block were identified in 84 (36.4%), 42 (18.2%), 29 (12.6%), and 5 patients (2.2%), respectively. The results revealed that group A patients were most likely to have had cardiac arrhythmias during their ICU stay and at the time of last follow-up (P < 0.001), while the intraoperative incidence of cardiac arrhythmia during surgery was not statistically significant between the two groups (P = 0.06). Conclusions: In the absence of any statistical differences in the other risk factors between the two groups, the difference in the incidence of conduction disorders can be attributed to the type of suturing used during the procedure.

Comparative study of efficacy of modified continuous smead-jones versus interrupted method of midline laparotomy fascial closure for contaminated cases

Background: Mass closure of midline laparotomy fascial wound is undoubtedly superior to layered closure technique. For elective surgeries continuous method is recommended over interrupted to avoid wound dehiscence, but controversy exists in the literature about the best method of midline fascial suturing in contaminated cases. Thus this is the study to compare two techniques of closure.Methods: Prospective non-randomised study. Two groups are study group who underwent modified smead-Jones method of fascia closure and control group who underwent interrupted closure. Outcome parameters studied were time required for closure, length of suture material needed, postoperative wound infection and wound dehiscence. Data was analysed statistically using Chi-square test.Results: Time required for study group was significantly lesser than control and the length of suture required was also significantly less. Wound infection rate in study group was lesser than control but the difference was statistically insignificant (p &gt;0.05). Wound dehiscence rate was significantly less in the study group (p &lt; 0.05) compared to control group.Conclusions: In Smead-Jones method of closure tension between two loops is distributed in such a way that the fascial edges are well approximated. Originally described method was interrupted. Continuous method has advantage of being faster and has less risk of wound dehiscence due to dynamic distribution of increased tension in postoperative period due to see-saw effect. We proposed modification of original Smead-Jones technique by doing it in continuous manner to increase the benefits and found this method to be fast, cost-effective, equally effective in controlling wound infection and better than interrupted technique to prevent wound dehiscence.

A randomized controlled trial of interrupted versus continuous suturing techniques for radiocephalic fistulas

Continuous suturing techniques have conventionally been used for the end-to-side anastomoses of radiocephalic fistulas (RCFs); however, primary patency rates are poor. Only 50% to 60% of RCFs ever achieve functional patency. We hypothesized that a hybrid interrupted-continuous suturing technique (as used in many microsurgical procedures) may improve outcomes in fistulas constructed from small vessels. A randomized controlled trial comparing hybrid interrupted-continuous (n = 42) with continuous (n = 36) suturing techniques for RCF was undertaken. Patients were excluded if vessels were <1.8 mm in diameter or if previous ipsilateral fistula had been attempted. A priori power calculation indicated that a sample size of 78 patients was required to detect an improvement in patency from 50% to 80% (α = .05, β = .8). The primary end point was primary patency at 6 weeks (assessed by a blinded observer for the presence of thrill and bruit). Secondary end points were immediate patency, functional patency (assessed clinically and by ultrasound) at 6 weeks, and presence of anastomotic stenosis. Groups were comparable for basic patient demographics, operating surgeon, and vessel diameter as measured on preoperative ultrasound (mean age, 58.9 ± 13 years; 68% male). Primary patency at 6 weeks was higher in the hybrid interrupted-continuous suturing technique group (71% vs 47%; P = .01). Immediate patency was also higher in the hybrid interrupted-continuous suturing technique group (93% vs 67%; P < .001). There was no significant difference in functional patency at 6 weeks (52% vs 36%; P = .18). Three patients developed an anastomotic stenosis. All were in the hybrid interrupted-continuous suturing technique group. One patient from the interrupted suturing technique cohort required re-exploration for bleeding. A hybrid interrupted-continuous suturing technique yielded higher immediate and 6-week primary patency rates for RCF. The hybrid interrupted-continuous suturing technique may improve anastomotic compliance and reduce the narrowing and puckering that can occur on suture tightening in small-caliber vessels. Based on these findings, consideration should be given to performing hybrid interrupted-continuous anastomoses for RCFs.

Lung Function Tests in Preschool Children.

The measurement of lung function by spirometry is routinely used to monitor and adequately treat children with asthma. The assessment and evaluation of lung function in children aged 3-5 years has been neglected for a long time because of the difficulty to perform forced expiratory maneuvers. However, the use of techniques such as the interrupter technique and the forced oscillation technique, which only require passive collaboration and where the only request to the child is to breathe at tidal volume, has overcome this limitation. Other techniques such as the measurement of specific airway resistance by plethysmography or the measurement of the lung clearance index using the multiple-breath washout might be helpful in this regard, although these techniques are less standardized in preschool children.

Modified interrupted suturing technique for preventing suture irritation

Figure 1. Interrupted suture with stiff suture tags. Even though a continuous suturing technique is less time consuming, the failure of any part of the suture may result in loosening along its whole length. Therefore, horizontal mattress and interrupted suturing techniques are recommended for a guided bone regeneration procedure. A polypropylene suture (PPS) is also used to avoid wound dehiscence, because a PPS can resist muscle pull with prolonged high tensile strength, knot security, expansion due to swollen soft tissue, and minimal tissue reaction. However, the stiff suture tags of a PPS may irritate the fragile mucosa and result in pain and hematoma. If suture irritation occurs after a guided bone regeneration procedure, fabricating a custom soft tissue guard is preferable to early removal of the sutures. However, an additional laboratory procedure is required, and the patient must wear a guard continuously for 2 weeks until the sutures can be removed. Moreover, direct pressure on a surgical site may result in membrane exposure. This tip presents a modified interrupted suture technique to avoid suture irritation without a guard. However, this method is technique-sensitive because of the kinking effect of this material and the difficulty in accurately placing the sutures.

The pursestring technique for endoscopic revision of gastric bypass

A significant proportion of patients regain weight after Roux-en-Y gastric bypass. Endoscopic revision of dilated gastrojejunal anastomosis, called transoral outlet reduction (TORe), has proven effective and allows patients to avoid reoperation. Traditionally, TORe has been performed with an interrupted stitching technique with placement of stitches across the anastomosis. In this video, we demonstrate the pursestring and double pursestring techniques for TORe.

Prevention of Incisional Surgical Site Infection Using a Subcuticular Absorbable Suture in Elective Surgery for Gastrointestinal Cancer.

This study examined whether subcuticular absorbable sutures actually reduce incisional SSI in patients undergoing surgery for gastrointestinal (GI) cancer. Surgical site infection (SSI) is still a source of major complications in digestive tract surgery. Reportedly, incisional SSI can be reduced using subcuticular suturing. We performed subcuticular suturing using a 4-0 absorbable monofilament in patients undergoing elective surgery for GI cancer beginning in 2008. Using an interrupted technique, sutures were placed 1.5-2.0cm from the edge of the wound, with everted subcuticular sutures created at intervals of 1.5-2.0cm. The control group consisted of cases in which the common subcutaneous suture method using clip. One hundred cases were examined in the subcuticular group. The incidence of SSI was 0% in the subcuticular suture group, compared with 13.9% in the control group; this difference was significant. Incisional SSI can be prevented using the devised subcuticular absorbable sutures in patients undergoing elective surgery for GI cancer.

Effect of Continuous Urethro-Vesical Anastomosis Technique in Incontinence After Radical Retropubic Prostatectomy, 1:1 Matching Study.

Purpose:Vesicourethral anastomosis (VUA) is an important step in radical prostatectomy and can affect clinical course in hospital. However, few studies comparing VUA by standard interrupted and continuous suturing techniques in radical retropubicprostatectomy (RRP) have been reported. We compared the postoperative outcomes and continence recovery rates of patients undergoing these two variations of VUA using 1:1 propensity score matching.Methods:From January 2008 to January 2014, a total of 188 patients underwent RRP. We conducted 1:1 propensity score matching based on age, prostate volume, pathological stage, status of nerve sparing, and two baseline characteristics (preoperative prostate-specific antigen [PSA] level and Gleason score determined by pathology). Patients were assigned to two groups based on the suturing method used (interrupted or continuous). After RRP, incontinence levels were assessed at 1, 3, 6, and 12months based on pad usage per day (0, dry; ≤1, social continence; ≥2, incontinence).Results:Each group consisted of 47 patients. The continuous group had a lower incidence of VUA site leakage (0% vs. 10.6%, P=0.022), but there were no significant differences in the rates of postoperative urethral stricture (6.4% vs. 6.4%, P=1.00) andpyuria (43.6% vs. 45.0%, P=0.770) between the two groups. The rate of recovery to social continence was greater in the continuous group at postoperative 3 months (85.1% vs. 66.0%, P=0.031). About 50% of patients had no incontinence (pad perday=0) after 6 months (59.6% in the continuous group and 51.1% in the interrupted group, P=0.407) and at postoperative 12 months, the dry rate 61.7% in the interrupted group and 80.4% in the continuous group (P=0.047). The times required toreach social continence (3.21 months vs. 3.77 months, P=0.056) and no incontinence (7.23 months vs. 7.63 months, P=0.132) were also shorter in the continuous group, but these differences were not statistically significant.Conclusions:The results of this study suggest that earlier recovery to social continence and a higher rate of complete recovery (dry) could be expected with VUA by continuous suturing. Furthermore, if adequate surgical experience is accumulated, VUAwith continuous suturing could be performed without difficulty.

Survivor Perspectives on IPV Perpetrator Interventions

More effective work with perpetrators of intimate partner violence (IPV) can be built upon a better understanding of how and why they change their behavior. This article presents a systematic narrative review of female IPV survivor perspectives on the changes brought about by IPV perpetrator programs. Fourteen databases and web search engines were searched and 16 articles reporting relevant qualitative findings were identified. Survivors often reported some level of positive change through their partner’s engagement with a program, but the sustainability of this change is unclear and there was also some negative feedback. From the survivors’ perspective, key barriers to perpetrator change include alcohol dependency, mental health challenges, relationship dynamics, and their family of origin. Mechanisms by which perpetrators are held to account, namely, survivor validation and judicial measures, were seen as central to the change process. Survivors perceived changes in perpetrator behavior (the use of conflict interruption techniques and new communication skills) and changes in perpetrators’ belief systems (adopting new perspectives). Changes in belief systems were associated with more complete desistence from violence and would appear more difficult to effect. The review highlights the complexity in this field, which is discussed by the authors with reference to practice, policy, and research.

Bedside intravascular ultrasound-guided inferior vena cava filter placement in medical-surgical intensive care critically-ill patients

Introduction and objectivePulmonary Embolism (PE) is a potentially life-threatening complication of critical illness. Prophylactic inferior vena cava filter (IVC) placement offers a protection rate of 99% against fatal PE. Transportation of critically ill patients from the intensive care unit to the interventional radiology suit is a potential risk and cumbersome. Bedside IVC filter placement offers protection against fatal PE without added risk of transportation. Transabdominal ultrasound visualization of the IVC can be difficult because of patient body habitus or recent abdominal surgeries. Intravascular Ultrasound (IVUS) is an appealing imaging guidance that does not have this limitation. We are aiming at evaluation the safety and outcome of bedside IVUS-guided Günther Tulip filter placement in the intensive care units patients. ResultsThe single venous access technique via the femoral vein was used. Filter placement was successful in 95% of cases (35/37). In two earlier cases filters misplaced at the right iliocaval confluence were fluoroscopically repositioned in the infrarenal IVC. Neither PE nor PE-related mortality was recorded. Renal impairment was seen in 35% of cases (n=13/37). The body mass index calculation in 27 patients revealed obesity in 67% of the patients. ConclusionsBedside IVUS-guided filter placement in medical-surgical critically ill patient in intensive care unit is a feasible, safe and reliable technique for IVC interruption. IVUS may be the most appropriate tool to guide filter insertion in obese patient.

Clinical and Pulmonary Function Markers of Respiratory Exacerbation Risk in Subjects With Quadriplegic Cerebral Palsy.

Although respiratory exacerbations are common in patients with quadriplegic cerebral palsy (CP), little is known about the factors that are related to increased exacerbation risk. This study aimed to identify the clinical and pulmonary function variables signaling risk of exacerbation in this type of patient. Thirty-one children and young adults with quadriplegic CP underwent a comprehensive history, physical examination, and pulmonary function test, including arterial blood gas analysis, airway resistance using the interrupter technique, and home overnight SpO2 monitoring. Subjects were divided into 2 groups depending on the number of respiratory exacerbations reported during the year before study entry: frequent exacerbators (ie, ≥ 2 exacerbations) and infrequent exacerbators (ie, < 2 exacerbations). The frequent exacerbators were more likely to require hospitalization due to respiratory disorders compared with the infrequent exacerbators (13/14 vs 9/17, P = .02). Respiratory exacerbation was found to be associated with diagnosis of gastroesophageal reflux (adjusted odds ratio of 23.95 for subjects with confirmed diagnosis, P = .02) and higher PaCO2 levels (adjusted odds ratio of 12.60 for every 5-mm Hg increase in PaCO2 , P = .05). Subjects with PaCO2 ≥ 35 mm Hg showed an exacerbation odds ratio of 15.2 (95% CI 1.5-152.5, P = .01). Gastroesophageal reflux and increased PaCO2 can be considered simple, clinically useful markers of increased exacerbation risk in young subjects with quadriplegic CP.

Thermal behavior and electrochemical heat generation in a commercial 40 Ah lithium ion pouch cell

Quantitative data on the thermal behavior of lithium ion batteries under charging and discharging conditions are essential for designing thermal management systems and improving battery safety. In this work, commercial 40 Ah lithium ion pouch cells with Li(Ni1/3Mn1/3Co1/3)O2 cathodes were tested under isoperibolic and adiabatic conditions in an Accelerating Rate Calorimeter at different charging/discharging currents from 5 A to 40 A. Adiabatic tests simulate the worst-case scenario of a battery pack without cooling. For charging and discharging an overall exothermic behavior was found and a total temperature increase for one half cycle between 3 and 11 K. Isoperibolic tests simulate a single cell under constant environmental temperature. Here an exothermic behavior for discharging and an endothermic behavior for charging were observed. To transfer the measured temperature changes into heat data, the effective specific heat capacity and the heat transfer coefficient were determined. For the first time the heat generation data for a large format pouch cell have been determined using both isoperibolic and adiabatic conditions. These data were compared with the total heat data calculated as the sum of reversible and irreversible heat that were measured by potentiometric and current interruption techniques respectively. A good agreement was found between all three heat generation determination methods.