Percutaneous Endoscopic Transgastric Jejunostomy: A New Approach

2005 ◽  
Vol 71 (3) ◽  
pp. 216-218 ◽  
Author(s):  
Willie Melvin ◽  
Joss D. Fernandez

A percutaneous transgastric jejunostomy allows long-term simultaneous gastric decompression and jejunal feedings. We have developed a safe and effective bedside technique for placement of a large-bore (22 French) feeding tube while providing gastric drainage with no mortalities and minimal morbidities. We have modified the push technique used for percutaneous gastrostomies and introduced a cut-away sheath that is placed using a modified Seldinger technique. The entire procedure is performed under endoscopic visualization. Our experience with more than 100 successful tube placements has made this method common practice at our institute. This technique is ideal for patients with poor gastric emptying of any etiology. We feel that this technique will have an expanding and important role in the future management of this patient population's nutritional problems.

Author(s):  
Vijitashwa Pandey ◽  
Zissimos P. Mourelatos ◽  
Annette Skowronska

Many repairable systems degrade with time and are subjected to time-varying loads. Their characteristics may change over time considerably, making the assessment of their performance and hence their design difficult. To address this issue, we introduce in this paper the concept of flexible design of repairable systems under time-dependent reliability considerations. In flexible design, the system can be modified in the future to accommodate uncertain events. As a result, regardless of how uncertainty resolves itself, a modification is available that will keep the system close to optimal provided failure events have been properly characterized. We discuss how flexible design of repairable systems requires a fundamentally new approach and demonstrate its advantages using the design of a hydrokinetic turbine. Our results show that long-term metrics are improved when time-dependent characteristics and flexibility are considered together.


Author(s):  
Hans Tammemagi

We need waste disposal methods that allow the human race to live on this planet in harmony with nature, preserving our resources and habitat and leaving a legacy for our children and grandchildren that does not deprive them of opportunities. These changes will not come easily; they will require resolve and foresight. Just as a mathematician develops the proof to a mathematical theorem, we must start from a basic axiom, and step by step, following a logical progression, we must build a practical framework for waste management. We started this task in chapter 2, where we derived three general principles from the axiom of sustainable development. Can we apply these general principles to develop practical guidelines—first, to overcome the shortcomings of existing landfills, and second, to find other, innovative disposal methods that will conform with sustainable development? Let us look at each of the three principles in turn. Human health and the environment must be protected, both now and in the future. This principle is fundamental and places important constraints on the siting and design of disposal facilities, and also on the form of the waste. In particular, the final four words, “and in the future,” are very important. This principle can be satisfied in two ways: by reducing the toxicity of the wastes so they pose minimal risk, or by containing wastes so that they cannot escape and cause harm. In some cases, the latter method includes controlled leakage at a rate that the environment can assimilate without long-term degradation. Wastes must be managed so that no burden is placed on future generations and they are not deprived of the opportunities we have had. In other words, our grandchildren should not have to spend their valuable resources to solve our waste problems, nor should they be denied resources because our generation has depleted them. Neither should their health and environment be placed at risk because of our actions. The main impacts of landfills on future generations are the requirement to provide ongoing guardianship and maintenance; the loss of valuable land; and impairment of groundwater, surface water, and the atmosphere.


2020 ◽  
Author(s):  
Amanda L. Logan

The Scarcity Slot is the first book to critically examine food security in Africa’s deep past. Amanda L. Logan argues that African foodways have been viewed through the lens of “the scarcity slot,” a kind of othering based on presumed differences in resources. Weaving together archaeological, historical, and environmental data with food ethnography, she advances a new approach to building long-term histories of food security on the continent in order to combat these stereotypes. Focusing on a case study in Banda, Ghana that spans the past six centuries, The Scarcity Slot reveals that people thrived during a severe, centuries-long drought just as Europeans arrived on the coast, with a major decline in food security emerging only recently. This narrative radically challenges how we think about African foodways in the past, with major implications for the future.


VASA ◽  
2001 ◽  
Vol 30 (Supplement 58) ◽  
pp. 6-14 ◽  
Author(s):  
Edmonds ◽  
Foster

The diabetic ischaemic foot has become an increasingly frequent problem over the last decade. However, we report a new approach consisting of a basic classification, a simple staging system of the natural history and a treatment plan for each stage, within a multi-disciplinary framework. This approach of "taking control" consists of two parts: 1. long-term conservative care including debridement of ulcers (to obtain wound control), eradication of sepsis (micribiological control), and provision of therapeutic footwear (mechanical control), and 2. revascularisation by angioplasty and arterial bypass (vascular control). This approach has led to a 50% reduction in the rate of major amputations in patients attending with ischaemic ulceration and absent foot pulses from 1989 to 1999 (from 4.6% to 2.3% per year). Patients who underwent angioplasty increased from 6% to 13%. Arterial bypass similarly increased from 3% to 7% of cases. However, even with an increased rate of revascularisation, 80% of patients responded to conservative care alone. This,we conclude, is an essential part of the management of all patients with ischaemic feet.


2006 ◽  
Vol 44 (05) ◽  
Author(s):  
T Várkonyi ◽  
É Börcsök ◽  
R Takács ◽  
R Róka ◽  
C Lengyel ◽  
...  

2020 ◽  
Vol 4 (3) ◽  
pp. 29-39
Author(s):  
Sulkhiya Gazieva ◽  

The future of labor market depends upon several factors, long-term innovation and the demographic developments. However, one of the main drivers of technological change in the future is digitalization and central to this development is the production and use of digital logic circuits and its derived technologies, including the computer,the smart phone and the Internet. Especially, smart automation will perhaps not cause e.g.regarding industries, occupations, skills, tasks and duties


2017 ◽  
Vol 168 (4) ◽  
pp. 181-185
Author(s):  
Marc Hanewinkel

The forest-game conflict – how can forest economics contribute to solve it? (Essay) Core parameters of forest economics such as land expectation value or highest revenue show that damage caused by wild ungulates can critically influence the economic success of forest enterprises. When assessing and evaluating the damage in order to calculate damage compensation, methods are applied in Germany that look either into the past (“cost value methods”) or into the future (“expected value methods”). The manifold uncertainties related to this evaluation over long-term production periods are taken into account within a framework of conventions through strongly simplifying assumptions. Only lately, the increased production risk due to game-induced loss of species diversity is also considered. Additional aspects that should be taken into account in the future are the loss of climate-adapted species, the change of the insurance values of forest ecosystems and the impossibility of specific management systems such as single-tree selection forestry due to the influence of game. Because of high transaction costs when assessing the damage, financial compensation should only be the “ultimate measure” and a meditation between stakeholder groups with the goal to find a cooperative solution before the damage occurs should be preferred.


2003 ◽  
Vol 20 (3-4) ◽  
pp. 46-82
Author(s):  
Fathi Malkawi

This paper addresses some of the Muslim community’s concerns regarding its children’s education and reflects upon how education has shaped the position of other communities in American history. It argues that the future of Muslim education will be influenced directly by the present realities and future trends within American education in general, and, more importantly, by the well-calculated and informed short-term and long-term decisions and future plans taken by the Muslim community. The paper identifies some areas in which a wellestablished knowledge base is critical to making decisions, and calls for serious research to be undertaken to furnish this base.


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