Evaluating the morbidity and efficacy of reoperative surgery in the central compartment for persistent/recurrent papillary thyroid carcinoma.

BACKGROUND: Although reoperative surgery in the central compartment (RCND) is indicated for bulky or progressive persistent/recurrent papillary thyroid carcinoma (PTC), its associated morbidity and disease outcomes remain unclear. We evaluated RCND outcomes by comparing them with those of patients who underwent primary central neck dissection (CND). METHODS: After matching for age, sex, tumor size, and initial tumor stage, the morbidity and outcomes of 50 consecutive patients who underwent RCND were compared with data from 75 patients who underwent primary therapeutic CND during the same period. Matching was performed blind to the morbidity and disease outcome of each patient. A stimulated thyroglobulin (sTg) <2 ng/ml was considered undetectable. RESULTS: Relative to primary CND, the incidence of extranodal extension (p = 0.010) and size of metastatic lymph nodes (p < 0.001) were significantly greater in the RCND group. Postoperative hypoparathyroidism and vocal cord palsy rates were comparable in the groups. There were two esophageal injuries in the RCND group and none in the primary CND group. The secondary CND group achieved a significantly lower undetectable postablation sTg rate (12.0 vs. 52.0 %, p = 0.001) and worse 10-year disease-free survival (35.6 vs. 91.8 %, p = 0.001) and cancer-specific survival (82.0 vs. 98.5 %, p = 0.001) than the primary CND group. CONCLUSIONS: Although RCND for persistent/recurrent PTC was performed with morbidity comparable to that seen with primary CND, it was associated with some serious complications. Short- and long-term disease control appeared moderate with approximately one-tenth of patients having an undetectable sTg level 6 months after ablation and one-third remaining clinically disease-free after 10 years.

New York City's healthcare transportation during a disaster: a preparedness framework for a wicked problem.

During a disaster, victims with varied morbidities are located at incident sites, while healthcare facilities with varied healthcare resources are distributed elsewhere. Transportation serves an essential equilibrating role: it helps balance the patients' need for care with the supply of care. Studying the special case of New York City, this article sets out the healthcare transportation components as: (1) incident morbidity; (2) transportation assets; and (3) healthcare capacity. The relationship between these three components raises an assignment problem: the management of healthcare transportation within a dynamic and partly unpredictable incident-transportation-healthcare nexus, under urban disruption. While the routine dispatch problem can be tackled through better geographic allocation software and technical algorithms, the disaster assignment problem must be confronted through real-time, mutual adjustment between institutions. This article outlines institutional alternatives for managing the assignment problem and calls for further research on the merits of alternative institutional models.

Counting crises: US hospital evacuations, 1971-1999.

OBJECTIVES: To investigate the relative distribution of hazards causing hospital evacuations, thereby to provide rudimentary risk information for hospital disaster planning. METHODS: Cases of hospital evacuations were retrieved from newspaper and publication databases and classified according to hazard type, proximate and original cause, duration, and casualties. Both partial and full evacuations were included. The total number of evacuation incidents for all hazards were compared to the total number of hospital incidents for the one hazard, fire, for which national data is available. RESULTS: There were 275 reported evacuation incidents from 1971-1999, with an annual average of 21 in the 1990s, the period for which databases were more reliable. The most, 33, were recorded in 1994, the year of the Northridge Earthquake. Of all incidents, 63 (23%) were attributable primarily to internal fire, followed by internal hazardous materials (HazMat) events (18%), hurricane (14%), human threat (13%), earthquake (9%), external fire (6%), flood (6%), utility failure (5%), and external HazMat (4%). CONCLUSIONS: More than 50% of the hospital evacuations occurred because of hazards originating in the hospital facility itself or from human intruders. While natural disasters were not the preponderant causes of evacuations, they caused severe problems when multiple hospitals in the same urban area were incapacitated simultaneously. Clearly, as hospitals are vulnerable to many hazards, mitigation investments should be assessed not in terms of single-hazard risk-cost-benefit analysis, but in terms of capacity to mitigate multiple hazards. In view of the many qualifications and limitations of the dataset used here, but value of such data for disaster planning, hospitals should be asked to submit standardized incident reports to permit national data gathering on major disruptions.

NCEER's mission and goals for the center - to - center project cooperative development of a framework for post-urban earthquake reconstruction strategies

This paper summarizes the background and objectives of a Center-to-Center cooperative project on the development of post-urban earthquake reconstruction strategies between the Internationall Center for Disaster Mitigation Engineering (INCCEDE-Japan) and the National Center for Earthquake Engineering Research (NCEER-USA). This paper defines the background, the important issues and the selected aspects of studies we hope to conduct, to benefit those who plan to take part in the studies of this Center-to Center project. therefore, this paper is an open-ended description of the intent of the project with the hope that it can provide some direction for a more effective contribution by those who are interested in taking part in this Center-to-Center collaborative research effort. (AU)

Seismic vibration reduction of highway bridge by real-time structural parameter modification (RSPM)

A new semi-active control system is considered for a three-span highway brigde seismic retrofitting. The bridge model is based on the design information of Memphis bridge 502-11#124/125. The performance criterion includes the relative displacement between superstructure and cap beam and the column base moments. Numerical analysis results show that, with the added RSPM control system, both the relative displacement and the base moment could be considerably reduced. (AU)

Real - time structural parameter modification (RSPM) : Development of innervated structures

This report presents a structural vibration reduction system which includes control algoritms and example devices. The concept of this system is to adaptively change the physical parameters of a structure based on dynamic information such as ground motions and the structure's response to these motions. This approach is referred to as Real-time structural parameter modification (RSPM). A structure implemented with RSPM capacity is called an innervated structure.This report presents only the basic concept and preliminary theoretical and experimental results to demostrate the feasibility of introducing innervating knowledge base for the design and construction of man-made structures with features and characteristics similar to those of living systems.(AU)

Bridge monitoring systems : An overview

This paper discusses the main components os a bridge monitoring system, some models used to predict bridge behavior, measurement and sensory systems, and outlines some approaches for developing an integrated data management system.(AU)

Smart concretes for civil infrastructure systems

Smart concretes for civil infrastructure systems are reviewed, with emphasis on carbon fiber reinforced concrete for strain/stress sensing as well as improved mechanical properties. The sensing by electrical resistance measurement had been demonstrated during compressive, tensile and flexural deformation.(AU)

Dynamic identification for existing buildings

In central and eastern United States, retrofit of existing buildings is an important issues in earthquake engineering research and practice. Because many structural vibration reduction approaches require the information of structures dynamic parameters, the corresponding identification for existing buildings becomes a pertinent technology and has been updated continuously in recent years. In this paper, several issues in dynamic identification by using four modal energy transfer ratio, are discussed. Comparisons with experimentally observed data of a six-story building are made (AU)