38 research outputs found
Risk factors of vaginal cuff infection in women undergoing laparoscopic hysterectomy for benign gynecological diseases
Full text linkAim This study aimed to identify the risk factors for vaginal cuff infection after laparoscopic hysterectomy for benign gynecological diseases. Methods We conducted a retrospective cohort study among 1559 Japanese women who underwent total laparoscopic hysterectomy (TLH) for benign indications between 2014 and 2018 at Teine Keijinkai Hospital in Sapporo, Japan. All patients received preoperative antibiotics based on appropriate timing, choice, and weight-based dosing. We assessed the risk factors of vaginal cuff infection after TLH, including demographic and clinical variables, and patient- and surgery-related factors, using univariable and multivariable logistic regression analyses. Results Among all the patients who underwent TLH, 71 cases of vaginal cuff infections (4.6%) were recorded. Univariate analyses showed that current smoking, pathological result of adenomyosis, use of Seprafilm as an antiadhesive material, white blood cell counts on postoperative day (POD) 2, C-reactive protein (CRP) level on POD2 and postoperative vaginal cuff hematoma were significantly associated with an increased risk of vaginal cuff infection. In multivariate analysis, current smoking, use of seprafilm, CRP level on POD2 and vaginal cuff hematoma were significantly associated with an increased risk of vaginal cuff infection. Conclusion Current smoking, use of seprafilm, CRP level on POD2 and vaginal cuff hematoma were identified as significant risk factors of vaginal cuff infection in the 30 days after surgery in Japanese women who underwent TLH for benign indications
Clinical utility of a novel ultrasonic vessel sealing device in transecting and sealing large vessels during laparoscopic hysterectomy using advanced hemostasis mode
No full textAbstractObjective(s)The ultrasonic advanced energy study device (AH device) is the first surgical device indicated to seal vessels up to and including 7mm using ultrasonic technology alone. This study assesses clinical experience during total laparoscopic hysterectomy (TLH) using advanced hemostasis mode (AHM).Study designThis was a prospective, non-randomized, single arm, multicenter, observational study which did not modify or influence current surgeon technique for elective TLH for benign disease.Each surgeon assessed hemostasis, defined as the hemostatic transection of the uterine vasculature (left/right) with at least one use of the AH device in AHM without the use of additional hemostatic measures other than the AH device. Patients were followed for 4–6 weeks after surgery.Vessel sealing performance was quantitatively assessed for transection and sealing of the uterine artery (UA), the uterine pedicle (UP; defined as cases where the UA could not be ‘isolated’) and the ovarian pedicle (OP) (when indicated). Adverse events (AEs) related to the AH device or procedures were collected.ResultsForty patients underwent the procedure. Mean age was 49 years and mean body mass index was 28kg/m2. Mean surgical duration was 88min. None required conversion to open procedure. Using only the AH device, hemostasis was achieved and maintained in 119 (94.4%) transections (both left and right sides of the UA/UP and OP). Additional hemostasis was achieved in 5 patients using conventional bipolar (4) or monopolar (1) energy. No patient required a blood transfusion postoperatively. Only one adverse event of pain was considered to be related to the use of the ultrasonic AH device during this study.ConclusionThese results support that the AH device with its AHM has clinical utility in sealing named vessels in TLH. The new algorithm to deliver energy in the AHM has the potential to reduce the need for additional hemostatic devices or products as well as the potential to reduce the need for multiple instrument changes during surgery
Creating spiritual values in tourism : insights from buddhist monks and tour operators
No full text202507 bcwhAccepted ManuscriptSelf-fundedEarly releaseGreen (AAM
Does trade openness helps or hinders industrialization?
Full text linkDoes Trade Openness Favour
or Hinder Industrialization and Development?
Mehdi Shafaeddin*
A paper prepared for the
Intergovernmental Group of Twenty-Four on International Monetary Affairs,
to be presented at the Technical Group meeting,
Geneva, 16-17 March 2006
Abstract
The purpose of this study is to examine whether free trade helps or hinders industrialization and
development. The author argues that there is neither a theoretical justification nor historical and
empirical evidence to support what he refers to as “trade liberalization hypothesis”(TLH). The
theory behind TLH is the doctrine of comparative cost advantage which can not be used as a
guide to caching up and achieving dynamic comparative advantage which is a policy-based effort.
Almost all successful industrializers went through a long period of selective infant industry
protection before subjecting their industries to trade liberalization gradually. The forced trade
liberalization imposed on the third world during the colonial era led to their de-industrialization,
specialization in primary commodities and underdevelopment. On the basis of empirical study of
a sample of developing countries which have undertaken trade liberalization during the last
quarter of a century and the case study of Mexico, which has been the champion of liberalization,
the author also concludes: that trade liberalization is essential when an industry reaches a certain
level of maturity, provided it is undertaken selectively and gradually; that the way it is
recommended by neo-liberals under the label of “Washington Consensus”, however, it is a
recipe for destruction of the industries at their early stages of infancy, or development; that if
through NAMA negotiations of the Doha Round, developing countries submit to developed
countries to accept their proposed Swiss formula, with a low coefficient (10), and binding of their
tariff lines at low levels, it would be at the cost of halting their industrialization process; that the
low income countries and others at early stages of industrialization, in particular, will be trapped
in production and exports of primary commodities, simple processing and at best assembly
operation and/or other simple labour intensive industries.
Finally, as international trading rules are not conducive to industrialization and
development, he argues for the need for a different framework of industrial and trade
policies outlined elsewhere**. Such a framework, however, requires a radical change in
international trade rules. Developing countries should not be worried, he emphasizes, to
be “blamed” for defending their policy autonomy in order to enhance their development.
*The author is a development economist, affiliated to the Institute of Economic Research,
University of Neuchate. He is the former head of Macroeconomics and Development Policies
Branch, Globalization and Development Strategies Division of UNCTAD and the author of Trade
Policy at the Crossroads; the Recent Experience of Developing Countries, Macmillan, 2005 as
well as a number of articles on trade, industrial and development policies. The author is grateful
to Mr A. Buira, the Director of G24 Secretariat, for his comments on an earlier draft. His thanks
also go to J. Pizzaro for his helpful assistance in processing data.
**Shafaeddin, M. (2005.c) “Towards an Alternative Perspective on Trade and Industrial
Policies”, Development and Change, 36.6:1143-1162.
Shafaeddin
Does trade openness helps or hinders industrialization?
Full text linkDoes Trade Openness Favour or Hinder Industrialization and Development? Mehdi Shafaeddin* A paper prepared for the Intergovernmental Group of Twenty-Four on International Monetary Affairs, to be presented at the Technical Group meeting, Geneva, 16-17 March 2006 Abstract The purpose of this study is to examine whether free trade helps or hinders industrialization and development. The author argues that there is neither a theoretical justification nor historical and empirical evidence to support what he refers to as “trade liberalization hypothesis”(TLH). The theory behind TLH is the doctrine of comparative cost advantage which can not be used as a guide to caching up and achieving dynamic comparative advantage which is a policy-based effort. Almost all successful industrializers went through a long period of selective infant industry protection before subjecting their industries to trade liberalization gradually. The forced trade liberalization imposed on the third world during the colonial era led to their de-industrialization, specialization in primary commodities and underdevelopment. On the basis of empirical study of a sample of developing countries which have undertaken trade liberalization during the last quarter of a century and the case study of Mexico, which has been the champion of liberalization, the author also concludes: that trade liberalization is essential when an industry reaches a certain level of maturity, provided it is undertaken selectively and gradually; that the way it is recommended by neo-liberals under the label of “Washington Consensus”, however, it is a recipe for destruction of the industries at their early stages of infancy, or development; that if through NAMA negotiations of the Doha Round, developing countries submit to developed countries to accept their proposed Swiss formula, with a low coefficient (10), and binding of their tariff lines at low levels, it would be at the cost of halting their industrialization process; that the low income countries and others at early stages of industrialization, in particular, will be trapped in production and exports of primary commodities, simple processing and at best assembly operation and/or other simple labour intensive industries. Finally, as international trading rules are not conducive to industrialization and development, he argues for the need for a different framework of industrial and trade policies outlined elsewhere**. Such a framework, however, requires a radical change in international trade rules. Developing countries should not be worried, he emphasizes, to be “blamed” for defending their policy autonomy in order to enhance their development. *The author is a development economist, affiliated to the Institute of Economic Research, University of Neuchate. He is the former head of Macroeconomics and Development Policies Branch, Globalization and Development Strategies Division of UNCTAD and the author of Trade Policy at the Crossroads; the Recent Experience of Developing Countries, Macmillan, 2005 as well as a number of articles on trade, industrial and development policies. The author is grateful to Mr A. Buira, the Director of G24 Secretariat, for his comments on an earlier draft. His thanks also go to J. Pizzaro for his helpful assistance in processing data. **Shafaeddin, M. (2005.c) “Towards an Alternative Perspective on Trade and Industrial Policies”, Development and Change, 36.6:1143-1162. Shafaeddin 1trade policy; indusrialization; development
Nonlinear Generation of Long Waves and the Reversal of Eddy Momentum Fluxes in a Two-Layer Quasigeostrophic Model
Full text link© 2021 American Meteorological Society. We thank Stephen Garner, Olivier Pauluis, and Nicholas Lutsko for feedback on earlier versions of this manuscript. This report was prepared by TLH under Award NA14OAR4320106 from theNational Oceanic and Atmospheric Administration, U.S. Department of Commerce. The statements, findings, conclusions, and recommendations are those of the author(s) and do not necessarily reflect the views of the National Oceanic and Atmospheric Administration, or the U.S. Department of Commerce. IMHand PZG are supported by the National Science Foundation Grant AGS-1733818. Data used in this research are archived on the Princeton University Research Computing Systems and are available upon request.Although classical theories of midlatitude momentum fluxes focus on the wave-mean flow interaction, wave-wave interactions may be important for generating long waves. It is shown in this study that this nonlinear generation has implications for eddy momentum fluxes in some regimes. Using a two-layer quasigeostrophic model of a baroclinic jet on a beta plane, statistically steady states are explored in which the vertically integrated eddy momentumflux is divergent at the center of the jet, rather than convergent as in Earthlike climates. One moves toward this less familiar climate from more Earthlike settings by reducing either b, frictional drag, or the width of the baroclinic zone, or by increasing the upper bound of resolvable wavelengths by lengthening the zonal channel. Even in Earthlike settings, long waves diverge momentumfrom the jet, but they are too weak to compete with short unstable waves that converge momentum. Weargue that long waves are generated by breaking of short unstable waves near their critical latitudes, where long waves converge momentum while diverging momentum at the center of the jet. Quasi-linear models with no wave-wave interaction can qualitatively capture the Earthlike regime but not the regime with momentum flux divergence at the center of the jet, because the nonlinear wave breaking and long-wave generation processes are missing. Therefore, a more comprehensive theory of atmospheric eddy momentum fluxes should take into account the nonlinear dynamics of long waves.National Oceanic and Atmospheric Administration, U.S. Department of Commerce National Oceanic Atmospheric Admin (NOAA) - USANational Science Foundation (NSF)Depto. de Física de la Tierra y AstrofísicaFac. de Ciencias FísicasTRUEpu
Ice-POP: Ice Application for Post-Operative Pain: A Randomized Controlled Trial
No full textThe general metadata -- e.g., title, author, abstract, subject headings, etc. -- is publicly available, but access to the submitted files is restricted to UT Southwestern campus access and/or authorized UT Southwestern users.BACKGROUND: The Opioid Crisis is directly linked to over-prescription of opioids by physicians. Non-opioid and non-pharmacologic forms of post-operative pain management need to be explored. Cryotherapy, accomplished with the use of ice, is a non-pharmacologic form of pain relief. There is limited data regarding cryotherapy and its application in abdominal surgery.
OBJECTIVE: To investigate the effectiveness of cryotherapy as an additional form of pain control in women undergoing total laparoscopic hysterectomy (TLH) for benign gynecologic conditions through a randomized trial.
METHODS: 52 patients were randomized evenly to receive standardized post-operative pain management with or without cryotherapy (abdominal ice packs applied directly following surgery). VAS pain scores and narcotic usage were collected at the patient's pre-op appointment, before surgery, at discharge, during a 1-day post-op phone interview, and at a 2-week post-op appointment. Questions about the patient's perception of pain were asked during the postoperative day 1 phone call. Quality of recovery scales were collected at enrollment and the 2-week post-op appointment. Demographic data, VAS pain scores, and narcotic usage were analyzed for significance via the student's t-test.
RESULTS: There was no statistically significant difference (p < 0.05) between the patient group receiving ice and no ice based on demographics, VAS pain score, narcotic usage, quality of recovery, and perception of pain control. However, for patients using ice, VAS pain scores were lower on postoperative day 1 and narcotic usage was lower in the post-anesthesia care unit (PACU). Patient perception of ice was largely positive with 87% of patients reporting they would use ice again while 83% would recommend ice to family/friends. Of note, less than half (38%) of opioids prescribed were used within 2 weeks post-op.
CONCLUSION: Based on the minimal risks of ice, low cost, and perceived benefit by patients including the opportunity for patient autonomy, we would recommend using ice immediately following surgery. Ice is a reasonable alternative to decrease the number of opiates prescribed
Inter-RAT Mobility Robustness Optimization in Self-Organizing Networks
No full textThe massive growth in mobile data communication requires new more efficient Radio Access Technology (RAT) such as Long Term Evolution (LTE) being deployed on top of legacy mobile communication systems. Inter-RAT handovers are triggered either when the signal level of the serving RAT becomes weak while a sufficiently high signal level is
measured from another RAT, or by traffic steering policies for balancing the load among different RATs, for example. Trouble-free operation of inter-RAT handovers requires an optimal setting of the handover parameters which is typically different for each cell and even location. Without knowing the detailed radio propagation conditions, directions and speeds of User Equipments (UEs), network planning can only provide a default setting which needs to be manually optimized during network operation with the aid of drive tests and expert knowledge. This manual optimization requires
extensive human intervention which increases Operational Expenses (OPEX) of mobile operators and yields sub-optimal mobility performance due to limited means for more detailed root cause analysis. Therefore, automatic mechanisms have been requested by
mobile operators to optimize the inter-RAT handover parameters. This optimization is known as inter-RAT Mobility Robustness Optimization (MRO) which is one of the use cases in Self-Organizing Network (SON).
The technical complexities and requirements on MRO are too difficult to be tackled efficiently and properly by existing manual optimization methods. Considering that mobile networks consist of a high number of cells, the number of handover thresholds to be optimized in a network is significant. Moreover, the intricate dependencies and interactions among the handover thresholds of different neighboring cells make MRO problems even more challenging and complicated. Current optimization methods such as the local search method Simulated Annealing, for example, can be used offline
in the network planning phase, however, they cannot be applied online in real-time networks to dynamically react on the changes in the environment and traffic. From that perspective, new optimization methods are needed to address the challenges and limitations imposed by MRO. In this thesis, several novel and feasible inter-RAT MRO
methods have been proposed and analyzed.
New key performance indicators which capture the different types of mobility failure events are proposed by the author of this thesis for the inter-RAT scenario. An inter-RAT handover is triggered by a dual-threshold measurement event where the first threshold corresponds to the serving cell and the second to the neighboring target cell of another RAT. This dual-threshold measurement event requires a more precise analysis of Too Late Handovers (TLHs). A TLH which is caused by the misconfigured serving cell threshold is distinguished from that which can be resolved by the target cell threshold. Thus, there are two types of TLHs in contrast to the intra-RAT case where a single type of TLH handover exists.
Inter-RAT handover thresholds of currently standardized RATs are configured and optimized cell-specifically. That is, the same handover thresholds are applied by the UEs irrespective of the neighboring handover target cell. The limitations of a cell-specific
optimization approach are analyzed and a new cell-group specific optimization approach where the handover thresholds are differentiated with respect to a group of neighboring target cells is proposed. For both cell-specific and cell-group specific optimization approaches, an automatic algorithm is developed to optimize the inter-
RAT handover thresholds. In order to analyze the impact of Time-to-Trigger (TTT), which is a time interval affecting the triggering of handovers, the MRO algorithm is extended to allow a joint optimization of handover thresholds and TTT. Based on findings that even cell-group specific parameters cannot resolve all mobility failure events in some cells where radio conditions are not stationary along the cell border, a more advanced location-specific approach is proposed. Unlike cell-based optimization approaches, the handover thresholds are configured and optimized per cell-area and
they can be differentiated with respect to neighboring target cells.
Simulative investigations are carried out to evaluate the performance of the different optimization approaches. It has been shown that mobility failure events are rather located in specific cells. Accordingly, the same UEs are probably affected all the time by these mobility failures which leads to high user dissatisfaction. This clearly indicates the need of cell-specific handover thresholds to resolve the mobility problems in some cells. Moreover, it is shown that the optimization of target cell threshold in a cell-group
specific manner yields an additional performance improvement compared to cell-specific optimization approach. The joint optimization approach of handover thresholds and TTT has shown advantages only when the handover thresholds are configured cell-specifically
rather than cell-group specifically. The mobility failure events that are not resolved by cell-based optimization approaches are mitigated by cell-area based optimization approach.
The investigations and concepts in this thesis have directly impacted 3rd Generation Partnership Project (3GPP) standard. Several contributions related to cell-specific and cell-group specific optimization approaches have been submitted and adopted by LTE Release (Rel.) 11 standard
The challenges of detecting and attributing ocean acidification impacts on marine ecosystems
Full text link© The Author(s), 2020. This article is distributed under the terms of the Creative Commons Attribution License. The definitive version was published in Doo, S. S., Kealoha, A., Andersson, A., Cohen, A. L., Hicks, T. L., Johnson, Z., I., Long, M. H., McElhany, P., Mollica, N., Shamberger, K. E. F., Silbiger, N. J., Takeshita, Y., & Busch, D. S. The challenges of detecting and attributing ocean acidification impacts on marine ecosystems. ICES Journal of Marine Science, 77(7-8), (2020): 2411-2422, https://doi.org/10.1093/icesjms/fsaa094.A substantial body of research now exists demonstrating sensitivities of marine organisms to ocean acidification (OA) in laboratory settings. However, corresponding in situ observations of marine species or ecosystem changes that can be unequivocally attributed to anthropogenic OA are limited. Challenges remain in detecting and attributing OA effects in nature, in part because multiple environmental changes are co-occurring with OA, all of which have the potential to influence marine ecosystem responses. Furthermore, the change in ocean pH since the industrial revolution is small relative to the natural variability within many systems, making it difficult to detect, and in some cases, has yet to cross physiological thresholds. The small number of studies that clearly document OA impacts in nature cannot be interpreted as a lack of larger-scale attributable impacts at the present time or in the future but highlights the need for innovative research approaches and analyses. We summarize the general findings in four relatively well-studied marine groups (seagrasses, pteropods, oysters, and coral reefs) and integrate overarching themes to highlight the challenges involved in detecting and attributing the effects of OA in natural environments. We then discuss four potential strategies to better evaluate and attribute OA impacts on species and ecosystems. First, we highlight the need for work quantifying the anthropogenic input of CO2 in coastal and open-ocean waters to understand how this increase in CO2 interacts with other physical and chemical factors to drive organismal conditions. Second, understanding OA-induced changes in population-level demography, potentially increased sensitivities in certain life stages, and how these effects scale to ecosystem-level processes (e.g. community metabolism) will improve our ability to attribute impacts to OA among co-varying parameters. Third, there is a great need to understand the potential modulation of OA impacts through the interplay of ecology and evolution (eco–evo dynamics). Lastly, further research efforts designed to detect, quantify, and project the effects of OA on marine organisms and ecosystems utilizing a comparative approach with long-term data sets will also provide critical information for informing the management of marine ecosystems.SSD was funded by NSF OCE (grant # 1415268). DSB and PM were supported by the NOAA Ocean Acidification Program and Northwest Fisheries Science Center, MHL was supported by NSF OCE (grant # 1633951), ZIJ was supported by NSF OCE (grant # 1416665) and DOE EERE (grant #DE-EE008518), NJS was supported by NSF OCE (grant # 1924281), ALC was supported by NSF OCE (grant # 1737311), and AA was supported by NSF OCE (grant # 1416518). KEFS, AK, and TLH were supported by Texas A&M University. This is CSUN Marine Biology contribution (# 306)
History and prophecy in the Qumran Pesharim: an examination of the key figures and groups in the Dead Sea Scrolls by way of their prophetic designations.
Full text linkThe thesis examines the Qumran pesharim and seeks to test the claim that these texts are solely 'historically' based. Instead, it finds that the interpretations are driven by prophetic concerns, founded on and guided by the biblical concept of 'pesher' as dream-interpretation. The study concentrates on the various sobriquets in the pesharim, and is loosely divided into two main parts. Part one examines those designations of groups, including the Kittim, Ephraim and Manasseh, and the Seekers of Smooth Things. Part two, meanwhile, focuses on the interrelationship between the Teacher of Righteousness, the Wicked Priest, and the Man of Falsehood. One of the dominating themes of the thesis is the stress laid on the relationship between the Teacher and the Man of Falsehood, while the thesis also proposes that 'Ephraim' and 'Seekers of Smooth Things' are an offshoot of the Man of Falsehood's original followers. This allows the opposition to this group in 4QpNahum to be properly understood, and suggests a lurk between the Qumran group and the proto-Pharisaic movement. In concluding, the study condemns the suggestion that the 'masking' by sobriquets intentionally conceals these subjects' identity. Rather, such masking links the intended target with prophetic expectations. In short, the thesis finds that although the two are often distinguished in modem scholarship, the correct interpretation of any aspect of the 'historical' pesharim inevitably relies on the understanding of the prophetic term 'pesher' - and vice versa. The thesis does not tackle the issue of the dating of these texts. Rather, it assumes the consensus view that the pesharim were composed during the first century BCE. Occasionally, it will be evident that a text requires a composition before or after a particular date or event, or even that it must postdate another Qumran text, but in general the question has not been an overriding concern
