bluuebunny/crossref_metadata_2025_split huggingface dataset:
Towards the Development of a Multi-Disciplinary Flight Trajectory Optimization Tool: GATAC
Authors: Gu Weiqun , Navaratne Rukshan , Quaglia Daniele , Yu Yang , Madani Irfan , Sethi Vishal , Jia Huamin , Chircop Kenneth , Sabatini Roberto , Zammit-Mangion David 
Published: July 2013

Reducing the impact on the environment and the associated commercial implications are two major challenges that the global commercial aviation industry is addressing with significant commitment today. In this respect, Clean Sky, which is a €1.6 billion Joint Technology Initiative part funded by the European Commission is the largest ever programme addressing the greening of air transportation in response to the Advisory Council for Aeronautics Research in Europe (ACARE) goals of reducing CO2 and perceived noise emissions by 50% and NOx by 80% by 2020 compared to 2000 condition.
This paper presents research work carried out within the Systems for Green Operations Integrated Technology Demonstrator (ITD) of Clean Sky that is associated with GATAC, a trajectory and route planning tool to enable the multi-objective optimization of flight trajectories and missions. The design and operational methodology of the tool, the optimization algorithms and models are discussed and the results of a preliminary application for a long-range commercial flight are presented.
Flow Control Over a Circular Cylinder Using Pulsed DBD Actuators
Authors: Schneck William C. , O’Brien Walter F. 
Published: July 2013

Immersed bodies such as struts, vanes, and instrumentation probes in gas turbine flow systems will, except at the lowest of flow velocities, shed separated wakes. These wakes can have both upstream and downstream effects on the surrounding flow. In most applications, surrounding components are designed to be in the presence of a quasi-steady or at least non-variant flow field. The presence of unsteady wakes has both aerodynamic and structural consequences. Active flow control of wake generation can therefore be very valuable. One means to implement active flow control is by the use of plasma actuation. Plasma actuation is the use of strong electric fields to generate ionized gas that can be actuated and controlled using the electric fields. The controlling device can be based on AC, DC, or pulsed-DC actuation. The present research was conducted using pulsed-DC from a capacitive discharge power supply.
The study demonstrates the applicability of, specifically, pulsed-DC plasma flow control of the flow on a circular cylinder at high Reynolds numbers. The circular cylinder was selected because its flow characteristics are related to gas turbine flowpath phenomena, and are well characterized. Further, the associated pressure gradients are some of the most severe encountered in fluid applications. The development of effective plasma actuators at high Reynolds numbers under the influence of severe pressure gradients is a necessary step toward developing useful actuators for gas turbine applications beyond laboratory use.
The reported experiments were run at Reynolds numbers varying from 50,000 to 97,000, and utilizing various pulse frequencies. Further, the observed performance differences with varying electric field strengths are discussed for these Reynolds numbers. The results show that flow behaviors at high Reynolds numbers can be influenced by these types of actuators. The actuators were able to demonstrate a reduction in both wake width and momentum deficit.
Characterizing the Maternal Adaptations of Pregnancy and Recovery Following Vaginal Delivery in the Rodent Model
Authors: Feola Andrew , Alperin Marianna , Moalli Pamela , Abramowitch Steven 
Published: July 2013

Pelvic organ prolapse and urinary incontinence are common conditions in women that significantly diminish quality of life. Vaginal delivery and maternal birth injury are the number one risk factors for the development of pelvic floor disorders. The goal of this study was to characterize maternal adaptations throughout pregnancy and recovery after vaginal delivery in terms of the passive quasi-static mechanical properties of the vagina using a rodent model.
Virgin (n = 8), mid-pregnant (n = 7, day 15–16), late-pregnant (n = 7, day 20–21), immediate postpartum (n = 8, <2 hours post delivery), and 4 week postpartum (n = 6) Long-Evans female rats were utilized in this study. The mechanical properties (tangent modulus, tensile strength, ultimate strain, and strain energy density) were quantified by testing longitudinal sections of vaginal tissue to failure.
The tangent modulus of virgin animals (25.1±5.1 MPa) was significantly higher compared to mid-pregnant (11.7±7.7 MPa, p = 0.003), late-pregnant (7.9±4.0 MPa, p<0.001), and immediate postpartum (8.5±4.7 MPa, p = 0.001) animals. A similar trend was also observed in the tensile strength, whereas the ultimate strain increased throughout pregnancy until the time of vaginal delivery. Recovery was observed four weeks postpartum as no significant difference was found from virgin animals for any of the parameters.
This study has shown a significant decrease in the tangent modulus and tensile strength along with an increase in the ultimate strain of longitudinal sections of vaginal tissue throughout pregnancy. These maternal adaptations are likely to increase the overall distensibility of the vagina and allow for vagina delivery with minimal injury. This process appears to be effective in the rodent model as the properties recovered to virgin levels by 4 weeks. In the future, we hope to alter these adaptations or exceed them in order to study the risk and impact of birth injury in this model.
Emergency department patient knowledge and physician communication regarding CT scans
Authors: Zwank Michael D , Leow Marissa , Anderson Christopher P 
Published: July 2013

ObjectivesThis study evaluated several aspects of patients’ and providers’ knowledge and attitude regarding emergency CT scan use. Specifically, is patient awareness of radiation risks changing over time and do levels of education affect this knowledge? Meanwhile, do emergency medicine providers discuss risks with patients and do patients want to know about these risks?MethodsWe conducted a survey of clinically stable patients in the emergency department (ED) after undergoing a CT scan.Results200 patients were surveyed. 82 (41%) were aware that CT scans are associated with radiation exposure. 50 (25%) patients were aware that radiation from CT can increase overall lifetime risk of cancer compared with only 2/76 (3%) conducted in 2002. 29 (14.5%) providers specifically discussed radiation risk with patients prior to the CT. There was a significant trend towards knowledge that CT uses x-rays among those with more education. However, there was no association between level of education and knowledge of cancer risk associated with radiation risk from CT. 82 (41%) would have liked more information regarding radiation risks from the provider.ConclusionsED patient knowledge has increased significantly over the past 8 years. At the same time, there is a trend towards ED providers more commonly discussing these risks. Level of education is associated with knowledge that CT uses x-rays, but not with knowledge that this is associated with a greater risk of cancer. Patients often want to be informed of these risks.
Impact of introducing a major trauma network on a regional helicopter emergency medicine service in the UK
Authors: McQueen Carl , Crombie Nick , Perkins Gavin D , Wheaton Steve 
Published: July 2013

IntroductionIn the West Midlands region of the UK, the delivery of prehospital trauma care has recently been remodelled through the introduction of a regionalised major trauma network (MTN). Helicopter emergency medical services (HEMS) are integral to the network, providing means of delivering highly skilled specialist teams to scenes of trauma and rapid transfer of patients to major trauma centres. This study reviews the impact of introducing the West Midlands MTN on the operation of one its regional HEMS units.MethodsRetrospective review of the Midlands Air Ambulance clinical database for the 6 months after the launch of the West Midlands MTN. The corresponding period for the previous year was reviewed for comparison. The contribution of trauma cases to overall workload, mission outcome data and the number of interventions performed at the scene were compared.ResultsThe proportion of HEMS activations for trauma cases was similar in both cohorts (70.84% before MTN vs 71.57% after MTN). The proportion of mission cancellations was significantly lower after the launch of the network (23.71% vs 19.03%). Significantly more scene attendances resulted in interventions by HEMS crews after the MTN launch (44.66% vs 56.92%).ConclusionsSince the introduction of the West Midlands MTN, tasking of HEMS assets appears to be better targeted to cases involving significant injury, and a reduction in mission cancellations has been observed. There is a need for more detailed evaluation of patient outcomes to identify strategies for optimising the utilisation of HEMS assets within the regional network.
E-045 A Randomised, Concurrent Controlled Trial to Assess the Safety and Effectiveness of the Penumbra Separator 3D as a Component of the Penumbra System in Acute Stroke Treatment
Authors: Frei D , Siddiqui A , Nogueira R , Mualem E , Sit S , Bose A 
Published: July 2013

Introduction/PurposeThe goal of the Penumbra System®Separator 3D Trial (3D RCT) is to assess the safety and effectiveness of the 3D as a component of the Penumbra System®in the revascularisation of large vessel occlusion in acute ischaemic stroke. The novel Separator 3D, with intraluminal chambers to secure clot, should provide more effective clot removal with the large inner diameter aspiration catheters.Materials and MethodsThe 3D RCT is a prospective, multicentre, randomised, concurrent controlled, non-inferiority study. Up to 230 patients from 18 to 85 years old who present with large vessel occlusion (≥2.5mm) within 8 hours of symptom onset and are refractory to or not eligible for IV rtPA therapy are eligible. Patients with an NIHSS score of 8 or greater are randomised (1:1) to treatment with the Penumbra System including the 3D device or the Penumbra System alone. The primary endpoints are revascularisation of the target vessel as defined by a TICI score of 2 or 3 and incidence of 24-hour serious adverse events (SAEs). An independent, blinded Core Lab will review and assess imaging scans for TICI scores and ICH. A Clinical Event Committee/Data Safety Monitoring Board will evaluate SAEs and monitor safety. Secondary endpoints include good 90-day neurological and functional outcomes (NIHSS, mRS scores), all cause mortality, and incidence of symptomatic intracranial haemorrhage.ResultsTo date, 25 centres are screening, and 80 patients are enrolled, of which 49 are randomised.ConclusionThe Separator 3D Trial will determine if inclusion of a novel 3 dimensional clot retriever as a component of the Penumbra System®provides efficient revascularisation with acceptable safety.DisclosuresD. Frei: 3; C; Penumbra, Inc. A. Siddiqui: None. R. Nogueira: None. E. Mualem: 5; C; Penumbra, Inc. S. Sit: 5; C; Penumbra, Inc. 6; C; Penumbra, Inc. A. Bose: 4; C; Penumbra, Inc. 5; C; Penumbra, Inc.
E-050 The Rationale for the Vertebral artery Ischaemia Stenting trial (VIST)
Authors: Clifton A , Markus H , Kuker W , Rothwell P 
Published: July 2013

Symptomatic vertebral stenosis is associated with a high risk of recurrent stroke Most of this risk is in the first weeks Intracranial stenosis is associated with a higher risk Vertebral stenting looks promising but its use is unproven. Trials such as the Vertebral artery Ischaemia Stenting Trial are needed In any trial, or in clinical practice, patients needs to be randomised, and stented, urgently after first symptoms The higher stroke risk in intracranial stenosis means this group could benefit more, even if they have a higher intra-operative risk. The rationale for the VIST trial and an outline and recruitment update of the trial will be presented.DisclosuresA. Clifton: None. H. Markus: None. W. Kuker: None. P. Rothwell: None.
E-053 Management of Tongue Venous and Lymphatic Vascular Malformations
Authors: Yakes W 
Published: July 2013

PurposeTo determine the efficacy of ethanol embolisation in management of tongue vascular malformations.Materials and MethodsThirty-nine patients (22 females, 17 males; mean age: 38 years) presented with tongue vascular malformations. Forty-seven patients had undergone 61 failed previous procedures (embo, laser, surgery, steroid injection, alpha-interpheron, radiation). All patients had baseline arteriograms and MRs. All patients underwent direct puncture ethanol therapy.ResultsOf 39 patients with venous-lymphatic malformations, 27 patients had dramatic reduction and 12 patients’ therapy is on-going with concurrent reductions (mean f/up: 60 months). One patient with mixed veno-lymphatic malformation required surgical debulking of excess tissues (>90% after treatment). Minor complications such as tongue blisters (9 instances) healed spontaneously; 3 tongue mucosal injuries healed spontaneously; 3 infections responded to antibiotic treatment; 1 area of hemi-focal numbness resolved.ConclusionEthanol embolotherapy is a primary form of therapy to eradicate low-flow vascular malformations of the tongue permanently at long-term follow-up. Rarely is concurrent surgery required except to debulk an enlarged tongue that shrink minimally after treatment of the underlying vascular malformation. Low complications are encountered. Partial or total glossectomy should be avoided.DisclosuresW. Yakes: None.
E-056 MR CLEAN - Multicentre Randomised Clinical trial of endovascular treatment for acute ischaemic stroke in the Netherlands (NTR1804)
Authors: Majoie C , Berkhemer O , Beumer D , Oostenbrugge R van , Fransen P , Zwam W van , Lugt A van der , Roos Y , Dippel D 
Published: July 2013

RationaleIschaemic stroke is often caused by embolic occlusion of proximal intracranial arteries. The effect of intravenous alteplase is limited in these patients. Endovascular treatment increases the likelihood of recanalisation, but the effect of treatment on functional outcome is not certain.AimThe main purpose of the Multicentre Randomised Clinical trial of Endovascular treatment for acute ischaemic stroke in the Netherlands (MR CLEAN) is to assess the effect on functional outcome and safety of endovascular treatment in patients with a proximal intracranial arterial occlusion in the anterior circulation.DesignMR CLEAN is a pragmatic phase III multicentre randomised clinical trial with blinded outcome assessment. The intervention contrast is endovascular treatment with trombolytics (urokinase or alteplase) and/or mechanical trombectomy versus no endovascular treatment. The choice of endovascular treatment modality for each patient is left to the discretion of the local investigator and treating physicians. Background medical management is delivered according to national standards and guidelines. It may include intravenous alteplase within the first 4.5 hours after onset.OutcomesThe primary outcome is the score on the modified Rankin scale (mRS) 90 days after inclusion in the study. Secondary outcomes are the NIHSS score at 24 hours, vessel patency, infarct size, and the occurrence of major bleeding. The randomisation will be stratified for use of intravenous alteplase, planned treatment modality (intra-arterial thrombolysis, mechanical trombectomy or both) treatment centre and stroke severity. The effect of treatment will be estimated by means of the ordinal logistic regression (shift analysis). In total, 500 patients will be included in the trial.DiscussionThe trial is going well. We estimated that inclusion of patients will take 4 years. The trial has started in December 2010. As of November 2012, 12 participating centres are active and 234 patients have been included.DisclosuresC. Majoie: 1; C; Dutch Heart Foundation. 6; C; EV3, Penumbra, Angiocare, Top Medical, Lamepro/Medac. O. Berkhemer: None. D. Beumer: None. R. van Oostenbrugge: None. P. Fransen: None. W. van Zwam: None. A. van der Lugt: None. Y. Roos: None. D. Dippel: 1; C; Dutch Heart Foundation. 6; C; EV3, Penumbra, Angiocare, Top Medical, Lamepro/Medac.
E-062 Coiling Cost per Volume Analysis and Strategy for Cost Reduction
Authors: Wang C , Hui F 
Published: July 2013

Introduction/PurposeAneurysm treatment is a major revenue driver of neurointerventional surgery. The cost of devices used during treatment has a direct effect on the profitability and financial sustainability of a given therapy. For aneurysm coiling procedures, the major component of material costs is the cost of implanted coils. As the healthcare system becomes increasingly cost-sensitive, understanding and controlling costs will prove to be instrumental in maintaining the future health of the specialty while maintaining patient outcomes.Stable coil embolisation and aneurysm occlusion is not well understood, but may relate to packing density - achieving a minimum sum total coil volume. Other approaches include achieving lower porosity ratios at inflow zone of the aneurysm, which may achieve functional occlusion of an aneurysm despite residual internal unfilled volume. This approach is best exemplified by flow diversion devices.Modelling the second approach is currently not feasible, as critical factors remain poorly understood, but modelling a reasonable strategy for minimising procedure material costs to achieve a minimum packing density may help identify methods of reducing coiling costs on a volumetric efficiency basis. To date no analysis has been done to model this relationship.Materials and MethodsThe price information for 468 different coils used by our institution were obtained by Q-Sight and normalised to the price of the least expensive coil. Coil volumes were lifted from the database of AngioSuite Neuro Edition software. Coils were grouped as frame, finish or fill coils by FKH by tertiary structural elements for framing coils, and size and length for finishing coils.ResultsMean normalised coil cost per volume by categories yield 0.22 ± 0.24/mm3 for framing coils, 0.25 ± 0.22/mm3 for fill coils, and 0.99 ± 0.81 for finish coils. Between categories, there was no significant difference (p=0.32) between frame vs fill coils, but an extremely significant difference between both of the former vs finish coils (p < 0.000001). Individual cost/volume of each coil are collectively displayed in figure 1, grouped by coil type.ConclusionsAs a class, finishing coils are approximately 4 times as expensive as their frame and filling counterparts. Upon closer of figure 1 though, as a general trend smaller coils, regardless of frame, fill or finish designation, have a much higher cost per volume.This analysis suggests that the approach when coiling to minimise costs is to always insert the largest volume coil possible.DisclosuresC. Wang: None. F. Hui: None.
E-066 Follow Up and Complication Review of Symptomatic Intracranial Angioplasty and Stenting in a Non-Academic Setting
Authors: Parker M , Yin J , Rutledge N , Conrad K , Horowitz B , Luci J 
Published: July 2013

Introduction/PurposeIntracranial stenosis and treatment remains controversial based on mixed reports of complication rates and varying results of medical treatment. We reviewed our series of intracranial angioplasty and stenting done only on symptomatic patients refractory to medical management to the SAMMPRIS trial and as a basis for quality improvement.Materials and MethodsA retrospective review of 42 sequential patients ranging from 29 to 86 years old (average 61) with symptomatic intracranial stenosis refractory to medical therapy and treated by angioplasty and stenting from December 2006 to March 2011 at our institution was undertaken. Four cases were not included in the analysis because of technical failure of stent placement.ResultsAverage presenting stenosis was 74.5% and residual 15.8% after angioplasty and stenting. The patients were followed for up to 3 years.Of the patients who received angioplasty and stenting 8.8% (4 patients) died within 30 days, three from complications of the procedure (6.8%) and one six days later from supraventricular tachycardia and cardiac arrest associated with a pre-procedure myocardial infarction.Three additional patients had strokes associated with their procedures for a total complication rate of (13.3%) and five cases have shown asymptomatic restenosis (11%) in the past 3 years.Compared to the SAMMPRIS trial the overall complication rate is similar (13.3%) versus (14%) with a higher death rate (6.8%) versus (2.2%)Analysis of our deaths found that two of the deceased patients had hypertensive spikes during extubation and subsequently deteriorated after initially being neurologically intact. One of these patients developed a basal ganglia haemorrhagic transformation (HI2) and went on to have a large ischaemic MCA infarct, the other a subarachnoid haemorrhage consistent with vessel rupture.ConclusionWe found that successful angioplasty and stenting can be performed in a nonacademic setting with similar complication rates to other reports. Choosing symptomatic patients that have failed aggressive medical management may account for our outcomes.The two of the deaths in our series may be associated with complications from our anaesthesia care. We have since changed our protocol to have ongoing IV Bp and pain management during extubations.DisclosuresM. Parker: None. J. Yin: None. N. Rutledge: None. K. Conrad: None. B. Horowitz: None. J. Luci: None.
E-071 Final Results of the Solitaire FR Thrombectomy for Acute Revascularisation (STAR) - Prospective, Multi-Centre, Controlled Clinical Trial in EU, Australia, and Canada
Authors: Bonafe A 
Published: July 2013

Solitaire FR is the first in the new generation of mechanical thrombectomy devices based on a stent retriever technology for the treatment of acute ischaemic stroke. The Solitaire FR Thrombectomy for Acute Revascularisation (STAR) study is the largest controlled, prospective, multi-centre study on the use of a stentriever only (Solitaire FR) for acute ischaemic stroke.MethodsPatients undergoing mechanical thrombectomy for acute ischaemic stroke in the anterior circulation were enrolled in 14 clinical sites in Europe, Canada and Australia. STAR is the first single arm, observational, controlled, multi-centre, prospective study using TICI 2b for revascularisation success. The aim of the study was to evaluate mechanical thrombectomy with the Solitaire FR when used as first intention device for the respective indications for mechanical thrombectomy. Patients were treated with the Solitaire FR Revascularisation Device in routine practice according to the ‘Instructions for Use’ (Balloon guiding catheter use and maximum number of 3 passes per vessel) to reach final result. The primary endpoint was revascularisation (TICI 2b) of the occluded vessel. The secondary endpoints were the clinical outcome mRS at 90 days, and time to revascularisation. The safety endpoints were the serious adverse events (SAEs) related to the device or the procedure. Patients were enrolled consecutively and there was an independent core-lab imaging review as well as a clinical events committee.Results202 patients were enrolled in the study with first enrolment in October 2010 and final enrolment in May 2012. The median age of the population was 72 years old and 60.4% of female patients. The median NIHSS was 17. Final patient follow-up occurred in September 2012 and the data has been completely independently monitored and core lab reviewed.ConclusionsIn patients with acute ischaemic stroke, treatment with the Solitaire FR device indicated a high level of success in revascularising vessels in the proximal circulation. In real-world practice using established protocols, the STAR results indicate a new paradigm for improving patient outcomes. (ClinicalTrials.gov numberNCT01327989).DisclosuresA. Bonafe: 2; C; covidien.