It is a commonly held belief that a repeat caesarean section through a low vertical scar provides easier access and fewer complications than an operation through a previous Pfannenstiel incision. To test this hypothesis the records of one hundred and twenty one repeat caesarean sections were retrospectively reviewed by the author. These records were reviewed at the two large teaching hospitals of the University of the Witwatersrand, Chris Hani Baragwanath and Johannesburg General Hospital. Statistically significant findings were that older women were more likely to have had an initial midline incision. Incision to delivery times were faster via the midline (4 min) than the Pfannenstiel incision (5.5 min). Total operating times did not differ significantly. The findings do show that repeat midline incisions are faster (1.5 min) to deliver, but do not address the patient’s need for a cosmetically pleasing wound scar.

M.Med.(Anaesthesia), Faculty of Health Sciences, University of the Witwatersrand, 2011 / BACKGROUND Multiple studies have been conducted comparing the efficacy and duration of analgesia obtained from spinal anaesthesia containing local anaesthetics as well as opioids. The literature available has not considered the individual‟s HIV status as a variable. Postoperative analgesic duration and requirements in this group of patients may differ due to the occurrence of acute and chronic pain syndromes, pain arising from the disease itself, side effects of treatment for HIV infection, or opportunistic infections. Response to opioid analgesia may be altered due to previous opioid exposure, potential increase in nociception, drug interactions and emotional status. OBJECTIVES The primary objective of this study was to determine the time to post-operative analgesic request in HIV-positive and negative individuals having caesarean sections under spinal anaesthesia containing bupivacaine or bupivacaine and fentanyl. The secondary objectives of this study were to determine if factors such as height, ethnicity, level of education, CD4 count, and antiretroviral therapy impacted on the duration of analgesia obtained.

Lau, Tze Kin. / "May 1998." / Thesis (M.D.)--Chinese University of Hong Kong, 1998. / Includes bibliographical references (p. 165-178). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Mode of access: World Wide Web.

Three measurements of top-quark pair production cross sections in proton-proton collisions at sqrt(s) = 13 TeV using data collected by the ATLAS experiment are presented. The single-lepton final states are used, where one electron or muon, two b-jets and two other jets can be identified. The inclusive ttbar production cross section is measured to be sigma(ttbar) = 817 +/- 13 (stat.) +/- 103 (syst.) +/- 88 (lum.) pb, which is in good agreement with predictions and with other measurements. Absolute and relative differential cross sections of ttbar production are also measured, showing an overall good agreement with predictions, except for the top-quark transverse momentum distribution. As already reported in measurements at lower proton-proton collision energies, this distribution is shifted towards higher momenta in all predictions with respect to the observations. Total and differential fiducial cross sections of ttbar production in association with heavy-flavour jets are also presented. All tested models are found to agree with data within the uncertainties of these measurements.

One concern for medical professionals and women experiencing cesarean deliveries is the use of indwelling urinary catheters, which is associated with a delay in first void time, slower ambulation time, increased discomfort, longer hospital stays, and an increased risk for urinary tract infections. The purpose of this project was to determine if a practice change regarding the use of urinary catheters among pregnant women decreases the number of women receiving a catheter prior to having a cesarean section in a small community hospital. The knowledge to action and Rosswurm and Larabee's models were used to guide this project, which was comprised of 2 phases. Phase 1 included a team of 10 experts that created the needs assessment that would establish hemodynamic stability using a 4-point scale. The items for inclusion in the needs assessment included primary cesarean, repeat cesarean, no urinary tract infection present, no fetal distress present, no systemic disorders present, no hypertensive disorders present, and no contraindications for anesthesia. Phase 2 was the implementation and evaluation of the needs assessment and new practice guidelines. Statistical analysis was performed using the Mann Whitney U test. There was 98% compliance (p < 0.001.) with the use of the assessment in women undergoing a cesarean delivery and a 64% reduction in the length of time an indwelling catheter was left in place. However, there was no significant change in the number of women receiving a catheter prior to cesarean delivery after a needs assessment was performed (p = 0.805). This project has potential implications that would support social change by reducing the use of indwelling catheters among hemodynamically stable women undergoing cesarean deliveries.

Treatise (D.M.A.)--University of Texas at Austin, 2006. / Vita. Includes bibliographical references.

Intelligent well completions are increasingly being used in horizontal, multilateral, and multi-branching wells. Such completions are equipped with permanent sensors to measure temperature and pressure profiles, which must then be interpreted to determine the inflow profiles of the various phases produced that are needed to characterize the well??s performance. Distributed temperature measurements, using fiber optics in particular, are becoming increasingly more often applied. The value of an intelligent completion hinges on our capability to extract such inflow profiles or, at a minimum, to locate the entry locations of undesirable water or gas entries. In this research, a model of temperature behavior in multilateral wells was developed. The model predicts the temperature profiles in the build sections connecting the laterals to one another or to a main wellbore, thus accounting for the changing well angle relative to the temperature profile in the earth. In addition, energy balance equations applied at each junction predict the effects of mixing on the temperature above each junction. The multilateral wellbore temperature model was applied to a wide range of cases, in order to determine the conditions for which intelligent completions would be most useful. Parameters that were varied for this experiment included fluid thermal properties, absolute values of temperature and pressure, geothermal gradients, flow rates from each lateral, and the trajectories of each build section. From this parametric study, guidelines for an optimal application of intelligent well completion are represented.

Cross sections for K-shell ionization by heavy ions have been determined from the measurements of target K x-ray yields. The measurements were performed with Ar, Kr, and Xe ions at energies from 2.5 to 25 MeV/amu and self-supported metallic foil targets of Al, Ti, Cu, Zr, Ag, Sm, and Ta. The x-ray yields were measured with a Si(Li) detector, while the projectile ions were counted in coincidence with the x-rays using a plastic scintillation detector. In addition, the amount of secondary K-shell ionization and the degree of simultaneous L-shell ionization in primary K-shell ionizing collisions were assessed by performing high-resolution x-ray measurements on targets of Al, Ti, V, Co, and Cu with a curved crystal spectrometer. The results of the high resolution measurements revealed that the apparent average Lshell spectator vacancy fraction at the time of Kα x-ray emission, L p , may be represented by a universal function of the Geometrical Model’s parameter X for Z2 = 17 - 32. Multiple-vacancy Kα fluorescence yields and corrections for K-shell ionization by secondary processes were determined with the aid of the high resolution spectra for the targets Al, Ti, and Cu. Fluorescence yields for the other targets were determined using an extrapolation procedure. The resulting K-vacancy production cross sections for 2.5 to 6 MeV/amu projectiles were compared with a limited amount of available experimental data and shown to be in relatively good agreement. The ECPSSR predictions for all the targets except Al agreed reasonably well with experimental cross sections for Ar projectiles. The experimental cross sections for Kvacancy production in Al, Ti, Cu, Zr, and Ag were greatly deviated from the ECPSSR predictions. The cross sections for Kr on Sm and Ta were in good agreement with theory. The scaling properties of the Kα x-ray production cross sections were examined and a semiempirical “universal” curve was deduced that reproduces the measured cross sections to within ±30% on average. The relationship between the Kα x-ray production cross sections and the geometrical model’s universal variable also was examined.

First generation bioethanol generated from feedstocks is a sustainable alternative to fossil fuels, and the demand for fuel ethanol has promoted studies on the use of the grain as feedstock. This thesis describes various process designs and the economic feasibility for producing the main product ethanol and other by-products such as Biogas and DDGS (Distillers Dried Grains with Solubles) from the grain. The techno-economic analysis was performed by the data provided by Agroetanol industry, located in Norrköping, Sweden. The key target of this simulation work was to evaluate the influence of several process designs and the main production factors on the ethanol production process, in terms of energy efficiency, ethanol production cost and plant profitability. The main aim of this work was to simulate the current industrial process and to develop novel alternative retrofits by integrating new technologies and for investigating the effects on the plant profitability. In the base case, the cost sensitivity analysis was carried out on the grain buying price, ethanol and DDGS selling price. Along with the cost sensitivity analysis, the capacity sensitivity analysis was performed on the base case model to check the influence of different capacities on the plant profitability. While coming to the study of developing alternative retrofits, the three retrofits were developed on the base case process and they are as following: Retrofit 1) modifying the distillation and dehydration section of the base case retrofit (current process in Agroetanol), Retrofit 2) checking the impact of ethanol concentration on technical and economic aspects of the plant and Retrofit 3) installing the biogas digester.The modelling effort resulted in developing the base case model with an ethanol production rate of 41,985 ton/ year. The capital cost of the base case process was calculated to be at 68.85 million USD and the aspen economic analyzer calculated the product value of the ethanol and DDGS as 0.87 USD/litre and 0.37 USD/kg, respectively. Through cost sensitivity analysis results, it is identified that the ethanol selling price and the grain buying price have significant effects on the plant economy and it is confirmed that they are the main factors playing on the plant profitability in the base case model.The results of the alternative retrofits clearly demonstrate the importance of higher ethanol tolerant strains in ethanol production, which showed a less payback period compared to the base case. The payback periods of all the cases are showing the following patterns from the least to the highest: Retrofit 2 (17%) &gt; Base case &gt; Retrofit 3 &gt; Retrofit 2 (4%) &gt; Retrofit 1.Further retrofitting analysis results also suggested that using the stillage for biogas production will help in reducing the energy costs of the plant. The energy consumption of all the retrofits in ascending manner is as follows: Retrofit 3 &gt; Retrofit 2 (17%) &gt; Base case &gt; Retrofit 1 &gt; Retrofit 2 (4%). The energy usage result comparison of all the cases shows that, in third retrofit the overall energy consumption is decreased by 40% than the base case model.

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