Safe Reentry Research Articles

Advances in Drug Testing for Substance Abuse Alternative Programs

Substance abuse alternative programs for professionals in positions that influence public safety are available for a number of industries and health care professionals, including nurses. The primary focus of alternative programs is to provide early identification, entry into treatment, and safe reentry of nurse professionals with known histories of substance abuse. A key component of these alternative programs is monitoring abstinence through drug testing, and program administrators must make careful decisions regarding drug screening standards and the appropriate drug testing profile. Recent improvements in technology offer tests using alternative matrixes, such as oral fluid, hair, fingernail, and dried blood spots. In addition, new options for monitoring have become routine. Boards of nursing and alternative program administrators must understand the extent of these new offerings as well as their advantages and disadvantages.

The Italian Spacegate: Study and innovative approaches to future generation transportation based on High Altitude Flight

This paper summarizes the results of the pre-feasibility studies carried out in 2012 on the concept of sub orbital and hypersonic, high altitude flight in support of future generation transportation. Currently, while the High Altitude Flight is mostly instrumental to touristic purposes and emphasizes the so called Spaceports as futuristic, customers-luring airports featured with all the support services, the “Spacegate” concept deals with scheduled traveling in the upper part of the atmosphere between two points over the Earth surface, with significant reduction of the transfer time. The first part of the paper provides a theoretical approach to the matter, by proposing an “operational” mapping of the atmosphere as well as of the different kinds of flight occurring at High Altitude. The second part of the paper addresses the problem of the limited human capability of maintaining an active control of the vehicle during the re-entry phase and introduces the “Spacegate” concept as the conical portion of the atmosphere above the landing site, whose surface delimits the spiral-descending trajectories that the pilot can travel for a safe re-entry. This paper further outlines the results of the preliminary definition of top level operational requirements and derived architecture functional modules in support to the “Spacegate” implementation. Special attention was given to the favorable geographic and climatic conditions of Italy that make this Country suitable enough for future experimental sub orbital flights and related operations. An initial analysis was performed on the regulatory backbone that has to be built to properly operate High Altitude Flight vehicles in Italy according to the concept of an Italian “Spacegate”. A Preliminary Master Plan/Road Map for the “Spacegate” has been laid out, with special emphasis to selected near term activities and support infrastructures necessary to be carried out to better refine the study in preparation to the unfolding of further future endeavors.

Is the liberal use of preoperative 3-dimensional imaging and presternotomy femoral cutdown beneficial in reoperative adult congenital heart surgery?

Patients with congenital heart disease frequently survive into adulthood, and many of them will require repeat surgery. Often, the unique anatomy can make reoperative sternotomy and the conduct of cardiopulmonary bypass challenging. We evaluated the utility of preoperative 3-dimensional imaging and presternotomy femoral cutdown in reoperative adult congenital heart disease surgery. We retrospectively studied 205 adult patients, who had undergone reoperative cardiac surgery for congenital heart disease from 2006 to 2011. Using the operative history and 3-dimensional preoperative imaging findings, an algorithm was created to determine whether femoral cutdown or cannulation should be performed before sternal reentry. Analyses were performed to determine the benefits of this strategy. In addition, analyses were performed to identify adverse outcomes related to this strategy. Presternotomy femoral intervention was performed in 112 of 205 patients (55%)-femoral cutdown alone in 69 (34%) and femoral cutdown, cannulation, and institution of cardiopulmonary bypass in 43 (21%). Of the 19 patients (9%) with a cardiac injury, femoral cutdown had already been performed in 17, of whom 10 had also undergone cannulation. Only 2 patients required urgent femoral cutdown or cannulation. A strong correlation was found between the site of injury predicted by the preoperative algorithm and the actual site of cardiac injury (88%). In both univariate and multivariate models, the risk factors for cardiac injury included a history of cardiac injury during sternal reentry (18% vs 1%, P = .0001), proximity of the right ventricular outflow tract to the posterior chest wall (35% vs 14%, P = .04), and increased reoperative sternotomy incidence (P = .01). In 31 patients, despite safe reentry, the femoral vessels were used as a preferential site of venous (n = 6), arterial (n = 9), or venous and arterial cannulation (n = 16) because of anatomic constraints within the chest cavity. Three patients experienced groin complications (pseudoaneurysm, abscess, ischemia) requiring surgery. Cardiac injury during reoperative surgery in adults with congenital heart disease is not uncommon. The preoperative history and imaging findings could be predictive of certain cardiac injury patterns. Using the preoperative history and 3-dimensional imaging findings, a more selective algorithm for presternotomy femoral intervention might be warranted.

Trajectory Tracking Control of Hypersonic Reentry Vehicle Based on Adaptive Fuzzy System

Considering inaccurate model and simplified calculation problems of the hypersonic reentry vehicle, this paper presents an adaptive fuzzy control system of the trajectory tracking control method. Firstly we introduced the principle of fuzzy system, then used fuzzy control theory to approximate the second-order drag acceleration model and got drag model by fuzzy identification, finally designed the adaptive controller. The simulation results show that the fuzzy adaptive tracking control method don’t depend on the dynamic model, but only rely on drag of the vehicle suffered, it can be measured directly or obtained by the aerodynamic model of the flight, the can generate tracking guidance control law, and the fuzzy adaptive tracking control method enables hypersonic vehicle to track the drag reference trajectory, realizes safe reentry and the terminal states can meet the requirements of the terminal constraints with high precision.

An Examination of Stress, Coping, and Adaptation in Nurses in a Recovery and Monitoring Program

Addiction rates in nurses are higher than in the general population. The relationship between stress, coping, and adaptation in nurses (N = 82) enrolled in a recovery and monitoring program in the state of New Jersey was examined. Social support, a variable tested as a mediator of this relationship, was also examined. Participants completed the Perceived Stress Scale, Multidimensional Scale of Perceived Social Support, and Psychological General Well-Being Index. Negative relationships were found between stress and social support and stress and well-being, and a positive relationship was found between social support and well-being (all ps < .05). The direct relationship between stress and well-being was decreased in the presence of social support. The findings of this research suggest that, to assist nurses, an increased awareness of stress and its injurious effects on overall well-being must be identified so proactive measures can be implemented to prevent potential untoward consequences. Ultimately, methods to strengthen social support and social networks will enhance the probability of sustained recovery, relapse prevention, and safe reentry into nursing practice. Implications for behavioral health providers and health care practitioners are discussed.

Staged Resternotomy for a Retrosternal Giant Aneurysm of the Thoracic Aorta Using an Inferior T-Shaped Ministernotomy

We describe a staged resternotomy technique using an inferior T-shaped ministernotomy for three redo cases with a retrosternal aortic arch aneurysm. To minimize the disadvantages of resternotomy during closed-chest hypothermia, an inferior T-shaped ministernotomy was performed before approaching the aneurysm. After establishment of the cardiopulmonary bypass with femoral or axillary arterial cannulation, or both, and right atrial drainage, a venting catheter was inserted into the left ventricle and core cooling was induced at 25°C. The retrosternal aneurysm was then exposed by additional superior sternotomy. Under hypotherma with antegrade cerebral perfusion, the distal side of a four-branched graft was anastomosed. During rewarming, reconstruction of the arch vessels and proximal anastomosis of the branched graft were performed. In the 3 patients operated on using this technique, there were no perioperative deaths or serious complications. This suggests that the technique can be safely performed and minimizes the disadvantages of the widely used resternotomy technique.

The safe surgeon

Cardiac Surgery has come a long way since Bailey’s Mitral Valvotomy [1]. It is now very clear that heart surgery is safe effective and in some areas preserves life in terms of quality [2], although we are not sure any Cardiac Surgery can prolong life. The word prolong was perhaps used in comparison to the natural history of the disease rather than to adding extra years to one’s life. Who is a Safe Surgeon (SS)? And what does SS do differently? The current generation of busy surgeons do not have the time or inclination to adhere strictly to surgical safety recommendations. Although “safe surgeon” cannot be clearly defined, we have put down certain basic characteristics that are desirable, and hope these will help professionals to change their mindset for improved outcomes. A SS evaluates his patient personally. It is necessary to make eye contact, discuss, and reassure the patient directly. It is very essential that SS examine the patient thoroughly and seek relevant history. SS learns to view, interpret and understand investigational reports. SS does not go by the reports only to make a surgical judgment. The surgeon does not operate on echocardiograms or angiograms, most importantly SS operates on patients. The safe surgeon mentally prepares self and the patient for the procedure. SS must make a mental picture of how to approach this problem at surgery, should discuss with team of assistants, anesthetists and perfusionists before surgery is begun. SS must also seek and ensure any special requirements for the patient’s procedure (instruments, equipment, technique etc.). The safe surgeon is present in the operating room. The current World Health Organization (WHO) surgical safety checklist mandates that the patient and surgeon identify each other before going under the anesthetic [3, 4]. Remote control surgeons can easily overlook important safety precautions in addition to increasing their own anxiety. Serious complications can be effectively handled if SS is present. SS shall not betray the patient’s trust. The safe surgeon scrubs and assists the student. Nowhere is this more important than in cardiac surgery. A misplaced suture, an improper incision can lead to serious consequences. The assistants should never be neglected as they are a critical part of the surgical team, instrumental in a successful outcome [5]. The safe surgeon pays meticulous attention to technical details of the procedure. SS is ever observant and ensures satisfactory conduct of the procedure without missing steps. The safe surgeon conserves blood, respects the tissues, restores the anatomical barriers, leaves the least amount of foreign material and reconstructs tissue planes. It is especially important to ensure a safe second operation for the patient if required, by realizing that all cardiac surgical procedures are palliative with probable exception of, ligation of patient ductus arteriosus and direct surgical closure of atrial septal defect. That redo surgery may be required and to take necessary steps to ensure safe reentry. A safe surgeon leaves the operating room with the patient, or is present in the hospital until completion of procedure and patient settled in Intensive Care Unit (ICU). The surgeon completes the final steps of the surgical safety A. S. Kumar (*) IJTCVS, A-4 (Basement), Yojana Vihar, Delhi-110092, India e-mail: ijtcvs2000@hotmail.com

Influence of geometric factors on the punching load resistance of early-age fibre reinforced shotcrete linings

Understanding the early-age properties of fibre reinforced shotcrete (FRS) is critical to the accurate estimation of the time to safe re-entry under freshly sprayed FRS linings. Previous research in the field has indicated that shear failures dominate early-age load resistance and thereby govern the performance of a lining during the first few hours after spraying. This investigation has examined the influence of several geometric variables on shear resistance in a punching mode of failure. In particular, the research has addressed the influence of the size, shape, eccentricity, and inclination of punching loads on the apparent shear strength of an early-age fibre reinforced shotcrete (FRS) lining.

Pseudoaneurysm of the Ascending Aorta Combined with Aortic Valve Infective Endocarditis following Cardiac Operations

Aortic pseudoaneurysms are rare but life-threatening complications of aortic procedures. Operation on the femorofemoral bypass with hypothermic circulatory arrest has been the method of choice. Iatrogenic ascending aorta pseudoaneurysm combined with infective endocarditis of the aortic valve has never been reported. We describe a case of a pseudoaneurysm of the ascending aorta at the site of an aortotomy site concomitant with infective endocarditis of the aortic valve. A contrast computed tomographic scan was the investigation technology of choice. The operation was performed on femorofemoral bypass without hypothermic circulatory arrest, which provided safe re-entry and an opportunity to replace the infected aortic valve with a mechanical prosthesis and to repair the aortic defect with a patch. The ascending aorta pseudoaneurysm can be safely operated on with femorofemoral bypass without hypothermic cardiac arrest.

Restorative Reentry: A Strategy to Improve Reentry Outcomes by Enhancing Social Capital

A challenging question facing policy makers in the criminal justice arena is how to best encourage the safe and effective reentry of formerly incarcerated individuals in such a way that they become well-integrated and productive members of our communities. This article argues that blending theoretical components of restorative justice with strategies thought to improve social capital may result in better long-term outcomes of the reentry process. Policy recommendations are offered for constructing restorative reentry programs that promote evidence based outcomes.

Emergency trajectories for the Crew Transfer Vehicle

The studied type of Crew Transfer Vehicle (CTV) is basically a modified ATV and a capsule for the crew. The emergency trajectories of the CTV consist of a propelled exo-atmospheric arc and the re-entry of the capsule only. The starting point is a failure in the Ariane5 EPC (Étage Principal Cryotechnique) after the Launch Escape System (LES) has been jettisoned, i.e. in exo-atmospheric flight. The CTV emergency trajectories must assure the safe re-entry of the crew while avoiding any risk to population, i.e. descent on land is forbidden except in specially prepared areas, and shall minimize the number of rescue teams. Different strategies are analyzed, abort to Atlantic, abort to orbit and abort to Woomera (Australia). The launch and ascent trajectory of a launcher similar to Ariane5 EPS-V (two burns) is optimized (maximum payload into desired orbit) to obtain the initial conditions at failure. Other sub-optimal launch and ascent trajectories are computed to fulfill additional constraints of the CTV trajectories not applicable in conventional Ariane5 launches. The emergency trajectories computation will imply the optimization of the CTV propelled trajectory, the exo-atmospheric flight, and the capsule descent trajectory. Different lift-to-drag ratios are analyzed corresponding to different capsule designs (bi-conic and Viking-type). The CTV thrust level, capsule control strategy and launcher ascent trajectory constraints will be derived in order to assure the overlapping of the strategies, the avoidance of landing on Europe and the safety of the crew during the re-entry.

Early-age load resistance of fibre reinforced shotcrete linings

Widespread interest has developed into early-age strength development for fibre reinforced shotcrete (FRS) and its influence on the time to safe re-entry immediately after spraying. Cycle times for drive development within mines, and in civil tunnel construction, can strongly depend on the time to safe re-entry and this, in turn, affects excavation progress rates and overall project economy. The majority of research into safe re-entry times has focused on strength development in hardening shotcrete under the assumption that toughness, adhesion to the rock surface, and the ability of the FRS lining to support unstable ground are all related to the strength of the concrete matrix. Although anecdotal evidence supporting this assumption has been gathered through observations of satisfactory ground control at mines utilizing FRS for ground support, ad hoc evidence alone cannot be used as a basis for rational estimation of safe re-entry times. Instead, the present investigation has sought to quantify the parameters that influence early-age FRS lining capacity and develop an engineered approach to shotcrete lining design and estimation of safe early-age re-entry times through a rational assessment of load resistance.

Reoperation for Giant False Aneurysm of the Thoracic Aorta: How to Reenter the Chest?

Giant false or pseudoaneurysm of the aorta is a rare but dreadful complication occurring several months or years after cardiac or aortic surgery. We describe a surgical approach that allowed safe reentry in the chest in five patients, with a mean follow-up of almost seven years. From December 1991 to October 1999, five patients aged 34 to 74 years (mean age, 55 +/- 11.6 years), who had previously undergone a total of nine operations in other institutions, required reoperation for giant false aneurysm of the ascending aorta in a mean delay of 22.6 +/- 20.3 months (3 months to 6 years) after the last surgical procedure. In order to avoid major mediastinal wound and patient's exsanguination during resternotomy, the following technique has been used: femoral artery cannulation; right atrial cannulation through the femoral vein; femoro-femoral full-flow cardiopulmonary bypass; rectal temperature lowered to 25 degrees C; direct cannulation and cross-clamping of both carotid arteries through a direct cervical approach, and selective cerebral perfusion with cold blood (10 degrees C to 12 degrees C); circulatory arrest of the main circuit; chest opening; and mediastinal division. Despite the fact that the false aneurysm was entered in all patients, reopening of the chest has been safe in all cases. In four cases, the aortic repair consisted of complete graft replacement (Dacron) of the compromised aortic segment (ascending aorta in two; both ascending aorta and aortic arch in two). In one case, reimplantation of the left coronary ostium and closure of a fistula with the left ventricle was carried out. One patient with ongoing mediastinitis died from intractable septicemia and multiorgan failure. Presently, two patients are in excellent condition; one suffers from light neurologic sequelae (oculomotor nerves palsy) and one patient had a nonrelated stroke one year postoperatively. The technique of separate carotid cannulation and selective antegrade brain perfusion with cold blood during circulatory arrest at moderate core hypothermia has, in our opinion, many advantages. In addition to allowing harmless opening of the chest in the presence of most dangerous mediastinal false aneurysms, it implies no general deep hypothermia, reduced duration of cardiopulmonary bypass, and circulatory arrest of the lower part of the body, and safe and permanent brain protection throughout chest opening and mediastinal division. It has allowed us to safely reoperate on patients who are generally considered as a major surgical risk.

Repair of ascending aorta pseudoaneurysm without circulatory arrest in redo patient

A pseudoaneurysm of the ascending aorta is an unusual and potentially fatal complication after aortic surgical operations. TEE and CT scan are the investigations of choice. Surgical treatment is mandatory. We describe the successful management of a pseudoaneurysm of the ascending aorta, with aorto-sternal-cutaneous fistula requiring right axillary and femoral artery cannulation with Remote Access Perfusion® aortic cannula (Estech®, California, USA). Behaving like this we avoid hypotermic circulatory arrest, provide safe reentry and prevent an impending rupture.

Beyond the Bench: COEPs Contribute to Hurricane Relief

The conditions in Louisiana and Mississippi following Hurricanes Katrina and Rita reminded us all of our commonality in the human experience and moved many to help. Among those moved to help were the staff at the Community Outreach and Education Programs (COEPs) of NIEHS Centers across the country. Responding to communities in need is one of the primary functions of the COEPs, so providing outreach to those areas on the Gulf Coast impacted by the hurricanes seemed a natural step to take. “When our director volunteered our COEP [to lead efforts], we remarked that if COEPs had never existed, they would have had to be invented on August 28,” says Pamela Diamond, director of the NIEHS Center COEP at University of Texas Medical Branch (UTMB) in Galveston. Adds Robin Fuchs-Young, director of the COEP of the Center for Research on Environmental Disease at the University of Texas, M.D. Anderson Cancer Center (UTMDACC), “All of us saw what was happening on television and felt compelled on a human level to help in whatever way we could.”

Pseudoaneurysm of Ascending Aorta After Aortic Valve Replacement

A pseudoaneurysm of the ascending aorta is an unusual and potentially fatal complication after aortic surgical procedures. A contrast computed tomographic scan is the investigation of choice. Surgical treatment is mandatory. We describe the successful management of a pseudoaneurysm of the ascending aorta by instituting femorofemoral bypass and achieving hypothermic circulatory arrest, which provided safe reentry and prevented an impending rupture.

Aortic Reoperations Experience With 23 Patients Using Axillary Artery Cannulation

The increase in the number of cardiac operations has brought about an increase in aortic pathology that requires reoperation. The aim of the present study was to evaluate axillary artery cannulation in aortic reoperations. We operated on 23 patients diagnosed with acute type A aortic dissection (13 patients), chronic type A aortic dissection (7 patients), aortic pseudoaneursym (2 patients), and arcus aorta aneurysm (1 patient). The right axillary artery was cannulated directly or through a side graft which was anastomosed to the artery. Antegrade cerebral perfusion with moderate degree hypothermia was used for cerebral protection. Four patients were lost after the operation (17.4%) and no cerebral complications were encountered. Axillary artery cannulation provides safe reentry to the chest and provides good cerebral protection in aortic reoperations.

The FEM applicability for the first-stage design of inflatable bodies. Iteration methodology between FD and FEM for the inherently safe re-entry capsule for YES 2. The BREOGAN leakage protection system

The finite element method (FEM) is opposed to direct testing as approach for the first-stage design of inflatable bodies, to investigate the applicability the method may have in this field. Two FEM tools, LS-DYNA [1] and ABAQUS [2], are used for the modelling of the Yong Engineers’ Satellite 2 (YES2) and the Inflatable Re-entry Technology (IRT) concepts. The results thus obtained are compared to those reached through a testing campaign. As the inflatable is a new technology for re-entry and as the flexibility of the vehicles interacts with their aerodynamic performance, a new iterative FEM/fluid dynamics (FD) procedure is required. This paper presents this methodology, which is currently being developed and will be object of future work.This tool is studied with a membrane simulator. Finally, as further applications of an FEM tool, LS-DYNA is used to carry out a similarity analysis and to simulate the behaviour of a new method to reduce the effects of a leakage from an inflatable re-entry vehicle: the BREOGAN system, which combines effectiveness, simplicity and low cost.

Environmental monitoring of carbaryl applied in urban areas to control the glassy-winged sharpshooter in California.

Carbaryl insecticide was applied by ground spray to plants in urban areas to control a serious insect pest the glassy-winged sharpshooter, Homalodisca coagulata (Say), newly introduced in California. To assure there are no adverse impacts to human health and the environment from the carbaryl applications, carbaryl was monitored in tank mixtures, air, surface water, foliage and backyard fruits and vegetables. Results from the five urban areas - Porterville, Fresno, Rancho Cordova, Brentwood and Chico - showed there were no significant human exposures or impacts on the environment. Spray tank concentrations ranged from 0.1-0.32%. Carbaryl concentrations in air ranged from none detected to 1.12 microg m(-3), well below the interim health screening level in air of 51.7 microg m(-3). There were three detections of carbaryl in surface water near application sites: 0.125 ppb (parts per billion) from a water treatment basin; 6.94 ppb from a gold fish pond; and 1737 ppb in a rain runoff sample collected from a drain adjacent to a sprayed site. The foliar dislodgeable residues ranged from 1.54-7.12 microg cm(-2), comparable to levels reported for safe reentry of 2.4 to 5.6 microg cm(-2) for citrus. Carbaryl concentrations in fruits and vegetables ranged from no detectable amounts to 7.56 ppm, which were below the U.S. EPA tolerance, allowable residue of 10 ppm.

Mediastinal false aneurysm after thoracic aortic surgery

Background. Postoperative mediastinal false aneurysm is associated with a substantial morbidity and mortality. Surgical treatment is mandatory, although the individual approach varies according to the type of pathologic process, infection status, and site of origin of the aneurysm. Methods. Between April 1993 and February 1999, we treated 10 patients, aged 25 to 73 years, with anastomotic mediastinal false aneurysm originating from the proximal thoracic aorta. Nine had undergone prior operations on the ascending aorta (7, type A dissection repair; 1, aortitis; 1, root abscess) with a Dacron conduit (n = 5) or valved conduit (n = 4). The last patient had undergone valve replacement for excavating aortic root sepsis. False aneurysms were detected from 2 to 70 months after the most recent operation. Three patients had positive tissue cultures. The surgical procedure was direct suture repair of the disrupted anastomosis in 5, root or ascending aortic replacement with an aortic homograft in 4, and Dacron graft interposition in 1. Hypothermic low-flow perfusion with or without circulatory arrest was used in all patients. Results. There was one hospital death caused by staphylococcal mediastinitis. A false aneurysm recurred after direct suture repair in 2 patients with underlying type A dissection or aortitis. This resulted in one late death. One patient experienced a neurologic event during removal of an infected vascular graft. All 8 surviving patients are alive and well after a mean follow-up of 2 years. Three patients with mycotic false aneurysms remain free from infection after aortic homograft replacement. Conclusions. Mediastinal false aneurysms are surgically taxing. Low-flow hypothermic perfusion with or without circulatory arrest allows safe reentry. Radical surgery provides a satisfactory outcome in infected patients. Local repair of suture dehiscence in pathologic tissues may predispose to recurrence. We suspect that excessive use of formalin in gelatin-resorcin-formol glue may predispose to tissue necrosis.