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- 저자 : David Edwards (검색결과 43 건)
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A development study of drain fluid gastrografin as a biomarker of anastomotic leak
David A. Clark,Edward Yeoh,Aleksandra Edmundson,Craig Harris,Andrew Stevenson,Daniel Steffens,Michael Solomon 대한대장항문학회 2022 Annals of Coloproctolgy Vol.38 No.2
Purpose: Anastomotic leakage (AL) is the anathema of colorectal surgery. Its occurrence leads to increased morbidity and mortality and a prolonged hospital stay. Much work has gone into studying various biomarkers in drain fluid to facilitate early detection of AL. This stage 2a development study aims to assess the safety and feasibility of reliably detecting the iodine in Gastrografin (GG; Bayer Australia Ltd.) in drain fluid and stool samples by dual-energy computed tomography (DECT). Methods: This is a prospective, observational, controlled, consecutive cohort study establishing the safety and feasibility of the detection of GG in surgical drain fluid and stool as a biomarker of AL when patients with a low pelvic colorectal anastomosis undergo luminal flushing of the rectal tube with GG. Results: Ten consecutive patients were allocated to the saline flush group and the following 10 to the GG flush group. Three patients in the saline flush group developed an AL. One patient in the GG flush group developed an AL. An elevation in the drain fluid GG was detected using DECT on the day of clinical deterioration. None of the patients in the control group were found to have a positive result on DECT. Conclusion: This study demonstrates the safety of a novel approach to the early detection of AL from extraperitoneal colorectal anastomoses. The technique requires validation in a larger cohort and a multicenter study is planned to investigate the efficacy of GG rectal tube flushes as an early biomarker of AL in low pelvic anastomoses.
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Optimal Smooth Paths Based on Clothoids for Car-like Vehicles in the Presence of Obstacles
Edward Derek Lambert,Richard Romano,David Watling 제어·로봇·시스템학회 2021 International Journal of Control, Automation, and Vol.19 No.6
Automated Guided Vehicles are increasingly used for material transfer in factory and warehouse environments amongst humans and human operated vehicles. Safe and efficient operation is challenging when there is a mix of human and automated traffic as fixed guide paths can become blocked more frequently. In this work we aim to show smooth and efficient paths based on clothoid curves can be used to automatically plan diversions which can be traversed at high speed by automated fork-lift vehicles, which are car-like in the sense they have a limited turning radius and angular acceleration. The approach, based on numerical optimisation within convex region constraints is described in detail, and numerical results for curvature and sharpness are compared to a cubic spline on a small number of simulated environments. The clothoid spline is less affected, in terms of its objective function, by a shift in the obstacle boundaries than a cubic spline, for obstacle shifts below 0.5m. The clothoid spline takes longer to converge for but the output path has attractive qualities like lower peak sharpness, enabling high speed operation. The method is therefore most useful for applications where path quality is important and updates are required less frequently. Changing the objective function by increasing weighting parameter b allowed the path shape to be tuned to reduce the peak sharpness, at the cost of increasing the total length. With b > 100, convergence was poor because parts of the spline were pushed outside the assigned region, an artefact arising from the constraints only being enforced at the start and end of each segment. The analytical Jacobian of the constraints was effective at reducing the number of function evaluations to reach convergence.
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Asian Multilateralism: Implications for US Policy
( Edward A Olsen ),( David Winterford ) 한국국방연구원 1994 The Korean Journal of Defense Analysis Vol.6 No.1
During the Cold War security in Asia was dominated by several bilateral relationships between the United States and its Asian partners. In post-Cold War Asia there is growing interest in multilateralism for enhancing regional security. The Clinton administration refers to a "new Pacific community and has indicated interest in multilateral fora for discussing trade and security issues. However, like its predecessor, the administration has not developed a coordinated policy toward Asia. While there has been a new emphasis on trade policy, in terms of security there is greater continuity with the Bush administration, and Consequently, despite the Clinton administration`s "bott- om- u p review of US defense programs, there has been very little change in Washington`s strategic thinking concerning Asia. Instead of shaping a new US geopolitical vision for post-Cold War Asia, the administration muddles through from bilateralism toward multilateral structures. Although multilateralism may hold the promise of injecting balance and reciprocity into security relations, it confronts several major pitfalls that may undermine its prospects for success. This paper examines three of the most significant of these obstacles: the existence of multiple instances of "double containment" in America`s security policies toward Asia; the unpredictability of post-Cold War Asian regional political dynamics; and the difficulty of devising a new multilateralist surrogate for old US ideological motives in post-Cold War Asia. This paper argues that during the Cold War the United States crafted bilat- eral relations with Japan and South Korea aimed not only at containing the Soviet Union, China, and North Korea but restraining its own two treaty allies as well. That is, America`s strategy in Asia rested on two sets of "doub- le containment." In effect, US policy rested on "double containment.2" By linking two seemingly separate bilateral security arrangements embodying double-containment aspects, Washington geometrically multiplied the impact of its containment of its two allies within the larger anticommunist contain- ment approach. The paper examines the rationale, nuances, and structure of the two Northeast Asian versions of double containment. Given current reali- ties in Northeast Asia, the paper argues that double-containment2 is not only fully functional in the 1990s but it also continues to shape the security parameters of China, Taiwan, Southeast Asia and Oceania. The paper sug- gests that, as it did during the Cold War, Northeast Asian double containment continues to undermine moves toward a broader network of overall Asian collective security and may well foredoom such efforts to failure. Problems in Northeast Asia pose a second obstacle in the way of effective multilateralism. For example, if events in Korea were to take a dramatic turn for the worse or in case of temtorial conflict between Russia and Japan, it is not hard to visualize a rupture in US-Japan security ties. Such events would cause grave problems for overall Asian multilateralism since many Asian states do not share common security perceptions on these Northeast Asian issues. Most Asian states do seem to want Washington to stay engaged militarily in Asia, but Washington`s new interest in multilateralism may stem from it desire to shift burdens to regional powers, to thwart the great power aspira- tions of regional actors by harnessing them collectively in ways reminiscent of containment, and to maximize multilateral Asian strategic dependence on the United States to increase American economic leverage. Finally, in examining a third major obstacle to multilateralism, the paper argues that a sustained American commitment to multilateral security struc- tures in post-Cold War Asia requires linking these new arrangements to deeply felt American economic, political, and ideological interests. Asian governments have learned that post-Cold War America is still seeking to reshape Asian economic and political systems, and American ideological goals continue to inject tensions likely to undermine multilateral structures. Ironically, Washington may find to its dismay that part of the appeal of multi- lateralism to Asia is the prospective benefit it may offer in containing the United States. Are American policy-makers prepared to accept this restraint? The paper concludes by suggesting the choice is not between accepting or rejecting multilateralism but rather determinimg which variant of multilater- alism might be most successful. It suggests that an appropriate framework is likely to be a loosely structured Pax Condorninia, a form of multilateralism with Asian as well as American characteristics.
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