5 research outputs found
Comparison of the collagen haemostat Sangustop(R) versus a carrier-bound fibrin sealant during liver resection; ESSCALIVER-study
No full textBackground: Haemostasis in liver surgery remains a challenge despite improved resection techniques. Oozing from blood vessels too small to be ligated necessitate a treatment with haemostats in order to prevent complications attributed to bleeding. There is good evidence from randomised trials for the efficacy of fibrin sealants, on their own or in combination with a carrier material. A new haemostatic device is Sangustop(R). It is a collagen based material without any coagulation factors. Pre-clinical data for Sangustop(R) showed superior haemostatic effect. This present study aims to show that in the clinical situation Sangustop(R) is not inferior to a carrier-bound fibrin sealant (Tachosil(R)) as a haemostatic treatment in hepatic resection. Methods: This is a multi-centre, patient-blinded, intra-operatively randomised controlled trial. A total of 126 patients planned for an elective liver resection will be enrolled in eight surgical centres. The primary objective of this study is to show the non-inferiority of Sangustop(R) versus a carrier-bound fibrin sealant (Tachosil(R)) in achieving haemostasis after hepatic resection. The surgical intervention is standardised with regard to devices and techniques used for resection and primary haemostasis. Patients will be followed-up for three months for complications and adverse events. Discussion: This randomised controlled trial (ESSCALIVER) aims to compare the new collagen haemostat Sangustop(R) with a carrier-bound fibrin sealant which can be seen as a "gold standard" in hepatic and other visceral organ surgery. If non-inferiority is shown other criteria than the haemostatic efficacy (e.g. costs, adverse events rate) may be considered for the choice of the most appropriate treatment. Trial Registration: NCT0091861
A Stochastic Simulation Framework for the Government of Canada's Debt Strategy
No full textDebt strategy is defined as the manner in which a government finances an excess of government expenditures over revenues and any maturing debt issued in previous periods. The author gives a thorough qualitative description of the complexities of debt strategy analysis and then demonstrates that it is, in fact, a problem in stochastic optimal control. Although this formal definition is conceptually useful, the author recommends the use of simulation to help characterize the set of strategies that a government can use to fund its borrowing requirements. He then describes in detail a stochastic simulation framework, building from previous work in Bolder (2001, 2002); this framework forms one important element in the debt strategy decision-making process employed by the Government of Canada. The primary objective in constructing this stochastic simulation framework is to learn about the nature of the risk and cost trade-offs associated with different financing strategies. To this end, the paper includes a detailed description of the model; a set of possible debt cost and risk measures, including one potentially useful conditional risk measure; illustrative results under normal stochastic conditions; an analysis of the sensitivity of the results to various key model parameters; a novel approach to stress testing; and a possible framework for selecting a financing strategy, given assumptions about government risk preferences.Debt management; Econometric and statistical methods; Economic models
Fungal endophytes affecting the health and recovery of Long’s Braya (Braya longii) and Fernald’s Braya (Braya fernaldii), endangered endemic species of Newfoundland, Canada
No full textLong’s (Braya longii) and Fernald’s (B. fernaldii) Braya are endemic to the Great Northern Peninsula of Newfoundland, Canada. These herbaceous perennials are endangered due to habitat loss and degradation, as well as ongoing threats from fungal infections and insect herbivory. While recovery plans are being implemented, the identity of pathogenic fungi and their origins remain largely unknown. This study was initiated to describe the associated fungal community and infection symptoms. Plant tissues from three populations were sampled over five years yielding 326 fungal isolates identified primarily by nucleotide sequence analysis of the ITS-rDNA region. Isolates included 36 taxa, 16 of which were detected once and 5 detected three times or less. In contrast, 12 taxa were detected across multiple sites, sampling intervals and years. These included two species of Alternaria, Boeremia exigua, closely related species of the Didymellaceae, Botrytis cinerea, Fusarium sp., Colletotrichum sp., Stagonosporopsis sp., Pleospora sp. and Truncatella angustata. Some common taxa showed seasonal trends. The isolated fungi included known pathogens of Brassicaceae. The plants in this study frequently showed symptoms indicative of fungal infection and insect herbivory. These findings improve our knowledge of Braya endophyte communities and will inform recovery efforts for these endangered species.The presentation of the authors' names and (or) special characters in the title of the pdf file of the accepted manuscript may differ slightly from what is displayed on the item page. The information in the pdf file of the accepted manuscript reflects the original submission by the author
Randomized controlled multicenter trial on the effectiveness of the collagen hemostat Sangustop compared with a carrier-bound fibrin sealant during liver resection (ESSCALIVER study, NCT00918619)
No full textBackground: Despite improvements in liver surgery over the past decades, hemostasis during hepatic resections remains challenging. This multicenter randomized study compares the hemostatic effect of a collagen hemostat vs. a carrier-bound fibrin sealant after hepatic resection.
Methods: Patients scheduled for elective liver resection were randomized intraoperatively to receive either the collagen hemostat (COLL) or the carrier-bound fibrin sealant (CBFS) for secondary hemostasis. The primary endpoint was the proportion of patients with hemostasis after 3 min. Secondary parameters were the proportions of patients with hemostasis after 5 and 10 min, the total time to hemostasis, and the complication rates during a 3 months follow-up period.
Results: A total of 128 patients were included. In the COLL group, 53 out of 61 patients (86.9 %) achieved complete hemostasis within 3 min after application of the hemostat compared to 52 out of 65 patients (80.0 %) in the CBFS group. The 95 % confidence interval for this difference [−6.0 %, 19.8 %] does not include the lower noninferiority margin (−10 %). Thus, the COLL treatment can be regarded as noninferior to the comparator. The proportions of patients with hemostasis after 3, 5, and 10 min were not significantly different between the two study arms. Postoperative mortality and morbidity were similar in both treatment groups.
Conclusion: The collagen hemostat is as effective as the carrier-bound fibrin sealant in obtaining secondary hemostasis during liver resection with a comparable complication rate
Greening textile industry in Vietnam
No full text The textile and garment industry has made a remarkable contribution to the economic development of Vietnam and employs currently a large labor force of 2.5 million people.However, the textile industry is also seen as a most polluting and unsustainable industry due to the use of excessive amounts of materials and the release of large amounts of pollutants into the environment. In order to improve the environmental sustainability and effectiveness of the textile industry in Vietnam this study has looked into preventive measure, reuse/recycling options and improved end-of-pipe technologies, separately and in combination. The end-of-pipe treatment is the last step in the greening production model. Textile wastewater is very difficult to treat, especially regarding the high color intensity. Removal of color from textile wastewater was studied by varying the pH, the application of a biological treatment step, the application of coagulation/flocculation and of Advanced Oxidation Processes (O3, O3/H2O2, Fenton’s reagent). The coagulation process was very effective in color removal of insoluble dyestuffs (98%), but this process is not so suitable for wastewater containing only soluble dyestuffs (12-55%). Of the Advanced Oxidation Processes, the Fenton’s reagent process was the most effective method for color removal (81-98%)for the four types of wastewater tested. The decolorization with the ozone process at low pH (pH 5)showed that direct oxidation by molecular ozone is much more selective in color removal than the oxidation by hydroxyl radicals. The presence of colloidal particles caused a 12-fold increase for ozone needed to obtain the same color removal efficiency as for a wastewater without colloidal particles.Each of the investigated processes could only remove one or a few types of pollutants from the wastewater, with the consequence that effluents could not meet all the discharge regulations. The combination of an activated sludge process, and a coagulation and ozone process yielded the best color (45 Pt-Co) and COD (30 mg O2/L) removal at the lowest costs (0.3 €/m3), compared with all other tested combinations. Separate collection of wastewater streams in a factory can also strongly contribute to the efficiency and sustainability of wastewater treatment. In the wet processes of the textile industry 75% of the total water consumption is for rinsing purposes. Wastewater from most rinsing steps contains low amounts of pollutants and can be reused in other process stages or can be discharged without treatment. An industrial ecology zone model, integrating preventive cleaner production approaches, a waste exchange network for reuse and recycling, and new end-of-pipe technologies, has been developed and assessed in two case studies: the Thanh Cong Company and the Nhon Trach 2 Industrial Zone. The greening production model developed for the Thanh Cong Company, a large-scale textile company in Hochiminh city, included the combination of cleaner production, external waste exchange and end-of-pipe technology. The dyestuffs, auxiliary chemicals, water and energy consumption can be reduced significantly when the proposed cleaner production, the external waste exchange options and the improved end-of-pipe technologies are implemented. Total benefits in savings per day can be more than 1,000 US$. The industrial ecology zone model was designed in three steps. Firstly the greening production model developed for the Thanh Cong Company was applied to all textile enterprises in the industrial ecology zone that was considered. Secondly an outside waste exchange network was designed. The outside network includes reuse of waste plastics, waste paper and waste oil at recycling companies in the neighborhood. The last step is to treat solid waste and polluted air and to treat and reuse wastewater for irrigation (cotton cultivation), for use in sanitary systems and to water plants in the industrial zone. The case studies of the greening production model and of the industrial ecology zone model demonstrated that a successful industrial ecology practice not only depends on the interaction between enterprises inside but also on the interaction with the actor networks outside the industrial system:the economic networks, the social networks and the policy networks. These networks can contribute in different ways to the implementation of the models. In the case study of a large textile company the economic network is very important in the implementation of the greening production model and in the case study of an industrial ecology zone the policy network play the most important role in the implementation of the industrial ecology model. </p
