Flexible Scope Research Articles

Does Flexibility affect the NPD Performance? A Malaysian Electrical and Electronics (E&E) Industry Perspective

Main objective of the research is to develop the field of organizational performance by incorporating a wider scope of flexibility (MFD) aspects than is normally established in the NPD performance (NPP) literature. This survey-based paper is a confirmatory study using the resource-based theory, including 207 respondents with Malaysian electrical and electronics senior executives having mainly involved in development of new products. Five hypotheses were developed and analyzed statistically using multivariate approach. The results provided empirical evidences on how flexibility can be integrated holistically during development of new product. It suggests that successful leaders act as “integrating forces” on two levels: integrating the elements of corporate identity structures, and mediating between the corporate branding structures and the individual. The data used in this survey represent self-reporting by mainly the middle or top management in manufacturing organizations. Because of the chosen research approach, the research results may lack generalizability. This study would significantly contribute to the vibrant new product development of E&E manufacturing industries in Malaysia. To further illustrate, this paper includes implications for manufacturing organizations to adapt flexibility in the development of new products. Besides, practitioners would make better decision by indulgencing the relationships, in addition to enable application of concepts in this research to other environment such as oil and gas or food manufacturing companies and the firm’s decision makers would benefit from the findings of this research in this highly competitive and dynamic external business environment, in order to remain its competitive advantages over the competitors.

A Synopsis of Contemporary Anesthesia Airway Management

New airway equipment has recently become available that has reduced morbidity and mortality. However, airway disasters still occur. This article discusses the prudent escalation of the use of advanced airway equipment to prevent these disasters. We illustrate when and how to use a gum elastic bougie and a video-laryngoscope (VL). We also strongly recommend the combined use of the VL together with a flexible intubation scope (FIS) for both asleep and awake intubation when dealing with a genuinely difficult airway. Blind intubations should no longer be performed today. When an airway has been recognized as difficult it is the safest to aim for an awake or at least a spontaneously breathing intubation if circumstances do not allow for an awake intubation. Emergency cricothyroidotomy needs to be prepared for so that it can be executed rapidly in case the attempted awake intubation leads to complete airway obstruction.

Transoral rigid 70-degree laryngoscopy in a pediatric voice clinic.

Complaints of dysphonia and dysphagia frequently require rigid or flexible laryngoscopy in the office to aid in diagnosis. For young children, flexible laryngoscopy can be uncomfortable and often requires multiple adults to restrain the child. Rigid laryngoscopy does not result in crying but does require patient cooperation; thus, it is used primarily in adults. This project describes our experience using rigid laryngoscopy in a pediatric cohort. This was a retrospective chart review of patients at a pediatric voice clinic who underwent laryngoscopy from December 2011 through March 2017. Data analysis is via Student t test and descriptive analysis. Three hundred and eleven patients were identified with 423 unique laryngoscopy exams. Of those, 212 of the exams were flexible and 210 were rigid. One patient did not tolerate either rigid or flexible exam. There was a statistically significant difference in age between children diagnosed via rigid mean 10.92 years (range 2.39-19.14 years) versus flexible mean 6.51 years (range 0.41-19.29 years), P ≤ 0.01. Of the 44 children under 3 years of age, flexible laryngoscopy was used almost exclusively, with 43 of 44 (97.7%) flexible scope exams. Rigid laryngoscopy was performed on 24 of 115 (20.9%) children aged 3 to 5 years, 26 of 40 (65%) aged 6 years, and 159 of 223 (71.3%) aged 7 and older. Transoral 70o rigid laryngoscopy can be used in select children as young as 3 years of age. This modality allows for improved visualization of lesions with greater comfort for patients. Laryngoscope, 129:1657-1659, 2019.

PM 7/84 (2) Basic requirements for quality management in plant pest diagnostic laboratories

Specific scopeThis Standard specifies the general quality management requirements needed to perform diagnostic tests for plant pests in a laboratory. Another Standard (PM 7/98) includes specific quality management requirements for laboratories preparing for accreditation according to ISO/IEC Standard 17025 General requirements for the competence of testing and calibration laboratories (references to relevant parts of ISO/IEC Standard 17025 are included).Specific approval and amendmentThis Standard was first approved in 2007‐09.Revision approved in 2018‐09. This first revision was prepared to incorporate the conclusions and recommendations of the Workshop on Flexible Scope 2017‐06‐26/28.

Attachment in Syntax and Discourse: Towards an explanation for the flexible scope of non-restrictive relative clauses

Abstract Schlenker (2013) gives a number of puzzling counterexamples to the widely accepted claim that non-restrictive relative clauses (NRCs) are always interpreted with respect to the global context, and never in the scope of entailment-canceling operators such as if. Local readings are available for NRCs attached to their host clause by a coordinating coherence relation. This paper develops a theoretical explanation of this pattern. We argue that NRCs are interpreted locally only if they are attached locally to their host clause both in syntax and in discourse structure. Subordinating coherence relations like Elaboration and Explanation resist discourse attachment in the scope of if because they tend to go together with relations that can only hold between speech acts. Like other subordinate clauses, NRCs tend to express subordinating coherence relations, which ultimately explains their pervasive tendency for global interpretation. In other words, this study shows how a theory of discourse coherence can help solve a problem in sentence semantics.

Pure laparoscopic donor right hepatectomy: perspectives in manipulating a flexible scope.

Interest in pure laparoscopic donor hepatectomy (PLDH) is increasing worldwide with the donor's cosmetic demands and improvements in surgical techniques. Efficient manipulation of flexible scope is mandatory for successful PLDH, especially in right hepatectomy which requires more mobilization. This study provides guidelines on how to manipulate optimally a flexible scope. Data from 158 donors who underwent pure laparoscopic donor right hepatectomy (PLDRH) between November 2015 and December 2017 were retrospectively reviewed. None of the donors required transfusion, conversion to open hepatectomy, or experienced any irreversible disabilities or mortalities. Three types of laparoscopic view provided by the flexible scope, which are bird's eye view, low angle view, and lateral view, were applied to each step of the procedure. PLDRH can be successfully performed with maximizing visibility given by the tips and pitfalls in manipulating the flexible scope.

PM 7/98 (3) Specific requirements for laboratories preparing accreditation for a plant pest diagnostic activity

Specific scopeThis guideline includes specific quality management requirements for laboratories preparing for accreditation according to the ISO/IEC Standard 17025 General requirements for the competence of testing and calibration laboratories (2005, references to relevant parts of ISO/IEC Standard 17025 are included). It should be noted that in EPPO standards the verb ‘should’ carries the highest level of obligation.Specific approval and amendmentFirst approved in 2009‐09. First revision approved in 2014‐04. A second revision was prepared to incorporate the conclusions and recommendations of the Workshop on Flexible Scope 2017‐06‐26/28. Second revision approved 2018‐09.

Oral to nasal endotracheal tube exchange using both video and flexible laryngoscopes

This case describes the use of a video laryngoscope and flexible intubation scope to facilitate the exchange of an oral endotracheal tube for a nasal endotracheal tube in a patient with a potential...

Don’t bring a knife to a gunfight: Humpback whale biosonar reigns supreme

Stroboscopic echo imaging of the sort used by most bats and dolphins is well suited for the task of rapidly gulping prey. As an information seeking strategy, however, strobing is about as sophisticated as duct-taping a flashlight onto a helmet. Humpback whale biosonar signals, in contrast, create a temporally-extended echoic soundscape the likes of which no strober could ever conceive. By spectrally interleaving quasi-CF units with packets of shorter-duration FM units, humpback whales can likely detect multiple targets simultaneously from multiple bearings, including targets more than 5 km away, while at the same time tracking movements of individual targets. By maintaining relatively stationary positions and depths while signaling, humpback whales can potentially use not only direct echoes from targets, but also modulations in familiar acoustic scenes (“acoustic glints”) to interpret the movements of distant targets. By modulating temporal substructure within fixed-rate streams of signals, humpback whales may be able to extract self-generated echoes from a sea of potential maskers. The scope of vocal control, auditory processing, perceptual flexibility, and echoic memory required for a whale to construct and interpret such rich percepts far exceeds the kinds of delay-tuned, chirplet detection that bats and dolphins rely on to bump into food.

Reconstitution of Enzymatic Carbon–Sulfur Bond Formation Reveals Detoxification-Like Strategy in Fungal Toxin Biosynthesis

Gliotoxin is a virulence factor of the human pathogen Aspergillus fumigatus, the leading cause of invasive aspergillosis. The activity of this metabolite is mediated by a transannular disulfide bond, a hallmark of the epipolythiodiketopiperazine (ETP) family. Through the creation of fungal gene deletion mutants and heterologous protein expression, we unveiled the critical role of the cytochrome P450 monooxygenase (CYP450) GliC for the stepwise bishydroxylation of the diketopiperazine (DKP) core. We show for the first time the formation of the C-S bond from the DKP in a combined assay of GliC and the glutathione- S-transferase (GST) GliG in vitro. Furthermore, we present experimental evidence for an intermediary imine species. The flexible substrate scope of GliC and GliG in combination parallels P450/GST pairs used in eukaryotic phase I/II detoxification pathways.

Single-use versus reusable flexible ureteroscopes: a comprehensive cost-analysis decision model

Purpose: The significant improvements in flexible ureterorenoscopes have made flexible ureteroscopy the main treatment modality to target upper urinary pathologies. The purpose of this study was to critically evaluate all literature concerning the cost-effectiveness of flexible ureteroscopy comparing single-use with reusable scopes. Methods: A systematic online literature review was performed in PubMed, Embase and Google Scholar databases. Two separate urologists (GSM and FCT) performed the online search and reviewed all papers considered suitable and relevant for this analysis. Because of the paucity of high quality publications, not only prospective assessments but also case control and case series studies were included in the final analysis. All factors potentially affecting surgical costs or clinical outcomes were considered in the analysis. Results: 741 studies with the previously elected terms were found. Of those, 18 were duplicated and 77 were not related to urology procedures and were excluded. Of the remaining 646 studies, 59 published between 2000 and 2018 were considered of relevance to the pre-defined queries and were selected for further analysis. Stone free and complication rates were similar between single-use and reusable scopes. In special, urinary tract infection rate following flexible ureteroscopy is not inferior if a single-use device is used instead of a reusable scope. Operative time was in average 20% shorter if a digital scope was used, single-use or not. There is a suggestion that the learning curve is shorter with single-use devices but this is not consistent in the literature. Surgeon expertise impacts the longevity of the flexible scope. Reusable digital scopes seem to last longer than optic ones, though scope longevity is very variable worldwide. New scopes usually last three to four times more than refurbished ones and single-use ureterorenoscopes have good resilience throughout long cases. Both sterilization method and cleaning process impact scope longevity, the best results being achieved with Cidex and a dedicated nurse to take care of the sterilization process. The main factors that negatively impact device longevity regarding patient and disease are lower pole pathologies, large stone burden and non-use of a ureteral access sheath. Conclusions: The cost-effectiveness of a flexible ureteroscopy program is dependent of several aspects that must be considered when deciding whether to choose between a single-use and a reusable ureterorenoscope. Disposable devices are already a reality and will progressively become the standard as manufacturing price falls significantly.

The Use of Hacking as a Cybercrime Investigation Technique in Sri Lanka through the Perspectives of the Right to Privacy as Enumerated in Article 17 of International Covenant on Civil and Political Rights, Article 8 of European Convention on Human Rights and Fourth Amendment to the US Constitution

The Use of Hacking as a Cybercrime Investigation Technique in Sri Lanka through the Perspectives of the Right to Privacy as Enumerated in Article 17 of International Covenant on Civil and Political Rights, Article 8 of European Convention on Human Rights and Fourth Amendment to the US Constitution

Success of blind tracheal intubation using the Auragain laryngeal airway compared with the Intubating Laryngeal Mask Airway (lma Fastrach) by novice users: A manikin study

BackgroundThe Ambu® AuraGain™ is a new phthalate-free supraglottic airway device (SAD). It is disposable and has a preformed curvature similar to that of the Intubating Laryngeal Mask Airway (LMA Fastrach). It is proposed as a conduit for direct tracheal intubation assisted by a flexible scope. This study aims to compare the success of blind tracheal intubation via the AuraGain (AG) device, with that of the LMA Fastrach (FT) by novice users in manikins. Methods38 anaesthesia trainees/fellows and specialists with limited (<5 intubations) or no prior experience with intubating SADs were recruited for this manikin study. All participants attempted blind tracheal intubation with both devices up to two attempts and were allowed the use of a flexible bronchoscope on the third attempt if necessary. The primary outcome was first pass success at blind tracheal intubation. Overall success after 3 attempts, time to intubation, and ease of intubation on a visual analogue scale were also recorded. ResultsParticipants achieved a higher first pass success at blind tracheal intubation with FT compared to AG (FT 92.1%; AG 65.8%. p = 0.0049). By the third attempt, cumulative success rate was 97.4% for FT and 86.8% for the AG (p = 0.0888). Overall median ease of intubation recorded on a visual analogue scale was 2.0 out of 10 for FT and 4.0 for the AG. (p = 0.01). There was no significant difference in Time to intubation between the 2 devices (AG 103.8s vs FT 100.1, p = 0.6478). ConclusionsThe AuraGain had a significantly lower first attempt success rate at blind tracheal intubation compared with the LMA Fastrach, although there was no significant difference in overall success after 3 attempts. Intubating through the AuraGain was also deemed to be more difficult by novice users than the LMA Fastrach. Further clinical studies are required to evaluate blind intubation through the AuraGain.

MP08-13 HOW IS OUTPATIENT BLUE LIGHT CYSTOSCOPY USED IN CLINICAL ROUTINE? FIRST RESULTS FROM THE NORDIC REGISTRY

You have accessJournal of UrologyBladder Cancer: Non-invasive I1 Apr 2018MP08-13 HOW IS OUTPATIENT BLUE LIGHT CYSTOSCOPY USED IN CLINICAL ROUTINE? FIRST RESULTS FROM THE NORDIC REGISTRY Per Uno Malmstrom Per Uno MalmstromPer Uno Malmstrom More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.318AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Blue light cystoscopy (BLC) with hexaminolevulinate as an adjunct to white light cystoscopy (WLC) gives higher sensitivity for identifying bladder cancer and reduces recurrence rate compared to WLC alone. BLC is therefore recommended as an adjunct to WLC. Recently BLC with a flexible scope in the outpatient setting has been tested in a randomized prospective study with good results. A Nordic registry study has been initiated to observe the clinical utility and explore possible benefits of BLC in the outpatient setting. This abstract presents the first results of the study on behalf of the Nordic blue light registry investigators, focusing on treatment and patient experience. METHODS The Nordic registry includes patients with suspicion of non-muscle-invasive bladder cancer (NMIBC) or patients in routine follow-up. Hexaminolevulinate (Hexvix/Cysview, Photocure ASA) is instilled in the outpatient department, and the bladder examined with WLC and BLC. Biopsies are taken from suspicious lesions and tumors can be fulgurated on site. Data recorded are patient demographics, bladder cancer history, findings under WLC and BLC, treatment performed, patient preference, physician experience and further patient management. RESULTS To date, the study has included 79 NMIBC patients at four hospitals with 92 procedures with BLC as adjunct to WLC in the outpatient setting. Average age was 73 years and 22% were females. Previous history included Ta (61%), T1 (19%) and CIS (23%). In 71% of the procedures, suspicious lesions were treated in the office. In 26% of treated patients, physicians reported that treatment could be completed in the outpatient setting due to BLC, preventing referral to transurethral resection (TURBT). An added value of BLC was reported in 82% of the procedures. In addition to achieving complete treatment in the office, key advantages noted were additional lesions seen (29%) and confidence in recurrence free patient (23%). Treatment in the office was well tolerated. Of patients treated, all but 2 preferred the outpatient procedure compared to a TURBT. In 6 instances, the patient complained about discomfort associated with biopsy or fulguration. CONCLUSIONS BLC as an adjunct to WLC in the outpatient setting was easy to implement in routine management. It identified additional lesions and allowed more patients to receive complete treatment without referral to TURBT. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e101 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Per Uno Malmstrom More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Amsterdam's Greek merchants: protégés of the Dutch, beneficiaries of the Russians, subjects of the Ottomans and supporters of Greece

Merchant diasporas have long attracted the attention of scholars through the narrow prisms of ‘nations’ and states. The history of Amsterdam's Greek Orthodox merchants, together with the other cases—who left the Ottoman Empire in the eighteenth century and established a seemingly controversial range of networks involving the Dutch, Russian, Ottoman and Greek states there—is an oft-quoted example. This article draws attention to some of the problematic aspects of these perceptions of the relations between states and diaspora merchants. The main tenet of the article is that nation- and state-centred perspectives are limited in explaining the full scope of flexibility and pragmatism displayed by the diaspora merchants.

Pathologic Findings and Clinical Course of Midline Paraventricular Gliomas Diagnosed Using a Neuroendoscope.

Removal of midline paraventricular gliomas is difficult because of their deep localization and invasive character, requiring biopsy for pathologic diagnosis. This study aimed to assess the pathologic findings and clinical course of midline paraventricular gliomas diagnosed using a neuroendoscope. This study was performed as a retrospective investigation using a neuroendoscope of 26 patients whose tumors were diagnosed as midline paraventricular gliomas. The main loci of the lesions were the thalamus (11 patients), tectum (6 patients), and other areas (9 patients). Of these 26 patients, 21 (81%) had accompanying obstructive hydrocephalus. Surgery was performed via the lateral ventricle using a flexible scope. For patients with obstructive hydrocephalus, we added endoscopic third ventriculostomy, septostomy, and/or plasty of the foramen of Monro. Pathologic diagnosis was determined according to hematoxylin-eosin staining and immunohistochemistry using anti-GFAP, anti-Ki-67, anti-H3-K27M, and anti-IDH1-R132H antibodies. The pathologic diagnoses were grade I (5 patients), grade II (3 patients), grade III (6 patients), and grade IV (4 patients) gliomas. Six patients were diagnosed as having high-grade glioma, which was difficult to distinguish between grade III and grade IV. Two patients were undiagnosable. H3-K27M was strongly positive in 8 of 15 patients with high-grade glioma. All patients with high-grade gliomas died or received best supportive care within 2 years after surgery. Neuroendoscopic surgery is useful for midline paraventricular gliomas in terms of the treatment of obstructive hydrocephalus, as well as pathologic diagnosis and genetic analysis, which are required under the World Health Organization 2016 classification.

Thulium Laser Treatment of Upper Urinary Tract Carcinoma: A Multi-Institutional Analysis of Surgical and Oncological Outcomes.

To evaluate the efficacy and safety of ureteroscopic thulium laser (TL) treatment of upper urinary tract carcinoma (UTUC). Forty-two consecutive patients underwent conservative TL treatment for UTUC at two referral institutions. All patients underwent preliminary biopsy and then laser vaporization. A 272 μm and 365 μm laser fibers were used with a flexible and semirigid scope, respectively. Ablation was carried out with a 10 to 20 W power. Mean age at surgery was 68 years (SD 10.7). Mean tumor size was 14.3 mm (range 2-30 mm). Preliminary biopsy revealed the presence of low-grade disease in 29 (69.1%) patients, high-grade disease in 4 (9.5%) and 1 carcinoma in situ 1 (2.4%), whereas it was not conclusive in 8 (19%) cases. Final stage was pTa and pTis in 41 (97.6%) and 1 (2.4%) patients, respectively. Thirty eight percent (16) experienced Clavien-Dindo grade I complication, 47.6% (20) grade II, and 2.4% (1) grade III. Five (12%) patients underwent a second-look procedure due to residual disease. Eight (19%) patients experienced clinical recurrence. The median estimated recurrence-free survival was 44 months (SE 3.68). Four patients (9.5%) underwent a nephroureterectomy. Final pathological stage was pTis, pT3 high grade, pTa low grade, and pT0. Median follow-up was 26.3 months (range 2-54 months), and no progression or upstaging of disease occurred. TL management of UTUC is a safe and efficacious conservative treatment. Our experience shows optimal vaporization and hemostatic control in the absence of major complications.

Cervical spine motion during intubation: a fluoroscopic comparison between three intubation techniques

Background Anaesthetists are responsible for the management of the airway in patients with unstable cervical spine (C spine). The optimal tracheal intubation technique for patients with potential C spine injury remains controversial. Videolaryngoscopes are used in an attempt to balance the need to limit cervical motion and overcome the difficulty of obtaining laryngeal views especially with manual in-line stabilization or cervical collar. Aim The current study aimed to compare the degree of C spine movement during intubation using different devices, Macintosh direct laryngoscope, C-MAC D-Blade videolaryngoscope and flexible intubation video endoscope (FIVE), in anaesthetized patients with normal airway and simulated C spine immobilization. Patients and methods This study was carried out on 45 adult patients scheduled for radiographic procedures under general anaesthesia with endotracheal intubation (ETT). Patients were randomly divided into three equal groups (15 patients each) using the sealed envelope technique: group M (Macintosh direct laryngoscope), group D (C-MAC D-Blade) and group F (FIVE). C spine movement was recorded with continuous fluoroscopy at 3–8 frames/s using a digital videofluoroscopy unit during both laryngoscopy and intubation to capture the maximal extent of C spine movement. The following parameters were evaluated: age, BMI, airway score, haemodynamic parameters, glottic view grade (Cormack and Lehane), time to successful ETT insertion and maximum segmental spine motion. Results The three studied groups were matching as regards age, BMI and airway score. Heart rate and mean arterial blood pressure observed after insertion of the ETT were statistically higher in group M compared with groups D and F. However, there were no significant differences in mean observed HR and mean arterial blood pressure between groups D and F at all time intervals. The Macintosh (group M) had significantly higher C and L grades than the two other devices in groups D and F. There was no significant difference in C and L grades attainted by the D-Blade in group D and the FIVE in group F. D-Blade had significantly shorter intubation time compared with Macintosh and FIVE. Macintosh direct laryngoscope resulted in significantly greater cervical movement at all measured motion segments compared with D-Blade and FIVE. Meanwhile, FIVE caused significantly less motion compared with D-Blade. Conclusion In patients with potential C spine injury and cervical immobilization, D-Blade results in less cervical motion, better glottic views and shorter intubation time compared with Macintosh laryngoscope. Flexible intubation scope causes the least cervical motion but with the longest intubation time.

Anticipatory coarticulation and the minimal planning unit of speech.

One of the most persistent arguments against the segment as the minimal planning unit is that the seemingly ubiquitous, thus, presumed obligatory, nature of anticipatory coarticulation (AC) effects favors the syllable or a larger unit. By contrast, we present the results of 3 experiments showing that AC is not ubiquitous, but graded and variable based on (a) phonological availability and (b) the specific criterion to initiate articulation adopted by a speaker. We further argue that phonological encoding is parallel. These results point to (a) the segment, and not the syllable, as the minimal planning unit and (b) a flexible planning scope. Implications with respect to the current formulation of AC regarding phonological availability and the minimal unit of speech articulation are discussed. (PsycINFO Database Record

Interaction of Concept and Design

During the design process, various methods are used to develop the creative thinking. One of such methods is to commence the design process with a concept. The study aiming to emphasize the importance of concept covers a workshop themed as design with concept. The workshop was undertaken within the scope of Flexibility in Design course of Department of Interior Design, Faculty of Architecture under the Karadeniz Technical University. The workshop was structured as four phased. In the first phase, the students were provided with information regarding conceptual design; then in the second phase, the students were required to choose from one of the buildings that worldwide known architects used conceptual design method and to get information on the interpretation of method and in the third phase they were asked to design their forms derived from the concept. The last phase was comprised of discussing the similarities and differences of new forms generated from the concept. The study is considered as significant for the students in the way of experiencing the concept of a building designed by a concept and designing their own forms without seeing the building.