Lifetime Management Research Articles

Comorbidities and Complications in Adults with Pyruvate Kinase Deficiency

Comorbidities and Complications in Adults with Pyruvate Kinase Deficiency

Work-Life Integration and Time Management Strategies.

When choosing a career as a surgeon, we knowingly dedicate ourselves to a lifetime of service and education. Our commitment as physicians is but one of many commitments in the larger scheme of life where we function as family members, friends, athletes, and numerous other roles. Work and life are often described as two separate entities diametrically opposed to each other. In reality, personal and professional goals are part of a continuum where work is a major part of our lives and who we are as people and is not necessarily separate from the others. The goal-directed nature with which we approach our responsibilities as surgeons should be applied to all domains of life. As we progress along the training paradigm from intern to attending, control over time allocation increases. Understanding oneself, determining priorities, applying realistic expectations, cultivating a supportive environment, setting personal and professional goals, and being held accountable for progress and completion of these goals will allow us to utilize limited time efficiently to achieve what we individually desire from life.

Outcomes and costs of remote patient monitoring among patients with implanted cardiac defibrillators: An economic model based on the PREDICT RM database.

BackgroundRemote monitoring of implantable cardioverter‐defibrillators has been associated with reduced rates of all‐cause rehospitalizations and mortality among device recipients, but long‐term economic benefits have not been studied.Methods and ResultsAn economic model was developed using the PREDICT RM database comparing outcomes with and without remote monitoring. The database included patients ages 65 to 89 who received a Boston Scientific device from 2006 to 2010. Parametric survival equations were derived for rehospitalization and mortality to predict outcomes over a maximum time horizon of 25 years. The analysis assessed rehospitalization, mortality, and the cost‐effectiveness (expressed as the incremental cost per quality‐adjusted life year) of remote monitoring versus no remote monitoring. Remote monitoring was associated with reduced mortality; average life expectancy and average quality‐adjusted life years increased by 0.77 years and 0.64, respectively (6.85 life years and 5.65 quality‐adjusted life years). When expressed per patient‐year, remote monitoring patients had fewer subsequent rehospitalizations (by 0.08 per patient‐year) and lower hospitalization costs (by $554 per patient year). With longer life expectancies, remote monitoring patients experienced an average of 0.64 additional subsequent rehospitalizations with increased average lifetime hospitalization costs of $2784. Total costs of outpatient and physician claims were higher with remote monitoring ($47 515 vs $42 792), but average per patient‐year costs were lower ($6232 vs $6244). The base‐case incremental cost‐effectiveness ratio was $10 752 per quality‐adjusted life year, making remote monitoring high‐value care.ConclusionRemote monitoring is a cost‐effective approach for the lifetime management of patients with implantable cardioverter‐defibrillators.

Serial assessment of postoperative ventricular mechanics in young children with tetralogy of Fallot: Comparison of transannular patch and valve‐sparing repair

Little is known about the early time course of biventricular function and mechanics after tetralogy of Fallot (TOF) repair. We sought to evaluate and describe the evolution of the right ventricle (RV) after TOF repair in young infants and children using conventional echocardiographic parameters and global longitudinal strain (GLS). A retrospective review was performed of all patients with TOF and pulmonary stenosis who underwent repair from January 2002 to September 2015 and had at least 3 serial postsurgical echocardiograms spanning from infancy to early childhood (<8 years). Student's t test was performed to compare patients who underwent valve sparing (VS) versus transannular patch (TAP) repair. ANOVA was used to track measures of ventricular systolic function over time. We analyzed 151 echocardiograms performed on 42 patients. Pulmonary regurgitation (PR, moderate or severe) and the RV to left ventricular (LV) basal dimension ratio were higher in TAP patients (P<.04 at all-time points). Along with a significant increase in RV basal diameter Z-score in the TAP group (P<.001), there was an improvement in RV and LV GLS over time in both groups (P<.001). The LV GLS at last follow-up was lower in patients who underwent reoperation than those who did not (P=.050). LV GLS at the last follow-up echocardiogram was lower in patients with significant PR than those without (P<.001). Ventricular function appeared improve over time from the initial postoperative period in TOF patients. TAP repair was associated with a progressively higher RV/LV ratio in young children. GLS and RV/LV basal diameter ratio may be useful when following young children after TOF repair. Further research is necessary to understand the trajectory of ventricular functional and volumetric changes in young children in order to provide the most effective lifetime management of patients with TOF.

Integrated Additive Product Development for Multi-Material Parts

Abstract Current resource and energy requirements call for the use of most beneficial materials with suitable design at the right place as well as appropriate manufacturing technologies and associated process chains. Additive manufacturing (AM) can play a key role for prospective multi-material components, particular with its versatile advantages in design-driven flexibility, customization, and lightweight design. However, obstacles to industrialization are less due to the technology itself rather than to the actual process chain integration, from conception to production and testing. Accordingly, this contribution discusses an application example and arising problems with the integration of AM in product development. The authors highlight the most demanding steps of tailored constructive development methods, efficient manufacturing, post-processing and finishing as well as quality and lifetime management by continuous non-destructive testing.

Transformer lifetime management by analyzing the content of furan and gas dissolved in oil

In order to see the transformer insulation status, the temperature profile, the degree of polymerization (DP), the furan compound content, the carbon dioxide, and carbon monoxide concentration are monitored. By evaluating the degree of polymerization (DP) of the cellulose paper insulation and furans in the determination of the insulating oil, it can estimate the lifetime of the transformer. Analysis of cellulose insulation paper to see the degree of polymerization (DP) can be performed safely only when the transformer is interrupted. However, being a non-invasive test, determination of furane content in an oil-insulating oil is often used as an alternative method for measuring the DP average of insulation paper. In order to analyze the technical condition of a transformer, furan content in oil should be used and interpreted as a primary chemical indicator in conjunction with the results of carbon oxide from the dissolved gas analysis, the acidity and moisture results from the chemical tests, the methanol content from the chromatographic tests and other monitoring techniques.

The Significance of Carbon 14 in Graphite Reactor Components at End of Generation

It is estimated that there are at least 250,000 tonnes of irradiated graphite worldwide that will require eventual disposal. This graphite arises from a number of sources, but principally comprises moderator and structural materials for experimental reactors, production reactors, commercial power reactors and fuel assemblies. In the UK, a significant proportion of its irradiated graphite is classified as Intermediate Level Waste. Such waste is not heat generating but has a radioactive content exceeding 4 GBq per tonne alpha or 12 GBq per tonne beta/gamma activity. While the classification of waste is not consistent across states and proposals by individual states for the management of their graphite waste vary considerably, a common interest is the nature and distribution of its radioactive content. The radionuclides in irradiated graphite presenting the most significant long-term hazard are Carbon 14 (C-14) and Chlorine 36 (Cl-36) with half-lives of 5730 and 301,000 years respectively. For a better understanding of the way in which C-14 is produced, its distribution within irradiated graphite and realistic quantification of activity can potentially lead to improved characterization to validate its status within current or future waste classifications, segregation to reduce Intermediate Level Waste volumes, or treatment to reduce activity enabling re-classification as Low Level Waste. This paper reviews all these issues and then focuses on the significance of C-14. Some findings from a National Nuclear Laboratory study of C-14 levels in carbonaceous deposits and the underlying Magnox reactor graphite are presented to illustrate the need for thorough characterization of the waste material. These results are discussed in the context of aqueous leaching of C-14 from irradiated graphite and potential treatment options to minimize aqueous release. The paper concludes with some broader observations on the significance of C-14 in nuclear reactor graphite components and how these issues should be considered when preparing the lifetime management of new nuclear plant.

HIGH TEMPERATURE CYCLIC TEST RIG – A NEW RIG FOR HOT GAS PARTS LIFETIME VALIDATION

Flexible gas turbine operation requires adapted hot gas parts design and lifetime assessment methods. The High Temperature Cyclic Test Rig (HTCTR) is developed to cyclically test internally cooled components from combustor and turbine sections of gas turbines in close-to-engine conditions for a wide range of operating conditions in order to improve component lifetime management. These advanced tests should serve as basis for new model development and validation for conditions that are more representative of those in an engine than the standard material specimen tests.

Damage Localization in Composite Structures Using a Guided Waves Based Multi-Parameter Approach

Aerospace vehicles are demanded to withstand harsh conditions with a low weight impact. Composites have been increasingly adopted to meet such performances but they are affected by sudden and barely visible failures when subjected to low velocity impacts. The design criteria and the maintenance tasks in a damage tolerant approach are unavoidably compromised. Structural Health Monitoring is expected to avoid typical accommodations employed during design and lifetime management by achieving a cost-effective and on condition maintenance. This paper describes the use of guided ultrasonic waves excited and sensed by permanently attached piezoelectric transducers for detection and localization of unforeseen and hidden flaws in composite structures. A composite stiffened structures designed for real scale components is investigated to test a multi-parameter detection technique capable of predicting different wave features affected by hidden failures to detect any possible change in the structure. Usually, propagation behavior is exploited to detect changes in the waveguide focusing on the analysis of an intrinsic feature of the propagating wave. Numerical simulations and measurements carried out on a real-scale aircraft structure demonstrate that increasing the observed characteristics improves the result making efficient the diagnosis. Furthermore, it is shown that accounting a multi-parameter analysis of ultrasonic data enhances the localization reliability making use of the same reconstruction algorithm with data fusion approach while facing with different kind of damages.

Frontier of continuous structural health monitoring system for short &amp; medium span bridges and condition assessment

It is becoming an important social problem to make maintenance and rehabilitation of existing short and medium span(10-20 m) bridges because there are a huge amount of short and medium span bridges in service in the world. The kernel of such bridge management is to develop a method of safety(condition) assessment on items which include remaining life and load carrying capacity. Bridge health monitoring using information technology and sensors is capable of providing more accurate knowledge of bridge performance than traditional strategies. The aim of this paper is to introduce a state-of-the-art on not only a rational bridge health monitoring system incorporating with the information and communication technologies for lifetime management of existing short and medium span bridges but also a continuous data collecting system designed for bridge health monitoring of mainly short and medium span bridges. In this paper, although there are some useful monitoring methods for short and medium span bridges based on the qualitative or quantitative information, mainly two advanced structural health monitoring systems are described to review and analyse the potential of utilizing the long term health monitoring in safety assessment and management issues for short and medium span bridge. The first is a special designed mobile in-situ loading device(vehicle) for short and medium span road bridges to assess the structural safety(performance) and derive optimal strategies for maintenance using reliability based method. The second is a long term health monitoring method by using the public buses as part of a public transit system (called bus monitoring system) to be applied mainly to short and medium span bridges, along with safety indices, namely, “characteristic deflection” which is relatively free from the influence of dynamic disturbances due to such factors as the roughness of the road surface, and a structural anomaly parameter.

Micro Factory Retailing: An Alternative, More Sustainable Automotive Business Model

in any future sustainable automotive ecosystem, therefore, we would envisage a version of micro factory retailing as being one of the dominant business models for the supply and use of motorised personal mobility. MFR is based on networks of small dispersed, combined assembly, retail and aftercare or lifetime management (e.g., maintenance and repair, parts supply, upgrade, vehicle management and takeback) facilities that could operate car use under a product-service system (PSS) whereby ownership is retained by the company and users pay for their use.

Sustainable development of Nigeria’s solid minerals through metal recycling: a review

Metal recycling as a path way to sustainable development of Nigeria solid minerals deposits has been reviewed. This paper brings to bear the United Nations Sustainable Development Goals (2015-2030), classification of solid mineral deposits in Nigeria, potential contribution of the solid mineral sector to the nation’s gross domestic product (GDP), lifetime (lifecycle) management of a mineral resource, sustaining mineral resource through metal recycling (use of secondary materials) with some of its accompanying benefits, economics of metal recycling and the need for environmental impact assessment when sitting a recycling plant. The review has revealed the following; Metal recycling could oil the nation’s wheel of realising some of the objectives of the United Nations Sustainable Development Goals (SDGs), every state in Nigeria has at least one solid mineral deposit, one tonne of steel made from recycled steel translates to saving 1,115kg of iron ore, 625kg of coal and 53kg of limestone, recycling results in reduction of about 200 million tonnes yearly of CO 2 emissions, recycling also results in 76%, 40% and 86% reduction in water pollution, water usage and air pollution respectively and energy savings derivable from recycling 39% aluminum, 31% copper, 74% lead, 42% steel and 20% zinc are 95%, 85%, 60%, 62-74% and 60% respectively. Therefore, metal recycling provides one of the viable tools for sustaining the nation’s solid mineral deposits especially the metallic ores for the benefit of generations yet to be born.

배관 균열 및 밸브 개폐에 따른 진동과 음향방출의 특징 분석

Pipes and valves used in heat exchangers and power plants are exposed to high temperature and high pressure environments. Therefore if crack occurs, it may cause environmental pollution or fire. So that, the importance of early diagnosis and lifetime management is expanding. In this paper, studied on pipe and valve facility monitoring and early diagnosis system. The vibration and acoustic emission signals were obtained by using pipe which is a part of the heat exchanger, and characteristics of the signals were extracted from unlike analysis method with previous frequency analysis. In order to analyze the characteristics of pipe cracking and valve opening or closing, extracted features were selected using GA and PCA, SVM was used to classify features and evaluate classification performance. According to the results, feature classification was confirmed. Therefore, pipe cracks and valve opening/closing can be diagnosed early by analyzing characteristics of vibration and acoustic emission signals.

Transcatheter pulmonary valve replacement using the melody valve for treatment of dysfunctional surgical bioprostheses: A multicenter study

BackgroundStented bioprosthetic valves (BPVs) are commonly used for surgical pulmonary valve (PV) replacement in postoperative congenital heart disease, but develop structural failure in a time-related fashion. The Melody transcatheter PV (TPV) (Medtronic, Minneapolis, Minn) has been used to treat BPV dysfunction, but there have been few studies in this population. MethodsWe performed a retrospective, multicenter study to evaluate Melody valve function in patients who underwent TPV replacement (TPVR) into a dysfunctional pulmonary BPV. ResultsOne hundred patients who underwent TPVR at 10 centers between January 2010 and June 2015 were enrolled. The median patient age was 22 years (range, 5-79 years), and 32 patients were age <18 years. The underlying diagnosis was tetralogy of Fallot in 80 patients, and moderate or severe pulmonary regurgitation (PR) was present in 84%. The TPV was implanted into various types of BPVs, with a median size of 23 mm (range, 19-33 mm). At hospital discharge, PR was mild or less in all but 1 patient, and the mean Doppler right ventricular outflow tract (RVOT) gradient was reduced from a mean of 29.3 ± 12.0 mm Hg to 16.2 ± 6.9 mm Hg (median, 29 mm Hg to 16 mm Hg; P < .001). During follow-up (median, 12.4 months), no patients underwent reintervention on the TPV. Endocarditis was diagnosed in 1 patient who was managed medically without intervention. The mean RVOT gradient at the most recent follow-up was ≤35 mm Hg in all patients, and was similar to that at early postimplantation. PR was more than mild in only 1 patient. Hemodynamic outcomes did not differ between patients with small BPVs (≤23 mm) and those with large BPVs (≥25 mm). ConclusionsTPVR restores competence and relieves the obstruction of dysfunctional surgical BPVs, with excellent early results in both small and large BPVs, highlighting the potential for TPVR to extend the life of existing BPVs in adults and children. Collaboration between surgeons and cardiologists is important to determine the optimal lifetime management, combining surgical PV replacement and TPVR in this population.

Optimal Video-Distortion Network Utility and Lifetime Tradeoff for Wireless Multimedia Networks

An ever-increasing activity on social networks has led to tremendous increase in the use of wireless handheld devices, and this tendency is expected to continue in the future as well. Using these portable devices, a significant percentage of information exchange activity is either downloading or sharing of multimedia content. However, this raises new challenges, and for efficient transmission of information, both energy efficiency and quality-of-service assurance are imperative. The processing capability of these devices allows them to achieve efficient usage of both battery, as well as bandwidth, while not compromising the multimedia content quality. This paper proposes a joint network lifetime, utility and distortion management based on the multiobjective optimization framework. For that purpose, the notion of distortion-margin is introduced that can provide a certain level of robustness, which we can tradeoff with bandwidth and lifetime performance parameters. Based on sensitivity analysis, an appropriate selection of objective function for video quality robustness is made. An optimal performance tradeoff among contending objectives is evaluated for a distributed realization, and the evaluation results verify the performance gains.

Development and Practical Application of a Lifetime Management System for Prestressed Concrete Bridges

A practical Bridge Management System has been developed by the author, which is referred to as the Japanese Bridge Management System (J-BMS) for existing concrete bridges. This paper introduces a newly developed bridge management system for the prestressed concrete (PC) bridges (J-BMS PC version) which is integrated with the PC bridge rating expert system (PC-BREX). The proposed system is able to predict the deterioration process of the existing PC bridge superstructure components as well as assess a broad array of optional corrective strategies. The system also has the capability to search and retrieve from a J-BMS database system (J-BMS DB), the necessary information, carry out suitable analyses to arrive at some recommendations that would help users to optimize their decisions based on engineering aspects, cost and economic issues and bridge management policies. A comparison of the results of applying the system to some actual in-service PC bridges with a special designed survey form to experts shows that optimal maintenance planning as well as bridge rating can be predicted accurately by using the system.

Longitudinal Study of Bladder Continence in Patients with Spina Bifida in the National Spina Bifida Patient Registry

Achieving bladder continence in individuals with spina bifida is a lifetime management goal. We investigated bladder continence status through time and factors associated with this status in patients with spina bifida. We used National Spina Bifida Patient Registry data collected from 2009 through 2015 and applied generalized estimating equation models to analyze factors associated with bladder continence status. This analysis included 5,250 participants with spina bifida in a large, multi-institutional patient registry who accounted for 12,740 annual clinic visit records during the study period. At last followup mean age was 16.6 years, 22.4% of participants had undergone bladder continence surgery, 92.6% used some form of bladder management and 45.8% reported bladder continence. In a multivariable regression model the likelihood of bladder continence was significantly greater in those who were older, were female, were nonHispanic white, had a nonmyelomeningocele diagnosis, had a lower level of lesion, had a higher mobility level and had private insurance. Continence surgery history and current management were also associated with continence independent of all other factors (adjusted OR and 95% CI 1.9, 1.7-2.1 and 3.8, 3.2-4.6, respectively). The association between bladder management and continence was stronger for those with a myelomeningocele diagnosis (adjusted OR 4.6) than with nonmyelomeningocele (adjusted OR 2.8). In addition to demographic, social and clinical factors, surgical intervention and bladder management are significantly and independently associated with bladder continence status in individuals with spina bifida. The association between bladder management and continence is stronger in those with myelomeningocele.

Development of the Aircraft Structural Health Monitoring Equipment integrating Optical Sensor and Analog Sensor

The structure of the aircraft has made lots of effort to secure the safety, and the safety is remarkably secured through the lifetime management and the non-destructive inspection. However, periodic inspection requires much time and expense, and various monitoring techniques for aircraft structures are required, especially when the SHM technique is studied for composite structures that cannot use traditional lifetime management techniques. For performing this monitoring, the predeveloped analog sensor has a limit in durability and cable weight. Therefore, the demand for the monitoring equipment of the new technique has been increasing, and FBG and PZT sensor are used representatively. In this paper, we have developed a device that can acquire analog sensor (Accelerometer and Strain gage) and FBG sensor, and support interworking with the Air Data Bus (MIL-STD-1553B, Ethernet) for real-time analysis. Also, it satisfies various military environmental requirements for use in military aircraft. The equipment which is introduced in this paper is expected to be used for SHM and lifetime management.

A Model-Based Fast Protection System for High-Power RF Tube Amplifiers Used at the European XFEL Accelerator

The driving engine of the superconducting accelerator of the European X-ray free electron laser (XFEL) is a set of 27 radio frequency (RF) stations. Each of the underground RF stations consists of a multibeam horizontal klystron that can provide up to 10 MW of power at 1.3 GHz. Klystrons are sensitive devices with a limited lifetime and a high mean time between failures. In real operation, the lifetime of the tube can be significantly reduced because of failures. The special fast protection klystron lifetime management (KLM) system has been developed to minimize the influence of service conditions on the lifetime of klystrons. The main task of this system is to detect all events which can destroy the tube as quickly as possible, and switch off the driving RF signal or the high voltage. Detection of events is based on a comparison of the value of the real signal obtained at the system output with the value estimated on the basis of a high-power RF amplifier model and input signals. The KLM system has been realized in field-programmable gate array (FPGA) and implemented in XFEL. Implementation is based on the standard low-level RF micro telecommunications computing architecture (MTCA.4 or xTCA). The main part of the paper focuses on an estimation of the klystron model and the implementation of KLM in FPGA. The results of the performance of the KLM system will also be presented.

Nonequilibrium Thermodynamics of Rate-Capacity Lost Phenomena for Lithium-Ion Battery

Current prototypes of lithium-ion batteries lose capacity at high C-rate cycling. It is one of the paramount obstacles hindering many potential emerging technologies ranging from power tools and portable electronics to recent PHEV/EV. Recent studies show that electrodes’ stresses and deformations play a significant role in rate-capacity loss, suggesting that coupling effects exist between the mechanical energy, electrochemical transport process, and electrical potential and capacity. Current available models capturing such coupling effects are developed for specific cases, however. Such as models with idealized geometries, linear deformation or isotropic material properties, resulting the irreversible capacity loss found in experiments was inaccurately described. In this study, nonequilibrium thermodynamics and field equations are incorporated, in which nonlinear deformation and anisotropy material properties are included in the model. With that, one could systematically analyze and investigate phenomena between stress-induced rate capacity fade, phase transformation of anisotropic crystal cathodes, and large deformation on alloy anode for Li-ion batteries. The developed model can be embedded into finite element analysis algorithms to provide a design tool for nanostructure optimization. This research will help understand more details on electrodes’ mechanical behaviors, their influences on transport process in electrodes, and strategies for improving batteries’ high C-rate performance and supplying better lifetime management.