A Novel and Simple Method of Managing Thoracic Esophageal Perforation: The “ASSIST” Approach

2021 ◽  
pp. 000313482110635
Author(s):  
Quyen D. Chu ◽  
Raquel Candal ◽  
Robert K. White
Keyword(s):  
Esophageal Perforation ◽  
Normal Diet ◽  
Cervical Esophagus ◽  
Surgical Approaches ◽  
Barium Swallow ◽  
Simple Method ◽  
Novel Approach ◽  
Additional Surgery ◽  
High Level ◽  
Per Oral

Introduction Thoracic esophageal perforation (TEP) remains a therapeutic challenge that carries with it a high mortality. Because of its rare occurrence and management is complex, most patients are referred to higher level of care. Management is variable, ranging from a stent placement to an esophagectomy. Unfortunately, stent capabilities may not be readily available and the different surgical approaches can be complex, time-consuming, and demanding on a septic patient. Given these challenges, we conceived a simple 6-step (1) Antibiotics, (2) Suture the cervical esophagus with a 0- chromic, (3) Suture the abdominal esophagus with a 3-0 chromic, (4) Insert nasogastric tube above the sutured cervical esophagus, (5) Support nutrition with a jejunostomy, and (6) Tubes (placement of bilateral chest tubes). Methods Six consecutive septic patients with TEP who underwent an ASSIST approach were evaluated. On day 14, patients were taken to the OR for an esophagogastroduodenoscopy to open the cervical and hiatal esophageal closure. Patients then underwent a repeat barium swallow prior to resuming per oral (PO) intake. Results Sepsis resolved in all patients. One patient died of advanced cirrhosis. None of the living patients required additional surgery and all resumed a normal diet. Conclusions The “ASSIST” method is a viable option for managing septic patients with thoracic esophageal perforation. This novel approach does not require a high level of technical expertise and conceivably be performed by most centers without the need for immediate transfer to specialized facilities.

scholarly journals Towards a contemporary player learning in development framework for sports practitioners

2021 ◽  
pp. 174795412110023
Author(s):  
Mark O Sullivan ◽  
Carl T Woods ◽  
James Vaughan ◽  
Keith Davids
Keyword(s):  
Linear Process ◽  
Task Environment ◽  
Coach Education ◽  
Development Framework ◽  
Novel Approach ◽  
Non Linear ◽  
And Performance ◽  
Learning Development ◽  
High Level ◽  
User Friendly

As it is appreciated that learning is a non-linear process – implying that coaching methodologies in sport should be accommodative – it is reasonable to suggest that player development pathways should also account for this non-linearity. A constraints-led approach (CLA), predicated on the theory of ecological dynamics, has been suggested as a viable framework for capturing the non-linearity of learning, development and performance in sport. The CLA articulates how skills emerge through the interaction of different constraints (task-environment-performer). However, despite its well-established theoretical roots, there are challenges to implementing it in practice. Accordingly, to help practitioners navigate such challenges, this paper proposes a user-friendly framework that demonstrates the benefits of a CLA. Specifically, to conceptualize the non-linear and individualized nature of learning, and how it can inform player development, we apply Adolph’s notion of learning IN development to explain the fundamental ideas of a CLA. We then exemplify a learning IN development framework, based on a CLA, brought to life in a high-level youth football organization. We contend that this framework can provide a novel approach for presenting the key ideas of a CLA and its powerful pedagogic concepts to practitioners at all levels, informing coach education programs, player development frameworks and learning environment designs in sport.

scholarly journals Deep Reinforcement Learning for End-to-End Local Motion Planning of Autonomous Aerial Robots in Unknown Outdoor Environments: Real-Time Flight Experiments

Sensors ◽  
2021 ◽  
Vol 21 (7) ◽  
pp. 2534
Author(s):  
Oualid Doukhi ◽  
Deok-Jin Lee
Keyword(s):  
Reinforcement Learning ◽  
Real Time ◽  
Autonomous Navigation ◽  
Control Technique ◽  
Local Motion ◽  
Aerial Robots ◽  
Novel Approach ◽  
Outdoor Environments ◽  
Aerial Vehicle ◽  
High Level

Autonomous navigation and collision avoidance missions represent a significant challenge for robotics systems as they generally operate in dynamic environments that require a high level of autonomy and flexible decision-making capabilities. This challenge becomes more applicable in micro aerial vehicles (MAVs) due to their limited size and computational power. This paper presents a novel approach for enabling a micro aerial vehicle system equipped with a laser range finder to autonomously navigate among obstacles and achieve a user-specified goal location in a GPS-denied environment, without the need for mapping or path planning. The proposed system uses an actor–critic-based reinforcement learning technique to train the aerial robot in a Gazebo simulator to perform a point-goal navigation task by directly mapping the noisy MAV’s state and laser scan measurements to continuous motion control. The obtained policy can perform collision-free flight in the real world while being trained entirely on a 3D simulator. Intensive simulations and real-time experiments were conducted and compared with a nonlinear model predictive control technique to show the generalization capabilities to new unseen environments, and robustness against localization noise. The obtained results demonstrate our system’s effectiveness in flying safely and reaching the desired points by planning smooth forward linear velocity and heading rates.

scholarly journals Reconnecting a Fragmented Monument through Digital Mapping: The City Walls of Athens

2019 ◽  
Vol 2 (2) ◽  
pp. 177-195
Author(s):  
Markos Katsianis ◽  
Stamatina Lampraki ◽  
Anna-Maria Theocharaki ◽  
Maria Pigaki ◽  
Leda Costaki ◽  
...  
Keyword(s):  
Digital Media ◽  
Archaeological Sites ◽  
Geospatial Technologies ◽  
Archaeological Investigation ◽  
Digital Mapping ◽  
Cadastral Maps ◽  
Novel Approach ◽  
City Walls ◽  
High Level ◽  
The City

The fortifications of Athens have been a recurrent theme of archaeological investigation. In the past two centuries, parts of the walls have been located during rescue interventions at numerous sites in the urban fabric. At present, the visibility of the entire monument remains rather low as the traces of the walls are hidden beneath the modern city, marginalized within larger archaeological sites or preserved entirely by record. Despite the high level of scholarly work devoted to synthesize the available material, the volume of information accumulated over the years requires a novel approach that would systematize different types of evidence using digital media. In this respect, we attempt to revisit the city walls of Athens through the use of geospatial technologies. We target the informed development of an efficient GIS platform to record, store, integrate, explore and eventually disseminate resources on the Athenian fortifications. Our research employs published and archival sources (e.g. excavation drawings) in combination with historical maps (e.g. early cadastral maps, first maps of modern Athens) and complementary historical evidence (e.g. writings, illustrations, photography) to locate, document and integrate in space and time available data on lost and surviving fortification remains.

690 MINIMALLY INVASIVE APPROACH FOR ESOPHAGEAL LEIOMYOMA

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Norberto Daniel Velasco Hernandez ◽  
Héctor Rául Horiuchi ◽  
Lucas Abal ◽  
Matías Sabatini ◽  
Agustina Redondo ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Prone Position ◽  
Surgical Approaches ◽  
Barium Swallow ◽  
Esophageal Leiomyoma ◽  
Old Patients ◽  
Invasive Approach ◽  
Endoscopic Stent ◽  
Common Benign Tumor ◽  
History Of

Abstract   Esophageal leiomyoma is the most common benign tumor of the esophagus. Although enucleation via thoracotomy has been considered standard treatment, minimally invasive surgery is increasingly used for the treatment of this disease. The authors report the clinical outcomes of three procedures for enucleation. Methods From November 2011 to December 2020, 3 females (52, 58, and 67 years old) patients were treated for leiomyoma of the middle third of the esophagus. A history of dysphagia and chest pain was present. Upper gastrointestinal endoscopic, computerized tomography, and endoscopic ultrasound were performed, in only one case barium swallow was used. Results The surgical approaches included right thoracoscopy in prone position, enucleation, and small thoracotomy for removing the specimen. There were no major morbidities, including deaths. One patient presented a leak, which was resolved with an endoscopic stent. Conclusion Minimally invasive enucleation of esophageal leiomyoma can be performed effectively and safely. Right thoracoscopic in prone position for the removal of esophageal leiomyomas may be recommended as the treatment of choice in centers experienced with esophageal surgery.

A Model Predictive Approach for the Coordination of Powertrain Control Systems

2019 ◽  
Author(s):  
Stephanie Stockar ◽  
Cristian Rostiti ◽  
Marcello Canova ◽  
Michael Prucka
Keyword(s):  
Automotive Industry ◽  
Discrete Control ◽  
Control Algorithms ◽  
Control Engineering ◽  
Powertrain Control ◽  
Engineering Design Process ◽  
Powertrain System ◽  
Novel Approach ◽  
Automotive Powertrain ◽  
High Level

Abstract The design, calibration and integration of powertrain control algorithms has become significantly more complex in recent years, as the automotive industry faces increasing challenges in meeting consumer requirements and government regulations. Traditionally, the powertrain control engineering design process develops the engine and transmission controllers independently and then integrates them after an initial calibration. This process can lead to suboptimal performance and requires additional calibration and verification steps to improve the coordination of the various subsystems. This paper proposes a novel approach to achieve a systematic, high-level coordination, and optimization of the control strategy in an automotive powertrain system that will reduce overall calibration effort. Optimized set-points for engine and transmission controls are generated based on joint optimization of fuel consumption and drivability using Model Predictive Control to manage both continuous and discrete control variables. Simulation results confirm the control decisions made by the proposed coordinator match a well-calibrated production ECU with little tuning effort.

Advances in High-Speed Linear Design Technology: Novel Approach to Sidewall Geometry Design for Erosion Tests

2019 ◽  
Author(s):  
Maksim Sokolov ◽  
Max Lorenz ◽  
Mirco Rostamian ◽  
Christian Koch ◽  
Matthias Weissschuh ◽  
...  
Keyword(s):  
High Speed ◽  
Solid Particles ◽  
Flow Conditions ◽  
Compressor Cascade ◽  
Suction System ◽  
Erosion Testing ◽  
Geometry Design ◽  
Novel Approach ◽  
Design Paradigm ◽  
High Level

Abstract Test rigs for compressor cascade testing reported in literature are characterized by a high level of complexity. This is especially the case if a variable incidence should be allowed for or the flow conditions reach transonic or supersonic flow regimes. Incidence alteration capability is preferable for obtaining a more comprehensive picture of cascade properties. However, it necessitates a complex kinematic set-up in order to rotate the blades and to adjust the sidewall setting such that flow periodicity across the passages is ensured. Additionally, a complex sealing system is usually required to guarantee minimum flow disturbance. Often, a suction system is also introduced for boundary layer control and regulation of flow conditions. In the case of erosion testing the situation is exacerbated as the application of such conventional adjustment devices is ruled out due to the presence of solid particles in the flow. In this work an investigation of a new cascade design for erosion testing with variable incidence was conducted. A fixed sidewall geometry is proposed which ensures periodic flow conditions in the speed range of M = 0.5 up to M = 0.78 while allowing incidence adjustments in the range of i = ±10° as assessed by means of CFD. The novel design paradigm enables such flexibility by virtue of a self-regulating flow induced by flow separation from the fixed sidewall geometry. The latter has the benefit of not requiring a specialized mechanical setup and sealing due to the absence of movable parts in the flow. The calculated results show acceptable periodicity of various flow parameters within the passage at 50 percent blade height for all incidence settings considered. The conducted investigation has demonstrated that specially designed fixed sidewalls may enable sufficiently accurate transonic erosion testing under various incidence angles while making cascade erosion testing more economical and time efficient.

Intelligent Approach to Floor Vibration Control

2005 ◽  
Author(s):  
Janice L. Martell ◽  
Arya Ebrahimpour ◽  
Marco P. Schoen
Keyword(s):  
Cantilever Beam ◽  
Human Perception ◽  
Shopping Mall ◽  
Optimal Placement ◽  
Sensors And Actuators ◽  
Control Approach ◽  
Novel Approach ◽  
Floor Vibration ◽  
High Level ◽  
Floor System

Genetic Algorithms (GAs) have been used to solve a multiple of engineering problems with the civil engineering applications ranging from optimal placement of sensors and actuators on structures to pipeline layouts. GAs are especially useful in finding optimal solutions to problems that have many parameters with complex search spaces and a high level of interaction among the describing parameters. The novel experimental control approach presented in this paper uses a GA and a piezoelectric actuator to control the vibration of an aluminum cantilever beam. This set-up is based on a floor vibration problem, where the human perception of vibration dictates the sensitivities in the cost function of the GA. Lightweight floors can be excited by occupant activities such as walking, jumping and dancing. Humans are especially sensitive to vibrations in the range of 4 to 8 Hz. The occupancy of a floor system — whether the floor is used in an office, a shopping mall, or a ballroom — determines the degree to which humans are annoyed by the vibration. In this paper, the GA based control limits the peak acceleration within a predefined bandwidth. Since the cantilever beam has a higher natural frequency than a lightweight floor system a bandwidth of approximately 1.6–15.9 Hz (10–100 rad/s) is used as the frequency range to control. The control to be designed will be a genetic algorithm-robust controller. The analytical results indicate that this novel approach works well.

scholarly journals Predicting Currency Crises: A Novel Approach Combining Random Forests and Wavelet Transform

2018 ◽  
Vol 11 (4) ◽  
pp. 86 ◽  
Author(s):  
Lei Xu ◽  
Takuji Kinkyo ◽  
Shigeyuki Hamori
Keyword(s):  
Exchange Rate ◽  
Wavelet Transform ◽  
Real Exchange Rate ◽  
Random Forests ◽  
Currency Crises ◽  
Predictive Accuracy ◽  
Classification Model ◽  
Novel Approach ◽  
Variable Importance Measures ◽  
High Level

We propose a novel approach that combines random forests and the wavelet transform to model the prediction of currency crises. Our classification model of random forests, built using both standard predictors and wavelet predictors, and obtained from the wavelet transform, achieves a demonstrably high level of predictive accuracy. We also use variable importance measures to find that wavelet predictors are key predictors of crises. In particular, we find that real exchange rate appreciation and overvaluation, which are measured over a horizon of 16–32 months, are the most important.

scholarly journals Porous Alginate Scaffolds Assembled Using Vaterite CaCO3 Crystals

Micromachines ◽  
2019 ◽  
Vol 10 (6) ◽  
pp. 357 ◽  
Author(s):  
Alena Sergeeva ◽  
Anna S. Vikulina ◽  
Dmitry Volodkin
Keyword(s):  
Tissue Engineering ◽  
Internal Structure ◽  
High Performance ◽  
Drug Testing ◽  
Chemical Properties ◽  
Bioactive Molecules ◽  
The Novel ◽  
Novel Approach ◽  
Alginate Hydrogels ◽  
High Level

Formulation of multifunctional biopolymer-based scaffolds is one of the major focuses in modern tissue engineering and regenerative medicine. Besides proper mechanical/chemical properties, an ideal scaffold should: (i) possess a well-tuned porous internal structure for cell seeding/growth and (ii) host bioactive molecules to be protected against biodegradation and presented to cells when required. Alginate hydrogels were extensively developed to serve as scaffolds, and recent advances in the hydrogel formulation demonstrate their applicability as “ideal” soft scaffolds. This review focuses on advanced porous alginate scaffolds (PAS) fabricated using hard templating on vaterite CaCO3 crystals. These novel tailor-made soft structures can be prepared at physiologically relevant conditions offering a high level of control over their internal structure and high performance for loading/release of bioactive macromolecules. The novel approach to assemble PAS is compared with traditional methods used for fabrication of porous alginate hydrogels. Finally, future perspectives and applications of PAS for advanced cell culture, tissue engineering, and drug testing are discussed.

P201 LAPAROSCOPIC TRANSHIATAL OMENTAL REPAIR OF IATROGENIC ESOPHAGEAL PERFORATION IN ACHALASIA

2019 ◽  
Vol 32 (Supplement_2) ◽  
Author(s):  
Nebbia Martina ◽  
Riva Pietro ◽  
Da Roit Anna ◽  
Basato Silvia ◽  
Pansa Andrea ◽  
...  
Keyword(s):  
Esophageal Perforation ◽  
Delayed Diagnosis ◽  
Vital Signs ◽  
Laparoscopic Approach ◽  
Pleural Empyema ◽  
Water Soluble ◽  
Patch Repair ◽  
Barium Swallow ◽  
Esophageal Wall ◽  
Left Hemithorax

Abstract Aim Laparoscopic transhiatal omental patch repair(OPR) of esophageal perforation after pneumatic balloon dilatation(PBD) for achalasia. Background&Methods In August 2018 a 72yrs woman with a history of dysphagia for solids and liquids, nocturnal regurgitation and chest pain had a diagnosis of achalasia. After inhalation during a barium swallow the patient developed fever, respiratory insufficiency and worsening of vital signs leading to ICU and intubation. She developed a right-pleural empyema, massive pneumothorax and right-upper lobe abscess, requiring thoracotomy and right-superior lobectomy. She had been scheduled for a Per Oral Endoscopic Myotomy in November. After the submucosal tunnel, the procedure had been suspended due to presence of fibrosis. In December the patient underwent a first PBD up to 30mm with symptoms resolution and 2kg weight regain. In February, few hours after a second PBD up to 35mm, she complained mild pain at the left hemithorax and fever. 24hrs later a CTscan with water-soluble-contrast revealed a 3cm long esophageal perforation 5cm above the diaphragm and left paraesophageal mediastinal abscess without pleural involvement. Endoscopic treatment was excluded for significant dilatation of the esophagus and the fragile esophageal wall. Because of the frailty status of the patient, the delayed diagnosis, the high risk of a direct suture of the esophageal wall through a left thoracotomy, the even higher risk of an emergency esophagectomy, we performed a laparoscopic approach. Limited dissection of the esophagogastric-junction and of the left diaphragmatic crura allowed access to the abscess cavity, no attempt to direct suture was done, a drain was placed, a pedicled omental flap was realized filling the cavity and repairing the esophageal defect. A jejunostomy was placed. Results The post-op period was uneventful; a CTscan with per-os contrast on POD3 and POD9 didn’t show any collection. The patient started an oral semisolid-diet on POD11. An EGDS on POD19 confirmed the presence of the OPR in the esophageal lumen and after 2-months showed a completely re-epithelialized esophagus. Conclusions Laparoscopic trans hiatal OPR of esophageal perforation in achalasia proved to be a minimally invasive and effective procedure in this patient due to its immunogenic and angiogenetic properties.

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