Background. There are roughly 300,000 rib fractures treated for in the United States each year. These represent 10-26% of thoracic trauma injuries and have about a 10% mortality rate. There is a common belief that mortality in rib fracture patients can be contributed to the diagnosis of pneumonia, but this study does not support that claim. Purpose. To determine the predictors of morbidity and mortality in rib fracture patients. Methods. Using a level 1 trauma center patient registry, we retrospectively analyzed all patients that were admitted with at least one rib fracture (n=1,344). All predictors were analyzed with linear regressions. Results. The average age of the patients was 55.48 ± 20.29 years old and ranged between 15 and 98. ISS (OR: 1.0508, p<0.001), bilateral fractures (OR: 1.9495, p = 0.009) and pulmonary contusion (OR: 1.7481, p = 0.022) were all significant predictors of pneumonia. The age of the patient (OR: 1.0467, p < 0.001), ISS (OR: 1.0585, p <0.001), having 6 or more fractured ribs (OR: 3.1450, p < 0.001), the presence of hemothorax (OR: 2.5063, p = 0.048), and the use of mechanical ventilation (OR: 13.2125, p < 0.001) were all significant predictors of mortality. Flail segments (OR: 1.9871, p = 0.067), ISS (OR: 1.1267, p < 0.001), pulmonary contusions (OR: 1.5329, p = 0.047), pneumothorax (OR: 1.4372, p =0.073) and pneumonia (OR: 21.4516, p < 0.001) are all predictors of requiring mechanical ventilation. Conclusion. There are many studies that indicate rib fracture patients who are diagnosed with pneumonia have a higher risk or mortality. With this in mind, the logical course of treatment would be to counteract the complications pneumonia brings as to reduce the risk or mortality. To do this, it is recommend the patient be put on mechanical ventilation. While this has been seen to help with pneumonia patients, this study provides evidence that health care professionals should look for ways to reduce the need for mechanical ventilation instead of using it to combat the pneumonia.

No description available.

>Magister Scientiae - MSc / It is well known, that there is a severe lack of information available pertaining to neutron rich nuclei, specifically of those nuclei with mass numbers ≥ 60. These neutron rich nuclei are not easy to access in current experimental facilities or be produced with sufficient yield to allow for it to be studied. In order to expand our understanding of nuclear physics by studying the properties and characteristics of these nuclei, the development of new facilities producing Radioactive-ion Beams (RIBs) is required. The applications for RIBs are wide, allowing for deeper investigations into the properties of nuclei, their interactions and the manner in which they were formed in the early universe. Additionally, there are various interdisciplinary fields such as medicine, biology and material science in which RIBs can be utilized as a driving mechanism for new research and technological innovation. The iThemba Laboratory for Accelerator Based Sciences (iThemba LABS), South Africa, has proposed a new facility for the production and acceleration of radioactive-ion beams (RIBs). The RIB Project is to be developed in sequential phases and would produce a range of neutron-rich isotopes for low-energy materials science and nuclear physics research. Of specific interest, is the production of the Helium-6 isotope (6He), for its potential applications in various areas of nuclear physics research. The aim of this research work was to design, model and optimise a RIB production target capable of producing high intensity 6He beams, guided by the characteristics of the primary proton beam available for use at iThemba LABS. This research work/design study is however limited, due to the absence of experimentally measured and verified 6He cross section data for proton induced reactions on the proposed target materials (Graphite and Boron Carbide). However, best-estimate approaches were adopted through the use of validated computer codes. Additionally, all 6He yield results are presented as in-target yields, as this study did not cover the diffusion (isotope release) efficiency of the target systems in question. Three RIB production targets types were investigated using Graphite, Boron Carbide and Beryllium Oxide as potential target materials. Following numerous optimisation processes, a Boron Carbide RIB target was converged upon, proving to be suitable for the production of high intensity 6He beams at iThemba LABS, by meeting the material thermal and mechanical limiting criteria for operation. This target system was found to produce an in-target 6He yield rate of 2 ~ 3 x 1011 6He/s, considered sufficient for experimental application at iThemba LABS.

INTRODUÇÃO: A área da seccção externa da narina é a parte inferior da válvula nasal externa que é o primeiro obstáculo ao fluxo de ar. Existem dúvidas e controvérsias em relação a eficácia de tratamentos cirúrgicos nessa região do nariz durante a rinoplastia. Neste estudo, compararam-se em cadáveres o uso do enxerto de reforço alar modificado de cartilagem septal e costal para analisar o aumento da área seccional externa narinária. MÉTODOS: Trinta narinas de cadáveres foram dissecados no Serviço de Verificação de Óbito da Capital- Universidade de São Paulo. A escolha dos cadáveres foi aleatória (9 mulheres e 6 homens) excluíndo-se os casos com lesão deformante nasal ou doença intra-nasal. Todos os enxertos septais e costais apresentavam as mesmas dimensões (30 x 5 x 1 mm) e foram inseridos acima do ramo lateral das cartilagens alares de maneira aleatória. A seguir, realizaram-se fotos padronizadas e mensurações das 90 áreas seccionais externas de narina com o programa Autocad®; 30 antes de qualquer procedimento; 60 após a inclusão de enxertos (30 usando cartilagem costal e 30 usando cartilagem septal). A análise estatística foi feita com um modelo de medidas repetidas e ANOVA (análise de variância) para a variável área. A comparação das médias foi feita pelo método de Tukey, sendo o coeficiente de confiança global de 95%. RESULTADOS: A área seccional externa da narina sem tratamento, com inclusão de enxerto de reforço alar modificado septal e costal é, respectivamente, 0,76 cm2, 0,85 cm2 (aumento de 11,8%) e 0,91 cm2 (aumento de 19,7%). CONCLUSÃO: O enxerto de reforço alar modificado de costela é estatisticamente mais efetivo que o enxerto de reforço alar modificado de septo para aumentar a área de secção externa da narina / INTRODUCTION: The nostril cross-sectional area (bottom of the external nasal valve) presents the first obstacle to airflow. There are doubts and controversies regarding the effectiveness of surgical treatments in this region of the nose during a rhinoplasty. In this study, we have tested two modified strategies for alar reinforcement, one using a cartilage graft from the nasal septum and the other using rib cartilage, to analyze and compare their effectiveness in augmenting nostril cross-sectional area. METHODS: Thirty corpses nostrils were dissected in the Division of Postmortem Inspection at the University of São Paulo. Corpses were chosen at random (9 women and 6 men) excluding those with deforming nasal injury or intra-nasal disease. All nasal septum and rib grafts had the same dimensions (30 x 5 x 1 mm) and were inserted randomly above the lateral crura of the alar cartilages. Then, a total of 90 standardized photographs were taken to measure nostril cross-sectional area using the Autocad® program; one per nostril on all 15 cadavers, at three separate intervals. Thirty photos were taken prior to any procedure being performed, and 60 after the insertion in each nostril, of the two different types of cartilage grafts. After one graft was tested, it was removed and replaced with the other type. The order of the procedures was randomized. Statistical analyses were conducted using a model for repeated measures and ANOVA for the variable area. The comparison of means was done with Tukeys method and a 95% confidence coefficient. RESULTS: The nostril cross-sectional area before treatment, after modified alar reinforcement using septum cartilage graft, and after modified alar reinforcement using rib graft were 0,76 cm2, 0,85 cm2 (increase of 11,8%) and 0,91 cm2 (increase 19.7%), respectively. CONCLUSION: The modified alar reinforcement using grafts of rib cartilage is statistically more effective than the modified alar reinforcement using grafts of nasal septum in increasing the nostril cross-sectional area

Film cooling effectiveness on a gas turbine blade tip on the near tip pressure side and on the squealer cavity floor is investigated. Optimal arrangement of film cooling holes, effect of a full squealer and a cutback squealer, varying blowing ratios and squealer cavity depth are also examined on film cooling effectiveness. The film-cooling effectiveness distributions are measured on the blade tip, near tip pressure side and the inner pressure and suction side rim walls using a Pressure Sensitive Paint (PSP) technique. A blowing ratio of 1.0 is found to give best results on the pressure side whereas the other tip surfaces give best results for blowing ratios of 2. Film cooling effectiveness tests are also performed on the span of a fully-cooled high pressure turbine blade in a 5 bladed linear cascade using the PSP technique. Film cooling effectiveness over the entire blade region is determined from full coverage film cooling, showerhead cooling and from each individual row with and without an upstream wake. The effect of superposition of film cooling effectiveness from each individual row is then compared with full coverage film cooling. Results show that an upstream wake can result in lower film cooling effectiveness on the blade. Effectiveness magnitudes from superposition of effectiveness data from individual rows are comparable with that from full coverage film cooling. Internal heat transfer measurements are also performed in a high aspect ratio channel and from jet array impingement on a turbulated target wall at large Reynolds numbers. For the channel, three dimple and one discrete rib configurations are tested on one of the wide walls for Reynolds numbers up to 1.3 million. The presence of a turbulated wall and its effect on heat transfer enhancement against a smooth surface is investigated. Heat transfer enhancement is found to decrease at high Re with the discrete rib configurations providing the best enhancement but highest pressure losses. Experiments to investigate heat transfer and pressure loss from jet array impingement are also performed on the target wall at Reynolds numbers up to 450,000. The heat transfer from a turbulated target wall and two jet plates is investigated. A target wall with short pins provides the best heat transfer with the dimpled target wall giving the lowest heat transfer among the three geometries studied.

Thesis (M.A.)--State University of New York at Binghamton, Anthropology Department, 2007. / Includes bibliographical references.

This thesis focuses on the study of flow and heat transfer in porous media in both laminar and turbulent flow regimes, by using Volume Averaged Reynolds Navier Stokes (VARNS) approach. The main concern is to investigate the possibility of using porous media for the gas turbine blade cooling. Very recently, using this technique in blade cooling, particularly with internal cooling, has motivated many researchers due to an effective enhancement in the blade cooling. In this study turbulence is represented by using the Launder-Sharma low-Reynolds-number k-Îμ turbulence model, which is modified via proposals by Nakayama and Kuwahara (2008) and Pedras and de Lemos (2001) for extra source terms in the turbulent transport equations to account for the porous structure, which is treated as rigid and isotropic. Due to the changing of the effective porosity as the clear fluid region is approached, the porosity and additional source term in the macroscopic Reynolds averaged Navier-Stokes equations are relaxed across a thin transitional layer at the edges of the porous media. This is achieved by utilizing exponential damping relations to consider these changes. The Local Thermal Equilibrium (LTE) (one-energy equation) model is used for the thermal analysis in porous media. In order to investigate the validity of the extended model, laminar and turbulent flow in different cases, fully developed and developing flows, have been considered. For laminar flows, fully developed plane channel flows with one and two porous layers, a channel with a single porous block and partially filled porous channel flows have been examined for the purpose of validating the extra drag terms in the momentum equations. For the validation purpose for turbulent flows in porous media, the extended model has been tested in homogeneous porous media, turbulent porous channel flows, turbulent solid/porous rib channel flows, and repeated turbulent porous baffled channel flows. Results of all laminar cases show excellent qualitative agreements with the available numerical calculations and experimental data. Results of all turbulent cases show that the extended model returns generally satisfactory accuracy through the comparisons with the available data, except for some predictive weaknesses in regions of either impingement or adverse pressure gradients, both of which are largely due the underlying eddy-viscosity model formulation employed. Thus, from all results, it can be confirmed that the extended model is promising for engineering applications.

INTRODUÇÃO: A área da seccção externa da narina é a parte inferior da válvula nasal externa que é o primeiro obstáculo ao fluxo de ar. Existem dúvidas e controvérsias em relação a eficácia de tratamentos cirúrgicos nessa região do nariz durante a rinoplastia. Neste estudo, compararam-se em cadáveres o uso do enxerto de reforço alar modificado de cartilagem septal e costal para analisar o aumento da área seccional externa narinária. MÉTODOS: Trinta narinas de cadáveres foram dissecados no Serviço de Verificação de Óbito da Capital- Universidade de São Paulo. A escolha dos cadáveres foi aleatória (9 mulheres e 6 homens) excluíndo-se os casos com lesão deformante nasal ou doença intra-nasal. Todos os enxertos septais e costais apresentavam as mesmas dimensões (30 x 5 x 1 mm) e foram inseridos acima do ramo lateral das cartilagens alares de maneira aleatória. A seguir, realizaram-se fotos padronizadas e mensurações das 90 áreas seccionais externas de narina com o programa Autocad®; 30 antes de qualquer procedimento; 60 após a inclusão de enxertos (30 usando cartilagem costal e 30 usando cartilagem septal). A análise estatística foi feita com um modelo de medidas repetidas e ANOVA (análise de variância) para a variável área. A comparação das médias foi feita pelo método de Tukey, sendo o coeficiente de confiança global de 95%. RESULTADOS: A área seccional externa da narina sem tratamento, com inclusão de enxerto de reforço alar modificado septal e costal é, respectivamente, 0,76 cm2, 0,85 cm2 (aumento de 11,8%) e 0,91 cm2 (aumento de 19,7%). CONCLUSÃO: O enxerto de reforço alar modificado de costela é estatisticamente mais efetivo que o enxerto de reforço alar modificado de septo para aumentar a área de secção externa da narina / INTRODUCTION: The nostril cross-sectional area (bottom of the external nasal valve) presents the first obstacle to airflow. There are doubts and controversies regarding the effectiveness of surgical treatments in this region of the nose during a rhinoplasty. In this study, we have tested two modified strategies for alar reinforcement, one using a cartilage graft from the nasal septum and the other using rib cartilage, to analyze and compare their effectiveness in augmenting nostril cross-sectional area. METHODS: Thirty corpses nostrils were dissected in the Division of Postmortem Inspection at the University of São Paulo. Corpses were chosen at random (9 women and 6 men) excluding those with deforming nasal injury or intra-nasal disease. All nasal septum and rib grafts had the same dimensions (30 x 5 x 1 mm) and were inserted randomly above the lateral crura of the alar cartilages. Then, a total of 90 standardized photographs were taken to measure nostril cross-sectional area using the Autocad® program; one per nostril on all 15 cadavers, at three separate intervals. Thirty photos were taken prior to any procedure being performed, and 60 after the insertion in each nostril, of the two different types of cartilage grafts. After one graft was tested, it was removed and replaced with the other type. The order of the procedures was randomized. Statistical analyses were conducted using a model for repeated measures and ANOVA for the variable area. The comparison of means was done with Tukeys method and a 95% confidence coefficient. RESULTS: The nostril cross-sectional area before treatment, after modified alar reinforcement using septum cartilage graft, and after modified alar reinforcement using rib graft were 0,76 cm2, 0,85 cm2 (increase of 11,8%) and 0,91 cm2 (increase 19.7%), respectively. CONCLUSION: The modified alar reinforcement using grafts of rib cartilage is statistically more effective than the modified alar reinforcement using grafts of nasal septum in increasing the nostril cross-sectional area

The presence of rib fractures in deceased infants is generally considered to be highly specific of non-accidental injury, with some pathologists considering them to be evidence of abuse. Although rib fractures may occur during resuscitative efforts in adults, the general consensus is that such injuries are exceptional in infants owing to inherent plasticity within the thoracic region. The recommendation for cardiopulmonary resuscitation (CPR) of infants since the year 2000 has been for the use of the “two-thumb” technique. However, there has been limited biomechanical investigation to what injuries may occur subsequent to this specific form of CPR. The overall aim of this thesis was to determine if two-thumb CPR can cause similar rib injuries to those seen in abusive squeezing cases. In particular, whether or not this CPR technique allows for over excessive levering of the posterior rib over the transverse process of the spine. To this end, physical experimentation simulating both two-thumb CPR and abusive squeezing was performed on an immature swine model of the infant thorax. The results of these tests did not show any significant difference in the force required to compress the thorax by one third its original anterior-posterior diameter in the two scenarios. One third being the recommended depth for CPR compressions. Fractures resultant from the testing were assessed with radiography and computed tomography, techniques commonly used by post-mortem pathologists. The type and nature of the injuries observed were remarkably similar in both scenarios. Rib injuries were primarily seen in the anterior part of the thoracic cage in both CPR and abusive specimens. The specific site of rib fracture was typically close to or within the costochondral joints. There was however an apparent absence of posterior rib fractures in the abusively tested cohort. This is in part due to the slight difference in profile of the neck and head areas within the ribs of the surrogate model. This acts to reduce the mechanical advantage offered by levering over the transverse processes of the spine. This study has shown anterior fractures of the ribs result from two-thumb CPR, challenging the long held belief that CPR cannot produce rib fractures. X-ray CT offered a significant improvement on the ability to detect costochondral junction injuries. This would offer further support to the routine use of X-ray CT in post-mortem examinations of infants where the cause of death is unknown. This has the potential to offer differential interpretation to the cause of rib injuries, especially in cases of sudden unexpected deaths in infancy, where otherwise child abuse may be diagnosed.

This thesis deals with design and implementation of an algorithm for segmentation of ribs from thoracic CT data. For the segmentation method of rib centerlines detection is chosen. The first step of this approach is to extract the centerlines of all the bones located in the scan. These centerlines are divided into short primitives, which are subsequently classified into couple of categories, depending on whether they represent the centerline of the rib. Subsequently, the centrelines of ribs are used as the seed points of the region growing algorithm in three-dimensional space, which realizes the final segmentation of the ribs. Within the work, a database of 10 CT scans was manually annotated, which was subsequently used to validate a performance of the proposed segmentation approach. The achieved success rate of primitive classification is 96,7 %, the success rate of rib segmentation (Dice coefficient) is 86,8 %.