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- Clough, Rachel E, et al.
(author)
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Endovascular treatment of acute aortic syndrome
- 2011
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In: Journal of Vascular Surgery. - : Elsevier BV. - 0741-5214 .- 1097-6809. ; 54:6, s. 1580-1587
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Journal article (peer-reviewed)abstract
- BACKGROUND: The term acute aortic syndrome (AAS) encompasses a range of conditions that have a risk of imminent aortic rupture and where delays in treatment result in increased mortality. Endovascular treatment offers an attractive alternative to open surgery but little is known about the durability of the repair and the factors that predict mortality. METHODS: Prospective data were collected for a cohort of 110 consecutive patients with endovascular treatment for AAS. Patient and procedural characteristics were related to short- and midterm outcome using multivariate logistic regression analysis. RESULTS: There were 75 men and 35 women with a median age of 68 (range 57-76) years. The pathologies treated were acute dissection (35), symptomatic aneurysm (32), infected aneurysm (18), transection (12), chronic dissection (9), penetrating ulcer (3), and intramural hematoma (1). Thirty-day mortality was 12.7% and this was associated with hypotension (odds ratio [OR], 5.25), use of general anesthetic (OR, 5.23), long procedure duration (OR, 2.03), and increasing age (OR, 1.07). The causes of death were aortic rupture (4), myocardial infarction (4), stroke (3), and multisystem organ failure (3). The stroke and paraplegia rates were 7.3% and 6.4%, respectively. The 1-year survival was 81% and the 5-year survival 63%. Secondary procedures were required in 13 (11.8%) patients. Factors associated with death at 1 year were presence of an aortic fistula (OR, 9.78), perioperative stroke (OR, 5.87), and use of general anesthetic (OR, 3.76); and at 5 years were aortic fistula (OR, 12.31) and increasing age (OR, 1.06). CONCLUSIONS: Acute aortic syndrome carries significant early and late mortality. Emergency endovascular repair offers a minimally invasive treatment option associated with acceptable short and midterm results. Continued surveillance is important as secondary procedures and aortic-related deaths continue to occur throughout the follow-up period.
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| 3. |
- Kassebaum, Nicholas J., et al.
(author)
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Global, regional, and national disability-adjusted life-years (DALYs) for 315 diseases and injuries and healthy life expectancy (HALE), 1990-2015 : a systematic analysis for the Global Burden of Disease Study 2015
- 2016
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In: The Lancet. - 0140-6736 .- 1474-547X. ; 388:10053, s. 1603-1658
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Journal article (peer-reviewed)abstract
- Background Healthy life expectancy (HALE) and disability-adjusted life-years (DALYs) provide summary measures of health across geographies and time that can inform assessments of epidemiological patterns and health system performance, help to prioritise investments in research and development, and monitor progress toward the Sustainable Development Goals (SDGs). We aimed to provide updated HALE and DALYs for geographies worldwide and evaluate how disease burden changes with development. Methods We used results from the Global Burden of Diseases, Injuries, and Risk Factors Study 2015 (GBD 2015) for all-cause mortality, cause-specific mortality, and non-fatal disease burden to derive HALE and DALYs by sex for 195 countries and territories from 1990 to 2015. We calculated DALYs by summing years of life lost (YLLs) and years of life lived with disability (YLDs) for each geography, age group, sex, and year. We estimated HALE using the Sullivan method, which draws from age-specific death rates and YLDs per capita. We then assessed how observed levels of DALYs and HALE differed from expected trends calculated with the Socio-demographic Index (SDI), a composite indicator constructed from measures of income per capita, average years of schooling, and total fertility rate. Findings Total global DALYs remained largely unchanged from 1990 to 2015, with decreases in communicable, neonatal, maternal, and nutritional (Group 1) disease DALYs off set by increased DALYs due to non-communicable diseases (NCDs). Much of this epidemiological transition was caused by changes in population growth and ageing, but it was accelerated by widespread improvements in SDI that also correlated strongly with the increasing importance of NCDs. Both total DALYs and age-standardised DALY rates due to most Group 1 causes significantly decreased by 2015, and although total burden climbed for the majority of NCDs, age-standardised DALY rates due to NCDs declined. Nonetheless, age-standardised DALY rates due to several high-burden NCDs (including osteoarthritis, drug use disorders, depression, diabetes, congenital birth defects, and skin, oral, and sense organ diseases) either increased or remained unchanged, leading to increases in their relative ranking in many geographies. From 2005 to 2015, HALE at birth increased by an average of 2.9 years (95% uncertainty interval 2.9-3.0) for men and 3.5 years (3.4-3.7) for women, while HALE at age 65 years improved by 0.85 years (0.78-0.92) and 1.2 years (1.1-1.3), respectively. Rising SDI was associated with consistently higher HALE and a somewhat smaller proportion of life spent with functional health loss; however, rising SDI was related to increases in total disability. Many countries and territories in central America and eastern sub-Saharan Africa had increasingly lower rates of disease burden than expected given their SDI. At the same time, a subset of geographies recorded a growing gap between observed and expected levels of DALYs, a trend driven mainly by rising burden due to war, interpersonal violence, and various NCDs. Interpretation Health is improving globally, but this means more populations are spending more time with functional health loss, an absolute expansion of morbidity. The proportion of life spent in ill health decreases somewhat with increasing SDI, a relative compression of morbidity, which supports continued efforts to elevate personal income, improve education, and limit fertility. Our analysis of DALYs and HALE and their relationship to SDI represents a robust framework on which to benchmark geography-specific health performance and SDG progress. Country-specific drivers of disease burden, particularly for causes with higher-than-expected DALYs, should inform financial and research investments, prevention efforts, health policies, and health system improvement initiatives for all countries along the development continuum.
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| 5. |
- Mani, Kevin, et al.
(author)
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Predictors of Outcome after Endovascular Repair for Chronic Type B Dissection
- 2012
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In: European Journal of Vascular and Endovascular Surgery. - : Elsevier BV. - 1078-5884 .- 1532-2165. ; 43:4, s. 386-391
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Journal article (peer-reviewed)abstract
- Objectives: To assess the durability of endovascular repair (TEVAR) in chronic type B dissection (CD) and identify factors predictive of outcome. Design: Retrospective analysis of a prospective database. Materials: Patients undergoing TEVAR for CD at a tertiary referral centre 2000-2010. Methods: Analysis of pre-operative characteristics, operative outcome, false lumen thrombosis, aortic diameter and survival. Results: 58 consecutive patients were included (49 elective, 9 urgent, mean age 66 years). Mean aortic diameter was 6.4 cm (Standard deviation SD 1.3 cm). Three patients died perioperatively (5%, 1 urgent, 2 elective). Complications included retrograde type A dissection (n = 3), paraplegia (1), and transient ischaemic attack (1). Estimated survival (Kaplan-Meier) was 89% (1-year) and 64% (3-years). Forty-seven patients had mid-term imaging follow-up at mean 38 months. Reintervention rate was 15% at 1-year and 29% at 3-years. Aortic diameter decreased in 24, was stable in 15 and increased in 8. Mid-term survival was higher in patients with aortic remodelling (reduction of aortic diameter >0.5 cm; 3-year 89%) than without (54%; Log Rank p = 0.005). Remodelling occurred with extensive false lumen thrombosis. Conclusion: Satisfactory mid-term outcome after TEVAR for CD remains a challenge. Survival is associated with aortic remodelling, which is related to persistence of flow in the false lumen.
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| 7. |
- Mani, Mahesh, et al.
(author)
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Simulation and analysis for sustainable product development
- 2013
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In: International Journal of Life Cycle Assessment. - : Springer Science and Business Media LLC. - 1614-7502 .- 0948-3349. ; 18:5, s. 1129-1136
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Journal article (peer-reviewed)abstract
- Simulation plays a critical role in the design of products, materials, and manufacturing processes. However, there are gaps in the simulation tools used by industry to provide reliable results from which effective decisions can be made about environmental impacts at different stages of product life cycle. A holistic and systems approach to predicting impacts via sustainable manufacturing planning and simulation (SMPS) is presented in an effort to incorporate sustainability aspects across a product life cycle. Methods Increasingly, simulation is replacing physical tests to ensure product reliability and quality, thereby facilitating steady reductions in design and manufacturing cycles. For SMPS, we propose to extend an earlier framework developed in the Systems Integration for Manufacturing Applications (SIMA) program at the National Institute of Standards and Technology. SMPS framework has four phases, viz. design product, engineer manufacturing, engineer production system, and produce products. Each phase has its inputs, outputs, phase level activities, and sustainability-related data, metrics and tools.Results and discussion An automotive manufacturing scenario that highlights the potential of utilizing SMPS framework to facilitate decision making across different phases of product life cycle is presented. Various research opportunities are discussed for the SMPS framework and corresponding information models. The SMPS framework built on the SIMA model has potential in aiding sustainable product development.
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| 8. |
- Muroyama, Alexander, 1990, et al.
(author)
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Simulation and Analysis for Sustainability in Manufacturing
- 2011
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In: ASME 2011 International Design Engineering Technical Conferences & Computers and Information in Engineering Conference.
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Conference paper (peer-reviewed)abstract
- Sustainability has become a ubiquitous term in almost every field, especially in engineering design and manufacturing. Recently, an increased awareness of environmental problems and resource depletion has led to an emphasis on environmentally friendly practices. This is especially true in the manufacturing industry where energy consumption and the amount of waste generated can be high. This requires proactive tools to be developed to carefully analyze the cause-effect of current manufacturing practices and to investigate alternative practices. One such approach to sustainable manufacturing is the combined use of Discrete Event Simulation (DES) and Life Cycle Assessment (LCA) to analyze the utilization and processing of manufacturing resources in a factory setting. On an economic aspect such methods can significantly reduce the financial and environmental costs by evaluating the system performance before its construction or use. In this project, what-if scenarios in a simplified golf ball factory using as close to real-world data as possible demonstrate DES and LCA’s ability to facilitate decision-making and optimize the manufacturing process. Plastic injection molding, an energy-intensive step in the golf ball manufacturing process, is the focus of the DES model. AutoMod, a 3-D modeling software, was used to build the DES model and AutoStat was used to run the trials and analyze the data. By varying the input parameters such as type and number of injection molding machines and material used, the simulation model can output data indicating the most productive and energy efficient methods. On a more detailed level, the simulations can provide valuable information on bottlenecks or imbalances in the system. Correcting these can allow the factory to be both “greener” and more cost-effective.
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| 10. |
- Paju, Marja, et al.
(author)
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Framework and Indicators for a Sustainable Manufacturing Mapping Methodology
- 2010
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In: Proceedings of the 2010 Winter Simulation Conference. - 9781424498642 ; 42, s. 3411-3422
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Conference paper (peer-reviewed)abstract
- Reducing costs, improving quality, shortening the time-to-market, and at the same time act and think sus-tainable are major challenges for manufacturing industries. To strive towards these objectives, discrete event simulation (DES) has proven to be an effective tool for production system decision support. Large companies continuously log raw data, and are therefore able to collect large quantities of re-source event information. However, usually it is difficult to reuse data for future DES projects. Thus, the aim of this paper is to describe how to facilitate data sharing between data sources and DES models. A test implementation of a simulation data architecture has been realized. A data processing tool, a database and an interface were created, which provide reusable resource event data to pave the way for sustainable resource information in DES projects. The entirety data exchange is provided by standard XML documents following the latest Core Manufacturing Simulation Data recommendations.
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