text:
Red Indian Lake fishway, an innovative design for difficult conditions
International Nuclear Information System (INIS)
Red Indian Lake Dam is a large concrete gravity structure, 10-12 m high and 245 m long, in the Exploits River watershed in Newfoundland. The watershed is an ideal habitat for production of Atlantic salmon. Since 1985, the watershed above the dam has undergone an extensive stocking program to optimize the salmon production capacity of the upper reaches of the system. To sustain this development, a fishway was needed to permit returning salmon to bypass Red Indian Lake Dam, the last remaining migrational barrier. The difficulties with installing a fishway at the dam site included extreme variation in upstream water levels, the need to retrofit a fishway into an existing structure, and the necessity to attract fish into the fishway in competition with other flows from power plant, spillway, or waterfall. After examining several design approaches, an innovative design was developed incorporating two separate but interrelated flow ways: one to handle attraction water and the other for transportation water. The latter passage leads to a trap at the upper end of the fishway from which salmon are hoisted via a hopper/monorail system across the dam and into the lake. Construction of the fishway was staged over four phases between December 1985 and December 1988. 3 refs., 1 fig
Strengthening the foundations and bases during reconstruction and application hidroplyty in difficult ground conditions
Directory of Open Access Journals (Sweden)
?.?. ???????????
Full Text Available The article is devoted to the questions of strengthening of foundations during reconstruction of buildings with arrangement of underground parking in the difficult ground conditions.
Ahmet Uslu; Tülay Özdemir
Difficult asthma is a distinct entity of asthma, comprising approximately %5 of asthmatic patients. There is no agreed definition of difficult asthma. It will include asthma uncontrolled by new standard therapy, steroid dependent, steroid resistant and severe asthma. In this study difficult asthma; clinical features, risk factors, pathophysiology and novel therapies are summarized by literatures.
Optimizing Electroporation Conditions in Primary and Other Difficult-to-Transfect Cells
Jordan, Elizabeth T.; Collins, Michelle; Terefe, Joseph; Ugozzoli, Luis; Rubio, Teresa
Electroporation is a valuable tool for nucleic acid delivery because it can be used for a wide variety of cell types. Many scientists are shifting toward the use of cell types that are more relevant to in vivo applications, including primary cells, which are considered difficult to transfect. The ability to electroporate these cell types with nucleic acid molecules of interest at a relatively high efficiency while maintaining cell viability is essential for elucidating the pathway(s) in which...
Decreasing the cost of ground grid installations under difficult environmental conditions
International Nuclear Information System (INIS)
The purpose of a ground grid is to provide a means to carry and dissipate electrical currents into ground under normal and fault conditions. In some cases, especially in dry rock terrain, the soil resistivity can be very high, making it difficult and very expensive to install an acceptable ground grid. Usually a soil resistivity above 200 ohm-meter is considered high. This paper discusses and provides design calculations for a successful ground grid installation in a distribution substation located in one of the worst soil conditions encountered in the industry; a very rocky terrain where the resistivity is 1800 ohm-m. It is a practical application of the theories presented in ANSI/IEEE Std. 80-1986. The design application consists of bare copper combined with conventional and a new type of ground rod. The installation cost for this application was much less than the cost associated with that of a conventional installation
The Effects of Auditory-Visual Vowel Identification Training on Speech Recognition under Difficult Listening Conditions
Richie, Carolyn; Kewley-Port, Diane
Purpose: The effective use of visual cues to speech provides benefit for adults with normal hearing in noisy environments and for adults with hearing loss in everyday communication. The purpose of this study was to examine the effects of a computer-based, auditory-visual vowel identification training program on sentence recognition under difficult…
Contributions to the evaluation of observability performance in difficult ambient conditions, for observation equipment during night and day
Borcan, Octavia Violeta C.; Spulber, Catalin A.
The purpose of this paper is to establish an evaluation method of the observability performance for equipment that enables day and night vision (using thermal cameras, gated image intensification and CCD cameras using L3V based on e2v technology). This is done by modelling of experimental results of simulation setup in the lab. Starting from the predictive evaluation procedures of the observation, the paper analyses the relevance of method to establish the limits in the utilization of the above- mentioned equipment, from the point of view of the observation probability, in difficult ambient conditions, such as reduced illumination level or aerosol curtains. Moreover, the present work compares subjective factors that can influence the prediction by the participants on the experiments (age, training, decision time) and objective factors (contrast between background and image, resolution of the observation system and image noise).
Conflict Management: Difficult Conversations with Difficult People
Overton, Amy R.; Lowry, Ann C.
Conflict occurs frequently in any workplace; health care is not an exception. The negative consequences include dysfunctional team work, decreased patient satisfaction, and increased employee turnover. Research demonstrates that training in conflict resolution skills can result in improved teamwork, productivity, and patient and employee satisfaction. Strategies to address a disruptive physician, a particularly difficult conflict situation in healthcare, are addressed.
Conflict management: difficult conversations with difficult people.
Overton, Amy R; Lowry, Ann C
Conflict occurs frequently in any workplace; health care is not an exception. The negative consequences include dysfunctional team work, decreased patient satisfaction, and increased employee turnover. Research demonstrates that training in conflict resolution skills can result in improved teamwork, productivity, and patient and employee satisfaction. Strategies to address a disruptive physician, a particularly difficult conflict situation in healthcare, are addressed. PMID:24436688
Photovoltaic field emulation including dynamic and partial shadow conditions
International Nuclear Information System (INIS)
In this paper the development of a new laboratory prototype for the emulation of a photovoltaic (PV) field is presented. The proposed system is based on a DC/DC step-down converter topology and allows to obtain the solar array I-V curves, taking into account the environmental changes in solar irradiance and cell temperature. The DC/DC converter control strategy is deduced by using a comprehensive mathematical model of the PV field whose parameters are obtained from the knowledge of: (a) maximum power point data, measured when the PV plant power converter is running, (b) open circuit voltage and short-circuit current, measured off-line. This approach allows the most accurate representation of the PV source. Computer simulations and experimental results demonstrate that the proposed circuit acts as a highly accurate and efficient laboratory simulator of the photovoltaic array electrical characteristics both in steady state and transient conditions. Partial shading and fluctuating conditions can be reproduced too. Moreover the dynamic behaviour of the proposed laboratory emulator is suitable to its effective connection to power electronic interface to the utility or to load through a DC/DC boost converter.
Naming and counting disorders (conditions) included in newborn screening panels.
Sweetman, Lawrence; Millington, David S; Therrell, Bradford L; Hannon, W Harry; Popovich, Bradley; Watson, Michael S; Mann, Marie Y; Lloyd-Puryear, Michele A; van Dyck, Peter C
The rapid introduction of new technologies for newborn screening is affecting decisions about the disorders (conditions) that are required or offered as an option through public and private newborn screening. An American College of Medical Genetics report to the Health Resources and Services Administration summarized an extensive effort by a group of experts, with diverse expertise within the newborn screening system, to determine a process for selecting a uniform panel of newborn screening disorders. The expert panel did not propose a mechanism for counting or naming conditions. Differences in the nomenclature used to identify disorders have resulted in difficulties in developing a consensus listing and counting scheme for the disorders in the recommended uniform panel. We suggest a system of nomenclature that correlates the screening panel of disorders recommended in the American College of Medical Genetics report with the screening analyte and accepted standardized nomenclature. This nomenclature system is proposed to remove ambiguity and to increase national uniformity in naming and counting screening disorders. PMID:16735257
Confidence in Airline Performance in Difficult Market Conditions: An Analysis of JetBlue's Financial Market Results
Flouris, Triant; Walker, Thomas
This paper examines the stock market s reaction to JetBlue s Initial Public Offering (1PO) and subsequent price movements of the stock. In particular, w e examine whether the euphoria surrounding JetBlue s IPO carried over to other firms in the sector by testing whether the shares of JetBlue s competitors showed a significant price reaction to JetBlue s IPO. JetBlue's IPO took place just a few months following September 11, 2001. These events resulted in dramatic changes in the airline industry and had significant implications on the economic gains of airlines. We examine JetBlue s accounting and stock performance and compare it to the relative performance of Southwest Airlines (SWA), a representative of the loa-cost carrier group. In addition, we compare both JetBlue's and SWA's financial condition and the relative performance of their stock to two mainline U S. carriers, Continental and Northwest. representatives of the conventional-cost carrier group. We analyze whether there are any performance differences among the low-cost carriers and between low-cost carriers and conventional-cost carriers. In particular, we examine whether low-cost carriers were able to sustain the economic impacts of 9/11 better than the conventional-cost carriers.
A guideline for railway bridge inspection and condition assessment including the NDT toolbox
Helmerich, R.; Bie?, J.; Cruz, Paulo J. S.
The member states of the European Union organise the regular inspection and condition assessment of their railway infrastructure asset on national level. Advanced non-destructive testing is not included as part of most regular railway bridge inspection rules. The paper presents a guideline foe inspection and condition assessment of railway bridges promoting especially non-destructive testing (NDT) methods. Besides the state of the art, the guideline summarises the latest steps of research, pe...
Included yet Excluded? : Conditions for Inclusive Teaching in Physical Education and Health
A?stro?m, Peter
This dissertation has examined the conditions for teachers who teach Physical Education and Health (PEH) in elementary school (age 11-12) and their opportunities to pursue inclusive teaching with the aim of reaching all pupils. The compilation thesis consists of four different articles and provides knowledge from the perspectives of pupils and teachers, but it also includes teaching and learning processes that were studied in situ. The first article contributes to knowledge on how different r...
Directory of Open Access Journals (Sweden)
Klaus Vormbrock
Full Text Available Colorectal cancer (CRC is one of the leading causes of death from cancer in the world. We now know that 90% of CRC develop from adenomatous polyps. Polypectomy of colon adenomas leads to a significant reduction in the incidence of CRC. At present most of the polyps are removed endoscopically. The vast majority of colorectal polyps identified at colonoscopy are small and do not pose a significant challenge for resection to an appropriately trained and skilled endoscopist. Advanced polypectomy techniques are intended for the removal of difficult colon polyps. We have defined a "difficult polyp" as any lesion that due to its size, shape or location represents a challenge for the colonoscopist to remove. Although many "difficult polyps" will be an easy target for the advanced endoscopist, polyps that are larger than 15 mm, have a large pedicle, are flat and extended, are difficult to see or are located in the cecum or any angulated portion of the colon should be always considered difficult. Although very successful, advanced resection techniques can potentially cause serious, even life-threatening complications. Moreover, post polypectomy complications are more common in the presence of difficult polyps. Therefore, any endoscopist attempting advanced polypectomy techniques should be adequately supervised by an expert or have an excellent training in interventional endoscopy. This review describes several useful tips and tricks to deal with difficult polyps.
78 FR 34708 - Proposed Information Collection (Foot (Including Flatfeet (pes planus)) Conditions Disability...
...Kessinger, Veterans Benefits Administration (20M35...Conditions Disability Benefits Questionnaire)'' in...comments may be viewed online through the FDMS. FOR...Conditions Disability Benefits Questionnaire), VA...Questionnaire). Type of Review: New data...
DEFF Research Database (Denmark)
Meyer, Gitte
A critique of conventional science journalism is offered in this paper. The convention of science journalism as science transmission is claimed to be incapable of coping with challenges emerging from the present commercialization of science - letting science into society by embracing and being embraced by the market-place, while maintaining the old scientific alienation from political life. The case is made that modern science was born ambiguous towards the market-place, and that such ambivalence - relating to different interpretations of the idea of knowledge as a common good - is still to be encountered among scientists. Drawing on series of interviews with scientists from bioscience and biotechnology it is argued that, on the one hand, scientists are into marketing and PR exercises; but, on the other hand, they also voice a demand that journalists should make such marketing difficult. It is the conlusion of the paper that journalists must break with the convention of science transmission in order to fulfilthat demand, and in order to spur a political discussion, among scientists and in public, on how to maintain the idea of knowledge as a common good.
Management of difficult urticaria
Yadav Sudha; Bajaj A
Chronic urticaria, a major health problem causing patient?s distress, induces often physicians? dilemma while dealing with its etiology, investigations and management. Clinical approach of such cases should include apart from clinical history and physical examination laboratory investigations like routine blood test, thyroid profile, etc. as well as sometimes special test like autologous serum skin test. Management includes reassurance, avoidance of precipitating factors, treatm...
76 FR 9283 - Medicaid Program; Payment Adjustment for Provider-Preventable Conditions Including Health Care...
...Pulmonary embolism POA Present on admission PPC Provider-preventable condition PRA Paperwork...directly identifiable as related to the PPC and the resulting treatment. We are proposing...limited to the added cost resulting from the PPC. In Sec. 447.26(d), we have...
Management of difficult urticaria
Directory of Open Access Journals (Sweden)
Yadav Sudha
Full Text Available Chronic urticaria, a major health problem causing patient?s distress, induces often physicians? dilemma while dealing with its etiology, investigations and management. Clinical approach of such cases should include apart from clinical history and physical examination laboratory investigations like routine blood test, thyroid profile, etc. as well as sometimes special test like autologous serum skin test. Management includes reassurance, avoidance of precipitating factors, treatment of underlying disorders, and non-pharmacological approach along with pharmacotherapy. First line drug therapy comprises non-sedative and sedative antihistamines, second line doxepin, nifedipine, leukotriene-inhibitors, sulfasalazine, etc. and third line cyclosporine, dapsone, colchicin, etc.
Fault diagnosis of industrial systems by conditional Gaussian network including a distance rejection criterion
Verron, Sylvain; Tiplica, Teodor; Kobi, Abdessamad
The purpose of this article is to present a method for industrial process diagnosis with Bayesian network, and more particularly with conditional Gaussian network (CGN). The interest of the proposed method is to combine a discriminant analysis and a distance rejection in a CGN in order to detect new types of fault. The performances of this method are evaluated on the data of a benchmark example: the Tennessee Eastman Process. Three kinds of fault are taken into account on this complex process...
ATV rollover prevention system including varying grip conditions and bank angle
Richier, M.; Lenain, R.; Thuilot, B.; Berducat, M.
In this paper, an algorithm dedicated to light ATVs, which estimates and anticipates the rollover, is proposed. It is based on the on-line estimation of the Lateral Load Transfer (LLT), allowing the valuation of dynamic instabilities. The LLT is computed thanks to a dynamical model split into two 2D projections. Relying on this representation and a low cost perception system, an observer is proposed to estimate on-line the terrain properties (grip conditions and slope), then allowing to deduc...
Directory of Open Access Journals (Sweden)
Suneth Agampodi
Full Text Available Anuradhapura clinical society (ACS took a momentous decision this year to improve the quality of Anuradhapura Medical Journal (AMJ, the official journal of ACS. Moving away from the tradition of appointing an editor annually with the change of office bearers of ACS, the society appointed two of us as editors for unlimited period to elevate the quality of AMJ. Previously AMJ was a part of annual scientific sessions and from this year, it was decided to go for a proper journal rather than a conference publication. For all practical reasons we are on probation now! AMJ has been in existence for six volumes. We can assume minimum of six published issues if at least one issue per volume was published, and that's lot of work. One of the first things we have done is to obtain an International Standard serial Number (ISSN and digitalize the journal. With the help of Sioux Cumming and INASP we have managed to have the volume five and six in the Sri Lanka Journals Online (SLJOL (1. This issue (volume seven is the first issue under our stewardship. In this issue, we have two original articles, two case reports about bugs' bites, two perspectives, and a review on rhinosporidiosis by a world-renowned expert. Volume seven will have one issue. Hopefully volume eight will at least have two issues per year, Yala and Maha.All original articles, case reports, and perspectives published in this issue are peer-reviewed but not refereed, showing the red card is our job although we are heavily influenced by the reviewers. If we acquire enough merit in this birth, we will be bestowed with reviewers who are conscious of deadlines. But, you researchers can't wait till the next birth so please keep sending your research to us. If you have not heard from us still, it is because your manuscripts are being peer reviewed.There is a Sinhalese adage that "a devils abode is constructed according to the devil". The quality of the journal is reflected on the articles it receives. But the manuscripts are submitted according to the quality of the journal (impact factor, indexation, circulation,. This is a vicious circle almost similar to what we and many others faced as start up researchers yesteryear. Without a grant, it is difficult to do research but to receive a grant you have to show research (publications. Journal impact factors should not be used to assess individual researcher's contribution to science and for hiring, promotion, or funding decisions (2. Impact factors can be manipulated by journal editors and Thomson Scientific (the private company who creates impact factors is neither transparent about the process or have a clear policy (3.We are determined to elevate the quality of the journal. You will be the jury, but don't be a silent assassin. Please let us know what you think at least by an E-mail. Otherwise, same fate that happened to our ancient kingdom of Rajarata will befall on the AMJ!
Difficult to control atopic dermatitis
DEFF Research Database (Denmark)
Darsow, Ulf; Wollenberg, Andreas
Difficult to control atopic dermatitis (AD) presents a therapeutic challenge and often requires combinations of topical and systemic treatment. Anti-inflammatory treatment of severe AD most commonly includes topical glucocorticosteroids and topical calcineurin antagonists used for exacerbation management and more recently for proactive therapy in selected cases. Topical corticosteroids remain the mainstay of therapy, the topical calcineurin inhibitors tacrolimus and pimecrolimus are preferred in certain locations. Systemic anti-inflammatory treatment is an option for severe refractory cases. Microbial colonization and superinfection contribute to disease exacerbation and thus justify additional antimicrobial / antiseptic treatment. Systemic antihistamines (H1) may relieve pruritus but do not have sufficient effect on eczema. Adjuvant therapy includes UV irradiation preferably of UVA1 wavelength. "Eczema school" educational programs have been proven to be helpful.
Specificity of psychomotor reactions in the conditions of support deprivation including effects of countermeasures
Nichiporuk, Igor; Ivanov, Oleg
Activity of the cosmonaut demands high level of psychomotor reactions (PMR) which can vary during space flight under the influences of psychophysiological state's variability and unusual inhabitancy that causes the necessity of PMR estimation's inclusion into quality monitoring of capacity for work (CW). A main objective of research was a study of features of visual-motor reactions (VMR) and elements of CW of the person within simulation of microgravity effects via 7-day dry immersion (DI) in healthy male-volunteers 20-35 years old. The experimental data were received which testified to peculiarities of VMR and recognition of simple figures of main colors of a visible spectrum (red, green, blue, the RGB-standard) in the conditions of the DI characterized by support deprivation and decreased proprioceptive afferentation - in a control series and in a series with use of mioelectrostimulation as a countermeasure.
Guide for Operational Configuration Management Program including the adjunct programs of design reconstitution and material condition and aging management
International Nuclear Information System (INIS)
This standard presents program criteria and implementation guidance for an operational configuration management program for DOE nuclear and non-nuclear facilities. This Part 2 includes chapters on implementation guidance for operational configuration management, implementation guidance for design reconstitution, and implementation guidance for material condition and aging management. Appendices are included on design control, examples of design information, conduct of walkdowns, and content of design information summaries
Effective communication during difficult conversations.
Polito, Jacquelyn M
A strong interest and need exist in the workplace today to master the skills of conducting difficult conversations. Theories and strategies abound, yet none seem to have found the magic formula with universal appeal and success. If it is such an uncomfortable skill to master is it better to avoid or initiate such conversations with employees? Best practices and evidence-based management guide us to the decision that quality improvement dictates effective communication, even when difficult. This brief paper will offer some suggestions for strategies to manage difficult conversations with employees. Mastering the skills of conducting difficult conversations is clearly important to keeping lines of communication open and productive. Successful communication skills may actually help to avert confrontation through employee engagement, commitment and appropriate corresponding behavior PMID:23833841
Children with deafblindness : difficult differential diagnostics
DEFF Research Database (Denmark)
Dammeyer, Jesper Herup
Introduction: The group of children with deafblindness is very heterogeneous. It can be difficult to identify children with deafblindness and to estimate the significance of the sensory loss for the child's development. Material and method: The article presents two cases where it has been difficult to distinguish between deafblindness, autism and mental retardation. Findings: Deafblindness alone may be the cause of conditions similar to autism, mental retardation etc. It is always important to test a hypothesis which states that a serious sensory loss (deafness, blindness or deafblindness) is at the top of a diagnostic hierarchy, and that symptoms from other pervasive developmental disorders come secondary. Conclusion: Differential diagnostics between deafblindness, autism, mental retardation and other serious pervasive developmental disorders are often difficult. Clinical experience is needed, cross-disciplinary cooperation, specialized diagnostic methods together with a long observation and intervention period in order to be able to determine the functioning level of the child in question.
Teaching Difficult Topics with Primary Sources
Potter, Lee Ann
"Difficult" or "challenging" topics to teach include racism, violence, genocide, bullying, gangs, abuse (physical, emotional, and substance), slavery, suffering, hatred, terrorism, war, disease, loss, addiction, and more. But by confronting them with students, in the safety of a classroom through thoughtfully constructed lessons (ones that take…
Frequency analysis and new diagnoses by the important circuit modelling simulation including active elements under severe accident conditions
International Nuclear Information System (INIS)
The simulation for frequency analysis and new diagnostic of the important circuits modelling including active elements under severe accident conditions has been performed. Unlike for design basis accidents, there are inherently some uncertainties to instrumentation capabilities under severe accident conditions. Various methods to obtain information during the severe accident have been suggested. An eleven-step process for obtaining information from a malfunctioning instrument or the abnormal value of the parameter was reviewed. The circuit simulation analysis and diagnosis methods are used to assess instruments in a detail when they give apparently abnormal reading. The simulations can be useful to investigate what the signal and circuit characteristics would be similar to variety of symptoms that can result from severe environment conditions. In this paper, circuit simulations are performed for respective circuit types. Furthermore these equivalent circuit are composed of the passive elements and active elements which were modelled equivalent to real circuit composition. Output signals were processed by the Fast Fourier Transforms technique to get frequency domain informations, new feature expulsion for abnormal signals from the malfunction instruments as a real time would be obtained
Difficult Problems Having Easy Solutions
Bolina, Oscar
We discuss how a class of difficult kinematic problems can play an important role in an introductory course in stimulating students' reasoning on more complex physical situations. The problems presented here have an elementary analysis once certain symmetry features of the motion are revealed. We also explore some unexpected directions these problems lead us.
Adenomyosis: Difficult to Diagnose, and Difficult to Treat
Wood, C.
Drug therapy may be effective in controlling symptoms but the frequent coexistence of endometriosis and the lack of controlled studies make their efficacy difficult to quantify. Danazol IUD has been shown to reduce symptoms. Conservative surgery involving endomyometrial ablation, laparoscopic myometrial electrocoagulation or excision has proven to be effective in more than 50% of patients, although follow up has been restricted to three years. Arterial uterine artery embo...
Multiphase Binary Mixture Flows in Porous Media in a Wide Pressure and Temperature Range Including Critical Conditions
Afanasyev, A.
Multiphase flows in porous media with a transition between sub- and supercritical thermodynamic conditions occur in many natural and technological processes (e.g. in deep regions of geothermal reservoirs where temperature reaches critical point of water or in gas-condensate fields where subject to critical conditions retrograde condensation occurs and even in underground carbon dioxide sequestration processes at high formation pressure). Simulation of these processes is complicated due to degeneration of conservation laws under critical conditions and requires non-classical mathematical models and methods. A new mathematical model is proposed for efficient simulation of binary mixture flows in a wide range of pressures and temperatures that includes critical conditions. The distinctive feature of the model lies in the methodology for mixture properties determination. Transport equations and Darcy law are solved together with calculation of the entropy maximum that is reached in thermodynamic equilibrium and determines mixture composition. To define and solve the problem only one function - mixture thermodynamic potential - is required. Such approach allows determination not only single-phase states and two-phase states of liquid-gas type as in classical models but also two-phase states of liquid-liquid type and three-phase states. The proposed mixture model was implemented in MUFITS (Multiphase Filtration Transport Simulator) code for hydrodynamic simulations. As opposed to classical approaches pressure, enthalpy and composition variables together with fully implicit method and cascade procedure are used. The code is capable of unstructured grids, heterogeneous porous media, relative permeability and capillary pressure dependence on temperature and pressure, multiphase diffusion, optional number of sink and sources, etc. There is an additional module for mixture properties specification. The starting point for the simulation is a cubic equation of state that is used for mixture thermodynamic potential - entropy - calculation in pressure, enthalpy and composition variables. A polynomial spline is implemented to save the potential for subsequent hydrodynamic simulations. At this stage the majority of complicated thermodynamic procedures are performed prior to hydrodynamic that results in sufficient acceleration of calculations. The code was used for analysis of multiphase water-carbon dioxide mixture flows in porous media. Using the developed methodology the mixture phase diagram was calculated both below and above critical point of water. A zone of three-phase state conditions was detected where the mixture splits in three phases: liquid water and liquefied and gaseous carbon dioxide. The mixture flows subjected to formation of the three-phase flow region were investigated. The work is supported by Grant of the President of the Russian Federation (575.2010.1, 4810.2010.1).
Wear mechanism between alloy 600 and SS-409 by fretting including impact and sliding motion at high temperature conditions
International Nuclear Information System (INIS)
Fretting wear tests including impact and sliding motion of steam generator tube were performed to investigate wear volume and wear mechanism between alloy-600 tubes and 409 stainless steel (SS-409) tube support plates in the simulated operating conditions, pressure of 15 MPa, high temperature water of 290 C degrees and low dissolved oxygen (<10 ppb). The wear coefficients of alloy-600 and 409-stainless steel were estimated from the work rate. It was found that the wear coefficient for the material of alloy 600 steam generator tube is about half of that of SS-409 tube support plate materials, if the work-rate model is applicable. Hammer imprint, which is known to be an actual damaged wear pattern, has been observed on the worn surface. Wear progression model of impact-fretting wear has been proposed. The abrasive wear mechanism was dominant at the initial test period. In the stable impact-fretting progression, wearing steps are divided into three stages: the layer formation, the energy accumulation and the adhesion removing step. It was also observed that titanium rich phase contributes to the formation of voids and cracks in sub-layer. (authors)
Difficult physician-patient relationships.
Reifsteck, S W
Changes in the delivery of health care services in the United States are proceeding so rapidly that many providers are asking how the working relationships between doctors and patients will be effected. Accelerated by cost containment, quality improvement and the growth of managed care, these changes have caused some critics to feel that shorter visits and gatekeeper systems will promote an adversarial relationship between physicians and patients. However, proponents of the changing system feel that better prevention, follow-up care and the attention to customer service these plans can offer will lead to increased patient satisfaction and improved doctor-patient communication. Dedicated to addressing these concerns, the Bayer Institute for Health Care Communication was established in 1987 as a continuing medical education program (CME) focusing on this topic. A half-day workshop on clinician-patient communication to enhance health outcomes was introduced in 1992 and a second workshop, "Difficult' Clinician-Patient Relationships," was developed two years later. The two courses discussed in this article are offered to all physicians, residents, medical students, mid-level providers and other interested staff within the Carle system. PMID:10186308
Difficult Bond. Derrida and Jewishness
DEFF Research Database (Denmark)
Siegumfeldt, Inge Birgitte
Watchful insomnia can be a nerve-wracking business especially if there is a question to be, if not resolved, then at least confronted; or a decision called for, not despite the famous undecidablity hypothesis, but precisely because of it. Thus it is that finally, casting off the shadows of the night, Jacques Derrida steps into the daylight, in Paris in December 2000, to address directly the question of his Jewishness. Even if his presentation remains marked by the reservations shown in the past, and in particular the casting of affiliation in the self-cancelling terms of its annulment, Derrida nevertheless here lets down his guard in a way he had not done before. And the outcome is remarkable: for the first time he ascribes the aporetic structure of his thinking to a particular propensity for indeterminacy, which he aligns –not with Judaism in any of its doctrinal forms— but with the haunting event of 'circumcision' and with his own, somewhat idiosyncratic, experience of being Jewish. As both theme and strategy, 'circumcision' has indeed become a trope of tremendous significance in Derrida's writing as it articulates itself inside the aporia where affiliation is inevitably determined by its own effacement. It epitomizes a difficult double bond which may well have a direct bearing on Derrida's construal of what it means to think deconstructively.
Electric scroll compressor for mobile air conditioning including heat pump; Elektrischer Scrollverdichter in PKW Klimaanlage mit Waermepumpe
Energy Technology Data Exchange (ETDEWEB)
Mardorf, Lutz; Menger, Peter; Heiker, Mathias [Hochschule Osnabrueck (Germany). Labor fuer Angewandte Thermodynamik
In a two-zone climatic chamber a refrigeration cycle for mobile air conditioning of an electric vehicle was designed by switching with multi way valves between cooling and heating cycle. As a refrigerant compressor, an electric scroll compressor is used. In experimental studies, the COPs and compressor ratios of the two modes are shown. (orig.)
International Nuclear Information System (INIS)
RA and RB, the two research reactors at the Vinca Institute of Nuclear sciences were built in the late 1950s. Both were designed according to the national (former Yugoslavia) plan for developing nuclear energy. Although some modifications have been successfully made, they are now suffering from problems of ageing and funding since the attitude to the country's nuclear program has changed. Some of the equipment is fit for a museum. But the problem of ageing components is only one of the difficulties faced by the operators, they also cope with the political and financial conditions prevailing in the country
Tough Choices in Difficult Times.
Scheer, Sage Ann
Key areas school districts have used in making the decision to purchase technology applications include: what the district hopes to achieve by purchasing the system; how the proposed system will support the district's vision and help achieve the strategic plan; what the effect of the proposed solution will be on staffing; and what type of timeline…
Solving difficult hepatobiliary problems in children
Scientific Electronic Library Online (English)
A J W, Millar.
Full Text Available Most difficult hepatobiliary (HPB) problems in infancy and childhood result from pathological anatomical/mechanical derangements; therefore, surgery on the liver and bile ducts depends on a detailed understanding of liver structure, function and repair response to injury or disease. The surgeon must [...] be aware of the very diverse range of anatomical variations. Perhaps key to improving the outcome of paediatric HPB surgery is centralised management and associating this with a paediatric liver transplant programme, which adds expertise and, frequently, the added benefit of adult HPB surgical input to paediatric surgical care. In the United Kingdom, this has resulted in excellent measurable benefit, particularly in the management of biliary atresia, but also of choledochal cysts, portal hypertension and liver tumours. These conditions are briefly discussed here, with focus on the technical aspects of operative management.
Guide for Operational Configuration Management Program including the adjunct programs of design reconstitution and material condition and aging management
International Nuclear Information System (INIS)
This standard presents program criteria and implementation guidance for an operational configuration management program for DOE nuclear and non-nuclear facilities in the operational phase. Portions of this standard are also useful for other DOE processes, activities, and programs. This Part 1 contains foreword, glossary, acronyms, bibliography, and Chapter 1 on operational configuration management program principles. Appendices are included on configuration management program interfaces, and background material and concepts for operational configuration management
Northern Adriatic Sea hydrographic conditions from October 2002 – September 2003, including the climatic heating anomaly of summer 2003
Directory of Open Access Journals (Sweden)
Nastjenjka SUPI?
Full Text Available CTD data were collected during 38 cruises in the northeastern Adriatic from October 2002 to September 2003 and were analyzed in the context of long-term variability (from data collected over a period of 38 years. A prognostic statistical model was created to fit the long-term data and predicted values were compared to those of the in situ CTD measurements. As with air temperatures, values attained by the sea in summer 2003 far exceeded those expected by predictive models and were induced by very large heat input from the atmosphere. In conditions of very low regional freshwater input and intrusions of more saline water masses from the south, salinity values in the spring/summer period lay far outside typical salinity values for the area.
Dealing with the difficult utility
International Nuclear Information System (INIS)
STS HydroPower, Ltd. (STS) is an independent hydroelectric power developer involved in the full scope of hydroelectric activities. This includes the permitting, design, financing, turbine design and manufacturing, site construction and operation of small to mid-sized hydroelectric sites across the United States. At the present time, STS owns and operates nine sites in four states with a combined capacity of 20 megawatts. In dealing with the implementation of these sites, STS has dealt with five different utilities. In addition, in pursuing additional development opportunities throughout the United States, STS has had contact with numerous other utilities. During this time it would be fair to conclude that each of these utilities has exhibited its own personality with respect to dealing with independent developers. To the credit of the utility industry, the majority of these utilities have been helpful and supportive of independent projects, but a small number of utilities have approached projects from an initial and continuing adversarial position. The purpose of this paper is to examine those options and procedures available to the developer when a utility is encountered with a negative predisposition
Clostridium difficile phages: still difficult?
Directory of Open Access Journals (Sweden)
MarthaRebecca JaneClokie
Full Text Available Phages that infect Clostridium difficile were first isolated for typing purposes in the 1980s, but their use was short lived. However, the rise of C. difficile epidemics over the last decade has triggered a resurgence of interest in using phages to combat this pathogen. Phage therapy is an attractive treatment option for C. difficile infection, however developing suitable phages is challenging. In this review we summarise the difficulties faced by researchers in this field, and we discuss the solutions and strategies used for the development of C. difficile phages for use as novel therapeutics.Epidemiological data has highlighted the diversity and distribution of C. difficile, and shown that novel strains continue to emerge in clinical settings. In parallel with epidemiological studies, advances in molecular biology have bolstered our understanding of C. difficile biology, and our knowledge of phage-host interactions in other bacterial species. These three fields of biology have therefore paved the way for future work on C. difficile phages to progress and develop. Benefits of using C. difficile phages as therapeutic agents include the fact that they have highly specific interactions with their bacterial hosts. Studies also show that they can reduce bacterial numbers in both in vitro and in vivo systems. Genetic analysis has revealed the genomic diversity among these phages and provided an insight into their taxonomy and evolution.No strictly virulent C. difficile phages have been reported and this contributes to the difficulties with their therapeutic exploitation. Although treatment approaches using the phage-encoded endolysin protein have been explored, the benefits of using "whole-phages" are such that they remain a major research focus. Whilst we don't envisage working with C. difficile phages will be problem free, sufficient study should inform future strategies to facilitate their development to combat this problematic pathogen.
Difficult conditions, high yields; Harte Bedingungen, hoher Ertrag
Energy Technology Data Exchange (ETDEWEB)
Hartmann, Stefan
St. Moritz in Switzerland is a world-famous holiday resort. In the summer of 2008, the world's biggest solar thermal power system for a hotel building was commissioned, with a collector surface of 295 square meters. In September 2009, the hotel received the Swiss Solar Award. (orig./AKB)
Initial Training with Difficult Items Facilitates Information-Integration but not Rule-Based Category Learning
Spiering, Brian J.; Ashby, F. Gregory
Previous research has disagreed about whether a difficult cognitive skill is best learned by beginning with easy or difficult examples. Two experiments are described that clarify this debate. Participants in both experiments received one of three types of training on a difficult perceptual categorization task. In one condition participants began with easy examples, then moved to examples of intermediate difficulty, and finished with the most difficult examples. In a second condition this orde...
Dealing with difficult students in the classroom.
Deering, C G; Shaw, S J
Despite the proliferation of literature on dealing with difficult people, little has been written on how to manage problematic students in the classroom. Every teacher encounters difficult students because the classroom is merely a microcosm of the outside world. Nursing educators strive to create an open and caring atmosphere in their classes, but it is still necessary to intervene when students disrupt the class by showing disrespect for others or by getting the discussion off track. The authors describe the most common difficult student roles seen in the classroom and suggest strategies for dealing with them. PMID:9348883
Road to Sobriety Is Difficult, but Possible
... Mini Medical School Health Resources AOA Partnerships The Road to Sobriety is Difficult, But Possible Page Content ... stop drinking again and seek immediate help. The road to sobriety is often long and bumpy, but ...
Difficult Channel Generation Using Genetic Algorithm
Siddhartha Banerjee; Mitra Tithi Dey; Sayari Dutta
For channel routing problems, Deutsch's channel examples were used extensively asbenchmarks for testing new algorithms. However, it is also important to test the performanceof channel routing algorithms on a wider variety of difficult examples. In this paper, wepresent a random channel routing generator which can generate difficult channel routinginstances of arbitrary size. In this paper our goal is to generate those channels using GeneticAlgorithm, which have maximum constraints (both verti...
Medical Students' Personal Determinants of Overcoming Strategies in Difficult Situations
Directory of Open Access Journals (Sweden)
Veretelnikova Yu.Ya.
Full Text Available Goal of the research was to study conditionality of overcoming strategies in difficult situations of social interaction by personal representations of attitude to others among medical students. Material and methods. 134 first-year students of Saratov State Medical University n.a. V. I. Razumovsky took part in the comparative diagnostic study. Results. Comparison of average indices of various strategies evidence in coping behaviour allowed revealing statistically significant dependence of coping behaviour modi in difficult situations of social interaction upon types of personal representations of attitude toward others and gender features of forming effective strategies of coping behaviour among medical students. Conclusion. Correlation between coping behaviour modi in difficult situations of social interaction and typology of personal representations of attitudes toward others among medical students was marked.
Numerical simulation of CO2 leakage from a geologic disposal reservoir, including transitions from super- to sub-critical conditions, and boiling of liquid of CO2
International Nuclear Information System (INIS)
The critical point of CO2 is at temperature and pressure conditions of Tcrit = 31.04 C, Pcrit = 73.82 bar. At lower (subcritical) temperatures and/or pressures, CO2 can exist in two different phase states, a liquid and a gaseous state, as well as in two-phase mixtures of these states. Disposal of CO2 into brine formations would be made at supercritical pressures. However, CO2 escaping from the storage reservoir may migrate upwards towards regions with lower temperatures and pressures, where CO2 would be in subcritical conditions. An assessment of the fate of leaking CO2 requires a capability to model not only supercritical but also subcritical CO2, as well as phase changes between liquid and gaseous CO2 in sub-critical conditions. We have developed a methodology for numerically simulating the behavior of water-CO2 mixtures in permeable media under conditions that may include liquid, gaseous, and supercritical CO2. This has been applied to simulations of leakage from a deep storage reservoir in which a rising CO2 plume undergoes transitions from supercritical to subcritical conditions. We find strong cooling effects when liquid CO2 rises to elevations where it begins to boil and evolve a gaseous CO2 phase. A three-phase zone forms (aqueous - liquid - gas), which over time becomes several hundred meters thick as decreasing temperatures permit liquid CO2 to advance to shallower elevations. Fluid mobilities are reduced in the three-phase region from phase interference effects. This impedes CO2 upflow, causes the plume to spread out laterally, and gives rise to dispersed CO2 discharge at the land surface. Our simulation suggests that temperatures along a CO2 leakage path may decline to levels low enough so that solid water ice and CO2 hydrate phases may be formed
Protection of mineral deposits - a way towards difficult compromises
Radwanek-B?k, Barbara; Nie?, Marek
Mineral deposits are non-renewable natural resources. Their protection and reasonable exploitation are crucial requests resulting from sustainable development principles. Those are also fundamental issues in frame of the intergeneration justice and fairness concept. Protection of mineral resources should be based on interrelated activities: maintaining the possibility of economic use of the identified mineral resources, reduced consumption of mineral resources and ensuring satisfactory results of new prospecting and development of innovative technologies for the mineral resources base. The main problem with guarantee to the use of mineral resources is the accessibility to sites with documented deposits and prospective areas of their occurrence. Often, this contradicts with the interests of residents, planners and needs of the biotic environment protection, thus is often a source of conflicts. Legislative regulations are necessary to mitigate such arguable matters. SWOT analysis carried out with respect to introducing such legal regulations serves to identify the sources of conflicts and difficulties associated with their solution. Consensus reaching is a difficult task, so all decision makers are required to show their mutual understanding and willingness to achieve the goals taking into consideration all benefits for the population (including future generations). Foundations for finding the middle ground are: making the communities aware of their demands on minerals and of indispensable conditions for satisfying these demands; providing complete and accessible information; factual, non-emotional negotiations between decision makers and the public.
Solid expandable technology facilitates reaching gas reservoirs in difficult formations
Energy Technology Data Exchange (ETDEWEB)
Holland, M.; Chipiuk, J. [Eventure Global Technology, Houston, TX (United States)
Solid expandable tubulars that facilitate the reaching of gas reservoirs in difficult formations were discussed in this presentation. Several photographs of solid expandable technologies were first offered. The presentation discussed expandable casing, an overview of trends, historical approach, and expandable design. The Bossier trend and Bossier development history were illustrated. Other photographs and illustrations that were presented included the Middle Shelf versus Deep Bossier and Nikanassin Monteith Foothills. Drilling conditions were also examined. The discussion regarding the adoption of expandables focused on lower costs in high cost service market; a protective liner required for the Upper Bossier; and a minimum 4 and a half inch production casing. The expandable approach met Texas regulations for freshwater sand protection and isolated weaker openhole zones. The expandable SlimWell solution was also illustrated along with lessons learned such as pilot hole/under-reaming; hole preparation; drilling fluid maintenance; polycrystalline diamond compact bits and motors to drill out launcher shoe; accelerated field production; and reduced capital expenditures. It was concluded that keys to success involve daily and weekly team meetings; management and recognition and support of mechanical risk and economic benefit; and dedicated drilling, completion, and field personnel. figs.
Initial training with difficult items facilitates information integration, but not rule-based category learning.
Spiering, Brian J; Ashby, F Gregory
Previous research has disagreed about whether a difficult cognitive skill is best learned by beginning with easy or difficult examples. Two experiments that clarify this debate are reported. Participants in both experiments received one of three types of training on a difficult perceptual categorization task. In one condition, participants began with easy examples, then moved to examples of intermediate difficulty, and finished with the most difficult examples. In a second condition, this order was reversed, and in a third condition, participants saw examples in a random order. The results depended on the type of categories that participants were learning. When the categories could be learned via explicit reasoning (a rule-based task), the three training procedures were equally effective. However, when the categorization rule was difficult to describe verbally (an information-integration task), participants who began with the most difficult items performed much better than participants in the other two conditions. PMID:19076490
Initial Training with Difficult Items Facilitates Information-Integration but not Rule-Based Category Learning
Spiering, Brian J.; Ashby, F. Gregory
Previous research has disagreed about whether a difficult cognitive skill is best learned by beginning with easy or difficult examples. Two experiments are described that clarify this debate. Participants in both experiments received one of three types of training on a difficult perceptual categorization task. In one condition participants began with easy examples, then moved to examples of intermediate difficulty, and finished with the most difficult examples. In a second condition this order was reversed, and in a third condition, participants saw examples in a random order. The results depended on the type of categories that participants were learning. When the categories could be learned via explicit reasoning (a rule-based task), all three training procedures were equally effective. However, when the categorization rule was difficult to describe verbally (an information-integration task), participants who began with the most difficult items performed much better than participants in the other two conditions. PMID:19076490
Difficult airway equipment: a survey of standards across metropolitan Perth.
Alakeson, N; Flett, T; Hunt, V; Ramgolam, A; Reynolds, W; Hartley, K; Hegarty, M; von Ungern-Sternberg, B S
The importance of appropriate equipment to manage the difficult airway has been highlighted by the publication of the Australian and New Zealand College of Anaesthetists (ANZCA) guidelines in 2012. We set out to audit compliance with these guidelines in all public and private sites providing general anaesthesia in metropolitan Perth. Public and private health care websites identified 39 sites of which 37 were studied. Institutional and ethics approval was obtained. A tick-box design audit tool, based on the ANZCA guidelines, was used to collect information regarding the dedicated difficult airway container (DDAC) at each site. As recommended in the guidelines, only equipment within the DDAC was considered. Further data about each site, including the number of theatre suites, satellite anaesthetic areas, use of capnography and categories of patients treated (adult, obstetric and paediatric) were collected. An adult DDAC was found at 92% of all sites, but none of the sites had all the essential equipment listed in the ANZCA guidelines. There was limited provision of adult difficult airway equipment within private sites compared to public, and less provision of paediatric difficult airway equipment across all sites treating paediatric patients in metropolitan Perth. Capnography was available in 76% of post anaesthesia care units and used regularly in 27%. Adherence to the ANZCA guidelines regarding the DDAC could be improved. Standardised equipment across a metropolitan region would be of value in the management of the difficult airway. PMID:25233181
Improving Web Search for Difficult Queries
Wang, Xuanhui
Search engines have now become essential tools in all aspects of our life. Although a variety of information needs can be served very successfully, there are still a lot of queries that search engines can not answer very effectively and these queries always make users feel frustrated. Since it is quite often that users encounter such "difficult…
PRAISE: Christians Educators and the Difficult Student
Beth E. Ackerman
This article defends the role of the Christian educator in reaching the difficult student. It further offers tips for handling the challenging student from a Christian perspective, coupled with tried-and-true research using the acronym PRAISE: being proactive, using reinforcements, assessing and analyzing the intent of misbehavior, being sincere, and empowering students and the Holy Spirit in them.
PRAISE: Christians Educators and the Difficult Student
Directory of Open Access Journals (Sweden)
Beth E. Ackerman
Full Text Available This article defends the role of the Christian educator in reaching the difficult student. It further offers tips for handling the challenging student from a Christian perspective, coupled with tried-and-true research using the acronym PRAISE: being proactive, using reinforcements, assessing and analyzing the intent of misbehavior, being sincere, and empowering students and the Holy Spirit in them.
How democracy resolves conflict in difficult games
Brams, Steven J; Kilgour, D. Marc
Democracy resolves conflicts in difficult games like Prisoners' Dilemma and Chicken by stabilizing their cooperative outcomes. It does so by transforming these games into games in which voters are presented with a choice between a cooperative outcome and a Pareto-inferior noncooperative outcome. In the transformed game, it is always rational for voters to vote for the cooperative outcome, because cooperation is a weakly dominant strategy independent of the decision rule and the number of ...
Laparoscopic Management of Difficult Recurrent Choledocholithiasis
Dixit, Anupam; Wynne, Kamal S.; Harris, Adrian M
The management of common bile duct stones has traditionally required open laparotomy and bile duct exploration. With the advent of endoscopic and laparoscopic technology in the latter half of the last century, endoscopic retrograde cholangiopancreatography and laparoscopic common bile duct exploration has become the mainstream treatment for common bile duct stones in most medical centers around the world. However, in some patients, endoscopic retrograde cholangiopancreatography is difficult a...
Difficult ("heartsink" patients and clinical communication difficulties
Directory of Open Access Journals (Sweden)
Faustino R Pérez-López
Full Text Available Faustino R Pérez-LópezDepartment of Obstetrics and Gynecology, Hospital Clínico de Zaragoza, Facultad de Medicina, Universidad de Zaragoza, Zaragoza, SpainAbstract: Managing the difficult patient requires a set of skills or strategies oriented at improving the physician–patient relationship and avoiding conflictive situations. There are different types of difficult patients who should be precisely identified for their management. These patients seek appropriate medical care which is not always provided. However, some may have unrecognized pathological illnesses, especially personality or psychiatry disorders. Clinical communications may be altered by professional and situational factors. In some circumstances, clinical symptoms are medically unexplainable or poorly defined as part of a disease or syndrome. Organic disease should be ruled out before patients are classified as having a somatoform disorder. Diagnosis may be delayed when symptoms are not properly evaluated therefore causing serious health consequences. Clinical competence, empathy, and high quality communication is required to succeed in difficult clinical encounters.Keywords: physician–patient communication, barriers to communication, expert patient
Difficult Conversations: From Diagnosis to Death
Marcus, Joel D.; Mott, Frank E.
Background Communication is the cornerstone of good multidisciplinary medical care, and the impact of conversations about diagnosis, treatment, and prognosis is indisputable. Healthcare providers must be able to have difficult conversations that accurately describe diagnostic procedures, treatment goals, and the benefits and/or risks involved. Methods This paper reviews the literature about the importance of communication in delivering bad news, the status of communication training, communication strategies, and psychosocial interventions. Results Although many published guidelines address difficult communication, communication training is lacking. Consequently, many clinicians may have difficulties with, or in the worst-case scenario, avoid delivering bad news and discussing end-of-life treatment. Clinicians also struggle with how to have the last conversation with a patient and how to support patient autonomy when they disagree with a patient's choices. Conclusion There is a clinical imperative to educate physicians and other healthcare workers on how to effectively deliver information about a patient's health status, diagnostic avenues to be explored, and decisions to be made at critical health junctions. Knowing how to implement the most rudimentary techniques of motivational interviewing, solution-focused brief therapy, and cognitive behavioral therapy can help physicians facilitate conversations of the most difficult type to generate positive change in patients and families and to help them make decisions that minimize end-of-life distress. PMID:25598738
[Difficult teenagers: the challenges of interdisciplinarity].
Saint-Andrté, Stéphane; Botbola, Michel
The adolescents in great distress, because of ruptures in the course of their lives and of their chaotic family environment, need educational and social actions. The consensual point of view is that responding to the needs of the so called "difficult adolescents" implies the involvement of educational, therapeutic and judicial services. Nevertheless, the usual tendency to categorize the users with the idea it will permit to guide them to the appropriate skill field and the transgressive characteristic of these adolescents' behaviours lead all these services to reject them and send them to the two other services. PMID:24450000
Difficult weaning in delayed onset diaphragmatic hernia
Directory of Open Access Journals (Sweden)
Ahmed Syed
Full Text Available Diaphragmatic injuries are relatively rare and result from either blunt or penetrating trauma. Regardless of the mechanism, diagnosis is often missed and high index of suspicion is vital. The clinical signs associated with a diaphragmatic hernia can range from no outward signs to immediately life-threatening respiratory compromise. Establishing the clinical diagnosis of diaphragmatic injuries (DI can be challenging as it is often clinically occult. Accurate diagnosis is critical since missed DI may result in grave sequelae due to herniation and strangulation of displaced intra-abdominal organs. We present a case of polytrauma with rib fracture and delayed appearance of diaphragmatic hernia manifesting as difficult weaning from ventilatory support.
A Moessbauer spectrometer for difficult isotopes
International Nuclear Information System (INIS)
The parameters of some Moessbauer isotopes present experimental difficulties either because high velocities, low frequencies, low temperatures, or any combination of these conditions, are needed. A simple approach to easing these difficulties is described, using a mechanical resonant system and a phase locked loop. (author)
[Anesthesia in spontaneous ventilation for difficult intubation].
Salvi, N; Orliaguet, G
Difficult intubation in children is rare and often predictable during anesthesia consultation. This allows to establish a strategy to provide fiberoptic guided tracheal intubation with spontaneous ventilation in function of age and children pathology. A good knowledge of physiologic and anatomic children particularities, of fiberoptic technique and the respect for some principles lead to ensure the security of this procedure. First principle is to use only one anesthetic inhaled or intravenous agent in order to limit an important decrease of ventilation. The anesthetic technique recommended for pediatric fiberoptic guided intubation is inhaled anesthesia with sevoflurane. But it is possible to use an intravenous agent, like propofol, with a continuous infusion (bolus of 0.1 to 0.3 mg/kg then 0.1-0.3mg/kg per hour for maintenance) or with target controlled infusion (Schnider model, initial concentration 2.5 ?g/mL, then increase by 0.5 ?g/mL steps) particularly in children older than 5 years with an anesthetic depth control. Whatever the agent, the dose must to be titrated to maintain spontaneous ventilation. Second principle is to combine an airway local anesthesia with general anesthesia to limit airway reactivity. First, a nose topical anesthesia is administered with lidocaine plus naphazoline in children older than 2 years. Then, a laryngeal topical anesthesia is realized with lidocaine 1% (1-2 mL, 2mg/kg) through operating channel of fiberoptic bronchoscope. Finally, third principle is to ensure patient oxygenation with several techniques like use of endoscopic facial mask or nasopharyngeal tube. The use of laryngeal mask is a rescue technique in case of spontaneous ventilation lost. In conclusion, each institution has to establish an algorithm with his own knowledge, constantly feasible and regularly taught. PMID:24209989
Making light of a difficult phase
International Nuclear Information System (INIS)
Physicists are always striving to gain control over matter at the quantum level, and ultrafast lasers are just about the best way of achieving this. By precisely controlling the intensity, wavelength and duration of extremely short pulses of light, we can manipulate electronic processes at the atomic level. If these pulses can be shortened to the scale of attoseconds, then the electromagnetic fields within them will be changing on the same timescale as the motion of the electron. This means that physicists can use the pulses to steer electrons with astonishing precision, and control processes such as the emission of light and chemical reactions. Until now, however, there has been a fundamental obstacle to the production of such short pulses. At the sub-femtosecond level, a laser pulse contains only a few cycles of the carrier electromagnetic wave. As the pulse evolves the carrier wave can therefore become out of phase with the amplitude envelope, which can lead to a variety of different electric-field waveforms. This makes it difficult to put the pulse to any constructive use. The difference in phase between the carrier and envelope waves is called the carrier-envelope phase (CEP), and controlling it precisely is essential for a new generation of experiments that will probe and manipulate processes that occur on a sub-femtosecond timescale. Now physicists in Vienna and Germany have managed to do just that, allowing the carrier-envelope phase of a high-power ultrashort-envelope phase of a high-power ultrashort pulsed laser to be altered at will. With this set-up they were able to control electrons at the scale of 250 as (250x 018s), and they claim that their technique is limited only by the most fundamental barrier we know - quantum-mechanical uncertainty. (U.K.)
The effect of including a series of isometric conditioning contractions to the rowing warm-up on 1,000-m rowing ergometer time trial performance.
Feros, Simon A; Young, Warren B; Rice, Anthony J; Talpey, Scott W
Rowing requires strength, power, and strength-endurance for optimal performance. A rowing-based warm-up could be enhanced by exploiting the postactivation potentiation (PAP) phenomenon, acutely enhancing power output at the beginning of a race where it is needed most. Minimal research has investigated the effects of PAP on events of longer duration (i.e. 1,000-m rowing). The purpose of this research was to investigate the effects of PAP on 1,000-m rowing ergometer performance through the use of 2 different warm-up procedures: (a) a rowing warm-up combined with a series of isometric conditioning contractions, known as the potentiated warm-up (PW), and (b) a rowing warm-up only (NW). The isometric conditioning contractions in the PW were performed by "pulling" an immovable handle on the rowing ergometer, consisting of 5 sets of 5 seconds (2 seconds at submaximal intensity, and 3 seconds at maximal intensity), with a 15-second recovery between sets. The 1,000-m rowing ergometer time trial was performed after each warm-up condition, whereby mean power output, mean stroke rate, and split time were assessed every 100 m. Ten Australian national level rowers served as the subjects and performed both conditions in a counterbalanced order on separate days. The PW reduced 1,000-m time by 0.8% (p > 0.05). The PW improved mean power output by 6.6% (p < 0.01) and mean stroke rate by 5.2% (p < 0.01) over the first 500 m; resulting in a reduction of 500-m time by 1.9% (p < 0.01), compared with the NW. It appears that the inclusion of isometric conditioning contractions to the rowing warm-up enhance short-term rowing ergometer performance (especially at the start of a race) to a greater extent than a rowing warm-up alone. PMID:22266645
Approaching difficult communication tasks in oncology.
Back, Anthony L; Arnold, Robert M; Baile, Walter F; Tulsky, James A; Fryer-Edwards, Kelly
Effective communication skills enable physicians to improve patients' understanding of their illnesses, improve patient adherence to treatment regimens, use time efficiently, avoid burnout, and increase professional fulfillment. Common communication pitfalls include blocking, lecturing, depending on a routine, collusion, and premature reassurance. Fundamental communication skills include "ask-tell-ask," "tell me more," and responding empathetically. Key communication tasks that are linked to the illness trajectory include: the first visit, giving bad news, making anticancer treatment decisions, offering clinical trials, completing anticancer therapy, and discontinuing palliative chemotherapy. While enhancing or acquiring new skills ultimately requires practice and feedback over time, this article provides a cognitive map for important communication skills that physicians need over the course of caring for a person with cancer. PMID:15890639
Management of difficult airway in intratracheal tumor surgery
Directory of Open Access Journals (Sweden)
Agarwal Surendra K
Full Text Available Abstract Background Tracheal malignancies are usual victim of delay in diagnosis by virtue of their symptoms resembling asthma. Sometimes delayed diagnosis may lead to almost total airway obstruction. For difficult airways, not leaving any possibility of manipulation into neck region or endoscopic intervention, femorofemoral cardiopulmonary bypass can be a promising approach. Case Presentation We are presenting a case of tracheal adenoid cystic carcinoma (cylindroma occupying about 90% of the tracheal lumen. It was successfully managed by surgical excision of mass by sternotomy and tracheotomy under femorofemoral cardiopulmonary bypass (CPB. Conclusion Any patient with recurrent respiratory symptoms should be evaluated by radiological and endoscopic means earlier to avoid delay in diagnosis of such conditions. Femorofemoral cardiopulmonary bypass is a relatively safe way of managing certain airway obstructions.
Thermoelastic stresses in non-uniform geological environments difficult outline
Directory of Open Access Journals (Sweden)
?.?. ??????
Full Text Available Thermal stresses concern not renewed type of stresses, that is once having liberated, they cannot accumulate more. The estimation of purely thermoelastic contribution to a lithosphere stress state gives the additional information, allowing to predict the danger connected with such natural factors, as seismic and volcanic activity. Some theoretical thermoelastic problems for the geological environment of a difficult outline with non-uniform thermophysical characteristics are considered. The decision is received on the basis of a numerical finite elements method. Influence of the model fixation, the geometrical factor and boundary conditions on distribution of thermal stresses and dislocation is investigated. Computing experiments have shown, that the size of the maximum thermal stresses reaches 500 bar. The maximum values of vertical dislocation are reached by 90 m, and horizontal — 50 m. Neutral plane position are precisely defined.
The 'Physics Cup': interesting problems are difficult
International Nuclear Information System (INIS)
An overview of the online competition, Physics Cup—IPhO2012 is given. This preceded the 43rd International Physics Olympiad and included ten problems, published monthly. Three problems, the most popular among the contestants, are discussed in detail. These problems deal with laser speckle patterns, geometrical optics and LC circuits with four degrees of freedom. The results of the competition and of the poll carried out among the contestants are used to discuss the relationship between the properties of the problems: difficulty, closeness to reality and beauty (as perceived by the contestants). (paper)
Management of the difficult duodenal stump.
Burch, J M; Cox, C L; Feliciano, D V; Richardson, R J; Martin, R R
Leakage from the duodenal stump has been the most feared complication of the Billroth II reconstruction following gastric resection. The purpose of our study was to evaluate four methods of duodenal stump closure in 200 patients. One hundred and forty-seven (74%) patients had duodenal ulcers; 28 (14%) had gastric ulcers; and 25 (13%) had a variety of other inflammatory conditions. The most common indication for operation was acute hemorrhage (51%), followed by perforation (24%), intractability (15%), and obstruction (10%). Conventional duodenal closures were performed in 160 (80%) patients, Nissen's closure in 25 (13%), Bancroft's closure in 6 (3%), and tube duodenostomy in 9 (5%). Duodenal leaks occurred in four (2.5%) patients with conventional closures and in three (33%) patients with tube duodenostomies. No leaks occurred in patients with Nissen's or Bancroft's closures. The hospital mortality rate for the series was 9.5%; however, no patient who developed a duodenal leak died. We conclude that Nissen's and Bancroft's closures were safe and effective, but that tube duodenostomy did not reliably prevent uncontrolled leakage. PMID:1670218
[The problem of the difficult intubation].
Landauer, B; Schmid, T O
Endotracheal intubation has become widespread routine in modern anaesthesiology and intensive care. Nevertheless, there are still patients in whom endotracheal intubation fails or is hampered by anatomical malformations. In these cases "conventional" attempts at intubation are not only time-consuming but also involve considerable risk for the patient, including total failure. Moreover these techniques (e.g., blind nasal) require a highly skilled performer as well as a good deal of luck. Under such circumstances, fiberoptic endotracheal intubation is the method of choice. This technique is easy to perform even by untrained persons, achieves a high rate of success and nearly totally lacks special hazards. The practical points of the procedure are outlined and possible problems discussed, which, however, are rare. PMID:7125155
Analysis of the hydrographic conditions and cyst beds in the San Jorge Gulf, Argentina, that favor dinoflagellate population development including toxigenic species and their toxins
Krock, Bernd; Borel, C. Marcela; Barrera, Facundo; Tillmann, Urban; Fabro, Elena; Almandoz, Gastón O.; Ferrario, Martha; Garzón Cardona, John E.; Koch, Boris P.; Alonso, Cecilia; Lara, Rubén
The overlay of cooler nutrient enriched Beagle-Magellan water with warmer nutrient depleted shelf water and a strong stratification of the water column in the San Jorge Gulf region, Argentina, coincided with relatively high dinoflagellate abundances in April 2012, up to 34,000 cells L- 1. This dinoflagellate proliferation was dominated by Ceratium spp., but environmental conditions also favored to a lesser amount the occurrence of toxigenic dinoflagellates, such as Alexandrium tamarense and Protoceratium reticulatum, whose toxins were hardly detected in any other areas along the expedition transect of the R/V Puerto Deseado between 38 and 56°S (Ushuaia-Mar del Plata) in March/April 2012. Generally vegetative cells of A. tamarense and P. reticulatum co-occurred with their respective phycotoxins in the water column and their cysts in the upper sediment layers. Two strains of A. tamarense were isolated from the bloom sample and morphologically characterized. Their PSP toxin profiles consisted of C1/2, gonyautoxins 1/4 and to a lesser amount of neosaxitoxin and confirmed earlier data from this region. The ratios between autotrophic picoplankton and heterotrophic bacteria were higher in shelf waters in the north than in Beagle-Magellan waters in the south of San Jorge Gulf.
Effects of Cd and Ni toxicity to Ceratophyllum demersum under environmentally relevant conditions in soft and hard water including a German lake
Energy Technology Data Exchange (ETDEWEB)
Andresen, Elisa, E-mail: firstname.lastname@example.com [University of Konstanz, Department of Biology, D-78457 Konstanz (Germany); Opitz, Judith, E-mail: email@example.com [University of Konstanz, Department of Biology, D-78457 Konstanz (Germany); Thomas, George, E-mail: email@example.com [University of Konstanz, Department of Biology, D-78457 Konstanz (Germany); Stärk, Hans-Joachim, E-mail: firstname.lastname@example.com [UFZ – Helmholtz Centre for Environmental Research, Department of Analytical Chemistry, Permoserstr. 15, D-04318 Leipzig (Germany); Dienemann, Holger, E-mail: firstname.lastname@example.com [Saxon State Company for Environment and Agriculture, Business Domain 5 (Laboratory), Department 53, Bitterfelder Str. 25, D-04849 Bad Düben (Germany); Jenemann, Kerstin, E-mail: firstname.lastname@example.com [Sächsisches Landesamt für Umwelt, Landwirtschaft und Geologie, Abteilung Wasser, Boden, Wertstoffe, Zur Wetterwarte 11, D-01109 Dresden (Germany); Dickinson, Bryan C., E-mail: firstname.lastname@example.com [Harvard University, Department of Chemistry and Chemical Biology, 12 Oxford Street, Cambridge, MA 02138 (United States); Küpper, Hendrik, E-mail: email@example.com [University of Konstanz, Department of Biology, D-78457 Konstanz (Germany); University of South Bohemia, Faculty of Biological Sciences and Institute of Physical Biology, Branišovská 31, CZ-370 05 ?eské Budejovice (Czech Republic)
Highlights: •Hardly any macrophytic growth occurred in an oligotrophic hard water lake in Germany. •All parameters were optimal, besides elevated, nanomolar concentrations of Ni and Cd. •We cultivated submerged macrophytes in real and simulated hard and soft lake water. •Nanomolar Cd and Ni inhibited the plants' photosynthetic light reactions in soft water. •The inhibition was synergistic, i.e. stronger than the addition of Cd and Ni effects. -- Abstract: Even essential trace elements are phytotoxic over a certain threshold. In this study, we investigated whether heavy metal concentrations were responsible for the nearly complete lack of submerged macrophytes in an oligotrophic lake in Germany. We cultivated the rootless aquatic model plant Ceratophyllum demersum under environmentally relevant conditions like sinusoidal light and temperature cycles and a low plant biomass to water volume ratio. Experiments lasted for six weeks and were analysed by detailed measurements of photosynthetic biophysics, pigment content and hydrogen peroxide production. We established that individually non-toxic cadmium (3 nM) and slightly toxic nickel (300 nM) concentrations became highly toxic when applied together in soft water, severely inhibiting photosynthetic light reactions. Toxicity was further enhanced by phosphate limitation (75 nM) in soft water as present in many freshwater habitats. In the investigated lake, however, high water hardness limited the toxicity of these metal concentrations, thus the inhibition of macrophytic growth in the lake must have additional reasons. The results showed that synergistic heavy metal toxicity may change ecosystems in many more cases than estimated so far.
Effects of Cd and Ni toxicity to Ceratophyllum demersum under environmentally relevant conditions in soft and hard water including a German lake
International Nuclear Information System (INIS)
Highlights: •Hardly any macrophytic growth occurred in an oligotrophic hard water lake in Germany. •All parameters were optimal, besides elevated, nanomolar concentrations of Ni and Cd. •We cultivated submerged macrophytes in real and simulated hard and soft lake water. •Nanomolar Cd and Ni inhibited the plants' photosynthetic light reactions in soft water. •The inhibition was synergistic, i.e. stronger than the addition of Cd and Ni effects. -- Abstract: Even essential trace elements are phytotoxic over a certain threshold. In this study, we investigated whether heavy metal concentrations were responsible for the nearly complete lack of submerged macrophytes in an oligotrophic lake in Germany. We cultivated the rootless aquatic model plant Ceratophyllum demersum under environmentally relevant conditions like sinusoidal light and temperature cycles and a low plant biomass to water volume ratio. Experiments lasted for six weeks and were analysed by detailed measurements of photosynthetic biophysics, pigment content and hydrogen peroxide production. We established that individually non-toxic cadmium (3 nM) and slightly toxic nickel (300 nM) concentrations became highly toxic when applied together in soft water, severely inhibiting photosynthetic light reactions. Toxicity was further enhanced by phosphate limitation (75 nM) in soft water as present in many freshwater habitats. In the investigated lake, however, high water hardness limited the toxicity of these metal concentrations, thus the inhibition of macrophytic growth in the lake must have additional reasons. The results showed that synergistic heavy metal toxicity may change ecosystems in many more cases than estimated so far
Penile Corporeal Reconstruction during Difficult Placement of a Penile Prosthesis
Directory of Open Access Journals (Sweden)
Sherif R. Aboseif
Full Text Available For some patients with impotence and concomitant severe tunical/corporeal tissue fibrosis, insertion of a penile prosthesis is the only option to restore erectile function. Closing the tunica over an inflatable penile prosthesis in these patients can be challenging. We review our previous study which included 15 patients with severe corporeal or tunical fibrosis who underwent corporeal reconstruction with autologous rectus fascia to allow placement of an inflatable penile prosthesis. At a mean follow-up of 18 months (range 12 to 64, all patients had a prosthesis that was functioning properly without evidence of separation, herniation, or erosion of the graft. Sexual activity resumed at a mean time of 9 weeks (range 8 to 10. There were no adverse events related to the graft or its harvest. Use of rectus fascia graft for coverage of a tunical defect during a difficult penile prosthesis placement is surgically feasible, safe, and efficacious.
Implications of the KONVERGENCE Model for Difficult Cleanup Decisions
Energy Technology Data Exchange (ETDEWEB)
Piet, Steven James; Dakins, Maxine Ellen; Gibson, Patrick Lavern; Joe, Jeffrey Clark; Kerr, Thomas A; Nitschke, Robert Leon
Abstract—Some cleanup decisions, such as cleanup of intractable contaminated sites or disposal of spent nuclear fuel, have proven difficult to make. Such decisions face high resistance to agreement from stakeholders possibly because they do not trust the decision makers, view the consequences of being wrong as too high, etc. Our project's goal is to improve sciencebased cleanup decision-making. This includes diagnosing intractable situations, as a step to identifying a path toward sustainable solutions. Companion papers describe the underlying philosophy of the KONVERGENCE Model for Sustainable Decisions,1 and the overall framework and process steps.2 Where knowledge, values, and resources converge (the K, V, and R in KONVERGENCE), you will find a sustainable decision – a decision that works over time. For intractable cases, serious consideration of the adaptable class of alternatives is warranted – if properly implemented and packaged.
Percutaneous transhepatic cholelithotripsy for difficult common bile duct stones.
DEFF Research Database (Denmark)
Stage, J G; Moesgaard, F
BACKGROUND AND STUDY AIMS: A study was carried out to assess the feasibility of a new rapid technique for percutaneous transhepatic access to the biliary tract with endoscopic lithotripsy (percutaneous transhepatic cholelithotripsy). PATIENTS AND METHODS: 14 patients with biliary stones resistant to endoscopic retrograde cholangiography and extracorporeal shock wave lithotripsy underwent cholelithotripsy, utilizing a new dilation kit with massive teflon dilators covered by "peel-away sheets". RESULTS: Successful lithotripsy was performed in all patients by laser lithotripsy through a choledochoscope or ureteroscope in ten patients and by stone removal by basket in the remaining four patients. The procedure was carried out using local anesthesia in the last 11 patients. Except for two patients with transient cholangitis, no complications occurred. CONCLUSIONS: Difficult bile duct and intrahepatic stones can be treated successfully with a simple percutaneous transhepatic cholelithotripsy procedure including local anesthesia, dilation and stone clearance.
Pipeline developments 1998 and beyond : more choices, more difficult decisions
International Nuclear Information System (INIS)
Some of the basic economic principles that drive gas prices and gas flows across North America, and the pressures these have placed on the pipeline sector, are reviewed. Of pressing importance to the natural gas industry in Western Canada is the prospect that in the near future industrial gas users in eastern Canada will have a wider array of pipeline choices available to them than ever before. This will mean that the users will face more offerings from more pipeline providers, forcing pipeline owners to make more difficult decisions regarding new pipeline capacity. Variables such as price, terms and conditions will become increasingly negotiable. Market power concerns also remain an important issue. As a result, there is increasing call for market-based financial regulation of pipelines. 'Market gaming' a condition where a firm manipulates the market to its own market advantage is also receiving considerable attention. The latter is of particular concern in the United States. Against this background, the nature of competition (or the lack of it) in natural gas transport, the influence of short-term service revenues for pipelines, pipeline commitments through subsidiaries, and concerns over short term pipeline valuations skewing investment decisions, are issues that will continue to invite much attention. Regarding market outlook, it was noted that significantly increased export capacity from Alberta could raise the costs of Alberta supplies to eastern Canadian end-uslberta supplies to eastern Canadian end-users relative to other supply/transport options which may now be viable economic alternatives. figs
Resolution of Difficult Pronouns Using the ROSS Method
Hofford, Glenn R.
A new natural language understanding method for disambiguation of difficult pronouns is described. Difficult pronouns are those pronouns for which a level of world or domain knowledge is needed in order to perform anaphoral or other types of resolution. Resolution of difficult pronouns may in some cases require a prior step involving the application of inference to a situation that is represented by the natural language text. A general method is described: it performs entity...
Plasma hot machining for difficult-to-cut materials, 1
International Nuclear Information System (INIS)
Machinability of difficult-to-cut materials has been a great concern to manufacturing engineers since demands for new materials in the aerospace and nuclear industries are more and more increasing. The purpose of this study is to develop a hot machining to improve machinability of high hardness materials. A plasma arc is used for heating materials cut. The surface just after being heated is removed as a chip by tungsten carbide tools. The turning experiments of high hardness steels with aid of plasma arc heating show not only the decrease in cutting forces but also the following effectiveness: (1) The application of the plasma hot machining to the condition, under which a built-up edge (BUE) appears in turning 0.46%C steel, makes the BUE disappeared, bringing less flank wear. (2) In the case of 18%Mn steel cutting, deep groove wear on the end-cutting edge diminishes, and roughness of the machined surface is improved by the prevention from chatter. (3) Although the chilled cast iron has high hardness of above HB = 350, the plasma hot machining makes it possible to cut it with tungsten carbide tools having less chipping and flank wear. (author)
ECO2M: A TOUGH2 Fluid Property Module for Mixtures of Water, NaCl, and CO2, Including Super- and Sub-Critical Conditions, and Phase Change Between Liquid and Gaseous CO2
Energy Technology Data Exchange (ETDEWEB)
Pruess, K.
ECO2M is a fluid property module for the TOUGH2 simulator (Version 2.0) that was designed for applications to geologic storage of CO{sub 2} in saline aquifers. It includes a comprehensive description of the thermodynamics and thermophysical properties of H{sub 2}O - NaCl - CO{sub 2} mixtures, that reproduces fluid properties largely within experimental error for temperature, pressure and salinity conditions in the range of 10 C {le} T {le} 110 C, P {le} 600 bar, and salinity from zero up to full halite saturation. The fluid property correlations used in ECO2M are identical to the earlier ECO2N fluid property package, but whereas ECO2N could represent only a single CO{sub 2}-rich phase, ECO2M can describe all possible phase conditions for brine-CO{sub 2} mixtures, including transitions between super- and sub-critical conditions, and phase change between liquid and gaseous CO{sub 2}. This allows for seamless modeling of CO{sub 2} storage and leakage. Flow processes can be modeled isothermally or non-isothermally, and phase conditions represented may include a single (aqueous or CO{sub 2}-rich) phase, as well as two-and three-phase mixtures of aqueous, liquid CO{sub 2} and gaseous CO{sub 2} phases. Fluid phases may appear or disappear in the course of a simulation, and solid salt may precipitate or dissolve. TOUGH2/ECO2M is upwardly compatible with ECO2N and accepts ECO2N-style inputs. This report gives technical specifications of ECO2M and includes instructions for preparing input data. Code applications are illustrated by means of several sample problems, including problems that had been previously solved with TOUGH2/ECO2N.
Difficult diagnoses in the skeletal radiology; Schwierige Diagnosen in der Skelettradiologie
Energy Technology Data Exchange (ETDEWEB)
Freyschmidt, Juergen [Klinikum Bremen-Mitte (Germany). Beratungsstelle und Referenz-Zentrum fuer Osteoradiologie
The book on difficult diagnoses in the skeletal radiology discusses the path from symptom to diagnoses including image interpretation. Specific case studies concern the skull, the spinal cord, pelvis, shoulder and chest, upper and lower extremities. The used radiological techniques include projecting radiography, computerized tomography, scintiscanning, PET/CT, NNR imaging and ultrasonography.
Genetic evidence of multiple loci in dystocia - difficult labour
Directory of Open Access Journals (Sweden)
Westgren Magnus
Full Text Available Abstract Background Dystocia, difficult labour, is a common but also complex problem during childbirth. It can be attributed to either weak contractions of the uterus, a large infant, reduced capacity of the pelvis or combinations of these. Previous studies have indicated that there is a genetic component in the susceptibility of experiencing dystocia. The purpose of this study was to identify susceptibility genes in dystocia. Methods A total of 104 women in 47 families were included where at least two sisters had undergone caesarean section at a gestational length of 286 days or more at their first delivery. Study of medical records and a telephone interview was performed to identify subjects with dystocia. Whole-genome scanning using Affymetrix genotyping-arrays and non-parametric linkage (NPL analysis was made in 39 women exhibiting the phenotype of dystocia from 19 families. In 68 women re-sequencing was performed of candidate genes showing suggestive linkage: oxytocin (OXT on chromosome 20 and oxytocin-receptor (OXTR on chromosome 3. Results We found a trend towards linkage with suggestive NPL-score (3.15 on chromosome 12p12. Suggestive linkage peaks were observed on chromosomes 3, 4, 6, 10, 20. Re-sequencing of OXT and OXTR did not reveal any causal variants. Conclusions Dystocia is likely to have a genetic component with variations in multiple genes affecting the patient outcome. We found 6 loci that could be re-evaluated in larger patient cohorts.
Difficult issues in mentoring: recommendations on making the "undiscussable" discussable.
Bickel, Janet; Rosenthal, Susan L
Many mentoring relationships do not reach fruition because the individuals fail to bridge a critical difference. When a difference prevents a learning partnership from achieving its potential, the loss is multidimensional for the individuals and the institution--wasting opportunities for the fostering of current and future talent. Insights into when such impasses are likely to arise may help both mentors and mentees address what feels "undiscussable." The authors offer numerous examples of how differences related to ethnicity, language, gender, and generation may interfere with the development of mentoring relationships. Next, the authors offer recommendations on preparing for and handling difficult conversations, including creating safety, noticing assumptions and emotions, and raising sensitive issues. Virtually all faculty can become more effective at communicating across differences and addressing difficulties that prevent mentoring relationships from achieving their potential. The pay-offs for these efforts are indisputable: increased effect in the limited time available for mentoring, an expanded legacy of positive influence, and enhanced communication and leadership skills. The honing of these relational skills enhances the colleagueship and teamwork on which virtually all research, clinical, and educational enterprises depend. Academic health centers that systematically support mentoring enhance institutional stability, talent development, and leadership capacity. PMID:21869662
How libraries make tough choices in difficult times purposeful abandonment
Stern, David
Contemporary library managers face the need to make difficult choices regarding resource allocation in the modern business environment. How Libraries Make Tough Choices in Difficult Times is a practical guide for library managers, offering techniques to analyze existing and potential services, implement best practices for maximizing existing resources, and utilize pressing financial scenarios in order to justify making difficult reallocation decisions. The book begins by asking the fundamental questions of why, what, and how, moving on to look at how to manage expectations and report to both a
Strategies and algorithms for management of the difficult airway.
Heidegger, Thomas; Gerig, Hans J; Henderson, John J
Management of the difficult airway is the most important patient safety issue in the practice of anaesthesia. Many national societies have developed algorithms and guidelines for management of the difficult airway. The key issues of this chapter are definition of terms, the advantages and disadvantages of the use of guidelines, and a comparison of different algorithms and guidelines for management of the most important clinical airway scenarios. Although there is no strong evidence of benefit for any specific strategy or algorithm for management of the difficult airway, there is strong agreement that a pre-planned strategy may lead to improved outcome. PMID:16408540
How to optimally manage unhappy, anxious, and difficult patients.
Malakouti, Mona; Brown, Gabrielle; Wang, Eva; Leon, Argentina; Koo, John
Patient satisfaction has been and is of growing importance in healthcare. Recent healthcare initiatives aim to provide physicians with performance feedback reports based partially on patient completed surveys; thus, patient satisfaction will be an even more important determinant of high quality care. In the field of dermatology, patient satisfaction is particularly relevant and at times difficult to achieve, since many patients are plagued with chronic skin diseases often requiring intensive topical regimens or undesirable systemic immunosuppressants. The discussion of patient satisfaction is usually restricted to encounters with the general clinic population leaving encounters with difficult patients largely underreported; therefore, we provide examples of more common difficult patient encounters a dermatologist may face with specific recommendations on how to best optimize patient satisfaction. PMID:25160112
Recent and historic sediment dynamics along Difficult Run, a suburban Virginia Piedmont stream
Hupp, Cliff R.; Noe, Gregory B.; Schenk, Edward R.; Bentham, Adam J.
Suspended sediment is one of the major concerns regarding the quality of water entering the Chesapeake Bay. Some of the highest suspended-sediment concentrations occur on Piedmont streams, including Difficult Run, a tributary of the Potomac River draining urban and suburban parts of northern Virginia. Accurate information on catchment level sediment budgets is rare and difficult to determine. Further, the sediment trapping portion of sediment budget represents an important ecosystem service that profoundly affects downstream water quality. Our objectives, with special reference to human alterations to the landscape, include the documentation and estimation of floodplain sediment trapping (present and historic) and bank erosion along an urbanized Piedmont stream, the construction of a preliminary sediment balance, and the estimation of legacy sediment and recent development impacts. We used white feldspar markers to measure floodplain sedimentation rates and steel pins to measure erosion rates on floodplains and banks, respectively. Additional data were collected for/from legacy sediment thickness and characteristics, mill pond impacts, stream gaging station records, topographic surveying, and sediment density, texture, and organic content. Data were analyzed using GIS and various statistical programs. Results are interpreted relative to stream equilibrium affected by both post-colonial bottomland sedimentation (legacy) and modern watershed hardening associated with urbanization. Six floodplain/channel sites, from high to low in the watershed, were selected for intensive study. Bank erosion ranges from 0 to 470 kg/m/y and floodplain sedimentation ranges from 18 to 1369 kg/m/y (m refers to meters of stream reach). Upstream reaches are net erosional, while downstream reaches have a distinctly net depositional flux providing a watershed sediment balance of 2184 kg/m/y trapped within the system. The amounts of both deposition and erosion are large and suggest nonequilibrium channel conditions. Both peak discharge and number of peaks above base have substantially increased since the mid-1960s when urbanization of the watershed began. Deposition patterns are most closely correlated with channel gradient, sinuosity, and channel width/floodplain width for recent and historic periods. The substantial amounts of fine grained sediment deposited on the floodplain over the past two centuries or so do not appear to be closely related to historic mill pond presence or location. The floodplain continues to provide the critical ecosystem service of sediment trapping in the face of multiple human alterations. Trends in sediment deposition/erosion may react rapidly to land use practices within the watershed and offer a valuable barometer of the effects of management actions.
Experimental validation of a numerical model for predicting the trajectory of blood drops in typical crime scene conditions, including droplet deformation and breakup, with a study of the effect of indoor air currents and wind on typical spatter drop trajectories.
Kabaliuk, N; Jermy, M C; Williams, E; Laber, T L; Taylor, M C
Bloodstain Pattern Analysis (BPA) provides information about events during an assault, e.g. location of participants, weapon type and number of blows. To extract the maximum information from spatter stains, the size, velocity and direction of the drop that produces each stain, and forces acting during flight, must be known. A numerical scheme for accurate modeling of blood drop flight, in typical crime scene conditions, including droplet oscillation, deformation and in-flight disintegration, was developed and validated against analytical and experimental data including passive blood drop oscillations, deformation at terminal velocity, cast-off and impact drop deformation and breakup features. 4th order Runge-Kutta timestepping was used with the Taylor Analogy Breakup (TAB) model and Pilch and Erdman's (1987) expression for breakup time. Experimental data for terminal velocities, oscillations, and deformation was obtained via digital high-speed imaging. A single model was found to describe drop behavior accurately in passive, cast off and impact scenarios. Terminal velocities of typical passive drops falling up to 8m, distances and times required to reach them were predicted within 5%. Initial oscillations of passive blood drops with diameters of 1mmcrime scene conditions, the velocity of the drop within the first 1.5m of fall is affected little by drag, oscillation or deformation. Blood drops with diameter 0.4-4mm and velocity 1-15m/s cast-off from a rotating disk showed low deformation levels (Weber numbercrime scene conditions, few cast-off drops will break up in flight. However some impact-generated drops were seen to break up, some by the vibration, others by bag breakup. The validated model can be used to gain deep understanding of the processes leading to spatter stains, and can be used to answer questions about proposed scenarios, e.g. how far blood drops may travel, or how stain patterns are affected by winds and draughts. PMID:25447183
Evolving combinatorial problem instances that are difficult to solve.
van Hemert, Jano I
This paper demonstrates how evolutionary computation can be used to acquire difficult to solve combinatorial problem instances. As a result of this technique, the corresponding algorithms used to solve these instances are stress-tested. The technique is applied in three important domains of combinatorial optimisation, binary constraint satisfaction, Boolean satisfiability, and the travelling salesman problem. The problem instances acquired through this technique are more difficult than the ones found in popular benchmarks. In this paper, these evolved instances are analysed with the aim to explain their difficulty in terms of structural properties, thereby exposing the weaknesses of corresponding algorithms. PMID:17109606
Difficult airway equipment in departments of emergency medicine in Ireland: results of a national survey.
LENUS (Irish Health Repository)
Walsh, K
BACKGROUND AND OBJECTIVE: Adverse effects associated with difficult airway management can be catastrophic and include death, brain injury and myocardial injury. Closed-malpractice claims have shown prolonged and persistent attempts at endotracheal intubation to be the most common situation leading to disastrous respiratory events. To date, there has been no evaluation of the types of difficult airway equipment currently available in Irish departments of emergency medicine. The objective of this survey was to identify the difficult airway equipment available in Irish departments of emergency medicine. METHODS: Departments of emergency medicine in the Republic of Ireland with at least one dedicated Emergency Medicine consultant were surveyed via telephone. RESULTS: All of the departments contacted held at least one alternative device on site for both ventilation and intubation. The most common alternative ventilation device was the laryngeal mask airway (89%). The most common alternative intubating device was the surgical airway device (100%). CONCLUSIONS: Irish departments of emergency medicine compare well with those in the UK and USA, when surveyed concerning difficult airway equipment. However, we believe that this situation could be further improved by training inexperienced healthcare providers in the use of the laryngeal mask airway and intubating laryngeal mask airway, by placing greater emphasis on the ready availability of capnography and by the increased use of portable difficult airway storage units.
Free emission quotas for the industry - a difficult topic
International Nuclear Information System (INIS)
The Norwegian Parliament wants to establish a Norwegian market for emission quota trading and a public committee are evaluating the possibility of establishing a market. Free quotas as a means of securing the existence of industrial working places constitute a difficult issue. This publication discusses some of the issues
Why listening to English is difficult for Spanish students
Eastman Curtis, John Kendall
We examine the educational and cultural influences as well as some of the psychological and pedagogical factors which conspire to make listening comprehension difficult for Spanish students of English. We propose exercises which students should undertake as preparation and training for listening, and suggest an approach to the presentation and teaching of listening material.
Myth 5: Creativity Is Too Difficult to Measure
Treffinger, Donald J.
In his 1982 response to the myth that "creativity is too difficult to measure," Dr. Joe Khatena (a long-time contributor to the literature on creativity), characterized creativity as the "most exciting dimension of mental functioning." Building on a three-dimensional view of creativity (emphasizing the "individual," the "environment," and the…
Complement Constructions in English: Fairly Difficult for EFL Language Learners
Fazeli, Fatemeh; Shokrpour, Nasrin
Complement constructions vary significantly in English and Persian. There are more complementation structures in English than in Persian and a complement structure in Persian might have more than one equivalent in English. Producing complement structures (CSs) in English is very difficult for native speakers of Persian, especially in an EFL…
Privileged Identity Exploration: Examining Counselor Trainees' Reactions to Difficult Dialogues
Watt, Sherry K.; Curtis, Gregg C.; Drummond, Jerri; Kellogg, Angela H.; Lozano, Adele; Nicoli, Gina Tagliapietra; Rosas, Marisela
In this qualitative study, the authors examined master's-level counselor trainees' reactions to difficult dialogues in the classroom regarding racism, heterosexism/homophobia, and ableism over a 3-year period. Using the Consensual Qualitative Research method as introduced by C. E. Hill, B. J. Thompson, and E. N. Williams (1997), the data analysis…
Theory and numerical simulation of computationally difficult systems
International Nuclear Information System (INIS)
In this talk we study systems which are computationally difficult, that is the computational effort needed to study them grows very fast with the size of the system. We present some theoretical considerations and we report the results of some numerical simulations in a few examples: spin glasses, random direct polymers and random heteropolymers. (orig.)
Development of a no-moving-part blower for difficult operating conditions.
Czech Academy of Sciences Publication Activity Database
Tesa?, Václav
Ro?. 91, ?. 12 (2013), s. 2401-2411. ISSN 0263-8762 R&D Projects: GA ?R GA13-23046S Institutional research plan: CEZ:AV0Z20760514 Keywords : blower * fluidics * hazardous fluids Subject RIV: BK - Fluid Dynamics Impact factor: 2.281, year: 2013 http://www. science direct.com/ science /article/pii/S0263876213001081
Experiences from shaft sinking by drilling in unconsolidated rock under difficult geological and hydrological conditions
Energy Technology Data Exchange (ETDEWEB)
Mielcarek, W.
This paper describes performance of the SC 500 shaft sinking equipment employed in Czechoslovakia and in the GDR for drilling shafts in water bearing, loose cohesive or noncohesive ground. Shafts have an outside diameter up to 3.6 m and a depth of up to 204 m. The drilling technology is described as suction combined with flushing, uncased drilling advance and osmotically stabilized borehole walls using CMC flushing solutions (carboxymethylcellulose). Ten shafts were sunk with this technology in the Hodonin lignite field in Czechoslovakia from 1973 until 1980, with a combined depth of 1311 m. Shaft sinking results are evaluated: the mechanical boring speed was between 19 and 44 cm/h for 1620 mm shafts and between 6 and 13 cm/h for 3590 mm shafts. A maximum boring speed of 90 cm/h was achieved in fine sand. The suction and flushing technology was employed up to a depth of 70 m; a combination with air lift drilling was used for depths exceeding 70 m. The shaft boring technology is being developed to reach a depth of 300 m for sinking ventilation, escape and hoisting shafts in the Hodonin area with a 3.70 m inside shaft diameter.
If it's difficult to pronounce, it must be risky.
Song, Hyunjin; Schwarz, Norbert
Low processing fluency fosters the impression that a stimulus is unfamiliar, which in turn results in perceptions of higher risk, independent of whether the risk is desirable or undesirable. In Studies 1 and 2, ostensible food additives were rated as more harmful when their names were difficult to pronounce than when their names were easy to pronounce; mediation analyses indicated that this effect was mediated by the perceived novelty of the substance. In Study 3, amusement-park rides were rated as more likely to make one sick (an undesirable risk) and also as more exciting and adventurous (a desirable risk) when their names were difficult to pronounce than when their names were easy to pronounce. PMID:19170941
Endoscopic management of difficult common bile duct stones
Directory of Open Access Journals (Sweden)
Guru Trikudanathan
Full Text Available Endoscopy is widely accepted as the first treatment option in the management of bile duct stones. In this review we focus on the alternative endoscopic modalities for the management of difficult common bile duct stones. Most biliary stones can be removed with an extraction balloon, extraction basket or mechanical lithotripsy after endoscopic sphincterotomy. Endoscopic papillary balloon dilation with or without endoscopic sphincterotomy or mechanical lithotripsy has been shown to be effective for management of difficult to remove bile duct stones in selected patients. Ductal clearance can be safely achieved with peroral cholangioscopy guided laser or electrohydraulic lithotripsy in most cases where other endoscopic treatment modalities have failed. Biliary stenting may be an alternative treatment option for frail and elderly patients or those with serious co morbidities.
Difficult airway in a pediatric case of pycodysostosis.
Alkhalaf, Maizar M; Ali, Hassan Mohamed; Al Otaibi, Rashed
Pycodysostosis is a genetic autosomal rare disease with an incidence of 1:1.7 million births; the pathophysiology of the disease is related to mutation of cathepsin K gene. Sleep apnea, respiratory difficulties because of chest and oral abnormalities may cause a challenge to the anesthetist during intubation and/or mechanical ventilation. In this case report we will discuss a case of pycodysostosis with a difficult airway. PMID:25886438
Using a mock trial to make a difficult clinical decision.
Smith, R.
Many clinical decisions have to be taken with inadequate scientific information. Reaching a consensus among experts has been tried as one response to this problem. Another, described here, is to use legal process to dissect a difficult question. In this case a mock trial--using barristers, expert witnesses, and a jury--was conducted on whether bone marrow transplantation should be offered to all children with symptomatic sickle cell disease. Transplantation seems to offer about a 90% cure rat...
Usage of I++ Simulator to Program Coordinate Measuring Machines when Common Programming Methods are difficult to apply
Directory of Open Access Journals (Sweden)
G?ska A.
Full Text Available Nowadays, simulators facilitate tasks performed daily by the engineers of different branches, including coordinate metrologists. Sometimes it is difficult or almost impossible to program a Coordinate Measuring Machine (CMM using standard methods. This happens, for example, during measurements of nano elements or in cases when measurements are performed on high-precision (accurate measuring machines which work in strictly air-conditioned spaces and the presence of the operator in such room during the programming of CMM could cause an increase in temperature, which in turn could make it necessary to wait some time until conditions stabilize. This article describes functioning of a simulator and its usage during Coordinate Measuring Machine programming in the latter situation. Article also describes a general process of programming CMMs which ensures the correct machine performance after starting the program on a real machine. As an example proving the presented considerations, measurement of exemplary workpiece, which was performed on the machine working in the strictly air-conditioned room, was described
Characterization of parameters and strategies used by physical therapists in difficult mechanical ventilation weaning
Directory of Open Access Journals (Sweden)
Fabíola Maria Sabino Meireles
Full Text Available Objective: To characterize the main strategies and parameters used by physical therapists in difficult mechanical ventilation weaning. Methods: Cross-sectional study including all the physical therapists working in adult Intensive Care Units in three public hospitals in Fortaleza-CE. A questionnaire with closed questions related to difficult mechanical ventilation weaning was applied, with either one or multiple answers. The data was treated with descriptive and non-parametric analysis. Results: Among the parameters mostly used by the 56 interviewed physical therapists for the difficult weaning, were found: current volume reduction (26 - 46.4% and desaturation during aspiration (17 - 30.4%. It was observed that 38 (67.9% alternate T-tube and continuous positive airway pressure (CPAP as strategies for difficult weaning, and 28 (50% reported reducing the pressure support. There was no statistical difference between the strategies used in the studied hospitals, neither correlation between strategies and parameters. Conclusion: It was found that physical therapists have been performing similar strategies, which are also shown in the literature, but this is not the case with the parameters. The parameters used are not supported by the literature.
Emotional distance to so-called difficult patients
DEFF Research Database (Denmark)
Michaelsen, Jette Joost
Scand J Caring Sci; 2011 Emotional distance to so-called difficult patients Purpose: To explore nurses' relationships with patients they regard as being difficult. How do nurses feel about such patients and relate to them, and what are the consequences for nurse and patient? Design and methods: A qualitative study inspired by hermeneutic phenomenology was conducted. The data were obtained through participant observation and interviewing in a home nursing unit in a Danish municipality. During an initial 3 month period, eighteen participant observations were conducted with 12 nurses during their visits to 96 patients. During the following 3 months, 12 more participant observations were made with three nurses visiting 50 patients. Four of these patients whom the three nurses found difficult were selected and six interviews conducted with these patients. Eleven interviews were conducted with five nurses. Patients' case records were studied and four meetings with the staff were arranged to discuss the findings. Data collection lasted 18 months in all. Findings: Three strategies were identified: persuasion, avoidance (emotional distance), and compromise. Interestingly, in the relationship with a particular patient, the avoidance strategy did not necessarily represent the terminal stage, since a nurse could revert to the compromise strategy. Some of the nurses experienced painful emotions regarding these interactions. Conclusions: The avoidance strategy (emotional distance) resulted in important social and health problems of some patients not being recognized, and some nurses using it expressed the fear of losing contact with their emotional lives. The compromise strategy gave possibilities for dialogue. Study limitations: The focus was mainly on the nurses and their perspectives. It would be interesting to study in greater detail the perspectives of the patients.
Hemorrhagic herpes encephalitis: A difficult diagnosis in computed tomography
International Nuclear Information System (INIS)
Herpes simplex encephalitis (HSE) is the most common sporadically appearing encephalitis in Central Europe. Differential diagnosis to brain tumors or spontaneous intercerebral hemorrhage is difficult. There are CT scan findings which are characteristic of HSE but there are no pathognomonic patterns. These characteristic findings are helpful in differential diagnosis to neoplastic or vascular processes. Thus, other diagnostic procedures (i.e. brain biopsy) to confirm diagnosis of HSE and effective therapy may be carried out in time. The difficulties in differential diagnosis are shown by the presented case. (orig.)
Hydraulically actuated fuel injector including a pilot operated spool valve assembly and hydraulic system using same
Shafer, Scott F. (Morton, IL)
The present invention relates to hydraulic systems including hydraulically actuated fuel injectors that have a pilot operated spool valve assembly. One class of hydraulically actuated fuel injectors includes a solenoid driven pilot valve that controls the initiation of the injection event. However, during cold start conditions, hydraulic fluid, typically engine lubricating oil, is particularly viscous and is often difficult to displace through the relatively small drain path that is defined past the pilot valve member. Because the spool valve typically responds slower than expected during cold start due to the difficulty in displacing the relatively viscous oil, accurate start of injection timing can be difficult to achieve. There also exists a greater difficulty in reaching the higher end of the cold operating speed range. Therefore, the present invention utilizes a fluid evacuation valve to aid in displacement of the relatively viscous oil during cold start conditions.
Determination of difficult to measure actinides in radioactive liquid waste
International Nuclear Information System (INIS)
In decommissioning of a nuclear facilities and radioactive waste treatment the activity of various radionuclides need to be measured for the waste characterization. Radiochemical separation of 241Am, 237Np and isotopes of plutonium was tested on model solution of evaporator concentrate sample for isolation of each of them for alpha-spectrometry analysis. This paper describes use of the molecular recognition technology product AnaLig(R)Pu-01 gel from IBC Advanced technologies, Inc. to effectively and selectively pre-concentrate, separate and recover difficult-to-measure actinides from model solution of evaporator concentrate samples which belong to the most difficult matrices to analyse. The method is suitable for analysing highly contaminated samples of radioactive waste in a relatively short time. For counting the alpha activity of 241Am, 239,240Pu, 238Pu and 237Np ORTEC 576A alpha-spectrometer equipped with ULTRATM ion implanted silicon detectors (600 mm2 active area) was used. The spectra were processed by using the Alpha-visionTM 32-bit emulation software from the EG and G ORTEC company. (authors)
Approaches to the difficult patient/parent encounter.
Breuner, Cora Collette; Moreno, Megan A
Most pediatricians have experienced uneasy interactions involving patients and/or their parents. The majority of literature on this topic reflects encounters in adult medicine, without providing much information for pediatricians who also face this challenge. Unique to the pediatric approach is the added quotient of the parent/family dynamic. Patients or their parents may have personality disorders or subclinical mental health issues, physicians may be overworked or have a lack of experience, and the health care system may be overburdened, fragmented, and inundated with poor communication. Recognizing the physical or emotional responses triggered by challenging patients/families may allow the provider to effectively partner with, instead of confront, the patient or the family. In this article we review existing literature on this subject and describe possible strategies for the pediatrician to use during a difficult encounter. PMID:21173004
Strategies for Managing Difficult Clinical Situations in Between Sessions.
Karakurt, Gunnur; Anderson, Amber; Badford, Alyssa; Dial, Shannon; Korkow, Hannah; Rable, Frank; Doslovich, Serife Fulya
Therapists often have to deal with situations that make them uneasy to leave their clients on their own. They can go home and wonder what their clients are doing, whether they are safe, have a place to stay, even whether or not they are fighting. These thoughts can be overwhelming for the therapist. They may think about their clients' safety, they may also be worried about their own professional way of dealing with these situations, and its implications for them as clinician. The aim of this paper is to assist therapists to manage their own anxiety and to help them help their clients in between sessions in difficult situations such as suicidality, child abuse and neglect, intimate partner violence, crisis and stress management. PMID:25294951
A Difficult Choice for Newspapers: Advertisers or Readers?
Directory of Open Access Journals (Sweden)
Bar?? Bulunmnaz
Full Text Available Almost entire advertisement revenues are acquired by newspapers in print media. Along with rapid technological developments and the intensive competitive climate in newspaper sector; the gulf between high cost and low revenue has widened, and newspapers are obliged to subsidize this deficit with advertisement revenues. Newspapers in Turkey have two separate groups of customers. The first one of those groups is the advertisers and the other is the readers of that newspaper. Due to economic reasons, this compulsory dependency on advertisement revenue causes newspapers to fall into a paradox between advertisers and readers. In this article we will firstly explain advertisement and its place in marketing; then give information about the advertising sector and the distribution of Turkish advertising pie among media. Later, the relation between advertisers and readers that place newspapers in difficult circumstances will be explicated in detail, analysis and assessments will be made regarding about it.
[Is extracorporeal liver surgery useful for difficult hepatic resections?].
Huguet, C; Gavelli, A; Harb, J; Mansvelt, B; Vorburger, T; Roger Clément, R; Mac Namara, M
Five cases of hepatic tumor deemed unresectable by conventional techniques are presented to illustrate the potential benefit offered by complete hepatic vascular exclusion (Pringle maneuver associated with inferior vena cava clamping below and above the liver). The most extensive and difficult liver resections may be achieved, with possible venous reconstruction, if the clamping period is not interrupted. Hepatic vascular exclusion may exceed one hour, up to 85 minutes in this series, with a good liver tolerance, in the absence of preoperative liver dysfunction. The advantages and disadvantages of the ex situ extracorporeal liver resections performed under similar circumstances are discussed. The authors consider that the role of ex situ liver procedures should be very limited. PMID:1550315
Radon mitigation experience in difficult-to-mitigate schools
International Nuclear Information System (INIS)
Initial radon mitigation experience in schools has shown sub-slab depressurization (SSD) to be generally effective in reducing elevated levels of radon in schools that have a continuous layer of clean, coarse aggregate underneath the slab. However, mitigation experience is limited in schools without sub-slab aggregate and in schools with characteristics such as return-air ductwork underneath the slab or unducted return-air plenums in the drop ceiling that are open to the sub-slab area (via open tops of block walls). Mitigation of schools with utility tunnels and of schools constructed over crawl spaces is also limited. Three Maryland schools exhibiting some of the above characteristics are being researched to help understand the mechanisms that control radon entry and mitigation in schools where standard SSD systems are not effective. This paper discusses specific characteristics of potentially difficult-to-mitigate schools and, where applicable, details examples from the three Maryland schools
Structural health monitoring systems in difficult environments. Offshore wind turbines
Energy Technology Data Exchange (ETDEWEB)
Faulkner, P.; Cutter, P.; Owens, A. [Strainstall Monitoring, Midsomer Norton (United Kingdom)
The paper discusses the design and capability of Structural Health Monitoring Systems (SHMS) deployed on Offshore Wind Turbines together with the management of the tasks and risks in the offshore environment. The application of SHMS in difficult environments is a particularly challenging task, where ease of installation, ruggedness and reliability of equipment is essential in providing the key information of the structural integrity of Offshore Wind Turbine Towers. This information is required to evaluate the structural response, status and remaining operational life of the structure. The installation and commissioning of such systems have a significant focus on safety and access to the structures where onsite retrofitting of sensors and instrumentation are carried out in the field. Experience has been gained during the installation and commissioning of over 30 systems that have been deployed in the field in the UK offshore sector over the last two year period. (orig.)
The bogeyman cometh: a strategic approach for difficult adolescents.
O'Connor, J J; Hoorwitz, A N
Unpredictable and threatening events can sometimes alter one's view of reality. The altered perception may in turn result in altered forms of behavior and interaction with others. Deliberate efforts to facilitate this altered perception is sometimes attempted by invoking mythical forces such as the Bogeyman, Death, Satan, a shaman, or a sorcerer. Anthropological observations of shamanic magic suggest a number of components that appear to be responsible for these reality-altering experiences. These can be employed to create such experiences in the treatment of difficult adolescents for whom usual solutions have been ineffective. The experience results in systemic changes that render the adolescent accessible to more usual forms of treatment and more functional interactions with adults. The crafting of this kind of experience is illustrated in a case example. Parallels with other clinical practices as well as ethical considerations are discussed. PMID:6734794
How can schools build learning organisations in difficult education contexts?
Directory of Open Access Journals (Sweden)
Kholeka Constance Moloi
Full Text Available There is paucity in the study of learning organisations within the education sector and particularly in schools working in difficult socio-economic contexts, such as those studied in this investigation. In this qualitative study I therefore sought evidence from teachers, in one of the districts of Gauteng province, through in-depth, semi-structured focus group interviews to establish what a learning organisation is. Using data obtained through two in-depth, semi-structured focus group interviews with 16 teachers, themes were constructed to theorise their experiences on what a learning organisation is. The results showed that teacher commitment to personal learning enhanced student achievement. This study contributes to the understanding of theories on learning organisations from the experiences of these teachers working in disadvantaged townships schools.
Anti-reflux procedure for difficult-to-treat asthmatic children, case report and literature review
Directory of Open Access Journals (Sweden)
Hu Zhi-Wei
Full Text Available Abstract Gastroesophageal reflux disease (GERD is a commonly encountered condition in children, which at times causes respiratory distress, such as asthmatic symptoms, and results in serious morbidity and even mortality. The complexity is sometimes so obscure, that it can cause paradoxical diagnoses and treatment. Here we present two cases of children with difficult-to-treat asthmatic symptoms, which were eventually found to be related to GERD. The two children were treated with anti-reflux procedures and both became symptom free. Literature was also reviewed to shed a light into this complex disease.
Team Work in International Programs: Why is it so difficult?
DEFF Research Database (Denmark)
Lauridsen, Karen M.; Madsen, Henning
Team Work in International Programs: Why is it so difficult? And what can we do about it? It is common knowledge that students often find it difficult to collaborate on assignments, projects, etc., but we require that they do so for a number of reasons, e.g. to learn how to work in teams or take advantage of the diversity represented by team members. In programmes that accept international students, these difficulties seem to increase. Home students are often reluctant to enter into collaboration with their international peers, whereas the international students tend to be much more open towards intercultural collaboration. The issues that arise seem to be grounded in linguistic, cultural and educational factors. This paper reports on and discusses a study of student responses to intercultural collaboration (in English) in two programmes at Aarhus University, Denmark. One conclusion is that the international students are more prepared to work in multicultural teams than their Danish peers. Another one tellsus that once students have experience with the diversity of these teams, at least some of them become more open towards working in such teams in the future. It is interesting to discuss the pedagogical and didactic implications of these findings. What can we as lecturers/teachers do in order to have students buy into the added value of diversity and multicultural teams from the beginning? The presenter will reflect on this in order to facilitate a discussion and exchange of experience among the participants. Participants may expect to obtain a raised awareness of the issues at stake as regards student collaboration in international programmes and to learn from the knowledge and experience of colleagues.
Prediction is difficult, preparation is critical and possible
DEFF Research Database (Denmark)
Zilli, Romano; Dalton, Luke
Problem Statement: Animal disease challenges appear to be ever increasing with new and emerging conditions rapidly becoming global problems due to factors such as climate change and globalisation of trade. Avian Influenza, Ebola, African Swine Fever and Porcine Epidemic Diarrhoea are just a few of the many transboundary diseases for which global cooperation in research is vital. These diseases can cause serious social, economic and environmental damage and in some cases also threaten human health. Various social, technological, economic, environmental, political and biological driving forces act at the level of the source of infection, transmission pathways, and the outcomes. Changes to such challenges and uncertainties are inevitable and foresight in identifying strategies is required for us to prepare for a sustainable future. The EU-funded Global Network on Infectious Diseases of Animals and Zoonoses (STAR-IDAZ) conducted foresight studies as part of its objective to improve coordination of research activities on the major infectious diseases of animals (including zoonoses) to hasten the delivery of improved control methods. The aim of these studies was to identify the scientific and technological needs, including research capacity and support structures to prevent, control or mitigate animal health and zoonotic challenges for 2030 and beyond. While our ability to predict the future is often limited, being prepared to engage with whatever may happen is critical. Methods: Foresight workshops were initially conducted in the Americas involving consideration of scenarios developed in Canada, Asia and Australasia based on the seven questions method, and in Europe involving scenario building and back-casting. Following these regional exercises, critical drivers already identified in a range of other related foresight projects were classified under eight categories and the top 3 – 5 drivers in each category were ranked with the level of uncertainty noted (high/medium/low) by experts from a range of backgrounds from Europe, Africa and the Middle-East, Asia and Australasia and the Americas. The likely impact of these drivers on various disease categories was considered, a preferred future scenario agreed and back-casting conducted at a workshop held in Moscow in June 2014. More than 40 veterinarians and animal health scientists from around the world outlined priorities in terms of research capability and capacity to attain the ideal future. Results: In each of the regions, the research capacity and knowledge networks required to optimise enablers and ameliorate barriers to our ability to meet future animal disease challenges were identified then grouped and prioritised across the regions to give an overall list in which transnational data sharing, knowledge transfer, public-private partnerships, vaccinology/immunology, vector control, antimicrobial resistance, socioeconomics, genetics/bioinformatics and utilisation of big data rated highly. Conclusion: The outputs of the STAR-IDAZ Foresight study will form the basis of a Global Strategic Research Agenda with which research funders and programme managers can prioritise and coordinate national research efforts to improve global collective preparedness for future animal, human and environmental challenges.
The Difficult Way of Social Psychology in Russia
Galina M. Andreeva
The article describes the main stages and directions of the development of social psychology in USSR and Russia. The comparison of theoretical approaches of Russian and Western social psychology is carried out. Special emphasis is made on the problem of social cognition and coping, which are important in the conditions of changing reality. New professional tasks of social psychology are discussed. The necessity of finding a new paradigm in social psychological investigations in conditions of ...
Gearbox Condition Monitoring under Variable Operational Conditions
Toshkova, Daniela; Lieven, Nicholas; Morrish, Peter; Titurus, Branislav; Moore, Will; Brinkworth, Niel
The gearbox vibration spectrum is complicated and overloaded with artefacts, making it difficult for the eye to register a change due to a fault. In order to overcome this difficulty this paper presents a gearbox condition indicator, which can be trended. The gearbox condition indicator is based on the summation of the sideband levels around the first three harmonics of the gear mesh frequency. The sensitivity of the proposed gearbox condition indicator to damage is investigated using seeded ...
Precut sphincterotomy: A reliable salvage for difficult biliary cannulation
Directory of Open Access Journals (Sweden)
Ulku Saritas
Full Text Available Even experienced endoscopists have 90% success in achieving deep biliary cannulation with standard methods. Biliary cannulation may become difficult in 10%-15% of patients with biliary obstruction and precut (access sphincterotomy is frequently chosen as a rescue treatment in these cases. Generally, precut sphincterotomy ensures a rate of 90%-100% successful deep biliary cannulation. The precut technique has been performed as either a fistulotomy with a needle knife sphincterotome or as a transpapillary septotomy with a standard sphincterotome. Both methods have similar efficacy and complication rates when administered to the proper patient. Although precut sphincterotomy ensures over 90% success of biliary cannulation, it has been characterized as an independent risk factor for pancreatitis. The complications of the precut technique are not limited to pancreatitis. Two more important ones, bleeding and perforation, are also reported in some publications as being observed more commonly than during standard sphincterotomy. It is also reported that precut sphincterotomy increases morbidity when performed in patients without dilatation of their biliary tract. Nevertheless, precut sphincterotomy is a good alternative as a rescue method in the setting of a failed standard cannulation method. This paper discusses the technical details, timing, efficacy and potential complications of precut sphincterotomy.
The Difficult Empowerment in Danish Hospital: Power to the nurses!?
DEFF Research Database (Denmark)
Witt, Flemming; Nielsen, JŘrn Flohr
The employee empowerment literature promises better organizational performance as well as more motivated and satisfied employees. However, this literature often neglects the specific context of public services in general, or the health care sector, hospitals, and nursing in particular. Nurses in Danish public hospitals work in a unique situation that makes the uncritical transfer of empowerment interventions intended to redesign their work difficult or even unfeasible. Analysis from an institutional perspective of the ongoing power struggle between agens of change at several levels in the Danish health care field indicates how norms originating from the public bureaucracy and medical comminities constrain such micro-level change initiatives. According to an organizational change perspective, narrow interventions would likely be inadequate, since conflict is likely given the particular characteristics of public organizations, and the specific attitudes of physicians and politicians and their desire to control the hospital sector. At the same time, this paper also emphasizes that the empowerment concept is likely to appeal to hospital managers and nurses in the Danish public hospital sector, since it builds on the nursing professions's self-conceptualization and is associated with better organizational performance. Our analysis starts by clarifying the concept of "nursing empowerment", and then applies a field perspective on Danish hospitals in order to identify the forces that may limit the possibility of empowering nurses and nursing. Based on this analysis, we discuss how to bring about successful nursing empowerment interventions.
Percutaneous lithotripsy for removing difficult bile duct stones using endoscopy
Energy Technology Data Exchange (ETDEWEB)
Kim, See Hyung; Sohn, Chul Ho; Kim, Young Hwan [Dongsan Medical Center, Keimyung University College of Medicine, Daegu (Korea, Republic of)
To describe efficacy of percutaneous lithotripsy for removing difficult bile duct stones using endoscopy. A total of 88 patients with difficulties for the removal of bile duct stones using endoscopy (an impacted stone, stone size > 15 mm, intrahepatic duct (IHD) stone, stone size to bile duct diameter ratio > 1.0), were enrolled in this study. A 12 Fr sheath was inserted through the percutaneous transhepatic biliary drainage (PTBD) tract, and then nitrol stone baskets and a 0.035' snare wire were used to capture, fragment and remove the stones. The technical and clinical success rates were analyzed, together with an analysis of any complications. The overall technical success rate of stone removal was achieved in 79 of 88 patients (89.8%). In five of nine patients with failed stone removal, small residual IHD stones were noted on a cholangiogram. Even if stone removal failed in these cases, cholangitic symptoms were improved and the drainage catheter was successfully removed. Therefore, clinical success was achieved in 84 of 88 patients (95.5%). There were no significant procedure-related complications, except for sepsis in one case. Billiary stone removal using the stone basket and guide-wire snare technique through the PTBD tract is a safe and effective procedure that can be used as a primary method in patients with difficulties for the removal of bile duct stones using endoscopy.
Nuclear energy and public opinion - a difficult relationship
International Nuclear Information System (INIS)
Nuclear energy remains an explosive subject. Less people demand to give up nuclear energy at once but the emotional and cognitive environment of attitudes to nuclear energy makes this relative 'peaceabilty' seem a very precarious issue. The Chernobyl shock is still active. The future will depend on whether new accidents will occur in nuclear power stations and how dangerous they will be. The highly political nature and the polarization of the subject together with an assumingly still negative coverage by the mass media and a general distrust of the people in established politics will make it very difficult to influence attitudes by means of information. We should attempt to bring sober facts and objectiveness to the discussion of nuclear energy and to involve citizens more actively than in the past while ensuring that there is less auto-selectivity (bias). What we also need is the basic and credible readiness of all participants to accept the results of a democratic process of the development of opinion. (orig./HSCH)
Vía respiratoria difícil en paciente obstétrica acondroplásica / A difficult airway in an obstetrics patient presenting with achondroplasia
Scientific Electronic Library Online (English)
Lisette Elena, Llanos Palmira; Sahily Irene, López Rabasa; Alejandro, Fonseca León; Gonzalo Santos, González Rodríguez; Jorge Humberto, Díaz Rodríguez.
Full Text Available Introducción: La acondroplasia es la condición más común asociada a una estatura baja con grave desproporción anatómica. Las complicaciones de la vía respiratoria difícil constituyen una de las causas más frecuente de su morbilidad y mortalidad, entre las que se pueden citar: macroglosia, escasa ape [...] rtura bucal, presencia de una tráquea estrecha, limitación en la movilidad cervical, problemas pulmonares crónicos, mandíbula pequeńa con aglomeración de la dentadura y mentón prominente. Objetivo: Describir la conducta anestésica de una paciente obstétrica acondroplásica con vía respiratoria difícil. Caso Clínico: Paciente del sexo femenino, de 20 ańos de edad, con diagnóstico de acondroplasia y asma bronquial. Embarazo gemelar de 34 semanas el cual le imposibilitaba la deambulación, la sostenibilidad, dificultad respiratoria y no tolerancia del decúbito supino. Se le practicó cesárea, abordaje de vía respiratoria difícil, intubación con máscara laríngea Fastrach colocación de tubo endotraqueal # 6.0, ventilación controlada adecuada, utilización de relajantes musculares no despolarizantes, estabilización hemodinámica intraoperatoria, recuperación. Se trasladó a Sala Recuperación Anestésica sin complicaciones. Alta médica a los 10 días de hospitalización. Conclusiones: El abordaje de la vía respiratoria de las pacientes con Acondroplasia constituye un enigma para los anestesiólogos, pero la discusión multidisciplinaria y la ejecución de un plan de actuación favoreció el buen resultado del binomio madre-feto. Abstract in english Introduction: The achondroplasia is the commonest condition associated with a low height with a severe anatomical disproportion. The complications of the difficult airway are one of the more frequent cause of morbility and mortality including: macroglossia, an scarce buccal aperture, presence of a n [...] arrow trachea, limitation of cervical mobility, chronic pulmonary problems, small mandible with teeth crowding and a prominent chin. Objective: To describe the anesthetic behavior of an obstetrics patient with achondroplasia and a difficult airway. Clinical case: A female patient aged 20 diagnosed with achondroplasia and bronchial asthma. A twin pregnancy of 34 weeks avoiding her to walk, to stand up, respiratory difficulty and no tolerance of supine decubitus. She undergoes a cesarean section, approach of the difficult airway, intubation with a Fastrach laryngeal mask, placement of the #6.0 endotracheal tube, appropriate controlled ventilation, use of non-depolarizing muscle relaxants, intraoperative hemodynamic stabilization, recovery. She was transferred to Anesthesia Recovery Ward with complications, was discharged at 10 days of hospitalization. Conclusions: The approach of the airway of patients with achondroplasia is an enigma for anesthesiologists, but the multidisciplinary discussion and the performance of action plan favored the good result of mother-fetus duo.
The Difficult Way of Social Psychology in Russia
Directory of Open Access Journals (Sweden)
Galina M. Andreeva
Full Text Available The article describes the main stages and directions of the development of social psychology in USSR and Russia. The comparison of theoretical approaches of Russian and Western social psychology is carried out. Special emphasis is made on the problem of social cognition and coping, which are important in the conditions of changing reality. New professional tasks of social psychology are discussed. The necessity of finding a new paradigm in social psychological investigations in conditions of cardinal transformations and ambiguity is stated as well as vectors and tendencies of its elaboration.
Newer trends in the management of psoriasis at difficult to treat locations: Scalp, palmoplantar disease and nails
Directory of Open Access Journals (Sweden)
Handa Sanjeev
Full Text Available Psoriasis is a common, chronic, inflammatory disease with a wide range of clinical presentations. The disease severity ranges from mild to severe. Plaque type of psoriasis is the most common. A number of factors like previous treatment history and comorbid conditions influence the treatment of psoriasis in an individual patient. Location of the lesions is also an important consideration. Psoriasis localized to certain areas of the body like scalp, nails, palms and soles remains difficult to treat. These sites have been referred to as the difficult locations in literature. This article covers the management of psoriasis limited to these special areas.
Why is it so difficult to measure big G?
Faller, James
The determination of the Newtonian constant of gravitation, big G, continues to be one of Nature's greatest challenges to the skills and cunning of experimental physicists. The reasons: Big G is small, scientists are human, and error budgets are flawed. In spite of the fact that on the scale of the Universe, big G's effects are so big as to single handedly hold everything together, on the scale of a single research laboratory, big G's effects are so small that they go unnoticed. And, it is this ``smallness'' that makes the determination of this (seemingly unrelated to the rest of physics) fundamental constant so difficult. Furthermore, because they are human, scientists want to get the ``right'' (read previously obtained) answer; and this goal can affect their otherwise good judgment. Finally, error budgets are fundamentally flawed because they cannot make allowances for error sources that have not been thought of. During its nearly 300 year measurement history, the accuracy with which G is known has barely increased by three orders of magnitude; during the past 30 years the progress, measured by agreement rather than claimed accuracy of individual measurements, has been essentially zero. Nevertheless, this Mount Everest of precision measurement continues to provide an experimental challenge upon which metrologists can hone their laboratory skills for generations to come. Finally, this presentation will be understandable and interesting for ``students of all ages.'' In this year of GR100, Einstein will be mentioned more than once, and my hope is that some of you who would not normally ``risk'' attending a talk outside of your own specialty or discipline will consider coming to this one.
Engineering classification of karst ground conditions
Directory of Open Access Journals (Sweden)
Full Text Available On a world scale, the dissolution of limestone and gypsum by natural waters creates extensive karst landforms that can be very difficult ground for civil engineers. Caves threaten foundation integrity, notably where their width is greater than their roof thickness. Sinkholes pose many problems, and are classified into six types, including subsidence sinkholes formed in soil cover within karst terrains. Rockhead morphology varies from uniform to pinnacled, also creating difficult ground to excavate or found upon. A proposed engineering classification of karst defines various complexities of ground conditions by the geohazards that they provide, mainly the caves, sinkholes and rockhead relief. Ground investigation techniques and foundation design philosophies are considered so that they are appropriate to the ground conditions provided by the different classes of karst.
What Makes Biology Learning Difficult and Effective: Students' Views
Cimer, Atilla
The present study aims to determine the biological topics that students have difficulties learning, the reasons why secondary school students have difficulties in learning biology, and ways to improve the effectiveness of students' biology learning. For these purposes, a self-administered questionnaire including three open-ended questions was…
High-precision Penning trap mass measurements of 'difficult' elements produced via projectile fragmentation with LEBIT
International Nuclear Information System (INIS)
Rare isotope beams of many elements can be difficult or impossible to obtain at ISOL facilities due to their high melting points or chemical reactivity, but they are easily produced by projectile fragmentation and in-flight separation, a technique that rapidly produces fragments lighter than the projectile in a chemistry-free manner. Until recently, such high-energy projectile fragments could not be reduced to the thermal energies necessary for precision mass measurements in Penning traps. The Low Energy Beam and Ion Trap (LEBIT) facility at the National Superconducting Cyclotron Laboratory (NSCL) has demonstrated that projectile fragment beams can be thermalized and measured in a high-precision Penning trap. Since 2005, over 30 isotopes have been measured with LEBIT, including several isotopes of elements which are difficult for ISOL facilities to produce, such as Fe, Co, Si, Br, and S. These measurements have contributed to our understanding of nuclear structure, nuclear astrophysics, and fundamental symmetries. Some recent highlights include the discovery of an isomeric state in 65Fe, testing the Isobaric Mass Multiplet Equation (IMME) with the A ?=? 32, T ?=? 2 quintet with a measurement of 32Si, probing out to the proton dripline with 70mBr, and studying the N ?=? 28 shell closure with measurements of 40???44S. Results of these measurements will be discussed, along with the technical developments whichnical developments which made them possible.
Penile Corporeal Reconstruction during Difficult Placement of a Penile Prosthesis
Aboseif, Sherif R.; Kim, Dennis H; Timothy F. Lesser; Viet Q. Tran
For some patients with impotence and concomitant severe tunical/corporeal tissue fibrosis, insertion of a penile prosthesis is the only option to restore erectile function. Closing the tunica over an inflatable penile prosthesis in these patients can be challenging. We review our previous study which included 15 patients with severe corporeal or tunical fibrosis who underwent corporeal reconstruction with autologous rectus fascia to allow placement of an inflatable penile prosthesis. At a mea...
Prediction is Difficult, Especially the Future: A Progress Report
Andrew Booth; Anne Brice
Objective This paper reviews developments in the consolidation and diversification of the evidence based library and information practice (EBLIP) paradigm since publication of the authors' book Evidence Based Practice for Information Professionals: a Handbook in 2004.Methods The authors provide an updated narrative review of key themes in the development of evidence based librarianship within the context of the new consensual term 'EBLIP.' Sources for this thematic framework included ...
Riedel's goitre - rare and difficult to diagnose reason
International Nuclear Information System (INIS)
Introduction: The paper reports a female patient treated surgically for Riedel's goitre. A total of 4775 patients were treated surgically between 1 January 2000 and 31 December 2007 for various types of goitres. Thyroiditis was diagnosed in 193 (4.0%) cases. Among them Riedel's goitre was found in one (0.5%). Case report: A 51-year-old woman P.G. (case record No. 1377/2007) was admitted to our hospital with considerable dyspnea, both inspiratory and expiratory, accompanied by marked stridor and retrosternal goitre, the latter suspected of neoplasmic process. Thyroid gland was hard, its left lobe extending behind the sternum. No disorders in thyroid hormonal function or high antibody titre against thyroid peroxidase were observed. Ultrasonography revealed large thyroid gland with mediastinal invasion, nodulated and hypoechogenic. Fineneedle biopsy suggested thyroid colloidal tumor. X-ray of the chest and neck revealed wide upper portion of the mediastinum and narrow trachea. Laryngological examination confirmed paralysis of left vocal fold. The patient was operated under general endotracheal anesthesia. Both thyroid lobes were partially resected together with the isthmus, and malacic trachea was decompressed. No complications were observed during postoperative period. Paraffin histopathological examination confirmed the presence of Riedel's goitre.The patient was discharged in general good condition. She was under regular follow-up control and died 1.5 year after operaw-up control and died 1.5 year after operation from further progress of the disease. Conclusions: Clinical course of Riedel's goitre may cause remarkable diagnostic problems, and requires a differentiation with thyroid malignant tumor. Surgical treatment of Riedel's goitres helps to quickly obtain correct diagnosis and improve both clinical condition and life comfort of the patients. (authors)
Combustion-assisted laser cutting of a difficult-to-machine superalloy
International Nuclear Information System (INIS)
In laser cutting, the largest single application of lasers in manufacturing, the assist gas plays an important role in affecting the cutting performance. The assist gas is usually oxygen or an inert gas. In this paper acetylene and oxygen was employed to create combustion reactions during CO2 laser cutting that enabled an improvement in the cutting speed, and cut quality of a difficult-to-machine superalloy. A comparison with laser cutting of a plain carbon steel under identical conditions was also made to determine the usefulness of combustion energy. Results indicate that both cutting speed and quality are enhanced by the reduction in the viscosity of slag formed during cutting (which assisted in ejection of the slag through the bottom of the kerf) due to the heat released by the acetylene burning inside the kerf. Correlations of experimental data with a theoretical model provided the influence of combustion power and gas-flow power on the cutting phenomena
Diversity of life. Effects of power generation and transmission on biodiversity difficult to assess
International Nuclear Information System (INIS)
Scientific theories do not necessarily enable us to forecast the consequences of our actions on wildlife. Presumably, nature is able to adapt to environmental changes through variations on the genetic, species and ecosystem level; i.e. by means of biodiversity. The first studies conducted within the electricity sector show that the effects of emissions form an individual power plant on biodiversity are extremely difficult to assess because of long-range dispersion of the emission and many other factors simultaneously acting on the environment. Some concrete information about the impact of power transmission lines on biodiversity was obtained. These effects were primarily reversible. Some transmission line zones may even have favourable effects on biodiversity and on the living conditions of certain endangered species. (orig.)
Asthma of difficult handling, not all that hiss is asthma
International Nuclear Information System (INIS)
The paper tries about a patient of masculine sex 13 years old who consults initially for square that begins in February of 1999, consistent in cough, breathlessness and difficulty to breathe, he consults to one hospital where it is managed with beta two micronebulized, corticoids endovenous and oxygen being obtained improvement, reason why they give exit. Three days later he consults again for similar square; receiving the same treatment; a week later he presents cough and severe breathing difficulty, for that again consult and he is remitted to the Hospital San Rafael (Bogota) for no-improvement of the square. The paper includes the antecedents, exams, clinical evolution and paraclinics
Difficult clinical management of anti-tuberculosis DRESS syndrome.
Palmero, D; Castagnino, J; Musella, R M; Mosca, C; González Montaner, P; de Casado, G C
We describe 11 cases of anti-tuberculosis DRESS (drug-related rash with eosinophilia and systemic symptoms) syndrome, a potentially serious complication of treatment that led to interruption of treatment for prolonged periods, systemic corticosteroid use and the resumption of treatment with less effective regimens. All patients had rash and toxic hepatitis, one died of multi-organ failure and, contrary to expectations, the evolution of tuberculosis (advanced in most cases) did not progress under corticosteroid treatment. The drug most frequently involved was rifampicin, while retreatment schemes included, in most cases, levofloxacin, ethambutol, streptomycin and cycloserine. PMID:23114284
Biogenic hardparts: Difficult archives of the geological past (Invited)
Immenhauser, A.; Schone, B. R.; Hoffmann, R.; Niedermayr, A.
Biomineralized exo- or endoskeletons of fossil marine invertebrates are widespread and diverse components of the Phanerozoic rock record of Earth's past and present oceans. Exoskeletons serve as protection against environmental pressure or predators, whilst endoskeletons can act as support or serve as an attachment for muscles and ligaments and hence as a mechanism for transmitting muscular forces. Biogenic hard parts represent sophisticated products resulting from the hierarchical interaction of inorganic minerals (95%) and macromolecular organic matrices, forming commonly less than 5%. The significance of many biogenic carbonate archives lies in the time-resolved growth patterns and their ability to record ambient environmental conditions in the form of multiple geochemical properties (multi-proxy archives) that have been widely used to assess past oceanic seawater properties. Here, we compile and review published work dealing with crystallization pathways of skeletal hard parts secreted by mollusks (i.e., bivalves and cephalopods) as well as brachiopods as widely used archives of ancient neritic epeiric settings. Bivalves and cephalopods (e.g., extinct ammonoids and belemnites and extant Sepia, Nautilus and Spirula) all form accretionary calcitic, aragonitic or vateritic skeletal hard parts. Despite the fact that mollusks and brachiopods form part of very different branches of the animal phylogenetic tree, their biomineralization strategies are surprisingly similar. Our main focus lies in a critical assessment of the complex pathways of ions and aquo-complexes from their source (seawater) to the final product (biomineral). We do this as an attempt to critically test the commonly held hypothesis that many fossil hard parts precipitated (under favorable conditions and pending subsequent diagenetic alteration) in equilibrium with seawater. Two main observations stand out: (1) the present knowledge on pathways and mechanisms (e.g., ion channel trans-membrane or endocytosis and vesicle transport, precursor mineralogies etc.) is surprisingly incomplete and in many cases based on descriptive rather than mechanistic approaches; (2) in analogy to all metazoans, biomineralization processes of mollusks and brachiopods are complex and involve different mechanisms for different elements. The combined uptake of specific elements both from inorganic and metabolic sources represents a major problem. Despite all of these problems, field experiments document that these biominerals respond to the aquatic geochemistry and the physical properties (temperature, salinity, pH etc.) of their environment, albeit in a more complex manner than conventionally assumed. Significant advances in multi-proxy research, however, require a more holistic view of the physico-chemical and biological processes involved. The present contribution represents a first tentative step towards this goal.
Difficult-to-treat-pediatric Crohn's disease: focus on adalimumab
Directory of Open Access Journals (Sweden)
Zeisler B
Full Text Available Bella Zeisler, Jeffrey S Hyams Division of Digestive Diseases, Hepatology, and Nutrition, Connecticut Children's Medical Center Hartford, University of Connecticut School of Medicine, Department of Pediatrics, Farmington, CT, USA Abstract: Adalimumab is a fully humanized anti-tumor necrosis factor alpha monoclonal antibody that was recently granted regulatory approval in the USA for the treatment of moderate to severe Crohn's disease (CD in children. Like infliximab, the first biologic agent used to treat pediatric CD, regulatory approval was secured many years following approval for adults. The long delay between adult and pediatric approval has led to many years of off-label use of adalimumab, although it is anticipated that the use of adalimumab may further increase with official regulatory approval. To date, pediatric literature on the use of adalimumab for treatment of CD is limited, and pediatric practitioners have mostly extrapolated from research and experience provided by the adult literature. The aim of this paper is to review the literature regarding adalimumab for the treatment of pediatric CD, and includes a review of landmark adult studies as well as the pivotal pediatric study that facilitated regulatory approval. We also discuss the role of anti-tumor necrosis factor alpha agents including adalimumab in the current treatment paradigm for pediatric CD. Keywords: pediatrics, Crohn's disease, adalimumab, biologic agent
Easy and Difficult Performance-Approach Goals: Their moderating effect on the link between task interest and performance attainment
Directory of Open Access Journals (Sweden)
Monica Blaga
Full Text Available The purpose of this study was to demonstrate that the positive link between task interest and performance attainment can be negatively affected by the pursuit of difficult performance-approach goals. This was tested in a sample of 60 undergraduate students at a Dutch university. In line with expectations, for difficult performance-approach goals there was no link between task interest and performance attainment. Furthermore, among women this relation turned out to be negative. In an easy performance-approach goal condition, a positive link between task interest and performance attainment was found for both men and women, while in the control condition the same expected positive relation was not found. Theoretical and practical implications of these findings are discussed.
The Lula Government's First Year: The Difficult Transition
Directory of Open Access Journals (Sweden)
Sonia Fleury
Full Text Available In this article, the author analyses the first year of Luiz Inácio Lula da Silva's Government and highlights the importance of this Government for the process of democratic consolidation in Brazil. The contradiction between maintaining an orthodox economic policy and the expectations of creating conditions for development and social inclusion have marked the first year of this Government, subordinating all public policies to the logic of controlling inflation, paying off public debt, and increasing credibility in the international market. The reality of this macroeconomic policy and the costs imposed on the Brazilian society reveal the discrepancies between the financial economy and the real economy. The public policies of the Lula Government have been marked by economic restrictions and conflicts between the different forces that make up the governing coalition. The Government introduced innovative measures with the creation of different channels of participation and social agreement. In 2004, the Government will have to confront the challenges involved in going from a monetarist policy to a policy ofdevelopment and distribution of income.
Radiocarbon Dating of Difficult Samples: Natural and Laboratory Effects
International Nuclear Information System (INIS)
Radiocarbon dating by accelerator mass spectrometry (AMS) is routine in many laboratories around the world. The applications of 14C measurements based on the nuclide produced in the atmosphere are vast and generally easy to interpret, as the 14C value at the time of initial incorporation to the material is established. Clearly, the initial assumptions of the 14C composition are important. However, certain types of samples including bones, sediments, and lacustrine samples present special problems, since the basic assumptions can be different. These assumptions need to be treated carefully. We also encounter similar questions in the initial 14C when the nuclide is incorporated into rock surfaces or meteorites in space by direct "in situ" production of 14C in the silicate. In this talk, I will highlight some examples of these problems using some specific examples. (author)
Difficult to swallow: patient preferences for alternative valproate pharmaceutical formulations
Directory of Open Access Journals (Sweden)
Monali Bhosle
Full Text Available Monali Bhosle,1 Joshua S Benner,1 Mitch DeKoven,1 Jeff Shelton21Health Economics and Outcomes Research, IMS Health Inc, Falls Church, VA, USA; 2Answers and Insights Market Research, Inc, Indianapolis, IN, USAObjective: To determine the degree to which swallowing valproate (VP tablets is an issue, the proportion of patients who would prefer an alternative formulation, and the predictors of preference.Methods: A quantitative telephone survey of eligible adults (n = 400, ?18 years old who currently take (n = 236 or previously took (n = 164 VP tablets within the past 6 months was conducted.Results: More than half of the patients indicated that VP tablets were 'uncomfortable to swallow' (68.5%, n = 274 and were 'very interested' (65.8%, n = 263 in medications that were easier to swallow. When choosing conceptually between taking VP tablet once/day or an equally safe and effective but significantly smaller soft gel capsule twice per day, the 82.8%, (n = 331 preferred the soft gel capsule. In the multivariate regression analysis, perceiving soft gel capsules to be easier to swallow (OR = 73.54; 95% CI = 15.01 to 360.40 and taking VP more frequently (OR = 2.02; 95% CI = 1.13 to 3.61 were significant predictors of soft gel capsule treatment preference.Conclusion: VP users would prefer a formulation that is easier to swallow, even if it is needed to be taken twice per day. When choosing between medications with similar efficacy and safety, physicians can consider patient preferences to optimize conditions for medication adherence.Keywords: patient preference, valproate formulations, tablet characteristics
Pump apparatus including deconsolidator
Sonwane, Chandrashekhar; Saunders, Timothy; Fitzsimmons, Mark Andrew
A pump apparatus includes a particulate pump that defines a passage that extends from an inlet to an outlet. A duct is in flow communication with the outlet. The duct includes a deconsolidator configured to fragment particle agglomerates received from the passage.
Directed forgetting of negative self-referential information is difficult: an FMRI study.
Yang, Wenjing; Liu, Peiduo; Cui, Qian; Wei, Dongtao; Li, Wenfu; Qiu, Jiang; Zhang, Qinglin
A large body of evidence suggested that both emotion and self-referential processing can enhance memory. However, it remains unclear how these two factors influence directed forgetting. This study speculates that directed forgetting of negative self-referential memory is more difficult than forgetting of other-referential memory. To verify this speculation, we combined the directed forgetting paradigm with the self-reference task. The behavioral result suggested that although both self-referential and other-referential information can be directly forgotten, less self-referential information can be forgotten than other-referential information. At the neural level, the forget instruction strongly activated the frontal cortex, suggesting that directed forgetting is not memory decay but an active process. In addition, compared with the negative other-referential information, forgetting of the negative self-referential information were associated with a more widespread activation, including the orbital frontal gyrus (BA47), the inferior frontal gyrus (BA45, BA44), and the middle frontal gyrus. Our results suggest that forgetting of the self-referential information seems to be a more demanding and difficult process. PMID:24124475
Simulation of a new 3D imaging sensor for identifying difficult military targets
Harvey, Christophe; Wood, Jonathan; Randall, Peter; Watson, Graham; Smith, Gordon
This paper reports the successful application of automatic target recognition and identification (ATR/I) algorithms to simulated 3D imagery of 'difficult' military targets. QinetiQ and Selex S&AS are engaged in a joint programme to build a new 3D laser imaging sensor for UK MOD. The sensor is a 3D flash system giving an image containing range and intensity information suitable for targeting operations from fast jet platforms, and is currently being integrated with an ATR/I suite for demonstration and testing. The sensor has been extensively modelled and a set of high fidelity simulated imagery has been generated using the CAMEO-SIM scene generation software tool. These include a variety of different scenarios (varying range, platform altitude, target orientation and environments), and some 'difficult' targets such as concealed military vehicles. The ATR/I algorithms have been tested on this image set and their performance compared to 2D passive imagery from the airborne trials using a Wescam MX-15 infrared sensor and real-time ATR/I suite. This paper outlines the principles behind the sensor model and the methodology of 3D scene simulation. An overview of the 3D ATR/I programme and algorithms is presented, and the relative performance of the ATR/I against the simulated image set is reported. Comparisons are made to the performance of typical 2D sensors, confirming the benefits of 3D imaging for targeting applications.
Why Is the Overheating Problem Difficult: the Role of Entropy
Liou, Meng-Sing
The development of computational fluid dynamics over the last few decades has yielded enormous successes and capabilities being routinely employed today; however there remain some open problems to be properly resolved-some are fundamental in nature and some resolvable by operational changes. These two categories are distinguished and broadly explored previously. One, that belongs to the former, is the so-called overheating problem, especially in rarefying flow. This problem up to date still dogs every method known to the author; a solution to it remains elusive. The study in this paper concludes that: (1) the entropy increase is quantitatively linked to the increase in the temperature increase, (2) it is argued that the overheating is inevitable in the current shock capturing or traditional finite difference framework, and (3) a simple hybrid method is proposed that removes the overheating problem in the rarefying problems, but also retains the property of accurate shock capturing. This remedy (enhancement of current numerical methods) can be included easily in the present Eulerian codes.
Difficult OptEase Filter Retrievals After Prolonged Indwelling Times
Energy Technology Data Exchange (ETDEWEB)
Van Ha, Thuong G., E-mail: email@example.com; Kang, Lisa; Lorenz, Jonathan; Zangan, Steven; Navuluri, Rakesh; Straus, Christopher; Funaki, Brian [University of Chicago, Section of Interventional Radiology, Department of Radiology (United States)
PurposeThe OptEase vena cave filter (Cordis, Piscataway, NJ) is commercially available as a retrievable or permanent filter with short recommended indwelling time, presumably due to extensive contact of the filter side struts with the inferior vena cava wall and subsequent neointimal hyperplasia leading to incorporation. Our purpose was to evaluate OptEase filter retrievals with a long indwelling time period that required unconventional retrieval techniques.Materials and MethodsWe retrospectively reviewed patients who underwent OptEase filter retrieval with long undwelling times requiring additional maneuvers for retrieval. Techniques used included rigid endobronchial forceps dissection and wire-through-loop snare. Each patient underwent postretrieval venogram to evaluate for possible complications. In addition, patients had clinical follow-up 2 weeks after the retrieval procedure.ResultsThere were three patients (2 women, 1 man; average age 64 years) who underwent OptEase filter retrieval. The mean indwelling time was 6.4 months. The indwelling filters were successfully retrieved. There were no complications. Postprocedural follow-up showed no clinical pathology.ConclusionUnconventional techniques aided in the retrieval of OptEase filters with long indwelling times.
Prediction is Difficult, Especially the Future: A Progress Report
Directory of Open Access Journals (Sweden)
Andrew Booth
Full Text Available Objective This paper reviews developments in the consolidation and diversification of the evidence based library and information practice (EBLIP paradigm since publication of the authors' book Evidence Based Practice for Information Professionals: a Handbook in 2004.Methods The authors provide an updated narrative review of key themes in the development of evidence based librarianship within the context of the new consensual term 'EBLIP.' Sources for this thematic framework included professional literature, Internet searches, and the authors' personal experiences.Results ? While considerable achievements have been realized within a three?year period, most notably the instigation of the journal known as EBLIP, a broadening of the paradigm to other library sectors, and increased availability of implementation studies, many challenges remain. Of particular concern is the lack of international strategic foresight in determining rotation of the biennial international conferences and distribution of influential EBLIP infrastructures and initiatives.Conclusion ? While the enthusiasms and energies of individual practitioners and work teams have made considerable progress in meeting short?term objectives, uncertainty remains concerning how longer?term objectives requiring infrastructure and resources might be realized. From its faltering steps as a toddler EBLIP has developed to a 'prepubescent' stage with the promise of 'growth spurts' and 'emotional crises.' The next three years should prove both challenging and demanding.
Disarming Contankerous People: Coping with Difficult Personalities in ECE Work Settings
Hernandez, Luis; Smith, Connie Jo
Difficult personalities come in a variety of roles in just about every setting. While types have been identified in the typical corporate and business culture, difficult work personalities also inhabit the world of early childhood education (ECE) workplaces. Because difficult people have an impact on workplace morale and productivity, the topic…
Visual Impairment, Including Blindness
... from mild to severe (up to, and including, blindness). The degree of impairment will depend on: the ... through glasses, contacts, medicine, or surgery. The term "blindness" does not necessarily mean that a child cannot ...
Difficult embryo transfers or blood on catheter and assisted reproductive outcomes: a systematic review and meta-analysis.
Phillips, James A S; Martins, Wellington P; Nastri, Carolina O; Raine-Fenning, Nicholas J
We performed a systematic review and meta-analysis to examine whether a difficult embryo transfer or the presence of blood on the transfer catheter affects assisted reproduction outcomes. We searched the following databases: Cochrane Central Register of Controlled Trials (CENTRAL), Database of Abstracts of Reviews of Effects (DARE), MEDLINE, Embase, PsycINFO, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Literatura Latino-Americana e do Caribe em Cięncias da Saúde (LILACS). We aimed to determine the risk ratio (RR) associated with difficult embryo transfer or the presence of blood on the transfer catheter for the following outcomes: live birth, clinical pregnancy, and miscarriage. We identified 3066 papers, of which 194 were reviewed and nine were included. The outcome of live birth was not reported in any of the included studies and the effect on miscarriage was too imprecise for any conclusions. Pooled analysis of five studies demonstrated lower clinical pregnancy rates following a non-easy embryo transfer (RR=0.75; 95% CI=0.66-0.86). This included three studies showing subjectively difficult transfers reducing clinical pregnancies (RR=0.67; 95% CI=0.51-0.87) and two studies in which the need for additional manoeuvers reduced clinical pregnancies (RR=0.78; 95% CI=0.67-0.91). The presence of blood on the transfer catheter did not affect clinical pregnancy rates (RR=0.96; 95% CI=0.82-1.14) in five studies. We concluded that low quality evidence suggests that a difficult embryo transfer but not a bloody catheter reduces the chance of achieving a clinical pregnancy. More good quality studies are needed to evaluate the effect of difficult embryo transfer and the presence of blood on the catheter on the main outcomes of assisted reproduction. PMID:23347607
Statistical optimization of gold recovery from difficult leachable sulphide minerals using bacteria
Energy Technology Data Exchange (ETDEWEB)
Ahmed, Hussin A.M. [King Abdulaziz Univ., Jeddah (Saudi Arabia). Mining Engineering Dept.; El-Midany, Ayman A. [King Saud Univ., Riyadh (Saudi Arabia)
Some of refractory gold ores represent one of the difficult processable ores due to fine dissemination and interlocking of the gold grains with the associated sulphide minerals. This makes it impossible to recover precious metals from sulphide matrices by direct cyanide leaching even at high consumption of cyanide solution. Research to solve this problem is numerous. Application of bacteria shows that, some types of bacteria have great affect on sulphides bio-oxidation and consequently facilitate the leaching process. In this paper, leaching of Saudi gold ore, from Alhura area, containing sulphides before cyanidation is studied to recover gold from such ores applying bacteria. The process is investigated using stirred reactor bio-leaching rather than heap bio-leaching. Using statistical analysis the main affecting variables under studied conditions were identified. The design results indicated that the dose of bacteria, retention time and nutrition K{sub 2}SO{sub 4} are the most significant parameters. The higher the bacterial dose and the bacterial nutrition, the better is the concentrate grade. Results show that the method is technically effective in gold recovery. A gold concentrate containing > 100 g/t gold was obtained at optimum conditions, from an ore containing < 2 g/t gold i.e., 10 ml bacterial dose, 6 days retention time, and 6.5 kg/t K{sub 2}SO{sub 4}as bacteria nutrition. (orig.)
Veck, Wayne
This paper attempts to make important connections between listening and inclusive education and the refusal to listen and exclusion. Two lines of argument are advanced. First, if educators and learners are to include each other within their educational institutions as unique individuals, then they will need to listen attentively to each other.…
Celecoxib reduces symptoms in men with difficult chronic pelvic pain syndrome (Category IIIA
Directory of Open Access Journals (Sweden)
W.P. Zhao
Full Text Available We investigated the effectiveness of celecoxib in reducing symptoms in patients with difficult chronic pelvic pain syndrome (CPPS, NIH category IIIA. Sixty-four patients with category IIIA CPPS were randomized into two groups of 32 subjects each. One group was treated with celecoxib (200 mg daily and the other with placebo. All patients underwent treatment for 6 weeks and were evaluated clinically before (baseline and after 1, 2, 4, 6, and 8 weeks of treatment. The evaluation included the NIH Chronic Prostatitis Symptom Index (NIH-CPSI and a subjective global assessment (SGA. Repeated measures analysis of variance was used to evaluate treatment and time effects and their interaction. A decrease (means ± SD in total NIH-CPSI score from 23.91 ± 5.27 to 15.88 ± 2.51 in the celecoxib group and from 24.25 ± 5.09 to 19.50 ± 2.50 in the placebo group was observed during treatment (0 to 6 weeks. A statistically significant decrease was observed in pain subscore (P < 0.006, quality of life subscore (P < 0.032 and total NIH-CPSI score (P < 0.015 after 2, 4 and 6 weeks, but not in urinary subscore. In addition, 38% of the celecoxib and 13% of the placebo subjects had at least a moderate improvement in SGA. The trend was similar for the NIH-CPSI scores. However, the response to treatment in terms of total NIH-CPSI score or subscore was not significantly different from placebo after interruption of treatment for 2 weeks. Our results show that celecoxib provides significant symptomatic improvement limited to the duration of the therapy in patients with difficult category IIIA CPPS compared to placebo.
Three difficult cases: the challenge of autoimmunity, immunodeficiency and recurrent infections in patients with Good syndrome.
Arnold, S J; Hodgson, T; Misbah, S A; Patel, S Y; Cooper, S M; Venning, V A
Good syndrome (GS) is a rare, adult-acquired primary combined immunodeficiency syndrome arising in the context of previous or current thymoma. Patients with GS frequently develop recurrent sinopulmonary infections and are also at high risk of autoimmune manifestations, including skin conditions such as lichen planus. We report three middle-aged patients with GS complicated by multiple autoimmune and infectious manifestations. The combination of immunodeficiency, autoimmunity and recurrent infections seen in patients with GS continues to present a management challenge, particularly in patients with oral mucosal disease and recurrent candidiasis. Clinicians should be prompted to investigate an underlying immunodeficiency in patients with multiple autoimmune conditions and recurrent sinopulmonary infections. PMID:25059810
Conditions Affecting Treatment of Pertrochanteric Osteomyelitis
Directory of Open Access Journals (Sweden)
Steven Wen-Neng Ueng
Full Text Available Background: Although osteomyelitis following treatment of pertrochanteric fractures israre, management can be difficult and often results in several physical andeconomic difficulties. Data regarding treatment of patients withpertrochanteric osteomyelitis is currently limited. This retrospective studyevaluates the management of pertrochanteric osteomyelitis and presents ourexperience using a two-stage treatment protocol.Methods: From 1984 to 1998, twenty-three pertrochanteric osteomyelitis cases weretreated with a two-stage protocol comprising of an external skeletal fixator orBuck traction after radical debridement in the first stage and reconstructionin the second stage. The study included sixteen males and seven femaleswith a mean age of 48.3 years (range 16-82 years. Patients were categorizedas "successful" or "difficult" according to the number of operations they hadundergone. Conditions including patient age, compromised host, intervalbefore treatment, fracture severity, nonunion, hip joint involvement, multipleorganisms and the presence of oxacillin-resistant Staphylococcus aureuswere recorded for analysis.Results: Only twelve of the twenty-three (52% cases were successfully managed andinfection recurred in four (17.4% cases at final follow-up. Difficult casesmanaged by the two-stage protocol were more likely to be characterized byyounger age (p = 0.03, unstable fractures (p = 0.003 and nonunions (p =0.027.Conclusion: The use of external skeletal fixation is not recommended for managingpertrochanteric osteomyelitis. Success using a two-stage protocol was difficultto achieve. Initial fracture severity should be carefully assessed whendevising a treatment protocol for pertrochanteric osteomyelitis.
Reducing the Burden of Difficult-to-Treat Major Depressive Disorder: Revisiting Monoamine Oxidase Inhibitor Therapy
Culpepper, Larry
Objective: Difficult-to-treat depression (eg, depression with atypical or anxious symptoms, treatment-resistant depression, or depression with frequent recurrence) is a challenging real-world health issue. This critical review of the literature focuses on monoamine oxidase inhibitor (MAOI) therapy and difficult-to-treat forms of depression.
Deciphering the Distance between Distance Education and Working Professionals in Difficult Geographies
Pandey, Jatin; Singh, Manjari
This study investigates the factors that draw working professionals towards distance education programs, and the factors that sustain their distance education experience. The study is conducted in difficult terrains of Uttarakhand, a hilly state in India which helps us investigate the phenomenon in difficult geographies. Through interviews of ten…
Energy conditions and junction conditions
International Nuclear Information System (INIS)
We consider the familiar junction conditions described by Israel for thin timelike walls in Einstein-Hilbert gravity. One such condition requires the induced metric to be continuous across the wall. Now, there are many spacetimes with sources confined to a thin wall for which this condition is violated and the Israel formalism does not apply. However, we explore the conjecture that the induced metric is in fact continuous for any thin wall which models spacetimes containing only positive energy matter. Thus, the usual junction conditions would hold for all positive energy spacetimes. This conjecture is proven in various special cases, including the case of static spacetimes with spherical or planar symmetry as well as settings without symmetry which may be sufficiently well approximated by smooth spacetimes with well-behaved null geodesic congruences
Chronic fibrosing conditions in abdominal imaging.
George, Verghese; Tammisetti, Varaha Sairam; Surabhi, Venkateswar Rao; Shanbhogue, Alampady K
Chronic fibrosing conditions of the abdomen are relatively poorly understood and involve varied and often multiple organ systems. At histopathologic analysis, they share the unifying features of proliferative fibrosis and chronic inflammation. Different conditions in this group are often found in association with each other and with other fibrosing conditions outside the abdomen. Some of the confusion about these conditions stems from their complex nomenclature, which includes a gamut of alternate terms and eponyms. Many of them can be categorized within two large subgroups: the fibromatoses and immunoglobulin G4 (IgG4)-related disorders. While many of these entities are of uncertain etiology, some, especially the IgG4-associated conditions, appear to have an immune-mediated pathogenesis. Nephrogenic systemic fibrosis, sclerosing peritonitis, and retroperitoneal fibrosis have iatrogenic associations, while some of the fibromatoses are genetically inherited. Imaging differentiation of these conditions is difficult due to considerable overlap in their radiologic findings. However, certain conditions such as penile fibromatosis and sclerosing peritonitis may have unique imaging features that can help the radiologist make the diagnosis. Others such as deep fibromatoses and inflammatory pseudotumor demonstrate fibroproliferative mass formation and cannot be differentiated from neoplastic conditions at imaging. Thus, histopathologic correlation is often required to confirm their diagnosis. PMID:23842972
Herpes simplex virus-associated acute liver failure: a difficult diagnosis with a poor prognosis.
Ichai, Philippe; Roque Afonso, Anne Marie; Sebagh, Mylčne; Gonzalez, Maria Eugenia; Codés, Liana; Azoulay, Daniel; Saliba, Faouzi; Karam, Vincent; Dussaix, Elisabeth; Guettier, Catherine; Castaing, Denis; Samuel, Didier
We report 5 cases of acute liver failure related to herpes simplex (HSV) infection in 1 immunocompetent and 4 immunosuppressed patients. One patient was too ill for liver transplantation indication. Three patients, among the 4 listed, underwent liver transplantation. Three patients died 11 days to 1 year after transplantation and 2 patients died 2 to 3 days after admission. All presented with fever and none with skin lesions. The diagnosis of HSV-related hepatitis was made antemortem in only 2 patients on the basis of positive blood cultures and/or immunohistochemic findings. In the remaining patients, HSV diagnosis was made retrospectively on further histologic and virologic investigations. Primary HSV infection was certain or likely in all cases, including an HSV2 superinfection of an anti-HSV1-positive patient and two HSV superinfections of hepatitis B virus (HBV)-related chronic liver disease. In these latter patients, HSV diagnosis was totally unsuspected, despite fever. HSV superinfection has significantly contributed to liver dysfunction aggravation and death. In conclusion, the diagnosis of HSV hepatitis is difficult to establish in the absence of specific clinical signs. This may suggest the need for early administration of acyclovir in patients with suspected HSV hepatitis, without waiting for virologic confirmation. Diagnosis methods providing fast results (real-time polymerase chain reaction [PCR]) should be implemented. PMID:16315311
Celecoxib reduces symptoms in men with difficult chronic pelvic pain syndrome (Category IIIA)
Scientific Electronic Library Online (English)
W.P., Zhao; Z.G., Zhang; X.D., Li; D., Yu; X.F., Rui; G.H., Li; G.Q., Ding.
Full Text Available We investigated the effectiveness of celecoxib in reducing symptoms in patients with difficult chronic pelvic pain syndrome (CPPS), NIH category IIIA. Sixty-four patients with category IIIA CPPS were randomized into two groups of 32 subjects each. One group was treated with celecoxib (200 mg daily) [...] and the other with placebo. All patients underwent treatment for 6 weeks and were evaluated clinically before (baseline) and after 1, 2, 4, 6, and 8 weeks of treatment. The evaluation included the NIH Chronic Prostatitis Symptom Index (NIH-CPSI) and a subjective global assessment (SGA). Repeated measures analysis of variance was used to evaluate treatment and time effects and their interaction. A decrease (means ± SD) in total NIH-CPSI score from 23.91 ± 5.27 to 15.88 ± 2.51 in the celecoxib group and from 24.25 ± 5.09 to 19.50 ± 2.50 in the placebo group was observed during treatment (0 to 6 weeks). A statistically significant decrease was observed in pain subscore (P
A Case Study Approach to Nursing Home Placement: Smooth and Difficult Cases and Implications for Nursing.
Koplow, Sarah M; Gallo, Agatha M; Knafl, Kathleen A; Vincent, Catherine; Paun, Olimpia; Gruss, Valerie
Nursing home placement is one of the most challenging aspects of the caregiving journey. A case study approach was used to understand the experiences of caregivers during the first few months following nursing home placement. Two caregivers were selected from a larger qualitative descriptive study because their experiences exemplified smooth and difficult transitions for both themselves and their older family member. The caregivers were interviewed shortly after placement and 3 months post-placement. Four major contextual issues were identified that indicated the similarities and differences between the two cases, including (a) the caregiver's relationship with the older adult during the home caregiving time and post nursing home placement, (b) the circumstances surrounding placement, (c) support systems, and (d) continued involvement in care post-placement. Nursing home staff who understand these issues and address concerns through family-centered care can ease the transition and promote successful collaborations between staff and families. [Journal of Gerontological Nursing, 41(7), 58-64.]. PMID:25912239
[Difficult airway management using the air-Q in a patient with Klippel-Feil syndrome].
Komasawa, Nobuyasu; Miyazaki, Shinichiro; Soen, Masako; Kusunoki, Tomohiro; Tatsumi, Shinichi; Minami, Toshiaki
Patients with Klippel-Feil syndrome (KFS) frequently encounter difficult airway management due to skeletal abnormalities, including fusion of two or more vertebrae and short neck. We report successful tracheal intubation using the air-Q supraglottic airway device (air-Q). A 46-year-old woman (height, 149 cm; weight, 62 kg) with KFS was scheduled to undergo vertebral arch plasty for cervical spondylotic myelopathy. She could open her mouth sufficiently but could not tilt her head due to C1-3 fusion. Following administration of fentanyl 100 microg and propofol 120 mg, mask ventilation was achieved with jaw thrust maneuver. We then administered rocuronium 50 mg for immobilization and attempted tracheal intubation using the Pentax-AWS Airwayscope with a thin pediatric Intlock. However, we could not target the glottis, and ventilation via a size 3 i-gel or size 3.5 air-Q was unsuccessful. Using a size 2.5 air-Q, sufficient ventilation was finally achieved. We performed fiberoptic tracheal intubation through the air-Q using a tube with an internal diameter of 6.0-mm. We then exchanged the 6.0-mm tracheal tube with a 7.0-mm spiral tube using a 10 Fr tracheal tube introducer. PMID:24979859
Observational Study of Topical Imiquimod Immunotherapy in the Treatment of Difficult Lentigo Maligna
Directory of Open Access Journals (Sweden)
E.E. Craythorne
Full Text Available Lentigo Maligna (LM typically presents at sun-exposed sites in elderly patients as an asymmetric, slow-growing, irregularly pigmented macule with an irregular indented border. With changes in sun exposure behaviour LM is becoming more prevalent in middle-aged and younger adults.1The risk of melanoma developing in LM increases with duration of the disease and therefore age,2 and is difficult to quantify, estimates range from 2.2%2 to 50%3 over a lifetime, once invasive disease is established, the tumour carries the same prognosis as other types of cutaneous malignant melanoma as defined by Breslow thickness and presence of ulceration.LM presents a difficult clinical problem and generally there is little consensus on the optimum form of management. The recommended guidelines for treatment of LM are surgical excision with excision margins into clinically normal skin of 2–5 mm.4,5 Others have suggested that up to 20% of cases of LM would require margins greater than this.6 However, lesions are commonly large and located on cosmetically important head and neck sites. Excision may result in a poor cosmetic outcome and it is dif? cult to justify this approach when the risk of malignant transformation may well be low. Amelanotic lentigo maligna also remains a signi? cant problem and inevitably results in incomplete excision since clinical identi? cation of disease extent is impossible.7Non-surgical treatment options are used in 50% of U.K. patients over the age of 70, these include radiotherapy, retinoids,8 5-FU and azelaic acid. Cryotherapy, once popular, has fallen from favour because of reports of invasive melanoma occurring after cryotherapy ablation.9 Commonly a "watch and wait" policy is adopted.Imiquimod (Aldara, Meda Pharmaceuticals Ltd is a topical immune response modifier. The drug causes an increase in interferon locally and therefore may have a place in the management of superficial interferon sensitive malignancy. There are several reports of its use to treat lentigo maligna.10-12 We describe our experience with the use of imiquimod in a group of patients with LM on the head and neck where surgery was not an option.
The difficult-to-treat, therapy-resistant cough: why are current cough treatments not working and what can we do?
McGarvey, Lorcan
Cough can persist despite exhaustive diagnostic and therapeutic effort and has been termed 'idiopathic' or 'unexplained' but perhaps 'difficult to treat' cough is a more appropriate description. In this article the reasons for poor treatment response are discussed. These include a lack of physician fidelity to management guidelines, patient non-adherence and the lack of effective medicines. A number of randomized controlled trials have been undertaken including low dose opiate therapy, the use of a speech pathology intervention, oral antibiotics and antidepressants. The success or otherwise of such interventions will be discussed. A number of approaches to deal with the problem of 'difficult to treat cough' will be considered. PMID:23685213
Difficult airway in a patient with H1N1 pneumonia in intensive care unit
Directory of Open Access Journals (Sweden)
Meltem Türkay
Full Text Available The difficult airway is a frequent problem among adult patients in intensive care unit. All critical patients should initially be evaluated as a potential difficult airway cases. Development of a serious desaturation should be considered since these patients have less physiological reserve compared to those with difficult airway due to elective surgery. Development of respiratory failure with H1N1 associated pneumonia is likely and support of intubation and mechanic ventilator shall be needed. The objective of this report is to present the management of a patient with H1N1 associated pneumonia who required intubation however could not be intubated due to difficult airway. J Clin Exp Invest 2014; 5 (4: 617-619
Randomized controlled trial of the Pentax AWS, Glidescope, and Macintosh laryngoscopes in predicted difficult intubation.
LENUS (Irish Health Repository)
Malik, M A
The purpose of this study was to determine the potential for the Pentax AWS and the Glidescope to reduce the difficulty of tracheal intubation in patients at increased risk for difficult tracheal intubation, in a randomized, controlled clinical trial.
The Stanford Prison Experiment: Implications for the Care of the "Difficult" Patient.
Onishi, So L; Hebert, Randy S
Approximately 15% of patients are perceived by clinicians as "difficult." Early theories about difficult patients focused on patients' and clinicians' characteristics, often underemphasizing the influence of the environment on patients' behavior. The Stanford Prison Experiment, a classic experiment in the psychology of human behavior, provides a broader systems approach for understanding the environmental influences on patient behavior. A systems approach to the care of the difficult patient takes into consideration not only the patient's characteristics but also the health care environment and the more distal environments (ie, familial, societal, and cultural). Clinicians who are aware of the multilevel impact of these various environments on the behavior of patients are better equipped to understand, address, and hopefully even prevent difficult patient encounters. PMID:25248307
Forward movement of the lower mandible in the prediction of difficult intubation: a prospective study
Directory of Open Access Journals (Sweden)
Hussain khan Z
Full Text Available Background: Failed endotracheal intubation is one of the principal causes of morbidity and mortality in anesthetized patients. If the anesthetist can anticipate which patients may be more difficult to intubate, can reduce the risks of anesthesia greatly and be more prepared for any difficulties that may occur. The aim of this study was to investigate the inability of patients to protrude the lower jaw in predicting difficult intubation.Methods: In this prospective study, we enrolled 300 patients, above 16 years of age or older, who were scheduled for elective surgery. For all of the patients, before each operation, a single anesthesiologist measured the temporomandibular mobility, which was defined as the difference between the distances, from the lower incisors to the upper incisors in a neutral position and at maximum mandibular protrusion. At the time of intubation, another anesthesiologist, blinded to the preoperative airway assessment test, performed a laryngoscopy in which the laryngoscopic view of the larynx was determined according to the Cormack and Lehane scoring system. Difficult intubation was defined as laryngoscopic views of grade III and IV.Results: Twenty-one patients were identified as having difficult intubation. Only one patient could not be intubated. The forward movement of the mandible was significantly greater in patients with easy intubation compared to those with difficult intubation (6.42±1.95 mm vs. 3.58±1.26 mm respectively, P<0.001. The use of a cut-off point of less than 5 mm for prediction of difficult intubation showed a sensitivity of 92.86% and a specificity of 70.43%.Conclusion: The forward movement of the mandible is significantly greater in patients with easy intubation compared those with difficult intubation Although infrequent difficulties may arise, most patients that do not have indicators of difficult intubation will be easy to intubate under anesthesia.
Difficult intubation in a parturient with syringomyelia and Arnold–Chiari malformation: Use of Airtraq™ laryngoscope
Mustapha, Bensghir; Chkoura, K.; Elhassani, M.; Ahtil, R.; Azendour, H.; Kamili, N. Drissi
Anesthetic technique in parturient with syringomyelia and Arnold–Chiari malformation is variable depending on the teams. Difficult intubation is one of the risks when general anesthesia is opted. Different devices have been used to manage the difficult intubation in pregnant women. We report the use of Airtraq™ laryngoscope after failed standard laryngoscopy in a parturient with syringomyelia and Arnold–Chiari type I malformation.
New Methodologies for Development of High Efficient Machining of Difficult to Cut Materials
International Nuclear Information System (INIS)
The article focuses on the automotive and aerospace industries. In these industries the need for enhanced materials performance is necessary if they are to remain competitive in global terms. Unfortunately the material properties, which make them so attractive to the aerospace and automotive industry can also make them difficult to machine. This paper will discuss integrated developments in machining techniques and cutting tools, which are emerging to cope with difficult to cut materials.
Identification of abnormal operating conditions and intelligent decision system
Li, Xiuliang; Jiang, Junjie; Su, Hongye; Chu, Jian
In earth pressure balance (EPB) shield construction, the "plastic flow state" is difficult to form using the soil dug in the capsule because it can cause three abnormal operating conditions, including occlusion, caking in the capsule, and spewing at the outlet of the dump device. These abnormal operating conditions can, in turn, trigger failure in tunneling, cutter-device damage, and even catastrophic incidents, such as ground settlement. This present paper effectively integrates the mechanism of abnormal operating conditions and knowledge of soil conditioning, and establishes a uniform model of identifying abnormal conditions and intelligent decision support system based on the belief rule-base system. The model maximizes knowledge in improving the soil, construction experience, and data to optimize the model online. Finally, a numerical simulation with specific construction data is presented to illustrate the effectiveness of the algorithm.
Supporting clinical management of the difficult-to-treat TB cases: the ERS-WHO TB Consilium
Directory of Open Access Journals (Sweden)
Lia D'Ambrosio
The primary objective of the ERS/WHO TB Consilium is to provide clinical consultation for drug-resistant TB and other difficult-to-treat TB cases, including co-infection with HIV and paediatric cases. Through technical guidance to clinicians managing complex TB cases, the main contribution and outcome of the initiative will be a public health response aimed at achieving correct treatment of affected patients and preventing further development of drug resistance. The Consilum's secondary objective is to ensure monitoring and evaluation of clinical practices on the ground (diagnosis, treatment and prevention.
Advances in Rosetta structure prediction for difficult molecular-replacement problems
Energy Technology Data Exchange (ETDEWEB)
DiMaio, Frank, E-mail: email@example.com [University of Washington, UW Box 357350, Seattle, WA 98195 (United States)
Modeling advances using Rosetta structure prediction to aid in solving difficult molecular-replacement problems are discussed. Recent work has shown the effectiveness of structure-prediction methods in solving difficult molecular-replacement problems. The Rosetta protein structure modeling suite can aid in the solution of difficult molecular-replacement problems using templates from 15 to 25% sequence identity; Rosetta refinement guided by noisy density has consistently led to solved structures where other methods fail. In this paper, an overview of the use of Rosetta for these difficult molecular-replacement problems is provided and new modeling developments that further improve model quality are described. Several variations to the method are introduced that significantly reduce the time needed to generate a model and the sampling required to improve the starting template. The improvements are benchmarked on a set of nine difficult cases and it is shown that this improved method obtains consistently better models in less running time. Finally, strategies for best using Rosetta to solve difficult molecular-replacement problems are presented and future directions for the role of structure-prediction methods in crystallography are discussed.
Advances in Rosetta structure prediction for difficult molecular-replacement problems
International Nuclear Information System (INIS)
Modeling advances using Rosetta structure prediction to aid in solving difficult molecular-replacement problems are discussed. Recent work has shown the effectiveness of structure-prediction methods in solving difficult molecular-replacement problems. The Rosetta protein structure modeling suite can aid in the solution of difficult molecular-replacement problems using templates from 15 to 25% sequence identity; Rosetta refinement guided by noisy density has consistently led to solved structures where other methods fail. In this paper, an overview of the use of Rosetta for these difficult molecular-replacement problems is provided and new modeling developments that further improve model quality are described. Several variations to the method are introduced that significantly reduce the time needed to generate a model and the sampling required to improve the starting template. The improvements are benchmarked on a set of nine difficult cases and it is shown that this improved method obtains consistently better models in less running time. Finally, strategies for best using Rosetta to solve difficult molecular-replacement problems are presented and future directions for the role of structure-prediction methods in crystallography are discussed
Guidelines on uncomplicated urinary tract infections are difficult to follow: perceived barriers and suggested interventions
Directory of Open Access Journals (Sweden)
Zegers-van Schaick Judith M
Full Text Available Abstract Background Urinary tract infections (UTI are among the most common health problems seen in general practice. Evidence-based guidelines on UTI are available, but adherence to these guidelines varies widely among practitioners for reasons not well understood. The aim of this study was to identify the barriers to the implementation of a guideline on UTI perceived by Dutch general practitioners (GPs and to explore interventions to overcome these barriers. Methods A focus group study, including 13 GPs working in general practices in the Netherlands, was conducted. Key recommendations on diagnosis and treatment of uncomplicated UTI were selected from the guideline. Barriers to guideline adherence and possible interventions to address these barriers were discussed. The focus group session was audio-taped and transcribed verbatim. Barriers were classified according to an existing framework. Results Lack of agreement with the recommendations, unavailable and inconvenient materials (i.e. dipslides, and organisational constraints were perceived as barriers for the diagnostic recommendations. Barriers to implementing the treatment recommendations were lack of applicability and organisational constraints related to the availability of drugs in pharmacies. Suggested interventions were to provide small group education to GPs and practice staff members, to improve organisation and coordination of care in out of hour services, to improve the availability of preferred dosages of drugs, and to pilot-test guidelines regionally. Conclusions Despite sufficient knowledge of the recommendations on UTI, attitudinal and external barriers made it difficult to follow them in practice. The care concerning UTI could be optimized if these barriers are adequately addressed in implementation strategies. The feasibility and success of these strategies could be improved by involving the target group of the guideline in selecting useful interventions to address the barriers to implementation.
... or her orthopaedic surgeon. Purpose of Program _________________________________________________________________ Hip Conditioning Program After an injury or surgery, an exercise ... Target Muscles: The muscle groups targeted in this conditioning program include: • Gluteus maximus (buttocks) • Gluteus medius (buttocks) • ...
... should consult his or her orthopaedic surgeon. Spine Conditioning Program Purpose of Program _________________________________________________________________ After an injury or ... Target Muscles: The muscle groups targeted in this conditioning program include: • Cervical spine (neck) • Trapezius (neck and ...
... bones, joints, and muscles www.orthoinfo.org Knee Conditioning Program Purpose of Program _________________________________________________________________ After an injury or ... Target Muscles: The muscle groups targeted in this conditioning program include: • Quadriceps (front of the thigh) • Hamstrings ( ...
Colecistectomía laparoscópica difícil, estrategias de manejo / Difficult laparoscopic cholecystectomy, management strategies
Scientific Electronic Library Online (English)
Luis Fernando, Álvarez; Diego, Rivera; Miguel Evaristo, Esmeral; Marta Cecilia, García; Diego Fernando, Toro; Olga Lucía, Rojas.
Full Text Available La colecistectomía laparoscópica es uno de los procedimientos quirúrgicos practicados más frecuentemente por el cirujano general y en un importante número de casos se efectúa en pacientes mayores con gran inflamación vesicular, lo que pone a prueba los conocimientos y habilidades del cirujano. Es pe [...] rfectamente posible reconocer, antes del acto quirúrgico, en cuáles pacientes este resultará difícil en mayor o menor grado, para así diseńar estrategias de manejo intraoperatorio que nos permitan resolver favorablemente estos casos. En este artículo, el cual se presenta acompańado de videos de casos clínicos publicados en la página electrónica de la Asociación Colombiana de Cirugía (http://www.ascolcirugia.org), se pretende mostrar cuáles son las opciones de manejo en aquellos pacientes cuyas colecistectomías son muy difíciles por el grado de inflamación o por las enfermedades subyacentes y que constituyen alternativas de manejo viables para la colecistectomía laparoscópica clásica o para evitar la conversión a cirugía abierta; aunque también, se llama fuertemente la atención sobre la necesidad de una conversión temprana y oportuna antes de tener complicaciones o alteraciones iatrogénicas de la vía biliar u otro órgano vecino. Abstract in english Laparoscopic cholecystectomy is one of the most commonly performed procedures by the general surgeon and an important number of cases occur in elderly patients with major inflammation of the gallbladder, a condition that challenges the knowledge and ability of the surgeon. It is perfectible possible [...] to recognize, prior to surgery, which patients will present major or minor difficulties so as to design intraoperative strategies in order to favorably resolve such situations. This article is complemented wit uploaded YouTube videos in the web page of the Asociación Colombiana de Cirugía, http://www.ascolcirugia.org. It intends to show the different management options in those patients with very difficult cholecystectomies because of the degree of inflammation or the underlying pathology that constitute viable alternatives to the classic laparoscopic cholecystectomy or to avoid conversion open surgery; however, it also strongly calls attention to the need of early and timely conversion so as to avoid complications or iatrogenic lesion of the bile duct or neighbor organs.
Febre de etiologia indeterminada: encruzilhada de diagnósticos / Fever of unknown origin: a difficult diagnostic problem
Scientific Electronic Library Online (English)
Manuel, Oliveira; Carla, Meireles; Patrícia, Costa; Margarida, Guedes; Ana Luísa, Lobo.
Full Text Available Introduçăo: Os principais diagnósticos a considerar numa febre de etiologia indeterminada incluem as causas infecciosas, reumatológicas, imunológicas e neoplásicas. Caso clínico: Apresentamos o caso de uma criança de quatro anos do sexo masculino, observada por febre, cervicalgia e claudicaçăo da ma [...] rcha. Detectou-se anemia e marcadores inflamatórios elevados. No internamento foi-se evidenciando palidez, exantema maculo-papular em pico febril e adenomegalias cervicais. A avaliaçăo por Cardiologia evidenciou ectasia coronária, tendo iniciado imunoglobulina intravenosa (IGIV) por suspeita de Doença de Kawasaki atípica (DKa). Por persistęncia da febre invocou-se o diagnóstico mais provável de Artrite Idiopática Juvenil sistémica (AIJs). Discussăo: Após a exclusăo de outras causas, o diagnóstico diferencial entre DKa e AIJs é difícil pela inespecificidade dos achados. A suspeita de DKa, justifica a terapęutica com IGIV, mas a refractariedade a esta năo a exclui (10% de casos refractários). Por outro lado, está descrita a presença de dilataçőes coronárias em contexto de quadro inflamatório sistémico, tornando este achado sugestivo mas năo patognomónico de Doença de Kawasaki. Abstract in english Background: The most common causes of fever of unknown origin are infectious diseases, rheumatologic or immunologic diseases, and malignancies. Case report: The case of a four years old male child with fever, neck pain and limping gait is presented. He was anemic and had elevated inflammatory marker [...] s. He developed gradual pallor, maculopapular rash appearing with fever peaks, and cervical lymphadenopathy. Echocardiographic documentation of coronary artery ectasia, lead to intravenous immunoglobulin (IVIG) therapy for suspected atypical Kawasaki disease (aKD). The most probable diagnosis of systemic-onset Juvenile Idiopathic Arthritis (sJIA) was made after fever maintenance. Discussion: It is difficult to differentiate between aKD and sJIA because there are no specific findings. The suspicion of aKD should lead to IVIG therapy, but failure to respond is not an exclusion criterion (10% of patients are refractory cases). Systemic inflammatory disorders, like sJIA, may be associated with coronary artery dilation. This finding supports a diagnosis of aKD but is not specific for the condition.
A no-go related prefrontal negativity larger to irrelevant stimuli that are difficult to suppress
Directory of Open Access Journals (Sweden)
Crotti Nicola
Full Text Available Abstract Background There is a wide debate in the literature about whether N2/P3 effects in no-go trials reflect the inhibition of an intended action, or the absence of a negative movement-related potential typical of go trials. The aim of this study was to provide an objective measure of the suppression of irrelevant information (in a conjoined selective visual attention task under conditions that were perfectly comparable from the viewpoint of the motoric processes involved. Methods Twenty-nine right-handed students took part in the study. Their EEGs were recorded from 128 scalp sites while they viewed gratings of four different spatial frequencies (from 0.75 to 6 c/deg randomly flashed in the four upper and lower quadrants of the visual field. The tasks consisted of attending and responding to a conjunction of spatial frequency and space location. Intermediate frequencies (1.5 and 3 c/deg acted as distracters or lures. Analysis of the ERPs elicited by the same physical stimulus, close in spatial frequency to the actual target and falling within the attended quadrant (pseudo-target vs. a non-target location, allowed us to identify the time course and neural bases of brain activation during the suppression of irrelevant information. Results FAs were on average 9% for pseudo-targets and 0.2% for other types of lures, indicating that the former were more difficult to suppress. Target-related ERP components (occipito/temporal selection negativity, posterior P3b and precentral motor N2 were greater to pseudo-targets than other distracters. A large prefrontal negativity (370–430 ms was also identified, much larger to pseudo-targets than non-targets (and absent in response to real targets, thus reflecting response inhibition and top-down cognitive control processes. Conclusion A LORETA inverse solution identified the neural generators of this effect in the left dorsolateral prefrontal cortex (DLPF, left and right fusiform gyri and bilateral superior temporal cortices. The tentative hypothesis is advanced that these activations might reflect the modulatory effects exerted by the fronto/temporal circuit for the suppression of irrelevant information.
Musculoskeletal ultrasound including definitions for ultrasonographic pathology
DEFF Research Database (Denmark)
Wakefield, RJ; Balint, PV
Ultrasound (US) has great potential as an outcome in rheumatoid arthritis trials for detecting bone erosions, synovitis, tendon disease, and enthesopathy. It has a number of distinct advantages over magnetic resonance imaging, including good patient tolerability and ability to scan multiple joints in a short period of time. However, there are scarce data regarding its validity, reproducibility, and responsiveness to change, making interpretation and comparison of studies difficult. In particular, there are limited data describing standardized scanning methodology and standardized definitions of US pathologies. This article presents the first report from the OMERACT ultrasound special interest group, which has compared US against the criteria of the OMERACT filter. Also proposed for the first time are consensus US definitions for common pathological lesions seen in patients with inflammatory arthritis.
[Difficult conversations in medicine: an experiential, optional course with medical students].
Leone, Daniela; Moja, Egidio Aldo; Vegni, Elena
A 24 hrs optional course was realized with 15 students at the Medical School of Milan, with the aim of undertaking the management of the emotional aspects in a difficult communication in medicine. The course was realized through the use of active teaching tools; issues resulted from what literature consider as "difficult communication". Photolangage was used as pre-post test to assess the effects of the course; a satisfaction questionnaire was also used. From the content analysis of the data the course resulted effective both for the students' satisfaction and for the enhancing of their self reflective skills. PMID:19040126
Making difficult decisions how to be decisive and get the business done
Shaw, Peter J A
You are faced with so many difficult decisions. Often your decision making seems random. It can be swayed by different situations and emotions. You need to be more rigorous in the way you make decisions and yet you have very little time to do so. Experience from others who have made tough decisions and a framework to help you do so would be invaluable.The courage to make decisions is sometimes a bit elusive. It is difficult to find the calmness to be able to make and live with those decisions. There is so much that can be learned from the experience of others. After working through this book y
Lymphocytic colitis presenting as difficult diarrhoea in an African woman: a case report and review of the literature
Directory of Open Access Journals (Sweden)
Otegbayo Jesse A
Full Text Available Abstract Introduction Lymphocytic colitis is an uncommon intestinal disorder that presents with chronic diarrhoea. It is treatable, but in the developing world, its diagnosis may often prove difficult. Data and reports of this condition in Africa are scarce because most medical centres lack a functional gastrointestinal endoscopy unit that would aid in the diagnosis. Case presentation We present the case of a 53-year-old Nigerian woman with pathogen-negative chronic diarrhoea and a family history of chronic diarrhoea. She responded well to treatment after colonoscopy and colonic biopsy successfully diagnosed her illness. Conclusion Referral of patients with pathogen-negative chronic diarrhoea to medical centres that have facilities for colonoscopy and biopsy is important in the developing world.
Identificación de factores predictores de técnica epidural dificultosa en la paciente obstétrica / Identifying predictors of difficult epidural technique in pregnant
Scientific Electronic Library Online (English)
L. M., Charco Roca; V. E., Ortiz Sánchez; P., Cuesta Montero; A., Soria Quiles; L., Bonmati García.
Full Text Available Introducción: Los intentos repetidos de punción son factores de riesgo para la aparición de complicaciones neurológicas secundarias a la práctica de la analgesia espinal y aumentan la ansiedad del paciente. El objetivo de este estudio es determinar qué factores son mejores predictores de la colocaci [...] ón dificultosa del catéter epidural en la paciente obstétrica. Material y método: Estudio observacional y prospectivo en 120 gestantes a término que solicitan la analgesia epidural para el trabajo de parto. Se recogen variables demográficas y antecedentes de anestesia espinal previa no exitosa o considerada dificultosa por la paciente. Se identifican variables anatómicas y se clasifica la calidad de los puntos de referencia anatómicos según los criterios publicados por Chien en cuatro grados. Las condiciones de la técnica y la experiencia del anestesiólogo son similares en todos casos. Consideramos punción dificultosa si se necesita más de una punción en la piel o una punción pero más de un cambio de dirección de aguja en el espacio interespinoso. Se recoge el éxito obtenido y las complicaciones de la técnica. Resultados: Fueron calificadas de punción difícil según los criterios del estudio en el 36,67 % de los casos. En la mayoría de los casos la técnica fue efectiva obteniendo una adecuada analgesia. La incidencia de repunción epidural fue de 5 %. En las pacientes clasificadas en el grado 4, la tasa de punción epidural considerada dificultosa supuso un 90 %, necesitando en el 80 % de esos casos 3 o más intentos. En las pacientes con antecedentes personales de técnica neuroaxial dificultosa se encontró dificultad de punción epidural en un 28,57 % de los casos. El hábito corporal no tuvo efecto significativo sobre la tasa de éxito con el primer intento. Discusión: Nuestro estudio representa una buena estimación de la dificultad técnica de un bloqueo neuroaxial. Seria difícil saber si los datos reflejados serían extrapolables a la realización de la técnica en decúbito lateral, donde los puntos de referencia anatómicos son más difíciles de identificar. Conclusiones: Nuestra recogida concluye que el método más fiable para determinar de antemano la posibilidad de una dificultad técnica de colocación del catéter epidural lumbar es un examen de la espalda de la paciente para identificar la calidad de los puntos de referencia anatómicos e identificar la deformidad obvia de la columna vertebral. Abstract in english Introduction: Repeated attempts punctureare risk factors for the appearance of neurologic complications caused by the practice of spinal analgesia and increase patient anxiety. The purpose of this study is to determine which factor sare better predictors of difficult epidural catheter placement in t [...] he obstetric patient. Material and methods: Prospective observational study in 120 pregnant women at term who request edepidural analgesia during labor. Demographic variables and history of difficult or unsuccessful spinal anesthesia were collected. Anatomical variables were identified and the quality of anatomical landmarks was classified according to criteria published by Chien in four grades. The conditions of the technique and the experience of anesthesiologists were similar in all cases. It was considered as difficult puncture that in which was made more than one attempt on skin or more than one change of direction with the epidural needle in interspinous space. We collected the successand complications of the technique. Results: 36.67 % of cases were classified as difficult punctures according to the criteria of the study. In most cases the technique was effective obtaining asuccessful analgesia. The incidence of repeat epidural puncture was 5 %. In patients classified in grade 4, the percentage of difficult epidural puncture was 90 %, requiring in 80 % of the cases 3 or more attempts. In patients with a history of difficult neuraxial technique in 28.57 % of the cases was found difficulty in epidural puncture. Body habitus had no signif
Directory of Open Access Journals (Sweden)
A. Lesco
Full Text Available This paper present an analysis made on 1210 cases of laparoscopic cholecystectomies (LC. From these, 88 patients had associated pathology. The age of the patients was 11 – 82 yo. The indication for LC was large. In the study group (88 cases, the Acid-Base Balance (ABB, blood gasses, blood pressure, the central venous pressure (CVP, intra-cranial pressure (ICP, inspiratory resistance, temperature changes and also peritoneal biopsy were analysed. Methods: The multilateral study clinic-instrumental examinations of associate pathology in preoperative period were determined. Determination of the risk group and patients for LC has been allowed. Results: The CO2 pneumoperitoneum (PP (7-12 mmHg determines changes of the: 1 ABB (intra operator blood pH was 7.37 before and 7.25 after the procedure; 2 partial carbon dioxide (before 40, after 47; 3 blood pressure; 4 mean CVP (before operation - 6.67±0.17 and 10.73±0.29 after procedure (p<0.01; 5 ICP (8.65±0.19 mm, p<0.01; 6 inspiratory resistance; 7 temperature changes (due to the CO2 temperature. The conversion rate was (0,41%: complicated acute cholecystites (1, dense multiple adhesions (1, the incidence of significant hemorrhage (2, bile duct injury (1. The postoperative mortality were 0,33% (4 cases due to pulmonary artery tromboemboly. Billiary lesions during LC occur with a frequency of 0,41% (5 patients: four bile duct injuries and leaks and one case – right billiary accessory duct, were solved following another operation three days after the initial procedure. Wound infection was more frequently, occurring in 21 cases (1,74%. The other complications (14 cases include: subcutaneous emphysema and insufflations of the pro-peritoneal space, omentum, or mesentery. Conclusions: LC is a safety technique even in the patients with associated pathology, but the morbidity and mortality are high. No presumed ductal or vascular structure should be divided until its anatomical features have been completely demonstrated. If the ductal and vascular structures are so obscured by dense inflammation then the procedure should be converted to an open laparotomy. Intra-operative cholangiography will supply the surgeon with accurate details concerning the juncture of the cystic and common bile ducts. To avoid intra-operative bleeding during emergency cholecystectomy it is important to carefully dissect and identify both branches of the cystic artery as well as the main trunk before any suspected vascular structures are divided. Often the most difficult sources of bleeding to avoid in patients with acute cholecystitis is bleeding from the gallbladder fossa.
A Hindrance to Communication: The Use of Difficult and Incomprehensible Language.
Janicki, Karol
Reports on three empirical studies carried out within the theoretical framework of folk linguistics, using questionnaire data. Examines the layperson's reactions to the use of difficult and incomprehensible language. Subjects from Germany, Norway, Poland, and the United States were asked which professional language groups exhibit the use of…
Cutting Costs, Keeping Quality: Financing Strategies for Youth-Serving Organizations in a Difficult Economy
Keller, Eric
This research brief highlights three effective financing strategies that successful youth-serving organizations are using to maintain quality services despite difficult economic times. The brief provides examples of how organizations have implemented these strategies and offers tips to help leaders consider how best to adapt these strategies to…
Three clinical problems: weird thyroid function tests, difficult gout, and dementia.
Fry, Andrew; Vanderpump, Mark; Doherty, Michael; Kennedy, Angus; Firth, John
Speakers at the course were given vignettes describing one or more clinical scenarios on which to base their talks, selected because they represent common but challenging problems likely to be encountered by any physician practising in general internal medicine. Three of the subjects covered--weird thyroid function tests, difficult gout, and dementia--are presented here. PMID:16138497
Difficult-to-control asthma management through the use of a specific protocol
Scientific Electronic Library Online (English)
Pedro, Giavina-Bianchi; Marcelo Vivolo, Aun; Carla, Bisaccioni; Rosana, Agondi; Jorge, Kalil.
Full Text Available The present study is a critical review of difficult-to-control asthma, highlighting the characteristics and severity of the disease. It also presents a protocol for the management of patients with this asthma phenotype. The protocol, which was based on relevant studies in the literature, is describe [...] d and analyzed.
Complete elimination is a difficult goal for trachoma programs in severely affected communities.
Gill, Deborah A; Lakew, Takele; Alemayehu, Wondu; Melese, Muluken; Zhou, Zhaoxia; House, Jenafir I; Hong, Kevin C; Ray, Kathryn J; Gandhi, Nandini; Whitcher, John P; Gaynor, Bruce D; Lietman, Thomas M
The World Health Organization has distributed millions of doses of azithromycin to control the ocular chlamydial infection that causes trachoma. Theoretically, a loftier goal of elimination is feasible. Here, we demonstrate that, although local elimination of infection in the most severely affected communities is difficult, it is possible with biannual antibiotic distributions. PMID:18194094
Sakharov and the Grey Zone: Difficult Areas of Human Rights Activity
Orlov, Yuri
Drawing on my experience in human rights work and my discussions with A. D. Sakharov, I will explore some difficult areas of human rights activity in which human rights defenders cannot reach a consensus on how to proceed, and even on how to define the problem.
History Museums and Social Cohesion: Building Identity, Bridging Communities, and Addressing Difficult Issues
Rosenberg, Tracy Jean
Museums have the capacity to enhance social cohesion, which is the product of a trusting, connected community. History museums and historic sites, in particular, can serve communities by stimulating dialogue on difficult issues, accurately representing all the people of a nation, and creating forums for discussion among groups with disparate…
Incremental Learning of Difficult Words in Story Contexts: The Role of Spelling and Pronouncing New Vocabulary
Vadasy, Patricia F.; Sanders, Elizabeth A.
In this exploratory study the researchers examined examine the value of exposure to the spelling and pronunciation of word forms when introducing the meanings of new and difficult vocabulary words. Researchers randomly assigned kindergarten English learners to one of two types of storybook reading delivered by tutors. Students received individual…
Unusual Urethral Metastasis from Colon Carcinoma Presenting with Difficult Urination and Hematuria
Karakose, Ayhan; Aydogdu, Ozgu; Atesci, Yusuf Z.
Urethral metastases originating from the colon are extremely rare. We report a case of a 67-year-old man who presented with difficult urination and hematuria. Diagnostic cystoscopy showed an abnormal, exophytic lesion in his proximal penile urethra a bulbar urethra. His pathology was diagnosed as adenocarcinoma consistent with colon metastasis.
How to Handle Difficult Parents: Proven Solutions for Teachers. Second Edition
Tingley, Suzanne Capek
"How to Handle Difficult Parents" is a funny, but practical, guide to working effectively with parents and avoiding unnecessary conflict. Whether you're a teacher (regular or special education) or a coach, this book will give you practical suggestions regarding what to say and how to say it to parents who question your lesson plans, challenge your…
2010 ASCO Annual Meeting: progress in difficult-to-treat cancers
Directory of Open Access Journals (Sweden)
Günther J Wiedemann
Full Text Available The 46th Annual Meeting of the American Society of Clinical Oncology took place in June 2010 in Chicago, USA. More than 30,000 specialists discussed the latest innovations in research, quality, practice and technology in cancer. Here we highlight the most significant advances in difficult-to-treat cancers [2].
Mrs. Palacios, Miss Miller, Mr. Rowser
!!Classical Conditioning!! Classical conditioning is the use of Pavlovian conditioning procedures where a neutral stimulus becomes capable of evoking a response through pairing with an unconditioned stimulus. Click the link below to get an introduction into classical conditioning. Introduction to Classical Conditioning Now that you\\'ve been introduced to classical conditioning, view the clip at the link below, ...
Determination of difficult concepts in the interpretation of musculoskeletal radiographs using a web-based learning/teaching tool
Energy Technology Data Exchange (ETDEWEB)
Nunn, Heidi, E-mail: email@example.com [Norfolk and Norwich University Hospital NHS Foundation Trust, Colney Lane, Norwich, Norfolk NR4 7UY (United Kingdom); Nunn, David L. [Norfolk and Norwich University Hospital NHS Foundation Trust, Colney Lane, Norwich, Norfolk NR4 7UY (United Kingdom)
Aim: To identify which aspects of musculoskeletal radiograph image interpretation users of a web-based learning resource found to be most difficult. Method: The resource provides modular online training, based on twelve musculoskeletal anatomical and pathological areas. At the end of each module is a multiple choice self-test, which users can utilize to consolidate their learning. There are 217 questions within the tests. The results for all questions answered on or before 1st February 2011 were analyzed, and the lowest scoring 25% of questions subsequently reviewed. A low-scoring question implies that the subject was difficult. Results: Users provided a total of 117,097 answers. The range of scores provided by the test questions varied significantly (P < 0.0001), from 15.8% to 93.8%. Topics appearing in the lowest quartile were analyzed in detail. They included interpretation of paediatric radiographs, the Salter-Harris classification, soft-tissue signs and the identification of multiple injuries. The lowest scoring modules were the shoulder and ankle. Conclusion: The results of this study will help to guide educators both within radiography and other health professions in providing more targeted teaching in musculoskeletal image interpretation.
Determination of difficult concepts in the interpretation of musculoskeletal radiographs using a web-based learning/teaching tool
International Nuclear Information System (INIS)
Aim: To identify which aspects of musculoskeletal radiograph image interpretation users of a web-based learning resource found to be most difficult. Method: The resource provides modular online training, based on twelve musculoskeletal anatomical and pathological areas. At the end of each module is a multiple choice self-test, which users can utilize to consolidate their learning. There are 217 questions within the tests. The results for all questions answered on or before 1st February 2011 were analyzed, and the lowest scoring 25% of questions subsequently reviewed. A low-scoring question implies that the subject was difficult. Results: Users provided a total of 117,097 answers. The range of scores provided by the test questions varied significantly (P < 0.0001), from 15.8% to 93.8%. Topics appearing in the lowest quartile were analyzed in detail. They included interpretation of paediatric radiographs, the Salter-Harris classification, soft-tissue signs and the identification of multiple injuries. The lowest scoring modules were the shoulder and ankle. Conclusion: The results of this study will help to guide educators both within radiography and other health professions in providing more targeted teaching in musculoskeletal image interpretation.
Endoscopic papillary balloon dilation after sphincterotomy for difficult choledocholithiasis: A case-controlled study
Directory of Open Access Journals (Sweden)
Bruno Rosa
Full Text Available AIM: To evaluate the efficacy and safety of endoscopic sphincterotomy (EST + endoscopic papillary large balloon dilation (EPLBD vs isolated EST. METHODS: We conducted a retrospective single center study over two years, from February 2010 to January 2012. Patients with large (? 10 mm, single or multiple bile duct stones (BDS, submitted to endoscopic retrograde cholangio-pancreatography (ERCP were included. Patients in Group A underwent papillary large balloon dilation after limited sphincterotomy (EST+EPLBD, using a through-the-scope balloon catheter gradually inflated to 12-18 mm according to the size of the largest stone and the maximal diameter of the distal bile duct on the cholangiogram. Patients in Group B (control group underwent isolated sphincterotomy. Stones were removed using a retrieval balloon catheter and/or a dormia basket. When necessary, mechanical lithotripsy was performed. Complete clearance of the bile duct was documented with a balloon catheter cholangiogram at the end of the procedure. In case of residual lithiasis, a double pigtail plastic stent was placed and a second ERCP was planned within 4-6 wk. Some patients were sent for extracorporeal lithotripsy prior to subsequent ERCP. Outcomes of EST+EPLBD (Group A vs isolated EST (Group B were compared regarding efficacy (complete stone clearance, number of therapeutic sessions, mechanical and/or extracorporeal lithotripsy, biliary stent placement and safety (frequency, type and grade of complications. Statistical analysis was performed using ?2 or Fisher's exact tests for the analysis of categorical parameters and Student's t test for continuous variables. A P-value of less than 0.05 was considered statistically significant. RESULTS: One hundred and eleven patients were included, 68 (61.3% in Group A and 43 (38.7% in Group B. The mean diameter of the stones was similar in the two groups (16.8 ± 4.4 and 16.0 ± 6.7 in Groups A and B, respectively. Forty-eight (70.6% patients in Group A and 21 (48.8% in Group B had multiple BDS (P = 0.005. Overall, balloon dilation was performed up to 12 mm in 10 (14.7% patients, 13.5 mm in 17 (25.0%, 15 mm in 33 (48.6%, 16.5 mm in 2 (2.9% and 18 mm in 6 (8.8% patients, taking into account the diameter of the largest stone and that of the bile duct. Complete stone clearance was achieved in sixty-five (95.6% patients in Group A vs 30 (69.8% patients in Group B, and was attained within the first therapeutic session in 82.4% of patients in Group A vs 44.2% in Group B (P < 0.001. Patients submitted to EST+EPLBD underwent fewer therapeutic sessions (1.1 ± 0.3 vs 1.8 ± 1.1, P < 0.001, and fewer required mechanical (14.7% vs 37.2%, P = 0.007 or extracorporeal (0 vs 18.6%, P < 0.001 lithotripsy, as well as biliary stenting (17.6% vs 60.5%, P < 0.001. The rate of complications was not significantly different between the two groups. CONCLUSION: EST+EPLBD is a safe and effective technique for treatment of difficult BDS, leading to high rates of complete stone clearance and reducing the need for lithotripsy and biliary stenting.
Towards a unified model of pavlovian conditioning: short review of trace conditioning models
Kryukov, V. I.
There are three basic paradigms of classical conditioning: delay, trace and context conditioning where presentation of a conditioned stimulus (CS) or a context typically predicts an unconditioned stimulus (US). In delay conditioning CS and US normally coterminate, whereas in trace conditioning an interval of time exists between CS termination and US onset. The modeling of trace conditioning is a rather difficult computational problem and is a challenge to the behavior and connectionist approa...
Test conditions greatly influence permeation of water soluble molecules through the intestinal mucosa: need for standardisation.
Peeters, M.; Hiele, M.; Ghoos, Y.; Huysmans, V.; Geboes, K.; Vantrappen, G.; Rutgeerts, P.
Permeability tests are widely used to investigate the pathogenesis of various gastrointestinal diseases including coeliac disease, infectious diarrhoea, and inflammatory bowel disease. In Crohn's disease they are used as activity parameters by some investigators. Lack of standardisation, however, makes it very difficult to compare data reported in different studies. The aim of this study was to gather permeation data in well controlled test conditions to standardise the methods. Nine healthy ...
Prophylactic percutaneous transtracheal catheterisation in the management of patients with anticipated difficult airways: a case series.
Gerig, H J; Schnider, T; Heidegger, T
Primary tracheostomy under local anaesthesia is indicated in the management of an anticipated difficult airway in patients in whom less invasive procedures are expected to fail or have already failed. However, primary tracheostomy is a relatively complex procedure and places not inconsiderable stress on the patient. In a prospective study in our hospital over a period of 22 months, we were able to avoid primary tracheostomy in 11 patients with very difficult airways. All 11 patients were managed with prophylactically inserted transtracheal catheters and jet ventilation of the lungs. This ensured an adequate oxygen supply during tracheal intubation, and made overall patient management much easier. This method has established itself as a standard procedure in our hospital. PMID:16029230
Directed Forgetting of Negative Self-Referential Information Is Difficult: An fMRI Study
Yang, Wenjing; Liu, Peiduo; Cui, Qian; Wei, Dongtao; Li, Wenfu; Qiu, Jiang; Zhang, Qinglin
A large body of evidence suggested that both emotion and self-referential processing can enhance memory. However, it remains unclear how these two factors influence directed forgetting. This study speculates that directed forgetting of negative self-referential memory is more difficult than forgetting of other-referential memory. To verify this speculation, we combined the directed forgetting paradigm with the self-reference task. The behavioral result suggested that although both self-refere...
Double guidewire technique vs transpancreatic precut sphincterotomy in difficult biliary cannulation
Young Wook Yoo; Sang-Woo Cha; Woong Cheul Lee; Sae Hee Kim; Anna Kim; Young Deok Cho
AIM: To compare the outcomes between double-guidewire technique (DGT) and transpancreatic precut sphincterotomy (TPS) in patients with difficult biliary cannulation. METHODS: This was a prospective, randomized study conducted in single tertiary referral hospital in Korea. Between January 2005 and September 2010. A total of 71 patients, who bile duct cannulation was not possible and selective pancreatic duct cannulation was achieved, were randomized into DGT (n = 34) and TPS (n = 37) groups. D...
Evaluation of the Pentax-AWS(®) and the Macintosh laryngoscope in difficult intubation: a manikin study.
Kariya, T.; Inagawa, G.; Nakamura, K.; Fujimoto, J.; Aoi, Y.; Morita, S.; Goto, T.
BACKGROUND: The Pentax-AWS (AWS(®)), a new video laryngoscope, has been shown to be useful in cases of difficult intubation. We hypothesized that the AWS(®) would be more useful in the settings of a narrow upper airway than the Macintosh laryngoscope. We compared each device in simulated scenarios of representative difficulty of tracheal intubation using a manikin. The primary endpoint was the rate of successful intubation. METHODS: With each device, 23 anesthesiologists performed tracheal ...
Analysis of residual stresses induced by dry turning of difficult-to-machine materials
Outeiro, J. C.; Pina, J. C.; Saoubi, R. M.; Pusavec, F.; Jawahir, I. S.
Critical issues in machining of difficult-to-cut materials are often associated with short tool-life and poor surface integrity, where the resulting tensile residual stresses on the machined surface significantly affect the component's fatigue life. This study presents the influence of cutting process parameters on machining performance and surface integrity generated during dry turning of Inconel 718 and austenitic stainless steel AISI 316L with coated and uncoated carbide tools. A three-dim...
Machining of Some Difficult-to-Cut Materials with Rotary Cutting Tools
Stjernstoft, Tero
Automobile and aero industries have an increasing interestin materials with improved mechanical properties. However, manyof these new materials are classified as difficult-to-cut withconventional tools. It is obvious that tools, cutting processesand cutting models has to be devel-oped parallel to materialsscience. In this thesis rotary cutting tools are tested as analternative toexpensive diamond or cubic bore nitridetools. Metal matrix composites mostly consist of a light metalalloy (such as...
The Bonds and Burdens of Family Life: Using Narrative Analysis to Understand Difficult Relationships
Mary Breheny; Christine Stephens
Attempts to understand difficult family relationships have ignored the inextricable links between positive and negative relationships. Narrative analysis provides insight into complex relationships within social context. We analysed interviews with older people in New Zealand using levels of narrativity to reveal the negotiations required to manage personal identity at the intersection of competing public narratives. Participants and interviewers used public narratives of family life that rei...
On the Improvement of Multi-Legged Locomotion over Difficult Terrains using a Balance Stabilization Method
Javaid Iqbal; Umar Asif
This paper deals with the real?time walking of a multi-legged robot over difficult terrains using a balance stabilization method in order to achieve a fast speed and robust locomotion with minimal tracking errors. The stabilization method is described through a ZMP?based online pattern?generation scheme inspired by bio?mimetic stepping leg transferences with an active balance control so as to reduce the propagation of instability while performing rapid stepping actions for a fast walk...
The intubation scoop (i-scoop) - a new type of laryngoscope for difficult and normal airways.
Raymondos, K; Seidel, T; Sander, B; Gerdes, A; Goetz, F; Helmstädter, V; Panning, B; Dieck, T
The i-scoop is an intubation device with a curved guiding bar with laterally located lenses at its tip, rather than a blade. Twenty-five anaesthesiologists intubated a manikin that simulated first a normal and then a difficult airway. All participants were able to intubate the difficult airway with a good view of the glottis using the i-scoop. None was able to intubate using seven other laryngoscopes (Macintosh laryngoscope, GlideScope(®) GVL and AVL, McGrath(®) (Series 5/MAC), C-MAC(®) , A.P. Advance(™) ). Intubation was successful only with the Airtraq(®) (n = 10), the Airway Scope (n = 5), the C-MAC D-Blade (n = 2), the A.P. Advance DAB (n = 1) and the GlideScope DL Trainer (n = 1) (p < 0.001, success rate of i-scoop vs all 12 laryngoscopes combined). In contrast to all other videolaryngoscopes, intubation of the normal airway with the i-scoop was achieved even faster than with the Macintosh laryngoscope (p < 0.02). The i-scoop outperformed all other laryngoscopes in both difficult and normal airways, and therefore has potential as an easier and safer alternative to present devices. PMID:24894025
Detailed statistical analysis plan for the difficult airway management (DIFFICAIR) trial
DEFF Research Database (Denmark)
NŘrskov, Anders Kehlet; LundstrŘm, Lars Hyldborg
BACKGROUND: Preoperative airway assessment in Denmark is based on a non-specific clinical assessment left to the discretion of the responsible anesthesiologist. The DIFFICAIR trial compares the effect of using a systematic and consistent airway assessment versus a non-specific clinical assessment on the frequency of unanticipated difficult airway management.To prevent outcome bias and selective reporting, we hereby present a detailed statistical analysis plan as an amendment (update) to the previously published protocol for the DIFFICAIR trial. METHOD/DESIGN: The DIFFICAIR trial is a stratified, parallel group, cluster (cluster?=?department) randomized multicenter trial involving 28 departments of anesthesia in Denmark randomized to airway assessment either by the Simplified Airway Risk Index (SARI) or by a usual non-specific assessment. Data from patients' preoperative airway assessment are registered in the Danish Anesthesia Database. An objective score for intubation grading the severity, that is the severity of the intubations, as well as the frequency of unanticipated difficult intubation, is measured for each group.Primary outcome measures are the fraction of unanticipated difficult and easy intubations.The database is programmed so that the registration of the SARI is mandatory for the intervention group but invisible to controls.Data recruitment was commenced in October 2012 and ended in ultimo December 2013. CONCLUSION: We intend to increase the transparency of the data analyses regarding the DIFFICAIR trial by an a priori publication of a statistical analysis plan. TRIAL REGISTRATION: ClinicalTrials.gov: NCT01718561.
Notícias difíceis e o posicionamento dos oncopediatras: revisăo bibliográfica / Difficult news and the standpoint of pediatric oncologists: a bibliographical review
Scientific Electronic Library Online (English)
Selene Beviláqua Chaves, Afonso; Maria Cecília de Souza, Minayo.
Full Text Available Com objetivo de discutir e compreender as experięncias de oncopediatras diante da tarefa de comunicar notícias difíceis (ND) a pacientes e familiares procedeu-se uma revisăo bibliográfica a partir das bases de dados da Biblioteca Virtual em Saúde (BVS) que contém artigos divulgados por PubMed, Lilac [...] s, Scielo, Scopus e SciVerse, buscando a produçăo sobre o tema. Os artigos disponíveis, avaliados pela análise temática, evidenciam as seguintes questőes: caręncia de estudos focando a percepçăo dos profissionais sobre as notícias difíceis; a comunicaçăo como estratégia pela qual, aspectos psicossociais, culturais, bioéticos, legais e emocionais săo tratados; expectativa de habilidades médicas para as quais esses profissionais năo foram treinados. Observou-se também que informaçőes e treinamento dos profissionais sobre estratégias a cerca dos modos de lidar com a comunicaçăo de ND săo insuficientes para acompanhar o dinamismo das ocorręncias e das relaçőes pessoais na área de oncologia onde o paciente costuma estar ou sentir-se em constante ameaça de vida. Abstract in english In order to discuss and understand the experiences of oncologists faced with the task of communicating difficult news to children and their close family members, a bibliographical review was conducted in the Virtual Health Library databases containing the literature published by PubMed, Lilacs, Scie [...] lo, Scopus and SciVerse with input on the theme. The articles available evaluated by thematic analysis reveal the following aspects: the lack of studies focusing on the perception of professionals about imparting difficult news; communication as a strategy by which psychosocial, cultural, bioethical, legal and emotional aspects are handled; that more is expected from physicians than they were trained for. It was also seen that the information and training of professionals in strategies regarding how to handle the communication of difficult news needs to be ongoing in order to keep up with the dynamism of the occurrences and the physician-patient relations in the oncological field in which patients tend to be or feel under constant life-threatening conditions.
Urogynecologic conditions: interstitial cystitis/painful bladder syndrome.
Desrosiers, Laurephile; Garely, Alan D
Interstitial cystitis, also known as painful bladder syndrome, is a debilitating condition. The diagnosis is difficult and often is one of exclusion. Cystoscopy is the best way to confirm the diagnosis, but treatment can be initiated based on symptoms alone. Most patients benefit from an array of different drugs, including pentosan polysulfate, amitriptyline, hydroxyzine, and cimetidine. These treatments must be tailored for each patient. If oral drugs are ineffective, intravesical therapy can be attempted with dimethyl sulfoxide, heparin, or an anesthetic therapeutic combination containing lidocaine. Fulguration typically is performed if Hunner ulcers are found on cystoscopy. Hydrodistention, sacral neuromodulation, and intradetrusor onabotulinumtoxinA are sometimes useful. PMID:25756373
A review of methods for the analysis of orphan and difficult pesticides: glyphosate, glufosinate, quaternary ammonium and phenoxy acid herbicides, and dithiocarbamate and phthalimide fungicides.
Raina-Fulton, Renata
This article reviews the chromatography/MS methodologies for analysis of pesticide residues of orphan and difficult chemical classes in a variety of sample matrixes including water, urine, blood, and food. The review focuses on pesticide classes that are not commonly included in multiresidue analysis methods such as highly polar or ionic herbicides including glyphosate, glufosinate, quaternary ammonium, and phenoxy acid herbicides, and some of their major degradation or metabolite products. In addition, dithiocarbamate and phthalimide fungicides, which are thermally unstable and have stability issues in some solvents or sample matrixes, are also examined due to their special needs in residue analysis. PMID:25145125
A lack of response of the financial behaviors of biodiversity conservation nonprofits to changing economic conditions.
Larson, Eric R; Boyer, Alison G; Armsworth, Paul R
The effectiveness of conservation organizations is determined in part by how they adapt to changing conditions. Over the previous decade, economic conditions in the United States (US) showed marked variation including a period of rapid growth followed by a major recession. We examine how biodiversity conservation nonprofits in the US responded to these changes through their financial behaviors, focusing on a sample of 90 biodiversity conservation nonprofits and the largest individual organization (The Nature Conservancy; TNC). For the 90 sampled organizations, an analysis of financial ratios derived from tax return data revealed little response to economic conditions. Similarly, more detailed examination of conservation expenditures and land acquisition practices of TNC revealed only one significant relationship with economic conditions: TNC accepted a greater proportion of conservation easements as donated in more difficult economic conditions. Our results suggest that the financial behaviors of US biodiversity conservation nonprofits are unresponsive to economic conditions. PMID:25512840
Fistulas of the lower urinary tract: percutaneous approaches for the management of a difficult clinical entity.
Avritscher, Rony; Madoff, David C; Ramirez, Pedro T; Wallace, Michael J; Ahrar, Kamran; Morello, Frank A; Gupta, Sanjay; Murthy, Ravi; Wright, Kenneth C; Hicks, Marshall E
Fistulas of the lower urinary tract are uncommon conditions that may occur spontaneously or after therapy in patients with various pelvic abnormalities. When present, these fistulas are associated with urine leakage, which is often socially distressing and disabling. Unfortunately, factors that lead to the formation of genitourinary fistulas often increase their complexity or preclude surgical repair. A high failure rate is associated with surgical repair, and many patients are not optimal surgical candidates. For such patients, a percutaneous treatment approach is highly desirable. Percutaneous ureteral occlusion combined with insertion of a functioning nephrostomy tube allows complete diversion of urine in those patients in whom nephrostomy alone does not provide adequate relief. Many approaches to percutaneous ureteral occlusion have been used with variable success, including coils and gelatin sponge, isobutyl-2-cyanoacrylate, detachable balloons, radiofrequency electrocautery, ureteral clipping, and solid and soft polymer agents. Furthermore, percutaneous or retrograde ureteral stents may be used to preserve antegrade urine flow, and surgical options are also available. It is essential that the interventional radiologist involved in the care of these patients be familiar with these different techniques as well as with the limitations, pitfalls, and possible complications of their use. PMID:15486242
Optimal body balance disturbance tolerance skills as a methodological basis for selection of firefighters to solve difficult rescue tasks
Directory of Open Access Journals (Sweden)
W?adys?aw Jagie??o
Full Text Available The aim of this study is the methodology of optimal choice of firefighters to solve difficult rescue tasks. 27 firefighters were analyzed: aged from 22–50 years of age, and with 2–27 years of work experience. Body balance disturbance tolerance skills (BBDTS measured by the 'Rotational Test' (RT and time of transition (back and forth on a 4 meter beam located 3 meters above the ground, was the criterion for simulation of a rescue task (SRT. RT and SRT were carried out first in a sports tracksuit and then in protective clothing. A total of 4 results of the RT and SRT is the substantive base of the 4 rankings. The correlation of the RT and SRT results with 3 criteria for estimating BBDTS and 2 categories ranged from 0.478 (p<0.01 – 0.884 (p<0.01 and the results of SRT 0.911 (p<0.01. The basic ranking very highly correlated indicators of SRT (0.860 and 0.844, while the 6 indicators of RT only 2 (0.396 and 0.381; p<0.05. There was no correlation between the results of the RT and SRT, but there was an important partial correlation of these variables, but only then was the effect stabilized. The Rotational Test is a simple and easy to use tool for measuring body balance disturbance tolerance skills. However, the BBDTS typology is an accurate criteria for forecasting on this basis, including the results of accurate motor simulations, and the periodic ability of firefighters to solve the most difficult rescue tasks.
Directory of Open Access Journals (Sweden)
?.?. ?????????
Full Text Available In the article the analysis of modern directions of navigating spaces development of complex ergatic systems has been carried out, their transformation tendencies of structural and functional levels have been shown. Limitations of modern methods of the conflicts resolution of difficult dynamic systems have been exposed. For the conflicts resolution in environments of type CNS/ATM it has been offered to use the natural-scientific system approach. This approach contains full group virtual of navigating space symmetries, ergatic systems organization laws (functional and technological homeostasis, and also operation laws of complex technical systems. Control levels of conflicting dynamic objects have been formalized.
More efficient cutting difficult-to-machine materials by rotary tool
International Nuclear Information System (INIS)
Super-heat-resisting alloy and stainless steel used in gas turbines, aircraft components, and nuclear equipment are difficult to machine because their cutting temperatures are high compared to carbon steel. More efficient cutting is thus required. A rotary tool cuts materials without greatly increasing cutting temperature. By applying a self-propelled fabricated rotary tool for cutting super-heat-resisting alloy, cutting speed could be increased about three times for Inconel 718 and about five times for SUS304, and that minimum surface roughness was obtained when the rotary tool was tilted 30 degrees. (author)
Observational Study of Topical Imiquimod Immunotherapy in the Treatment of Difficult Lentigo Maligna
Craythorne, E. E.; Lawrence, C. M.
Lentigo Maligna (LM) typically presents at sun-exposed sites in elderly patients as an asymmetric, slow-growing, irregularly pigmented macule with an irregular indented border. With changes in sun exposure behaviour LM is becoming more prevalent in middle-aged and younger adults.1The risk of melanoma developing in LM increases with duration of the disease and therefore age,2 and is difficult to quantify, estimates range from 2.2%2 to 50%3 over a lifetime, once invasive disease is established,...
Difficult stent delivery: use of an aspiration catheter as a "sheath".
Ashikaga, Takashi; Nishizaki, Mitsuhiro; Yamawake, Noriyoshi
This is a report of a case in which stent delivery to the lesion location proved difficult because of severely calcified and tortuous proximal vasculature. Efforts to deliver a stent using a buddy wire, anchoring technique and five-in-seven guiding system were unsuccessful, whereas an aspiration catheter enabled stent delivery to the target lesion. This technique offers a potential alternative for cases in which some stent delivery methods are problematic. In addition, this technique may also prevent potential injury to drug-eluting polymer during stent delivery. PMID:18383152
Science Teachers' and Students' Perceived Difficult Topics in the Integrated Science Curriculum of Lower Secondary Schools in Barbados
Babalola Ogunkola; David Samuel
The study was designed to investigate the perception of students and teachers of the difficult topics in the lower secondary school science curriculum of Barbados; if there were statistically significant differences in (a) students' perception and teacher perception of difficult topics and (b) students' perception of difficult topics based on their gender, interest in science, study habits and school location and school category; as well as to determine the inter-relationships among the f...
Conditional indifference and conditional preservation
Kern-isberner, Gabriele
The idea of preserving conditional beliefs emerged recently as a new paradigm apt to guide the revision of epistemic states. Conditionals are substantially different from propositional beliefs and need specific treatment. In this paper, we present a new approach to conditionals, capturing particularly well their dynamic part as revision policies. We thoroughly axiomatize a principle of conditional preservation as an indifference property with respect to conditional structure...
Too difficult to govern? An assessment of the governability of transport biofuels in the EU
International Nuclear Information System (INIS)
Transport biofuels are currently the subject of heated debate in the EU. In the past decade the deployment of these technologies has been justified by claims of attractive environmental, geopolitical and rural development benefits. However, expectations have rapidly turned into deep criticism regarding the sustainability of these technologies and the desirability of pursuing the biofuel path. This situation has generated an on-going controversy and policy deadlock at EU level. This study explores these issues from a governance perspective. Employing the concept of system governability, derived from interactive governance theory, it attempts to shed some light on the problems facing the governance of biofuels and on how the quality of the governance system could be improved. The analysis showed that the governability of the system decreased substantially in the period 2003–2012 due to increasing governing needs and decreasing governing capacity. The quality of the governance system can be improved by (i) improving governing capacity by reducing conflicts among governing actors, advancing consistency among institutions and creating capacity at international and global level; and (ii) promoting advanced technologies and adjusting societal ambitions and expectations regarding biofuels. - highlights: • Biofuels in the EU are significantly more difficult to govern today than in 2003. • This is due to the qualities of the system to be governed and the governing system. • Sustainable biofuel systems are inherently difficult to govern
Evaluation of the Airtraq and Macintosh laryngoscopes in patients at increased risk for difficult tracheal intubation.
LENUS (Irish Health Repository)
Maharaj, C H
The Airtraq, a novel single use indirect laryngoscope, has demonstrated promise in the normal and simulated difficult airway. We compared the ease of intubation using the Airtraq with the Macintosh laryngoscope, in patients at increased risk for difficult tracheal intubation, in a randomised, controlled clinical trial. Forty consenting patients presenting for surgery requiring tracheal intubation, who were deemed to possess at least three characteristics indicating an increased risk for difficulty in tracheal intubation, were randomly assigned to undergo tracheal intubation using a Macintosh (n = 20) or Airtraq (n = 20) laryngoscope. All patients were intubated by one of three anaesthetists experienced in the use of both laryngoscopes. Four patients were not successfully intubated with the Macintosh laryngoscope, but were intubated successfully with the Airtraq. The Airtraq reduced the duration of intubation attempts (mean (SD); 13.4 (6.3) vs 47.7 (8.5) s), the need for additional manoeuvres, and the intubation difficulty score (0.4 (0.8) vs 7.7 (3.0)). Tracheal intubation with the Airtraq also reduced the degree of haemodynamic stimulation and minor trauma compared to the Macintosh laryngoscope.
Factors associated with difficult electronic health record implementation in office practice.
Fleurant, Marshall; Kell, Rachel; Jenter, Chelsea; Volk, Lynn A; Zhang, Fang; Bates, David W; Simon, Steven R
Little is known about physicians' perception of the ease or difficulty of implementing electronic health records (EHR). This study identified factors related to the perceived difficulty of implementing EHR. 163 physicians completed surveys before and after the implementation of EHR in an externally funded pilot program in three Massachusetts communities. Ordinal hierarchical logistic regression was used to identify baseline factors that correlated with physicians' report of difficulty with EHR implementation. Compared with physicians with ownership stake in their practices, physician employees were less likely to describe EHR implementation as difficult (adjusted OR 0.5, 95% CI 0.3 to 1.0). Physicians who perceived their staff to be innovative were also less likely to view EHR implementation as difficult (adjusted OR 0.4, 95% CI 0.2 to 0.8). Physicians who own their practice may need more external support for EHR implementation than those who do not. Innovative clinical support staff may ease the EHR implementation process and contribute to its success. PMID:22249965
On the Improvement of Multi-Legged Locomotion over Difficult Terrains using a Balance Stabilization Method
Directory of Open Access Journals (Sweden)
Javaid Iqbal
Full Text Available This paper deals with the real?time walking of a multi-legged robot over difficult terrains using a balance stabilization method in order to achieve a fast speed and robust locomotion with minimal tracking errors. The stabilization method is described through a ZMP?based online pattern?generation scheme inspired by bio?mimetic stepping leg transferences with an active balance control so as to reduce the propagation of instability while performing rapid stepping actions for a fast walking gait in the presence of external disturbances. The proposed control system uses a force?position controller [14] which takes impact dynamics into consideration to compensate for the effect of external perturbations during walking by estimating impulsive forces in real?time. Using the proposed stabilization method, the robot plans appropriate footholds on the ground in order to achieve a reasonable average walking speed over difficult terrains in a natural environment. The success and performance of the proposed method is realized through dynamic simulations and real?world experiments using a six?legged hexapod robot.
Supporting clinical management of the difficult-to-treat TB cases: the ERS-WHO TB Consilium.
D'Ambrosio, Lia; Tadolini, Marina; Centis, Rosella; Duarte, Raquel; Sotgiu, Giovanni; Aliberti, Stefano; Dara, Masoud; Migliori, Giovanni Battista
Multi-drug and extensively drug-resistant tuberculosis (MDR/XDR-TB) are considered a serious threat for TB control and elimination. The outcome of these patients is still largely unsatisfactory as of today, with treatment success rates being consistently below 50% at global level. The World Health Organization (WHO) recommends that management of MDR-TB cases is supported by a specialized team, including complementary medical professionals able to cover several perspectives (clinical, both for adults and children; surgical; radiological; public health; psychological; nursing, among others). Implementation of such a body (known as Consilium in most of the former Soviet Union countries) is often a pre-requisite to apply for international TB control funding and concessionally priced medicines to treat M/XDR-TB cases. The primary objective of the ERS/WHO TB Consilium is to provide clinical consultation for drug-resistant TB and other difficult-to-treat TB cases, including co-infection with HIV and paediatric cases. Through technical guidance to clinicians managing complex TB cases, the main contribution and outcome of the initiative will be a public health response aimed at achieving correct treatment of affected patients and preventing further development of drug resistance. The Consilum's secondary objective is to ensure monitoring and evaluation of clinical practices on the ground (diagnosis, treatment and prevention). PMID:25809773
Nanasiova, Olga
The definition of the conditional probability is very important in the theory of the probability. This definition is based on the fact, that random events can be simultaneously measurable. This paper deal with the problem of conditioning for such random events, which are not simultaneously measurable. This paper defines conditional states as convex combination of special states.
Structured Communication: Teaching Delivery of Difficult News with Simulated Resuscitations in an Emergency Medicine Clerkship
Lamba, Sangeeta; Nagurka, Roxanne; Offin, Michael; Scott, Sandra R.
Introduction The objective is to describe the implementation and outcomes of a structured communication module used to supplement case-based simulated resuscitation training in an emergency medicine (EM) clerkship. Methods We supplemented two case-based simulated resuscitation scenarios (cardiac arrest and blunt trauma) with role-play in order to teach medical students how to deliver news of death and poor prognosis to family of the critically ill or injured simulated patient. Quantitative outcomes were assessed with pre and post-clerkship surveys. Secondarily, students completed a written self-reflection (things that went well and why; things that did not go well and why) to further explore learner experiences with communication around resuscitation. Qualitative analysis identified themes from written self-reflections. Results A total of 120 medical students completed the pre and post-clerkship surveys. Majority of respondents reported that they had witnessed or role-played the delivery of difficult news, but only few had real-life experience of delivering news of death (20/120, 17%) and poor prognosis (34/120, 29%). This communication module led to statistically significant increased scores for comfort, confidence, and knowledge with communicating difficult news of death and poor prognosis. Pre-post scores increased for those agreeing with statements (somewhat/very much) for delivery of news of poor prognosis: comfort 69% to 81%, confidence 66% to 81% and knowledge 76% to 90% as well as for statements regarding delivery of news of death: comfort 52% to 68%, confidence 57% to 76% and knowledge 76% to 90%. Respondents report that patient resuscitations (simulated and/or real) generated a variety of strong emotional responses such as anxiety, stress, grief and feelings of loss and failure. Conclusion A structured communication module supplements simulated resuscitation training in an EM clerkship and leads to a self-reported increase in knowledge, comfort, and competence in communicating difficult news of death and poor prognosis to family. Educators may need to seek ways to address the strong emotions generated in learners with real and simulated patient resuscitations. PMID:25834685
Structured Communication: Teaching Delivery of Difficult News with Simulated Resuscitations in an Emergency Medicine Clerkship
Directory of Open Access Journals (Sweden)
Lamba, Sangeeta
Full Text Available Introduction: The objective is to describe the implementation and outcomes of a structured communication module used to supplement case-based simulated resuscitation training in an emergency medicine (EM clerkship. Methods: We supplemented two case-based simulated resuscitation scenarios (cardiac arrest and blunt trauma with role-play in order to teach medical students how to deliver news of death and poor prognosis to family of the critically ill or injured simulated patient. Quantitative outcomes were assessed with pre and post-clerkship surveys. Secondarily, students completed a written self-reflection (things that went well and why; things that did not go well and why to further explore learner experiences with communication around resuscitation. Qualitative analysis identified themes from written self-reflections. Results: A total of 120 medical students completed the pre and post-clerkship surveys. Majority of respondents reported that they had witnessed or role-played the delivery of difficult news, but only few had real-life experience of delivering news of death (20/120, 17% and poor prognosis (34/120, 29%. This communication module led to statistically significant increased scores for comfort, confidence, and knowledge with communicating difficult news of death and poor prognosis. Pre-post scores increased for those agreeing with statements (somewhat/very much for delivery of news of poor prognosis: comfort 69% to 81%, confidence 66% to 81% and knowledge 76% to 90% as well as for statements regarding delivery of news of death: comfort 52% to 68%, confidence 57% to 76% and knowledge 76% to 90%. Respondents report that patient resuscitations (simulated and/or real generated a variety of strong emotional responses such as anxiety, stress, grief and feelings of loss and failure. Conclusion: A structured communication module supplements simulated resuscitation training in an EM clerkship and leads to a self-reported increase in knowledge, comfort, and competence in communicating difficult news of death and poor prognosis to family. Educators may need to seek ways to address the strong emotions generated in learners with real and simulated patient resuscitations. [West J Emerg Med. 2015;16(2:344–352.
Natural selection and the conditions for existence: representational vs. conditional teleology in biological explanation.
Reiss, John O
Human intentional action, including the design and use of artifacts, involves the prior mental representation of the goal (end) and the means to achieve that goal. This representation is part of the efficient cause of the action, and thus can be used to explain both the action and the achievement of the end. This is intentional teleological explanation. More generally, teleological explanation that depends on the real existence of a representation of the goal (and the means to achieve it) can be called representational teleological explanation. Such explanations in biology can involve both external representations (e.g., ideas in the mind of God) and internal representations (souls, vital powers, entelechies, developmental programs, etc.). However, another type of explanation of intentional action (or any other process) is possible. Given that an action achieving a result occurs, the action can be explained as fulfilling the necessary conditions (means) for that result (end), and, reciprocally, the result explained by the occurrence of those necessary conditions. This is conditional teleological explanation. For organisms, natural selection is often understood metaphorically as the designer, intentionally constructing them for certain ends. Unfortunately, this metaphor is often taken rather too literally, because it has been difficult to conceive of another way to relate natural selection to the process of evolution. I argue that combining a conditional teleological explanation of organisms and of evolution provides such an alternative. This conditional teleology can be grounded in existence or survival. Given that an organism exists, we can explain its existence by the occurrence of the necessary conditions for that existence. This principle of the 'conditions for existence' was introduced by Georges Cuvier in 1800, and provides a valid, conditional teleological method for explaining organismal structure and behavior. From an evolutionary perspective, the conditions for existence are the range of boundary conditions within which the evolutionary process must occur. Moreover, evolutionary change itself can be subjected to conditional teleological explanation, because natural selection theory is primarily a theory about the relation between the conditions for the existence of organisms and the conditions for the existence of traits in populations. I show that failure to distinguish representational from conditional teleological explanation has confused previous attempts to clarify the relation of teleology to biology. PMID:16602488
High fidelity medical simulation in the difficult environment of a helicopter: feasibility, self-efficacy and cost
Directory of Open Access Journals (Sweden)
Holland Carolyn
Full Text Available Abstract Background This study assessed the feasibility, self-efficacy and cost of providing a high fidelity medical simulation experience in the difficult environment of an air ambulance helicopter. Methods Seven of 12 EM residents in their first postgraduate year participated in an EMS flight simulation as the flight physician. The simulation used the Laerdal SimMan™ to present a cardiac and a trauma case in an EMS helicopter while running at flight idle. Before and after the simulation, subjects completed visual analog scales and a semi-structured interview to measure their self-efficacy, i.e. comfort with their ability to treat patients in the helicopter, and recognition of obstacles to care in the helicopter environment. After all 12 residents had completed their first non-simulated flight as the flight physician; they were surveyed about self-assessed comfort and perceived value of the simulation. Continuous data were compared between pre- and post-simulation using a paired samples t-test, and between residents participating in the simulation and those who did not using an independent samples t-test. Categorical data were compared using Fisher's exact test. Cost data for the simulation experience were estimated by the investigators. Results The simulations functioned correctly 5 out of 7 times; suggesting some refinement is necessary. Cost data indicated a monetary cost of $440 and a time cost of 22 hours of skilled instructor time. The simulation and non-simulation groups were similar in their demographics and pre-hospital experiences. The simulation did not improve residents' self-assessed comfort prior to their first flight (p > 0.234, but did improve understanding of the obstacles to patient care in the helicopter (p = 0.029. Every resident undertaking the simulation agreed it was educational and it should be included in their training. Qualitative data suggested residents would benefit from high fidelity simulation in other environments, including ground transport and for running codes in hospital. Conclusion It is feasible to provide a high fidelity medical simulation experience in the difficult environment of the air ambulance helicopter, although further experience is necessary to eliminate practical problems. Simulation improves recognition of the challenges present and provides an important opportunity for training in challenging environments. However, use of simulation technology is expensive both in terms of monetary outlay and of personnel involvement. The benefits of this technology must be weighed against the cost for each institution.
Awake fiberoptic or awake video laryngoscopic tracheal intubation in patients with anticipated difficult airway management : a randomized clinical trial
DEFF Research Database (Denmark)
Rosenstock, Charlotte Vallentin; ThŘgersen, Bente
Awake flexible fiberoptic intubation (FFI) is the gold standard for management of anticipated difficult tracheal intubation. The purpose of this study was to compare awake FFI to awake McGrath® video laryngoscope, (MVL), (Aircraft Medical, Edinburgh, Scotland, United Kingdom) intubation in patients with an anticipated difficult intubation. The authors examined the hypothesis that MVL intubation would be faster than FFI.
Difficult behaviour in drug-misusing and non-drug-misusing patients in general practice--a comparison.
Thompson, J.
Some GPs may be unwilling to take on the management of drug misusers because of the risk of difficult behaviour. However, this study found that in a practice running a drug misuse treatment programme there was a relatively small difference in the rates of difficult behaviour from drug misusers and general patients.
Descriptions of Difficult Conversations between Native and Non-Native English Speakers: In-Group Membership and Helping Behaviors
Young, Ray; Faux, William V., II
This study illustrated the perceptions of native English speakers about difficult conversations with non-native English speakers. A total of 114 native English speakers enrolled in undergraduate communication courses at a regional state university answered a questionnaire about a recent difficult conversation the respondent had with a non-native…
A Novel 'Cheese Wire' Technique for Stent Positioning Following Difficult Iliac Artery Subintimal Dissection and Aortic Re-Entry
International Nuclear Information System (INIS)
Subintimal wire dissection is a well-established method for traversing difficult vascular occlusions. This technique relies on re-entry of the true lumen distal to the occlusion, which may be difficult in diseased vessels with significant calcification. This case report describes a novel 'cheese wire' technique to allow stent positioning without the use of proprietary re-entry devices.
[Is ex situ surgery of the liver useful for difficult hepatic resections?].
Huguet, C; Gavelli, A; Harb, J; Mansvelt, B; Vorburger, T; Roger Clément, R; MacNamara, M
Five cases of hepatic tumor deemed unresectable by conventional techniques are presented to illustrate the potential benefit offered by complete hepatic vascular exclusion (Pringle maneuver associated with inferior vena cava clamping below and above the liver). The most extensive and difficult liver resections may be achieved, with possible venous reconstruction, if the clamping period is not interrupted. Hepatic vascular exclusion may exceed one hour, up to 85 minutes in this series, with a good liver tolerance, in the absence of preoperative liver dysfunction. The advantages and disadvantages of the ex situ extracorporeal liver resections performed under similar circumstances are discussed. The authors consider that the role of ex situ liver procedures should be very limited. PMID:1288396
A case of hepatic angiomyolipoma difficult to distinguish from hepatocellular carcinoma
Directory of Open Access Journals (Sweden)
Masahiro Takahara, Yasuhiro Miyake, Kazuyuki Matsumoto, Daisuke Kawai, Eisuke Kaji, Tatsuya Toyokawa, Morihito Nakatsu, Masaharu Ando, Mamoru Hirohata
Full Text Available We report a case of hepatic angiomyolipoma with uncommon clinical features. A 56-year-old man presented with a hepatic tumor in the caudate lobe. The tumor was hypoechoic on ultrasonography, showed early-phase hyperattenuation on enhanced computed tomography and did not absorb iron on superparamagnetic iron oxide-enhanced magnetic resonance imaging. Hepatocellular carcinoma was highly suspected, and the patient underwent hepatic resection. Histologically, the tumor was mainly composed of smooth muscle cells and contained small amounts of adipose cells and blood vessels. On immunohistochemical staining, the smooth muscle cells were positive for a melanocytic cell-specific monoclonal antibody. In cases with uncommon features of angiomyolipoma, it is quite difficult to distinguish angiomyolipoma from hepatocellular carcinoma.
Why the $a_1$ meson might be a difficult messenger for the restoration of chiral symmetry
Vogel, Sascha
We perform a theoretical analysis of the $a_1$ resonance mass spectrum in ultra-relativistic heavy ion collisions within a hadron/string transport approach. Predictions for the $a_1$ yield and its mass distribution are given for the GSI-FAIR and the critRHIC energy regime. The potential of the $a_1$ meson as a signal for chiral symmetry restoration is explored. In view of the latest discussion, we investigate the decay channel $a_1 \\to \\gamma\\pi$ in detail and find a strong bias towards low $a_1$ masses. This apparent mass shift of the $a_1$ if observed in the $\\gamma\\pi$ channel might render a possible mass shift due to chiral symmetry restoration very difficult to disentangle from the decay kinematics.
Impact of online training on delivering a difficult medical diagnosis: Acquiring communication skills.
Saint-Dizier de Almeida, Valérie; Agnoletti, Marie-France
This paper deals with developing and assessing the training of physicians to deliver a difficult diagnosis to patients. The training is provided by a web-based self-training package. This online training emphasizes the structural, functional and relational dimensions of interviews delivering a serious diagnosis, and a logical set of recommendations for behavior towards the patient. The content is illustrated by numerous delivery interview sequences that are described and for which commentary is provided. This online package was expected to enable physicians to acquire new skills and change their mental picture of diagnosis delivery. Here we discuss the assessment of training in managing the delivery of a serious diagnosis. The approach taken and the methods used to measure knowledge and skills are presented. PMID:25959340
Methods to ease the release of thin polydimethylsiloxane films from difficult substrates
DEFF Research Database (Denmark)
Vudayagiri, Sindhu; Skov, Anne Ladegaard
Silicone elastomers are used as dielectric electroactive polymers for making actuators, generators, sensors, and as artificial muscles in medical applications. Current requirements in the actuator manufacturing put a strict limitation on the thickness of the elastomers, such that a maximum permissible thickness is around 25–50?µm. The relatively small Young's modulus for these elastomers is a requirement for actuation capabilities. However, peeling and release of such films during manufacture processes are very difficult. To ease the release of the films, techniques such as the use of release agents like surfactants and detergents, incorporating resins in the silicone matrix and grafting/adding low surface energy functionalities to the silicone elastomer have been tested. The methods used are required not to interfere with the Young's modulus and the dielectric permittivity in a negative way. Polysorbate-20, a non-ionic surfactant, fulfills all requirements and gives the lowest peel forces for the films.
Methods for health surveys in difficult settings: charting progress, moving forward
Directory of Open Access Journals (Sweden)
Tam Clarence C
Full Text Available Abstract Health surveys are a very important component of the epidemiology toolbox, and play a critical role in gauging population health, especially in developing countries. Research on health survey methods, however, is sparse. In particular, current sampling methods are not well adapted for certain 'difficult' settings, such as emergencies, remote regions without easily available sampling frames, hidden and vulnerable population groups, urban slums and populations living under strong political pressure. This special issue of Emerging Themes in Epidemiology is entirely devoted to survey methods in such settings, and builds upon a successful conference in London highlighting problems with current approaches and possible ways forward. Greater investment in research on health survey methods is needed and will have beneficial effects for populations in need.
China in the Copenhagen process: the difficult inclusion of an emerging power
International Nuclear Information System (INIS)
The authors propose an analysis of the Chinese assets and posture before the Copenhagen Conference. They evoke the environmental consequences of the rapid development of the Chinese economy and demography: urban pollution, acid rains, and desertification. They note that the Chinese government had to acknowledge these environmental concerns by specifying energetic performance objectives in its economic planning, by publishing a National Climate Change Programme and a middle and long term development plan for renewable energies. They outline that the different objectives related to energy performance, renewable energy production or greenhouse gas emissions are still difficult to implement at the local level as Chinese provinces are wishing to preserve their competitiveness. The authors comment China's posture in international negotiations as an emerging country or developing country which sets it free of any constraining objective. They examine the possibilities for changing this situation and involve China in reduction obligations. Then they try to foresee China's attitude in Copenhagen and to identify the possible scenarios
Un nuevo dispositivo para el abordaje de la vía respiratoria anatómicamente difícil.: El Airtraq ® / A new device for a respiratory airway of difficult anatomically access.: The Airtrak®
Scientific Electronic Library Online (English)
Idoris, Cordero Escobar; Irelys, Casacó Vázquez; Evelin, Silva Barrios; Raúl, Iglesias Hernández.
Full Text Available Introducción: La vía respiratoria anatómicamente difícil, resulta un reto al anestesiólogo. Múltiples son las opciones que existen para resolverlas. Recientemente, el laringoscopio óptico Airtraq ®, constituye una opción válida para abordar la tráquea en estas condiciones. Objetivos: Proporcionar la [...] enseńanza de un nuevo dispositivo para el abordaje de la vía respiratoria anatómicamente difícil. Desarrollo: Se propuso realizar el proceso de enseńanza aprendizaje con el laringoscopio óptico Airtraq ® para adquirir las habilidades suficientes y necesarias para poder realizar el abordaje de la vía respiratoria en general y de la vía respiratoria anatómicamente difícil en particular. Se describió la forma de colocar el dispositivo y las ventajas de su uso. Conclusiones: El Airtraq ®, es un dispositivos para el abordaje de la vía respiratoria anatómicamente difícil que puede ser utilizado de forma rápida y fácil. Abstract in english Introduction: The airway anatomically difficult is a challenge for anesthesiologist. There many options for its solution. Recently, the optical laryngoscope Airtraq®, is a valid option to approach the trachea in these conditions. Objectives: To teach on a new device to approach the airway anatomical [...] ly difficult. Development: We propose to carry out the teaching process with optical laryngoscope Airtraq® to acquire abilities sufficient and necessary to carry out the approach of the airway in general and of the airway anatomically difficult in particular. We described the way to insert the device and the advantages of its use. Conclusions: Airtraq® is a device to approach this type of airway that may to be used in a fast and easy way.
Perinatal risk factors including malformation
International Nuclear Information System (INIS)
The study gives a survey of the factors most frequently mentioned in the literature as factors likely to adversely affect a pregnancy. One essential aspect is the discussion of those factors that can be counted among the causes of malformations, as among others, prenatal radiation exposure. The study prepared within the framework of the research project 'Radiobiological environmental monitoring in Bavaria' is intended to serve as a basis for a retrospective and prospective evaluation of infant mortality, perinatal conditions and occurrence of malformations in Bavaria, with the principal idea of drawing up an environment - related health survey. The study therefore, in addition to ionizing radiation also takes into account other detectable risks within the ecologic context, as e.g. industrial installations, refuse incineration plants or waste dumps, or urbanity. (orig./MG)
564?Is It Really Difficult-to-treat Asthma? Don't Forget Other Causes of Wheeze
Kalkan, Ilkay Koca; Kalpaklioglu, A. Fusun
Background One in 4 asthma patients may not have their condition adequately controlled and experience persistent symptoms despite treated with high healthcare utilization. But do all of them really have asthma? Methods Here we present 3 cases; all were diagnosed as asthma, had been treating with multiple bronchodilators, even oral steroids and were not responding to the treatment. And so they were refered to our clinic as having difficult-to-treat asthma as candidates for omelizumab therapy. Results Case1: A 44-year-old female presented with 18 years history of dyspnea, wheeze and chronic cough. Her FEV1 was 37% of the predicted (0.93 lt), FVC and FEV1/FVC were subnormal and showed no reversibility. CT scan showed a deformed trachea with a diverticula in the posterior region with cystic bronchiectasis in lung parenchyma, bilaterally. Bronchial endoscopy showed dyskinesia extending almost totally throughout the tracheobronchial tree with complete expiratory collapse. Her diagnosis was changed as Mounier-Kuhn syndrome. Case 2: A 19-year-old female presented with 11 years history of persistent wheezing and dyspnea which were progressively increasing for the last 5 years. Her FEV1 was 85% and the FEV1/FVC % 77 of the predicted, showed no reversibility. Her CT scan was in normal limits. Fiberoptic bronchoscopy revealed a severe airway stenosis like a pinhole at the beginning of the right main bronchus, adjacent to the carina. Excluding her asthma diagnosis she underwent a balloon dilatation procedure, which improved her symptoms. Case 3: A 50-year-old female presented with 16 years history of dyspnea, wheeze, chronic cough. Her FEV1 was 40% of the predicted (0.91 lt), and showed reversibility of 28%. She had an elevated total IgE level of 1126 IU/mL with serum eosinophilia of 5.5%. Her HRCT scan revealed bilateral central bronchiectasis with fleeting pulmonary parenchymal opacities. Her sensitization to Aspergillus fumigatus was shown by positive skin testing. She was diagnosed as having allergic bronchopulmonary aspergillosis and oral itracanosole with steroid were added to her treatment which improved her symptoms. Conclusions Although all patients' symptoms looked like asthma, and all diagnosed as having asthma for many years, the diagnosis should always be confirmed before accepting them as "difficult-to-treat".
Categories children find easy and difficult to process in figural analogies
Directory of Open Access Journals (Sweden)
Full Text Available Analogical reasoning, the ability to learn about novel phenomena by relating it to structurally similar knowledge, develops with great variability in children. Furthermore, the development of analogical reasoning coincides with greater working memory efficiency and increasing knowledge of the objects and rules present in analogy problems. In figural matrices, a classical form of analogical reasoning assessment, some categories, such as color, appear easier for children to encode and infer than others, such as orientation. Yet, few studies have structurally examined differences in the difficulty of rule-types across different age-groups. This cross-sectional study of figural analogical reasoning examined which underlying rules in figural analogies were easier or more difficult for children to correctly process. School children (N=1422, M=7.0 years, SD=21 months, range 4.5-12.5 years were assessed in analogical reasoning using classical figural matrices and memory measures. The transformations the children had to induce and apply concerned the categories: animal, color, orientation, position, quantity and size. The role of age and memory span on the children's ability to correctly process each type of transformation was examined using explanatory item response theory models. The results showed that with increasing age and/or greater memory span all transformations were processed more accurately. The "what" transformations animal, color, quantity and size were easiest, whereas the "where" transformations orientation and position were most difficult. However, animal, orientation and position became relatively easier with age and increased memory efficiency. The implications are discussed in terms of the development of visual processing in object recognition versus position and motion encoding, the ventral ("what" and dorsal ("where" pathways respectively.
Double guidewire technique vs transpancreatic precut sphincterotomy in difficult biliary cannulation
Directory of Open Access Journals (Sweden)
Young Wook Yoo
Full Text Available AIM: To compare the outcomes between double-guidewire technique (DGT and transpancreatic precut sphincterotomy (TPS in patients with difficult biliary cannulation. METHODS: This was a prospective, randomized study conducted in single tertiary referral hospital in Korea. Between January 2005 and September 2010. A total of 71 patients, who bile duct cannulation was not possible and selective pancreatic duct cannulation was achieved, were randomized into DGT (n = 34 and TPS (n = 37 groups. DGT or TPS was done for selective biliary cannulation. We measured the technical success rates of biliary cannulation, median cannulation time, and procedure related complications. RESULTS: The distribution of patients after randomization was balanced, and both groups were comparable in baseline characteristics, except the higher percentage of endoscopic nasobiliary drainage in the DGT group (55.9% vs 13.5%, P < 0.001. Successful cannulation rate and mean cannulation times in DGT and TPS groups were 91.2% vs 91.9% and 14.1 ± 13.2 min vs 15.4 ± 17.9 min, P = 0.732, respectively. There was no significant difference between the two groups. The overall incidence of post- endoscopic retrograde cholangiopancreatography (ERCP pancreatitis was 38.2% vs 10.8%, P < 0.011 in the DGT group and the TPS group; post-procedure pancreatitis was significantly higher in the DGT group. But the overall incidence of post-ERCP hyperamylasemia was no significant difference between the two groups; DGT group vs TPS group: 14.7% vs 16.2%, P < 1.0. CONCLUSION: When free bile duct cannulation was difficult and selective pancreatic duct cannulation was achieved, DGT and TPS facilitated biliary cannulation and showed similar success rates. However, post-procedure pancreatitis was significantly higher in the DGT group.
Characteristic aspects of the housing and utilitiescomplex as a difficult organizational and economic system
Directory of Open Access Journals (Sweden)
Butyrin Andrey Yur'evich
Full Text Available The existing system of housing and utility services functioning is carried out for providing the relevant living environment standards to the population by means of effective functioning of the system of uninterrupted providing housing and utility services according to existing requirements of the Russian standards. Today there is a number of problems, which doesn't allow housing and utility services to function effectively. The main of them is providing high-quality housing and utility services to the population and system of their objective cost assessment. This problem is solved by means of reforming the housing and utility sphere with the possibility of attracting financial resources from private investors. Housing and Utility of the Russian Federation, the basis of which is the housing stock, has a very high specific weight in fixed assets of all the economy.Thus, Housing and Utility is a typical difficult organizational and economic system possessing characteristic features of openness, nonlinearity and dissipativity. In this re-gard, the reasonable approach to Housing and Utility development assumes the need to account for the principles of systemacity, focus and complexity, and also can be based on the existing in the theory and practice of management methodology by difficult organizational and economic systems.Now Housing and Utility development and financing investment programs of the municipal complex organizations is carried out according to the relevant Federal law, according to which the establishment system of limit indexes of change of tariffs and investment extra charges to tariffs for services of the organizations of a municipal complex. Also, innovative ways of energy efficiency increase and decrease in wear of funds is an attempt of the state to develop effective mechanisms of attracting private funds from investors.
Conditional indifference and conditional preservation
Kern-Isberner, G
The idea of preserving conditional beliefs emerged recently as a new paradigmapt to guide the revision of epistemic states. Conditionals are substantiallydifferent from propositional beliefs and need specific treatment. In thispaper, we present a new approach to conditionals, capturing particularly welltheir dynamic part as revision policies. We thoroughly axiomatize a principleof conditional preservation as an indifference property with respect toconditional structures of worlds. This principle is developed in asemi-quantitative setting, so as to reveal its fundamental meaning for beliefrevision in quantitative as well as in qualitative frameworks. In fact, it isshown to cover other proposed approaches to conditional preservation.
Perkowski, N.; Ruf, J.
It is well known that upward conditioned Brownian motion is a three-dimensional Bessel process, and that a downward conditioned Bessel process is a Brownian motion. We give a simple proof for this result, which generalizes to any continuous local martingale and clarifies the role of finite versus infinite time in this setting. As a consequence, we can describe the law of regular diffusions that are conditioned upward or downward.
Experience with simulator training for emergency conditions
International Nuclear Information System (INIS)
The training of operators by the use of simulators is common to most countries with nuclear power plants. Simulator training programmes are generally well developed, but their value can be limited by the age, type, size and capability of the simulator. Within these limits, most full scope simulators have a capability of training operators for a range of design basis accidents. It is recognized that human performance under accident conditions is difficult to predict or analyse, particularly in the area of severe accidents. These are rare events and by their very nature, unpredictable. Of importance, therefore, is to investigate the training of operators for severe accident conditions, and to examine ways in which simulators may be used in this task. The International Nuclear Safety Advisory Group (INSAG) has reviewed this field and the associated elements of human behaviour. It has recommended that activities are concentrated on this area. Initially it is encouraging the following objectives: i) To train operators for accident conditions including severe accidents and to strongly encourage the development and use of simulators for this purpose; ii) To improve the man-machine interface by the use of computer aids to the operator; iii) To develop human performance requirements for plant operating staff. As part of this work, the IAEA convened a technical committee on 15-19 September 1986 to review the experience with simulator training for emergency conditions, to review simulator modelling for severe accident training, to examine the role of human cognitive behaviour modelling, and to review guidance on accident scenarios. A substantial deviation may be a major fuel failure, a Loss of Coolant Accident (LOCA), etc. Examples of engineered safety features are: an Emergency Core Cooling System (ECCS), and Containment Systems. This report was prepared by the participants during the meeting and reviewed further in a Consultant's Meeting. It also includes papers which were presented during the meeting. A separate abstract was prepared for each of these 9 papers. Refs, figs, tabs
Recycling management including transportation experience
International Nuclear Information System (INIS)
The nuclear industry, at least in advanced countries such as Japan, France and other European countries, has developed for years a global strategy of fuel utilization which implies an extensive recycling and reuse of spent fuel. Such recycling strategies are now increasingly required from the industry in general by the various Governments and international organizations. Nuclear fuel recycling and waste management are the two faces of the same policy: the closed fuel cycle, whereby reprocessing of spent fuel makes available for recycling the energetic contents : uranium and plutonium, while segregating the real waste in categories for their specific treatment, conditioning, storage, transportation and final disposal. Plutonium recycling is performed through the fabrication of the so-called mixed oxide fuel (MOX), where fissile plutonium replaces the U 235 isotope used in UO2 fuel. The international trade of nuclear materials and services, under close control of IAEA and other national and international organization, has let to the circulation of materials between the producers of uranium and enrichment fuel, fabrication, reprocessing and recycling services, and the customers worldwide. The industrial transport experience now accumulated shows an excellent record in terms of safety and quality. This communication will describe the current situation and future trends of the recycling route mainly through COGEMA industrial experience. 1 figrial experience. 1 fig
Interactive film scenes for tutor training in problem-based learning (PBL: dealing with difficult situations
Directory of Open Access Journals (Sweden)
Kirschfink Michael
Full Text Available Abstract Background In problem-based learning (PBL, tutors play an essential role in facilitating and efficiently structuring tutorials to enable students to construct individual cognitive networks, and have a significant impact on students' performance in subsequent assessments. The necessity of elaborate training to fulfil this complex role is undeniable. In the plethora of data on PBL however, little attention has been paid to tutor training which promotes competence in the moderation of specific difficult situations commonly encountered in PBL tutorials. Methods Major interactive obstacles arising in PBL tutorials were identified from prior publications. Potential solutions were defined by an expert group. Video clips were produced addressing the tutor's role and providing exemplary solutions. These clips were embedded in a PBL tutor-training course at our medical faculty combining PBL self-experience with a non-medical case. Trainees provided pre- and post-intervention self-efficacy ratings regarding their PBL-related knowledge, skills, and attitudes, as well as their acceptance and the feasibility of integrating the video clips into PBL tutor-training (all items: 100 = completely agree, 0 = don't agree at all. Results An interactive online tool for PBL tutor training was developed comprising 18 video clips highlighting difficult situations in PBL tutorials to encourage trainees to develop and formulate their own intervention strategies. In subsequent sequences, potential interventions are presented for the specific scenario, with a concluding discussion which addresses unresolved issues. The tool was well accepted and considered worth the time spent on it (81.62 ± 16.91; 62.94 ± 16.76. Tutors considered the videos to prepare them well to respond to specific challenges in future tutorials (75.98 ± 19.46. The entire training, which comprised PBL self-experience and video clips as integral elements, improved tutor's self-efficacy with respect to dealing with problematic situations (pre: 36.47 ± 26.25, post: 66.99 ± 21.01; p Conclusions The interactive tool with instructional video clips is designed to broaden the view of future PBL tutors in terms of recognizing specific obstacles to functional group dynamics and developing individual intervention strategies. We show that this tool is well accepted and can be successfully integrated into PBL tutor-training. Free access is provided to the entire tool at http://www.medizinische-fakultaet-hd.uni-heidelberg.de/fileadmin/PBLTutorTraining/player.swf.
International Nuclear Information System (INIS)
This paper reports on numerous conditions (systemic diseases, metabolic diseases, etc.) that may also affect the foot and ankle. In many cases, imaging of the foot and ankle is not performed for primary diagnostic purposes. However, radiographic changes do occur with these conditions. Therefore, it is important to be aware of radiographic abnormalities that these diseases may cause in the foot and ankle
[Use of a new video-laryngoscope (McGRATH MAC) in patients with a difficult airway].
Arai, Takero; Saima, Shunsuke; Taguchi, Asuka; Iwabuchi, Yoko; Sato, Shoko; Kase, Sachiko; Okuda, Yasuhisa
We describe the clinical use of a new video-laryngoscope (McGRATH MAC, McG) in patients with a difficult airway and morbid obesity. In a patient, case no. 2, with a difficult airway, showing a Cormack-Lehane grade III view with Macintosh direct laryngoscope, the glottis opening (Cormack-Lehane grade I) was visualized with McG. McG also provided a good view of glottis opening in a patient with morbid obesity. McG will have a profound impact on the management of the difficult airway. PMID:24063144
Science Teachers' and Students' Perceived Difficult Topics in the Integrated Science Curriculum of Lower Secondary Schools in Barbados
Directory of Open Access Journals (Sweden)
Babalola Ogunkola
Full Text Available The study was designed to investigate the perception of students and teachers of the difficult topics in the lower secondary school science curriculum of Barbados; if there were statistically significant differences in (a students' perception and teacher perception of difficult topics and (b students' perception of difficult topics based on their gender, interest in science, study habits and school location and school category; as well as to determine the inter-relationships among the four student variables (gender, interest in science, study habits, school location.
Modelling classroom conditions with different boundary conditions
DEFF Research Database (Denmark)
Marbjerg, Gerd; Jeong, Cheol-Ho
A model that combines image source modelling and acoustical radiosity with complex boundary condition, thus including phase shifts on reflection has been developed. The model is called PARISM (Phased Acoustical Radiosity and Image Source Model). It has been developed in order to be able to model both specular and diffuse reflections with complex-valued acoustical descriptions of the surfaces. In this paper the PARISM model is used to simulate a rectangular room with most of the absorption located in the ceiling. This room configuration is typical for classroom conditions. The simulations are done using different boundary conditions in order to investigate the influence of phase shifts in reflections, the angle dependence of the reflection coefficient and the scattering coefficient. The focus of the simulations is to investigate the influence of the boundary condition on room acoustic measures which are important for evaluation of the acoustics in classrooms.
Engineering classification of karst ground conditions
Waltham, A. C.; Fookes, P. G.
On a world scale, the dissolution of limestone and gypsum by natural waters creates extensive karst landforms that can be very difficult ground for civil engineers. Caves threaten foundation integrity, notably where their width is greater than their roof thickness. Sinkholes pose many problems, and are classified into six types, including subsidence sinkholes formed in soil cover within karst terrains. Rockhead morphology varies from uniform to pinnacled, also creating difficult ground to exc...
Cyanoacrylate spray as treatment in difficult-to-manage gastrointestinal bleeding.
Toapanta-Yanchapaxi, Liz; Chavez-Tapia, Norberto; Téllez-Ávila, Félix
Gastrointestinal bleeding can be a life-treating event that is managed with standard endoscopic therapy in the majority of cases. However, up to 5%-10% of patients may have persistent bleeding that does not respond to conventional measures. Several endoscopic treatment techniques have been proposed as strategies to control such cases, such as epinephrine injection, hemoclips or argon plasma coagulation, but there are certain clinical scenarios where it is difficult to achieve hemostasis even though adequate use of the available resources is made. Reasons for these failures can be associated with the lesion features, such as extent or location. The use of long-standing techniques in non-traditional scenarios, such as with cyanoacrylate for gastric varices sclerosis, has been reported with favorable results. Although new products such as TC-325 or Ankaferd Blood Stopper hemosprays may be useful, their formulations are not available worldwide. Here we present two clinical cases with very different scenarios of gastrointestinal bleeding, where the use of cyanoacrylate in spray had favorable results in uncommon indications. Cyanoacrylate used as a spray is a technique that can be used as an alternative method in emergent settings. PMID:25228947
Measuring competition in plant communities where it is difficult to distinguish individual plants
DEFF Research Database (Denmark)
Damgaard, Christian
A novel method for measuring plant-plant interactions in undisturbed semi-natural and natural plant communities where it is difficult to distinguish individual plants is discussed. It is assumed that the ecological success of the different plant species in the plant community may be adequately measured by plant cover and vertical density (a measure that is correlated to the 3-dimensional space occupancy and biomass). Both plant cover and vertical density are measured in a standard pin-point analysis in the beginning and at the end of the growing season. In the outlined competition model the vertical density at the end of the growing season is assumed to be a function of the cover of all species at the start of the growing season, and the cover at the start of the growing season is assumed to be a function of the vertical density of all species at the end of the previous growing season. The method allows direct measurements of the competitive effects of neighbouringzplants on plant performance and the estimation of parameters that describe the ecological processes of plantplant interactions during the growing season as well as the process of survival and recruitment between growing seasons. Additionally, the presented method is suited for testing different ecological hypothesis on competitive interactions along environmental gradients, investigating the importance of competition, as well as predicting the likelihood of different ecological scenarios.
Parent perspectives on biomarkers for OCD: Talking of difficult presents, desired pasts, and imagined futures
DEFF Research Database (Denmark)
Whiteley, Louise Emma; Borgelt, Emily L
This paper investigates parent perspectives on potential future applications of neuroimaging and genetic research in the obsessive-compulsive disorder (OCD) clinic: for prediction, diagnosis, and treatment choice. It does so with a reflective eye on parental motivations for discussing near but still uncertain technological futures, and with attention to the conceptual and normative difficulties that such time-travelling talk presents. Grounded in qualitative interviews with parents whose children had participated in an OCD neuroimaging and genetic research study in the United States, we situate parent discussions of imagined futures in their projections from difficult presents and into desired pasts. Parents reported apparently high receptivity to potential future technological scenarios, connected to central challenges they faced in relation to OCD. Yet when parents responded to questions about biomarker tests with the reply, 'yes, anything that helps', uncertainty, caution, and resistance were expressed in implicit negotiations over what it means to 'help'. This paper further considers what the analysis of parent perspectives can contribute to ongoing attempts to situate questions about biological selfhood and the ontological status of the brain and genes in the concrete specificities of individual lived experience; where knowledge is defined in relation to both the actions and rhetorics it facilitates.
Vía aérea difícil en pediatría: signos predictores. Artículo de revisión Difficult airway in pediatrics. Predicting signs
Directory of Open Access Journals (Sweden)
Judith Pérez Lara
Full Text Available El manejo de la Vía Aérea es la A del ABC de la medicina moderna y representa un reto para el anestesiólogo experto, y aún más para el que se encuentra en entrenamiento. Una intubación difícil no anticipada es una emergencia médica, si no es tratada con rapidez y de forma apropiada, puede condicionar problemas serios y hasta la muerte del paciente. En el presente artículo se hace una revisión del diagnóstico precoz de esta entidad, mediante signos predictores, teniendo en cuenta algunas de las características principales de la vía aérea del nińo que la diferencian del adulto.The management of the airway is the A in the ABC of current medicine, and represents a challenge for an expert in anestesiology, and much more for those in the training process. An anticipated difficult intubation is a medical emergency which must be treated rapidly and properly because it can result in serious problems and lead to death. In this article a review of the early diagnosis of this entity through predicting signs , considering some main features at the child airway which are different from the adult's was carried out.
Vía aérea difícil en pediatría: signos predictores. Artículo de revisión / Difficult airway in pediatrics. Predicting signs
Scientific Electronic Library Online (English)
Judith, Pérez Lara; Alina, Acosta Menoya; Emilio, Díaz Gener; Ángel, González Martínez.
Full Text Available El manejo de la Vía Aérea es la A del ABC de la medicina moderna y representa un reto para el anestesiólogo experto, y aún más para el que se encuentra en entrenamiento. Una intubación difícil no anticipada es una emergencia médica, si no es tratada con rapidez y de forma apropiada, puede condiciona [...] r problemas serios y hasta la muerte del paciente. En el presente artículo se hace una revisión del diagnóstico precoz de esta entidad, mediante signos predictores, teniendo en cuenta algunas de las características principales de la vía aérea del nińo que la diferencian del adulto. Abstract in english The management of the airway is the A in the ABC of current medicine, and represents a challenge for an expert in anestesiology, and much more for those in the training process. An anticipated difficult intubation is a medical emergency which must be treated rapidly and properly because it can resul [...] t in serious problems and lead to death. In this article a review of the early diagnosis of this entity through predicting signs , considering some main features at the child airway which are different from the adult's was carried out.
Management of the difficult airway in children. A case report Abordaje de la vía aérea difícil en el nińo. Reporte de un caso
Directory of Open Access Journals (Sweden)
Dianelys De la Cruz Cruz
Full Text Available The anesthesiologist plays a unique role in the health care of all patients who will undergo a surgical procedure. In this sense, he is a key factor in the appropriate and timely management of the airway. There are special situations that condition a difficult airway and can have a profound impact on anesthetic morbidity and mortality. These risks increases in the case of children, that is why the case of a pediatric patient with a difficult airway caused by limitation of mouth opening, scheduled for elective surgery in order to treat this condition in the Pediatric University Hospital ¨Paquito González Cueto " in Cienfuegos, is presented.El anestesiólogo, juega un rol único en el cuidado de la salud de todo paciente que va a ser sometido a un acto quirúrgico. En este sentido, tiene un papel fundamental el abordaje, correcto y oportuno, de la vía aérea. Existen situaciones especiales que condicionan una vía aérea difícil, lo que puede tener un profundo impacto en la morbimortalidad anestésica. Estos riesgos se incrementan en el caso de los nińos. Por tales razones se presenta el caso de un paciente de edad pediátrica con una vía aérea difícil, por presentar limitación de la apertura bucal, este paciente se le realizó una cirugía electiva para el tratamiento de esta afección en el Hospital Pediátrico Universitario "Paquito González Cueto" de Cienfuegos.
Breaking the cycle: how I manage difficult atopic dermatitis Romper o ciclo: minha conduta em casos difíceis de dermatite atópica
Directory of Open Access Journals (Sweden)
Jon M. Hanifin
Full Text Available This review summarizes the general approach and philosophy of managing difficult atopic dermatitis. There are as many regimens as there are physicians, but too many fail to provide patients with adequate relief. This leads to the wasteful alternative - an allergy-seeking behavior that makes caring for these patients even more complicated. If we, as dermatologists, provide rational counseling on prevention and skin care along with effective, stable, anti-inflammatory therapy, our patients may stop seeking irrational approaches. The new flood of information relating to epidermal barrier provides a basis for seeking and treating xerotic conditions earlier during infancy with the hope that the increasing problems with atopic dermatitis and asthma may be lessened with simple and safe measures.Esta revisăo resume a abordagem geral e a filosofia na conduta de casos difíceis de dermatite atópica. Existe uma variedade de tratamentos, assim como de médicos, mas muitos falham e năo propiciam um alívio adequado aos pacientes, o que leva a uma alternativa dispendiosa, ou seja, um atitude que visa procurar alergias e complica ainda mais o tratamento desses pacientes. Se nós, como dermatologistas, oferecermos um aconselhamento racional sobre prevençăo e cuidados com a pele, junto com uma terapia antiinflamatória eficaz e estável, nossos pacientes irăo parar de procurar abordagens irracionais. O novo fluxo de informaçőes sobre a barreira epidérmica propicia uma base para investigar e tratar as doenças xeróticas em uma fase mais precoce durante o primeiro ano de vida, com a esperança de que os problemas crescentes relacionados ŕ dermatite atópica e asma possam ser atenuados com medidas simples e seguras.
Aruga, Takashi; Yabuki, Nobuyoshi; Arai, Yasushi
Cut-and-Cover tunnels are constructed on site. The various conditions of environments and techniques of construction make a significant influence on the quality of the tunnel. It is extremely difficult to rebuild the tunnel even if a structural trouble is found once the construction is completed. Thus, suitable maintenance is needed to ensure the tunnel is in a healthy condition. To execute better maintenance, the information on design and construction of the tunnel is vital for inspection of degradation, estimation of occurrence factors and planning of repair or refurbishing works. In this paper, we developed a product model for representing cut-and-cover tunnels including degradations for effective information use in maintenance work. As its first step, we investigated the characteristics of cut-and-cover tunnels and degradations about reinforced concrete members and developed a conceptual model. Then, we implemented the conceptual product model by expanding Industry Foundation Classes (IFC). Finally, we verified the product model by applying it to a simple tunnel.
Management of acute esophageal variceal bleeding by endoscopic sclerotherapy in technically difficult endoscopic band ligation cases—A population based cohort study
Directory of Open Access Journals (Sweden)
Gamal E. Esmat
Full Text Available Endoscopic band ligation is regarded as the main therapeutic option for acute esophageal variceal bleeding, while sclerotherapy may be used in the acute setting if ligation is technically difficult. The incidence of difficult-to-perform band ligation in acute esophageal variceal bleeding, as well as the outcome of patients subjected to injection sclerotherapy as an alternative treatment, has not been clearly investigated. Our aim is to study the outcome of patients subjected to injection sclerotherapy in the acute setting of esophageal variceal bleeding when endoscopic band ligation is technically difficult to perform. We included 151 patients with acute esophageal variceal bleeding originnating from medium or large sized varices. All patients were planned for EBL as the 1st treatment option (EBL group 61.6%, meanwhile, EIS using 5% ethanolamine oleate was reserved as the 2nd treatment option when EBL was technically difficult (EIS group 38.4%. The mean time to restore hemodynamic stability was significantly prolonged in the EIS group (11.5 ± 6.5 hrs versus 9.5 ± 5.0 hrs, p 0.05. Initial control of bleeding was significantly higher in the EBL group versus the EIS group (96.7% vs 84.5%, p 0.021. Re-bleeding was more among the EIS group (42.9% vs 24.2%, p 0.04. There were no significant differences as regarding mortality and duration of hospital stay. So, a considerable proportion of cases presenting with acute variceal bleeding will have difficulty in performing EBL. In these patients, sclerotherapy is not a waning procedure with an accepted success rate, without much additional complications and without deranging mortality.
Kamei, Kenju
We elicit human conditional punishment types by conducting experiments. We find that their punishment decisions to an individual are on average significantly positively proportional to other members' punishment decisions to that individual.
Thermal Decomposition of HEs Included in Industrial Perforating Systems
International Science & Technology Center (ISTC)
Predictive Model for Estimating the Effects Produced by Thermal Decomposition of HE Included in Perforating Systems of the Oil and Gas Industry on Their Normal Operation in Boreholes under Various Temperature and Time Conditions
Combined precut in difficult biliary cannulation / Precorte combinado en la canulación biliar difícil
Scientific Electronic Library Online (English)
Jesús, Espinel-Díez; Eugenia, Pinedo-Ramos; Luis, Vaquero-Ayala; Begońa, Álvarez-Cuenllas; Vanesa, Ojeda-Marrero.
Full Text Available Aim: precut sphincterotomy refers to a variety of endoscopic techniques that are used in order to access the bile duct when conventional methods of cannulation have failed. There are not significant data (such as efficacy, safety) about the use of different techniques of precutting at the same sessi [...] on. We have described our experience with combined precut sphincterotomy (CPS) and we have compared our results to the use of an isolated precut. Patients and methods: we have performed 247 precuts of a total of 2.390 ERCPs. Patients were distributed according to the type of precut practiced: Needle-knife, transpancreatic and combined precut sphincterotomies. "Combined precut" consisted in performing first a transpancreatic sphincterotomy and, if the access was not achieved, then performing a needle-knife sphincterotomy in the same session. The data about safety and efficacy were prospectively collected. The complications were defined according to the consensus criteria. Results: we performed precutting techniques in 247 patients. Needle-knife, transpancreatic, and combined precuts were performed in 125 (6.9%), 74 (4.1%) and 48 (2.6%) patients, respectively. Bile duct cannulation was successful in 48 patients (100%) in the group of combined precut, 121 patients (96.8%) in the transpancreatic group, and 67 patients (90.5%) in the needle-knife group (p = 0.03). There were not differences in complications rates between the three groups. There was no pancreatitis in the combined precut group. The complications were successfully managed with conservative treatment. Conclusions: combined precut sphincterotomy seems to be a safe and successful technique in those cases of difficult bile duct cannulation.
Laparoscopia no abdome agudo inflamatório de difícil diagnóstico Laparoscopy in inflamatory acute abdomen of difficult diagnosis
Directory of Open Access Journals (Sweden)
Antonio Carlos Valezi
Full Text Available OBJETIVOS: O objetivo deste estudo foi analisar a eficácia do método laparoscópico em casos de abdome agudo inflamatório de difícil avaliaçăo, quanto ŕ acurácia, sensibilidade, especificidade e valores preditivos positivo e negativo. MÉTODO: Foram examinados, prospectivamente, 29 doentes com suspeita clínica de abdome agudo inflamatório, que após exames clínico e complementares năo esclarecedores, foram submetidos ŕ laparoscopia diagnóstica e/ou terapęutica. RESULTADOS: A precisăo diagnóstica do exame foi de 96,5%. Com relaçăo ŕ terapęutica, 58,6 % dos doentes foram tratados por laparoscopia, 34,4% clinicamente e 6,8 % por laparotomia. A taxa de complicaçăo foi de 10,3%, com ausęncia de mortalidade nesta série. Os doentes submetidos ao tratamento laparoscópico, tiveram alta hospitalar em média 36 horas após o procedimento. CONCLUSŐES: A laparoscopia mostrou-se um método de elevada acurácia diagnóstica, que permitiu manejo terapęutico satisfatório, associado ŕ baixa morbidez e ŕ recuperaçăo pós-operatória precoce.OBJECTIVE: The aim of this study is to analize the efficacy of laparoscopy in cases of acute inflamatory abdomen of difficult diagnosis, according to accuracy, sensitivity, specificity and negative and positive predictive values. METHODS: The authors studied, prospectively, 29 patients with clinical suspicion of inflamatory acute abdomen, that, after inconclusive clinical and complemental investigations were submitted to diagnostic and / or therapeutic laparoscopy. RESULTS: In 96,5 % of the patients the procedure confirmed the diagnosis; 58,6 % of the patients were treated by laparoscopy, 6,8% by laparotomy and 34,4% received clinical treatment. The complication rate was 10,3 %, with no mortality in this study. Patients treated by laparoscopy were discharged from hospital in 36 hours after the procedure. CONCLUSIONS: Laparoscopy proved to be a good diagnostic and therapeutic method in acute inflamatory diseases of the abdomen and is associated with lower hospitalization time and lower rate of complications.
Risk Factors and Complications Associated with Difficult Retrieval of Embolic Protection Devices in Carotid Artery Stenting
International Nuclear Information System (INIS)
Purpose: This study was designed to investigate the risk factors and complications of difficult retrieval (DR) of embolic protection devices (EPDs) in carotid artery stenting (CAS). Methods: A total of 195 consecutive patients who underwent CAS between December 2007 and March 2010 in a general hospital were enrolled and divided into two groups: with DR and without DR. The risk factors of DR were analyzed with univariate and multivariate analyses. The complications of DR were recorded and analyzed. Results: A total of 30 (15.4%) patients with DR of EPDs were observed, of whom EPDs were successfully retrieved in 29, and in 1 was it taken out by surgical treatment. The retrieval time was significantly longer in patients with DR (490.5 ± 143.9 s) than in patients without DR (157.2 ± 15.7 s, p = 0.000). Vasospasm was observed more frequently in patients with DR than in patients without DR (55.2% vs. 14.5%, p = 0.000). Intracranial compilations were more frequent in patients with DR than in those without DR (17.2% vs. 0.6%, p = 0.000). Calcified plaques, degree of residual stenosis, types of the stents, and tortuosity index (TI > 80°) were all associated with DR. A logistic regression analysis indicated that calcified plaques (odds ratio (OR) = 6.5; p = 0.000) and TI > 80° (OR = 18.8; p = 0.000) were independent predictors of DR. Conclusions: Calcified plaques and TI > 80° may be related to DR in patients with CAS. DR may lengthen the retrieving time and increase the che retrieving time and increase the complications of the procedure.
Laparoscopia no abdome agudo inflamatório de difícil diagnóstico / Laparoscopy in inflamatory acute abdomen of difficult diagnosis
Scientific Electronic Library Online (English)
Antonio Carlos, Valezi; Jorge, Mali Junior; Rodrigo Gomes de, Oliveira; Mario, Liberatti; Antonio César, Marson; Edivaldo Macedo de, Brito.
Full Text Available OBJETIVOS: O objetivo deste estudo foi analisar a eficácia do método laparoscópico em casos de abdome agudo inflamatório de difícil avaliaçăo, quanto ŕ acurácia, sensibilidade, especificidade e valores preditivos positivo e negativo. MÉTODO: Foram examinados, prospectivamente, 29 doentes com suspeit [...] a clínica de abdome agudo inflamatório, que após exames clínico e complementares năo esclarecedores, foram submetidos ŕ laparoscopia diagnóstica e/ou terapęutica. RESULTADOS: A precisăo diagnóstica do exame foi de 96,5%. Com relaçăo ŕ terapęutica, 58,6 % dos doentes foram tratados por laparoscopia, 34,4% clinicamente e 6,8 % por laparotomia. A taxa de complicaçăo foi de 10,3%, com ausęncia de mortalidade nesta série. Os doentes submetidos ao tratamento laparoscópico, tiveram alta hospitalar em média 36 horas após o procedimento. CONCLUSŐES: A laparoscopia mostrou-se um método de elevada acurácia diagnóstica, que permitiu manejo terapęutico satisfatório, associado ŕ baixa morbidez e ŕ recuperaçăo pós-operatória precoce. Abstract in english OBJECTIVE: The aim of this study is to analize the efficacy of laparoscopy in cases of acute inflamatory abdomen of difficult diagnosis, according to accuracy, sensitivity, specificity and negative and positive predictive values. METHODS: The authors studied, prospectively, 29 patients with clinical [...] suspicion of inflamatory acute abdomen, that, after inconclusive clinical and complemental investigations were submitted to diagnostic and / or therapeutic laparoscopy. RESULTS: In 96,5 % of the patients the procedure confirmed the diagnosis; 58,6 % of the patients were treated by laparoscopy, 6,8% by laparotomy and 34,4% received clinical treatment. The complication rate was 10,3 %, with no mortality in this study. Patients treated by laparoscopy were discharged from hospital in 36 hours after the procedure. CONCLUSIONS: Laparoscopy proved to be a good diagnostic and therapeutic method in acute inflamatory diseases of the abdomen and is associated with lower hospitalization time and lower rate of complications.
Advertising and the internet: the difficult convergence Publicidade e internet: a difícil convergęncia
Directory of Open Access Journals (Sweden)
Maria Eduarda da Mota Rocha
Full Text Available Advertising and the internet: the difficult convergence — Ever since the crisis of Fordism, competition between companies has led to an increasingly fierce quest to draw the consumer's attention to advertisements, engendering what we call audience saturation resulting from the ubiquitousness of advertising. This saturation is aggravated as the rising costs of broadcasting in the mass media continually drive advertisers to seek new forms of addressing the consumer. In this context, it would be reasonable to expect the Internet to become a privileged route of access to the consumer. However, the Internet's relevance in traditional advertising is still negligible, at least in Brazil. This article strives to demonstrate this phenomenon, analyzing some recurring opinions in the advertising sector and explaining it in the light of an understanding of a broader advertising dynamics, thus contributing to the debate on the consequences of the advent of the Internet for the communication system and for culture. Desde a crise do fordismo, a concorręncia entre as empresas tem se traduzido em uma busca ainda mais frenética pela atençăo do consumidor ŕs mensagens publicitárias, o que levou ao que chamamos aqui de saturaçăo da audięncia, isto é, a banalizaçăo dos anúncios diante da sua multiplicaçăo. Essa saturaçăo é agravada quando o aumento dos custos de veiculaçăo nos meios de comunicaçăo de massa estimula os publicitários a buscarem novas formas de interpelaçăo do consumidor. Nesse cenário, năo seria de esperar que a internet despontasse como uma rota privilegiada de acesso ao consumidor? No entanto, a sua relevância para a publicidade tradicional é pequena no Brasil. Pretendemos entăo demonstrar esse fato, analisar algumas opiniőes recorrentes a esse respeito, dentro do campo publicitário, e explicá-lo ŕ luz de uma compreensăo da dinâmica publicitária mais abrangente. Nesse percurso, poderemos dar alguma contribuiçăo ao debate sobre as consequęncias do advento da internet para o sistema de comunicaçăo e a cultura.
Osteoinduction using autologous bone marrow in difficult orthopaedic problems – A clinical study
Directory of Open Access Journals (Sweden)
R. M. Shenoy
Full Text Available Background: Bone injury/insult heals by new bone formation a process termed as osteogenesis .When this regenerative process is deficient, healing is disturbed and need for osteoinduction arises. Various methods of osteoinduction in current practice are either extensive or expensive. Bone marrow as a natural source for osteoinduction was first described in the year 1869. The current study aims at evaluating the results of injection of bone marrow aspirate in its natural form without separating its contents, to induce osteogenesis in difficult orthopaedic problems. Methods: The procedure was carried out in the Operation theatre under sterile precautions. Bone marrow was aspirated from the iliac crest in all cases. A sternal puncture needle was used for aspiration and around 30 ml was injected immediately, directly into the fracture site on a previously placed needle with the help of image intensifier. All these fractures had a fixation device either externally or internally. There was no evidence of infection at the time of injection. Defective non unions were excluded from the study. Radiological assessment for union was done at an interval of 4 to 6 weeks. Number of injections given varied from 2 to 4 and interval between the injections varied from 4 to 6 weeks.Results: In a total number of 33 cases distributed as follows that is, 27 type 3 B, open tibial diaphyseal fractures with delayed union stabilized by external fixator, 1 closed tibial fracture with nonunion, 1 closed tibial fracture with implant failure, 2 humeral shaft fractures with plate osteosynthesis, 2 fracture shaft femur with internal fixation, all showed progressive callus and union within an average period of 12 to 18 weeks with 2 or 4 bone marrow injections.
Bayesian Sampling using Condition Indicators
DEFF Research Database (Denmark)
Faber, Michael H.; SŘrensen, John Dalsgaard
The problem of control quality of components is considered for the special case where the acceptable failure rate is low, the test costs are high and where it may be difficult or impossible to test the condition of interest directly. Based on the classical control theory and the concept of condition indicators introduced by Benjamin and Cornell (1970) a Bayesian approach to quality control is formulated. The formulation is then extended to the case where the quality control is based on sampling of indirect information about the condition of the components, i.e. condition indicators. This allows for a Bayesian formulation of the indicators whereby the experience and expertise of the inspection personnel may be fully utilized and consistently updated as frequentistic information is collected. The approach is illustrated on an example considering a concrete structure subject to corrosion. It is shown how half-cell potential measurements may be utilized to update the probability of excessive repair after 50 years.
Difficult Decisions: Animal Rights--Do We Have the Right to Do Research on Animals?
Parakh, Jal S.; Slesnick, Irwin L.
Discusses who has the right to determine the use of animals in scientific research which includes medical experimentation and the toxicity testing of compounds, ranging from pesticides to cosmetics. Provides a list of questions for consideration and discussion. (RT)
Prolactinoma in a Diabetic Dialysis Patient with Erectile Dysfunction: A Difficult Differential Diagnosis
Piccoli, Giorgina B; Bermont, Francesca; Magnano, Andrea; SORAGNA, GIORGIO; Terzolo, Massimo
Dialysis patients often suffer from erectile dysfunction. The prevalence of this symptom in the context of dialysis is as high as 90%. Diabetes, diffuse vascular disease and pharmacological therapy are attendant causes of this condition, severely impairing the quality of life. Due to the high frequency of erectile dysfunction in uremic patients, minimalist diagnostic approaches are often used. Nevertheless, a careful differential diagnosis is also warranted in well dialyzed patients to identi...
Development of a detector system for measurement of contamination at places with difficult access
International Nuclear Information System (INIS)
The objective of this research is the development and testing of the detector system for the measurement of very low-level radioactivity, even near background level, suitable for irregularly shaped surfaces like those inside small diameter tubes. The research carried out showed essential improvement of contamination measurements under real conditions (e.g. KRB-Gundremmingen, KKW-Biblis, ALKEM) by development of an integrated portable measuring device composed by a series of round and flat gas flow detectors
Operant conditioning in invertebrates
Brembs, Björn
Learning to anticipate future events on the basis of past experience with the consequences of one's own behavior (operant conditioning) is a simple form of learning that humans share with most other animals, including invertebrates. Three model organisms have recently made significant contributions towards a mechanistic model of operant conditioning, because of their special technical advantages. Research using the fruit fly Drosophila melanogaster implicated the ignorant gene in operant co...
Choice and conditioned reinforcement.
Fantino, E.; Freed, D.; Preston, R. A.; Williams, W. A.
A potential weakness of one formulation of delay-reduction theory is its failure to include a term for rate of conditioned reinforcement, that is, the rate at which the terminal-link stimuli occur in concurrent-chains schedules. The present studies assessed whether or not rate of conditioned reinforcement has an independent effect upon choice. Pigeons responded on either modified concurrent-chains schedules or on comparable concurrent-tandem schedules. The initial link was shortened on only o...
Trombosis venosa cerebral de difícil diagnóstico / Cerebral venous thrombosis of difficult diagnosis
Scientific Electronic Library Online (English)
David, Lira; Nilton, Custodio; Eder, Herrera-Pérez; Liza, Núńez del Prado; Erik, Guevara-Silva; Sheila, Castro-Suárez; Rosa, Montesinos.
Full Text Available Introducción: La trombosis venosa cerebral, una enfermedad cerebro vascular rara, afecta fundamentalmente nińos y mujeres en edad fértil. Caso clínico: Paciente de sexo femenino, 45 ańos de edad, evaluada en otro establecimiento de salud donde le diagnosticaron fiebre tifoidea, acudió a emergencia r [...] efiriendo un tiempo de enfermedad de 14 días, con cefalea frontal de moderada intensidad, náuseas y vómitos, fue hospitalizada por una probable hemorragia subaracnoidea. Al examen físico tenía funciones vitales estables y examen neurológico normal; la tomografia cerebral mostró edema cerebral difuso, la angiotomografía cerebral y resonancia magnética de encéfalo evidenciaron trombosis del seno sagital superior, transverso y sigmoide derecha. Los exámenes de analítica sanguínea fueron normales. Se diagnosticó trombosis venosa cerebral y se inició tratamiento antiedema cerebral y anticoagulación con heparina de bajo peso molecular y después con warfarina, siendo dada de alta sin compromiso neurológico. Discusión: La Trombosis venosa cerebral es una entidad rara y presenta síntomas inespecíficos; siendo el más frecuente la cefalea recurrente, persistente y refractaria al tratamiento, algunos casos son de díficil diagnóstico, el método diagnóstico de elección es la resonancia magnética en fase venosa y su tratamiento se realiza con anticoagulantes. Abstract in english Introduction: Cerebral venous thrombosis, rarely cerebrovascular disease, affects mainly children and women of childbearing age. Case report:. Female patient, 45 years of age, evaluated at another health center where she was diagnosed with typhoid fever, she went to emergency referring a time of ill [...] ness 14 days, with frontal headache of moderate intensity, nausea and vomiting, she was hospitalized with a probable subarachnoid hemorrhage. On physical examination, she had stable vital functions and normal neurological examination, brain tomography showed diffuse cerebral edema, cerebral angiography and MRI of the brain showed thrombosis of the sagittal sinus, transverse and sigmoid. Blood tests were normal. Cerebral venous thrombosis was the diagnosis and she was treated with antiedema cerebral and started anticoagulation with low molecular weight heparin and then with warfarin, after was discharged without neurological impairment. Discussion: Cerebral venous thrombosis is a rare entity and presents inespecific symptoms, the most frequent is persistent headache refractory to treatment, some cases are of difficult diagnosis, the diagnostic method of choice is MRI in venous phase and the treatment is with anticoagulants.
... have a certain health condition. You can have screening tests in the first or second trimester of pregnancy. First trimester screening is done at ... back of your baby's neck. Testing in the second trimester is called maternal ... You can get this blood test between 15 and 20 weeks of pregnancy. If ...
Hematuria de origen papilar o medular: entidad de difícil diagnóstico / Hematuria of papillary or medullar origin: a difficult diagnosis entity
Scientific Electronic Library Online (English)
Carmen, González Enguita; Jesús, Gómez Muńoz; Cristina, Martín Vivas; Leticia, López Martín; Luis Fernándo, Susanibar Napuri; Simona, Alexandro; Carlos, Caramelo Díaz; Remigio, Vela Navarrete.
Full Text Available Objetivo: Los hemangiomas renales de origen papilar o medular renal, es una entidad de difícil diagnóstico, siendo una de las causas más frecuentes de episodios crónicos de hematuria, por patología benigna, fundamentalmente en pacientes jóvenes (1). El objetivo de esta presentación es mostrar la dif [...] icultad de este diagnóstico y la necesidad de sospecharlo en cuadros con historia similar a la que expresan estos casos. Métodos: Se presentan 4 casos de hematuria espontánea de origen renal, con expresión clínica de dolor cólico, de la serie histórica del Servicio de Urología de la Fundación Jiménez Díaz-Capio, los dos últimos del ańo 2005-6. Se presenta la metodología diagnóstica y terapéutica realizada, incluidos los estudios de angioTAC y la URS (ureterorenoscopia flexible), asi como diversas opciones de tratamiento. Resultado: La hematuria se identificó como "esencial" al descartar la relación responsable con patología tumoral o litiásica, y de origen renal al seńalar claramente su origen. Se interpretó relacionada con angiomas o microangiomas de origen papilar o medular. En un caso la malformación vascular fue interpretada como FAV (fístula arteriovenosa) a ese nivel. Tras la URS exploradora, la hematuria cedió espontáneamente en dos casos. El caso histórico más antiguo requirió la exploración quirúrgica de las estructuras calicilares. Conclusión: Hace ańos y siguiendo el desarrollo profesional de la Especialidad de Urología, todos estos casos, de gran dificultad diagnóstica, eran sometidos a cirugía convencional, en muy pocas ocasiones con actitud conservadora, basada ésta en la exploración de las cavidades renales, intentando observar y encontrar el lugar del sangrado activo. La mayoría de los casos eran sometidos finalmente a Nefrectomía total o parcial. La posibilidad actual, de poder explorar las cavidades renales en su totalidad con el ureterorenoscopio flexible, permite un mejor diagnóstico de las lesiones y un tratamiento más conservador. El diagnóstico último de angioma renal papilar es anatomo-patológico, sin existir datos patogneumónicos de diagnóstico por la imagen Se piensa en esta patología, al final del proceso diagnóstico, y al identificar la zona papilar como origen del sangrado. La serie histórica de casos clinicos, con los hallazgos anatomo-patológicos de las nefrectomías realizadas, permite seńalar la entidad, como angioma papilar, en pacientes con clínica similar. Abstract in english Objectives: Renal haemangiomas of renal papillary or medullar origin are a difficult diagnosis entity, being one of the most frequent processes of chronic episodes of hematuria, secondary to benign disease, mainly in young patients (1). The objective of this paper is to show the difficulty of this d [...] iagnosis and the need to suspect it in cases with clinical history similar to the ones described in these cases. Methods: We report 4 cases of spontaneous hematuria of renal origin, with clinical presentation as renal colic, from the historical case series of the Fundacion Jimenez Díaz - Capio, the last two from the years 2005-6. We present the diagnostic and therapeutic methodology employed, including angio-CT and flexible ureterorenoscopy (URS) as well as various treatment options. Results: Hematuria was identified as "essential" when any relation with tumor or lithiasic pathologies was ruled out, and of renal origin when the source was clearly pointed. We interpreted it was related to angiomas or microangiomas of papillary or medullar origin. In one case, the vascular malformation was interpreted as an arterial venous fistula (AVF) at that level. Hematuria stopped spontaneously in two cases after exploratory URS. The eldest historical case required surgical expiration of the caliceal structures. Conclusion: Years ago, following the professional development of Urology as speciality, conventional surgery was carried out in all these cases, of very difficult diagnosis, with a very small number of cases undergoing a conservative appr
Tromboembolismo pulmonar e asma de difícil controlo / Pulmonary embolism and difficult-to-treat asthma
Scientific Electronic Library Online (English)
Catarina Teles, Martins; Carlos, Lopes; Alda, Manique; Dolores, Moniz; Renato, Sotto-Mayor; A Bugalho de, Almeida.
Full Text Available O controlo da asma é um factor crucial na abordagem do doente: a mais recente actualizaçăo do GINA considera que uma "asma difícil de tratar" é uma asma para investigar. O năo cumprimento da terapęutica, a DPOC concomitante, o tabagismo, a rinossinusite, o refluxo gastroesofágico e a obesidade săo c [...] onsiderados os principais motivadores da asma difícil de controlar. O presente trabalho teve por objectivo avaliar o papel do tromboembolismo pulmonar (TEP) na asma grave de difícil controlo. Foram revistos os processos clínicos de doentes asmáticos da consulta de Alergologia Respiratória do nosso Serviço, entre 2004 e 2006, com asma "persistente grave" de acordo com o GINA 2005. Foram seleccionados os que, apesar de terapęutica optimizada, apresentavam asma "năo controlada" (GINA 2006) e analisadas as suas causas. Dos 254 doentes estudados, 28 (11%) preenchiam os critérios de "asma persistente grave" (idade média 44±18 anos; 86% sexo feminino); destes, 57% (n=16) tinham doença "năo controlada" - 35% (n=6) por má adesăo ŕ terapęutica; 29% (n=5) por TEP (confirmado gamagraficamente); 12% (n=2) por rinossinusite grave; 6% (n=1) por síndroma hipereosinofílica; 6% (n=1) por contacto mantido com alérgenos e 6% (n=1) em estudo. Os doentes com TEP (idade média 56±9 anos; 80% sexo feminino; 80% raça branca) tiveram o diagnóstico de asma na idade adulta (média 37 anos), tendo decorrido cerca de 18 anos até ao diagnóstico de TEP. A análise dos factores predisponentes para TEP revelou: insuficięncia venosa periférica (40%), HTA (40%) e deficięncia de proteína C e S funcionais (20%). Todos os doentes efectuaram terapęutica anticoagulante (80% ainda mantém), referindo-se que, após o início da anticoagulaçăo, 40% dos doentes alcançaram o controlo da doença e 40% tęm, actualmente, asma "parcialmente controlada", năo se tendo verificado novos internamentos por agudizaçăo da doença. Os resultados do presente trabalho apoiam a inclusăo do TEP no grupo de comorbilidades possivelmente responsáveis pelo mau controlo da asma. Abstract in english Asthma control is a key point in patient management. GINA's most recent report emphasises the need to investigate uncontrolled asthma, of which non-compliance with treatment, COPD, smoking, chronic sinusitis, gastroesophageal reflux disease and obesity are the usual causes. The aim of this work is t [...] o evaluate the role of pulmonary thromboembolism (PTE) in cases of difficult-to-treat asthma. We reviewed the case reports of patients with severe persistent asthma followed in our Asthma Outpatients Clinic between 2004 and 2006. We selected the ones that maintained uncontrolled disease despite an optimal therapeutical approach and investigated the causes. In this group (n=254), 28 (11%) had severe persistent asthma and their mean age was 44 ± SD18 years old. 86% were females. Of these, 57% (n=16) had uncontrolled disease: 35% (n=6) due to non-compliance with treatment; 29% (n=5) pulmonary thrombombolism (scintigraphic confirmation); 12% (n=2) severe rhinosinusitis; 6% (n=1) hypereosinophilic syndrome; 6% (n=1) persistent allergen exposure and 6% (n=1) are still being investigated. Patients with TPE (mean age 56 ± SD9 years old; 80% females; 80% Caucasians) were diagnosed with asthma as adults (mean age 37 ± SD14 years old). The mean time until the diagnosis of TPE was 18 ± SD12 years. Predisposing factors for TPE were venous insufficiency (40%), hypertension (40%) and deficit of functional protein C and S (20%). All these patients received anticoagulant therapy (80% are still medicated). It should be noted that after the beginning of anticoagulants, 40% of the patients achieved control of their asthma and 40% have partially controlled disease. There were no hospital admissions for asthma exacerbations after the beginning of anticoagulation in this group. This study supports the inclusion of TPE in the group of comorbidities to consider while investigating uncontrolled asthma.
Operant Conditioning for Special Educators.
Pedrini, Bonnie C.; Pedrini, D. T.
The paper briefly explains operant conditioning as it pertains to special educators. Operant conditioning is thought to be an efficient method for modifying student behavior. Using the B. F. Skinner frame of reference, operant conditioning is said to include behavior modification and therapy, programed instruction, and computer assisted and…
Renal Sympathetic Denervation for the Treatment of Difficult-to-Control or Resistant Hypertension
Konstantinos Tsioufis; Michalis Doumas; Vasilios Papademetriou
Hypertension represents a major health problem with an appalling annual toll. Despite the plethora of antihypertensive drugs, hypertension remains resistant in a considerable number of patients, thus creating the need for alternative strategies, including interventional approaches. Recently, catheter-based renal sympathetic denervation has been shown to be fairly safe and effective in patients with resistant hypertension. Pathophysiology of kidney function, interaction and crosstalk betwe...
Going Around the Bend: Deep Inspiration Facilitates Difficult Stent Delivery in the Native Coronary Arteries
Attaran, Robert R.; Butman, Samuel; Movahed, Mohammad Reza
Percutaneous coronary intervention in tortuous or calcified vessels poses a substantial challenge for interventional cardiologists. Many techniques have been described to overcome the challenge, including the use of stiffer wires, buddy wires, the anchor balloon technique, and deep seating of the guide catheter. Herein, we describe a way to facilitate stent delivery in many tortuous, calcified, and acutely angled vessels: having the patient take a deep breath during the delivery. Deep inspira...
H-oil, a flexible process for maximum oil yield from difficult feedstocks
Energy Technology Data Exchange (ETDEWEB)
Eccles, R.M.
A discussion covers the incentives for using the Hydrocarbon Research Inc. (HRI) H-Oil Process, a commercially proven black oil hydrogen-addition process, in the light of rising oil prices; its various applications (vacuum-residual oil-recycle operations, desulfurization of heavy oil at moderate conversion levels, combination with coking or catalytic cracking, integration with hydrogen manufacture); the HRI ebullated-bed reactor used in the process and its advantages over conventional fixed-catalyst bed reactors; and commercial experience; and provides comparisons of an actual Kuwait H-Oil Unit performance with HRI estimates, based on current operating conditions, and H-Oil plant configurations for upgrading 8/sup 0/API, 7% sulfur Santa Maria, 12/sup 0/API, 1.5% sulfur San Joaquin Valley, and -1.3/sup 0/API, 9.9% sulfur Texas Heavy crude oils.
Alternative method of inservice hydraulic testing of difficult to test pumps
International Nuclear Information System (INIS)
The pump test codes require that system resistance be varied until the independent variable (either the pump flow rate or differential pressure) equals its reference value. Variance from this fixed reference value is not specifically allowed. However, the design of many systems makes it impractical to set the independent variable to an exact value. Over a limited range of pump operation about the fixed reference value, linear interpolation between two points of pump operation can be used to accurately determine degradation at the reference value without repeating reference test conditions. This paper presents an overview of possible alternatives for hydraulic testing of pumps and a detailed discussion of the linear interpolation method. The approximation error associated with linear interpolation is analyzed. Methods to quantify and minimize approximation error are presented
Staddon, J E R; D. T. Cerutti
Operant behavior is behavior "controlled" by its consequences. In practice, operant conditioning is the study of reversible behavior maintained by reinforcement schedules. We review empirical studies and theoretical approaches to two large classes of operant behavior: interval timing and choice. We discuss cognitive versus behavioral approaches to timing, the "gap" experiment and its implications, proportional timing and Weber's law, temporal dynamics and linear waiting, and the probl...
Prolactinoma in a diabetic dialysis patient with erectile dysfunction: a difficult differential diagnosis.
Piccoli, Giorgina B; Bermont, Francesca; Magnano, Andrea; Soragna, Giorgio; Terzolo, Massimo
Dialysis patients often suffer from erectile dysfunction. The prevalence of this symptom in the context of dialysis is as high as 90%. Diabetes, diffuse vascular disease and pharmacological therapy are attendant causes of this condition, severely impairing the quality of life. Due to the high frequency of erectile dysfunction in uremic patients, minimalist diagnostic approaches are often used. Nevertheless, a careful differential diagnosis is also warranted in well dialyzed patients to identify causes and corrigible patterns. The case reported here exemplifies this critical issue. A 44 year old obese diabetic patient complained about the recent onset of erectile dysfunction. On examination, the penile echo-Doppler was normal, and suggested a cause other than dia-betic vascular disease. The high dialysis efficiency (daily hemodialysis, flexible schedules, EKRc from 15 to 25 ml/min) warranted the same diagnostic work-up as would adopted for non-uremic patients. Whilst the rising prolactine level (76.1 microg/l and 129 ng/ml) was still in the range commonly found in dialysis patients, a nuclear magnetic resonance examination was carried out and led to the identification of prolactinoma. Therapy with cabergoline was found effective and sexual potency was restored. Normalization of hormonal patterns followed within 2 months. This is the first case so far reported in a daily dialysis patient. It underlines the importance of a non-minimalist approach to the problem of sexual disorders in renal replacement therapy (RRT) patients, at least when dialysis efficiency is high and onset is rapid. It also suggests considering prolactinoma as an emerging diagnosis in the general population, which can be detected by the use of sensitive imaging techniques in the differential diagnosis of this condition. PMID:17487344
Sturge-Weber-Syndrome with extreme ocular manifestation and rare association of upper airway angioma with anticipated difficult airway.
Wong, Hon Seng; Abdul Rahman, Ropilah; Choo, Swee Ying; Yahya, Nurlia
We report a rare case of an 18 year old girl with Sturge-Weber syndrome, she had extensive facial port wine stains, right bupthalmos and advanced glaucoma involving both eyes. She underwent right eye glaucoma drainage device surgery under general anaesthesia, and had a difficult intubation due to extensive angiomatous like soft tissue swelling at her upper airway. This report highlights the importance of being aware of the need for continuous follow-up in Sturge-Weber syndrome patients as this syndrome can lead to blindness due to advance glaucoma and the awareness of possible difficult intubation for this group of patients. PMID:23082461
Difficult Management of Coronary Artery Disease in a Patient with Thrombotic Thrombocytopenic Purpura
Jorfi, Fatemeh; Sanati, Hamid Reza; Zahedmehr, Ali; Shakerian, Farshad; Zahedi, Lida; Firouzi, Ata; Kiani, Reza; Elmi, Ghazal
Abstract Thrombotic thrombocytopenic purpura (TTP) is a rare syndrome affecting multiple organs. There is no sufficient evidence regarding the clinical cardiac manifestations of TTP. Nonetheless, pathologic cardiac involvement is quite frequent in acute TTP, which is predominantly manifested as myocardial necrosis due to coronary arteriolar microthrombosis. The present case report describes a 43-year-old man with long-standing remitted TTP, who suffered from a sequence of refractory thrombotic epicardial coronary events. Aggressive medical and interventional therapies, including long-term dual antiplatelets and coronary angioplasty, were finally successful in remitting the thrombotic events. During his two-year follow up, he has been asymptomatic. PMID:25870634
Including gauge corrections to thermal leptogenesis
Energy Technology Data Exchange (ETDEWEB)
Huetig, Janine
This thesis provides the first approach of a systematic inclusion of gauge corrections to leading order to the ansatz of thermal leptogenesis. We have derived a complete expression for the integrated lepton number matrix including all resummations needed. For this purpose, a new class of diagram has been invented, namely the cylindrical diagram, which allows diverse investigations into the topic of leptogenesis such as the case of resonant leptogenesis. After a brief introduction of the topic of the baryon asymmetry in the universe and a discussion of its most promising solutions as well as their advantages and disadvantages, we have presented our framework of thermal leptogenesis. An effective model was described as well as the associated Feynman rules. The basis for using nonequilibrium quantum field theory has been built in chapter 3. At first, the main definitions have been presented for equilibrium thermal field theory, afterwards we have discussed the Kadanoff-Baym equations for systems out of equilibrium using the example of the Majorana neutrino. The equations have also been solved in the context of leptogenesis in chapter 4. Since gauge corrections play a crucial role throughout this thesis, we have also repeated the naive ansatz by replacing the free equilibrium propagator by propagators including thermal damping rates due to the Standard Model damping widths for lepton and Higgs fields. It is shown that this leads to a comparable result to the solutions of the Boltzmann equations for thermal leptogenesis. Thus it becomes obvious that Standard Model corrections are not negligible for thermal leptogenesis and therefore need to be included systematically from first principles. In order to achieve this we have started discussing the calculation of ladder rung diagrams for Majorana neutrinos using the HTL and the CTL approach in chapter 5. All gauge corrections are included in this framework and thus it has become the basis for the following considerations. Furthermore, we have computed the Majorana neutrino production rate itself in chapter 6 to test our numerical procedure. In this context we have calculated the tree-level result as well as the gauge corrected result for the Majorana neutrino production rate. Finally in chapter 7, we have implemented the Majorana neutrino ladder rung diagram into our setup for leptogenesis: As a first consideration, we have collected all gauge corrected diagrams up to three-loop order for the asymmetry-causing two-loop diagrams. However, the results of chap. 5 showed that it is not sufficient to just include diagrams up to three-loop level. Due to the necessity of resumming all n-loop diagrams, we have constructed a cylindrical diagram that fulfils this condition. This diagram is the link between the Majorana neutrino ladder rung diagram calculated before on the one hand and the lepton asymmetry on the other. Therefore we have been able to derive a complete expression for the integrated lepton number matrix including all leading order corrections. The numerical analysis of this lepton number matrix needs a great computational effort since for the resulting eight-dimensional integral two ordinary differential equations have to be computed for each point the routine evaluates. Thus the result remains yet inaccessible. Research perspectives: Summarising, this thesis provides the basis for a systematic inclusion of gauge interactions in thermal leptogenesis scenarios. As a next step, one should evaluate the expression for the integrated lepton number numerically to gain a value, which can be used for comparison to earlier results such as the solutions of the Boltzmann equations as well as the Kadanoff-Baym ansatz with the implemented Standard Model widths. This numerical result would be the first quantitative number, which contains leading order corrections due to all interactions of the Majorana neutrino with the Standard Model particles. Further corrections by means of including washout effects and the Hubble expansion are expected to be reasonably small. Furthermore, it is very in
Including gauge corrections to thermal leptogenesis
International Nuclear Information System (INIS)
This thesis provides the first approach of a systematic inclusion of gauge corrections to leading order to the ansatz of thermal leptogenesis. We have derived a complete expression for the integrated lepton number matrix including all resummations needed. For this purpose, a new class of diagram has been invented, namely the cylindrical diagram, which allows diverse investigations into the topic of leptogenesis such as the case of resonant leptogenesis. After a brief introduction of the topic of the baryon asymmetry in the universe and a discussion of its most promising solutions as well as their advantages and disadvantages, we have presented our framework of thermal leptogenesis. An effective model was described as well as the associated Feynman rules. The basis for using nonequilibrium quantum field theory has been built in chapter 3. At first, the main definitions have been presented for equilibrium thermal field theory, afterwards we have discussed the Kadanoff-Baym equations for systems out of equilibrium using the example of the Majorana neutrino. The equations have also been solved in the context of leptogenesis in chapter 4. Since gauge corrections play a crucial role throughout this thesis, we have also repeated the naive ansatz by replacing the free equilibrium propagator by propagators including thermal damping rates due to the Standard Model damping widths for lepton and Higgs fields. It is shown that this leads to a comparable result to the solutions of the Boltzmann equations for thermal leptogenesis. Thus it becomes obvious that Standard Model corrections are not negligible for thermal leptogenesis and therefore need to be included systematically from first principles. In order to achieve this we have started discussing the calculation of ladder rung diagrams for Majorana neutrinos using the HTL and the CTL approach in chapter 5. All gauge corrections are included in this framework and thus it has become the basis for the following considerations. Furthermore, we have computed the Majorana neutrino production rate itself in chapter 6 to test our numerical procedure. In this context we have calculated the tree-level result as well as the gauge corrected result for the Majorana neutrino production rate. Finally in chapter 7, we have implemented the Majorana neutrino ladder rung diagram into our setup for leptogenesis: As a first consideration, we have collected all gauge corrected diagrams up to three-loop order for the asymmetry-causing two-loop diagrams. However, the results of chap. 5 showed that it is not sufficient to just include diagrams up to three-loop level. Due to the necessity of resumming all n-loop diagrams, we have constructed a cylindrical diagram that fulfils this condition. This diagram is the link between the Majorana neutrino ladder rung diagram calculated before on the one hand and the lepton asymmetry on the other. Therefore we have been able to derive a complete expression for the integrated lepton number matrix including all leading order corrections. The numerical analysis of this lepton number matrix needs a great computational effort since for the resulting eight-dimensional integral two ordinary differential equations have to be computed for each point the routine evaluates. Thus the result remains yet inaccessible. Research perspectives: Summarising, this thesis provides the basis for a systematic inclusion of gauge interactions in thermal leptogenesis scenarios. As a next step, one should evaluate the expression for the integrated lepton number numerically to gain a value, which can be used for comparison to earlier results such as the solutions of the Boltzmann equations as well as the Kadanoff-Baym ansatz with the implemented Standard Model widths. This numerical result would be the first quantitative number, which contains leading order corrections due to all interactions of the Majorana neutrino with the Standard Model particles. Further corrections by means of including washout effects and the Hubble expansion are expected to be reasonably small. Furthermore, it is very in
The Effect of Dexamathsone Iontophoresis on Decreasing Pain and Improving Function in Patients With Musculoskeletal Conditions.
Brown, Christopher D; Lauber, Christine A; Cappaert, Thomas
Iontophoresis is a method of local transfer of ionized medicated and non-medicated substances through the skin and into the target tissues using magnetic polarization. The anti-inflammatory properties exhibited by Dexamethasone sodium phosphate (DEX) combined with iontophoresis make it a potentially desirable treatment for clinicians wishing to administer a non-invasive localized drug concentration without having a large systemic concentration of that drug. Since concurrent treatments are commonly used in clinical practice many of the published studies that included the use of DEX also utilized concurrent treatments. However, this may make it difficult for clinicians to determine the individual effectiveness of DEX iontophoresis in treating musculoskeletal conditions. PMID:25203304
phenix.mr_rosetta: a new tool for difficult molecular replacement problems
Energy Technology Data Exchange (ETDEWEB)
Terwilliger, Thomas C [Los Alamos National Laboratory; Read, Randy [UNIV OF CAMBRIDGE; De Maio, Frank [UNIV OF WASHINGTON; Baker, David [UNIV OF WASHINGTON
The PHENIX development team is working with the Baker laboratory at the University of Washington to combine the power of Rosetta structure modeling with PHENIX automated molecular replacement (MR), model-building, density modification, and refinement. The basic idea is to find MR solutions with phenix. automr, rebuild them with Rosetta, including electron density map information, then rebuild those models with phenix. autobuild. The combination of Rosetta rebuilding and phenix rebuilding is the key part of this method. MR solutions are found with phenix. automr (Phaser), scored with LLG (optionally following Rosetta relaxation), the best solutions are picked and rebuilt with Rosetta including map information, the resulting models are scored with Rosetta, and then rescored with LLG, and the top models are rebuilt with phenix. autobuild. It can be very useful for cases where the search model used in molecular replacement is slightly too distant to rebuild successfully with phenix. autobuild. It can also be useful in cases where the model is too distant to even find a molecular replacement solution, and prerefinement with Rosetta can yield an improved search model.
Analysis of Smart Composite Structures Including Debonding
Chattopadhyay, Aditi; Seeley, Charles E.
Smart composite structures with distributed sensors and actuators have the capability to actively respond to a changing environment while offering significant weight savings and additional passive controllability through ply tailoring. Piezoelectric sensing and actuation of composite laminates is the most promising concept due to the static and dynamic control capabilities. Essential to the implementation of these smart composites are the development of accurate and efficient modeling techniques and experimental validation. This research addresses each of these important topics. A refined higher order theory is developed to model composite structures with surface bonded or embedded piezoelectric transducers. These transducers are used as both sensors and actuators for closed loop control. The theory accurately captures the transverse shear deformation through the thickness of the smart composite laminate while satisfying stress free boundary conditions on the free surfaces. The theory is extended to include the effect of debonding at the actuator-laminate interface. The developed analytical model is implemented using the finite element method utilizing an induced strain approach for computational efficiency. This allows general laminate geometries and boundary conditions to be analyzed. The state space control equations are developed to allow flexibility in the design of the control system. Circuit concepts are also discussed. Static and dynamic results of smart composite structures, obtained using the higher order theory, are correlated with available analytical data. Comparisons, including debonded laminates, are also made with a general purpose finite element code and available experimental data. Overall, very good agreement is observed. Convergence of the finite element implementation of the higher order theory is shown with exact solutions. Additional results demonstrate the utility of the developed theory to study piezoelectric actuation of composite laminates with pre-existing debonding. Significant changes in the modes shapes and reductions in the control authority result due to partially debonded actuators. An experimental investigation addresses practical issues, such as circuit design and implementation, associated with piezoelectric sensing and actuation of composite laminates. Composite specimens with piezoelectric transducers were designed, constructed and tested to validate the higher order theory. These specimens were tested with various stacking sequences, debonding lengths and gains for both open and closed loop cases. Frequency changes of 15% and damping on the order of more than 20% of critical damping, via closed loop control, was achieved. Correlation with the higher order theory is very good. Debonding is shown to adversely affect the open and closed loop frequencies, damping ratios, settling time and control authority.
??????????????????: ??????????????? A Survey of Circulation Librarians' Emotional Labor and Emotional Exhaustion: The Case of Difficult Patron Service in University Libraries
Directory of Open Access Journals (Sweden)
Chen Su-May Sheih
Full Text Available ???????????,????????????,??????????????,???????????????????????????????,????????????????????????????????????????????,??,???????????????????????????????????????,???????????????????????????????????,????????????????????????,????????????????????????????,????????????????,???????????????????????????????,????????????????????????????,?????????????????????????,???????????????????????At the front line of library service, circulation librarians devote considerable efforts to performing "emotional labor", i.e., maintaining a pleasant manner while dealing with difficult patrons. Using questionnaires, this study examines frequency of encountering difficult patrons, emotional labor, and degree of emotional exhaustion among university circulation librarians in Taiwan. Meanwhile, the current study also analyzes effects of circulation librarians' personal background factors on these three variables, and the correlation between them. The results suggested that university circulation librarians "scarcely" or "occasionally" encountered difficult patrons, among whom the most frequently encountered types were the "externally attributive" and "critical" ones. Nevertheless, circulation librarians were found high emotional labor workers who mostly performed emotional labor along the dimensions of "dealing with others' negative emotions" and "expressing one's positive emotions". Besides, circulation librarians "scarcely" or "occasionally" felt emotionally exhausted. In general, a positive correlation was found between librarians' frequency of encountering difficult patrons and degree of emotional exhaustion, while a negative correlation was found between librarians' emotional labor and degree of emotional exhaustion.
Pioderma Gangrenoso: apresentaçăo clínica de difícil diagnóstico Pyoderma gangrenosum: a clinical manifestation of difficult diagnosis
Directory of Open Access Journals (Sweden)
Mônica Santos
Full Text Available Pioderma gangrenoso é uma dermatose cutânea ulcerativa incomum, associada a uma variedade de doenças sistęmicas, incluindo doença inflamatória intestinal, artrites, neoplasias hematológicas, hepatites e aids. A sua patogęnese é desconhecida. O diagnóstico geralmente é baseado em evidęncias clínicas e confirmado com a exclusăo das outras etiologias de lesőes ulceradas cutâneas. Relatamos um caso de PG com ulceraçőes extensas com boa resposta ao tratamento.Pyoderma gangrenosum is an uncommon ulcerative cutaneous dermatosis associated with a variety of systemic diseases including inflammatory bowel disease, arthritis, hematological malignancies, hepatitis and acquired immunodeficiency syndrome (AIDS. The pathogenesis of pyoderma gangrenosum remains unknown. Its diagnosis is usually based on clinical evidence and confirmed through a process of elimination of the other possible causes of cutaneous ulcers. This report describes a case of pyoderma gangrenosum with extensive ulceration that responded well to treatment.
Difficult Cases of Pain and Nonpain Symptoms in Intractable Spinal Infections: A Case Series
Olsen, Molly L.; Havyer, Rachel D. A.; Smith, Thomas J.; Swetz, Keith M.
In the modern age of advanced surgical techniques and pharmacologic management, bacterial spinal infections (SIs) can be managed (either eradicated or suppressed) in many hosts. However, the optimal management of SIs may be limited by patient comorbidities, which do not allow for surgical management, or limited by antimicrobial options due to side effects, toxicities, or emerging drug resistance. In these settings, frank and honest discussion regarding risks and benefits of treatment should be pursued, including that the SI may be a terminal illness. In this case series, we present 3 patients who had bacterial SIs whose treatments were limited by the above-mentioned factors. Furthermore, each case presented challenges regarding optimal medical management of somatic and neuropathic pain associated with the SI. PMID:22144661
Education and training in radiation protection: a challenge in passing on a difficult and intricate message
International Nuclear Information System (INIS)
Current radiation protection is a very sophisticated and elaborate domain where, once the information about the exposure of persons is known in terms of the quantity of the effective dose, we can predict resulting radiological consequences related to the stochastic risk to the health of the exposed persons without a need for other details. In fact, the effective dose contains all pertinent information including the average organ dose distribution and relevant radiation and tissue weighting factors which take into account the specific effects of different types of radiation and selected tissue radiosensitivity. Since the effective dose cannot be measured directly, one has to rely on the monitoring of other appropriate measurable quantities and then do some conversions. The current structure of radiation protection quantities includes too many quantities, the definitions of some of which are not easy to understand and interpret. Moreover, there are numerous quantities based on the dose equivalent, such as the equivalent dose, effective dose, committed equivalent dose, committed effective dose, collective equivalent dose, collective effective dose, personal dose equivalent, ambient dose equivalent and directional dose equivalent, where the only unit of Sv is used.. There are a number of cases in open literature reflecting the difficulties and mistakes in the use of radiation protection quantities. Even more complicated situations are encountered in the field, where the staff responsible for personal and workplace monitoring is confused because of so many different quantities and where the staff may not be qualified and experienced enough to be able to make the relevant conversions and interpretations. The paper summarizes our experience in teaching students and lecturing in various training courses addressing radiation protection where the primary task was to ensure that all radiation protection personnel understood the quantities and units used in radiation protection in the correct way consistent with their latest definitions and ICRP recommendations. (author)
Pseudotumoral autoimmune pancreatitis mimicking a pancreatic cancer: a very difficult disease to diagnose
Directory of Open Access Journals (Sweden)
Nizar Miloudi
Full Text Available Autoimmune pancreatitis (AIP is a rare disorder, although the exact prevalence is still unkown. It is a type of pancreatitis that is presumed to have an autoimmune aetiology, and is currently diagnosed based on a combination of 5 criteria. However, in this day and age, some patients with AIP are likely to be resected for the suspicion of malignancy. The authors report a case of pseudo-tumoral autoimmune pancreatitis, reviewing some literature about it and underlining the difficulty in the diagnosis. A 56- year-old patient was referred to our unit for upper abdominal pain. In his past medical history we note mellitus diabetes. The clinical examination was unremarkable. Laboratory data showed no abnormal values. Upper endoscopy showed antral gastritis. Transabdominal ultrasonography showed a hepatic steatosis and 5 angiomas. No computed tomography scan was made. Magnetic resonance imaging (MRI showed 5 angiomas and a lesion of 20x20 mm of the pancreatic tail with decreased signal intensity on T1-weighted MR images, increased signal intensity on T2-weighted MR images. Due to concerns of pancreatic malignancy, the patient underwent open distal spleno-pancreatectomy. Histolo gical analysis of the resected specimen revealed no malignancy. Postoperatively, immunoglobulin G fraction 4 was slightly above of the upper limit of the normal range. After corticotherapy the patient is getting better. This case underlines the difficulties still encountered in the diagnosis of AIP. It has been frequently misdiagnosed as pancreatic cancer and caused unnecessary resection. In order to avoid unnecessary resections for an otherwise benign and easily treatable condition, it is urgent to refine diagnostic criteria and to reach an international consensus.
Extubation of the perioperative patient with a difficult airway / Extubación del paciente perioperatorio con una vía aérea difícil
Scientific Electronic Library Online (English)
Carin A., Hagberg; Carlos A., Artime.
Full Text Available Existe un volumen importante de literatura dedicada al tema del manejo de la vía aérea difícil, y se han desarrollado una serie de algoritmos y recomendaciones para el manejo seguro de pacientes en riesgo de una intubación difícil. Sin embargo, solo recientemente se ha despertado una mayor concienci [...] a acerca de la extubación de la vía aérea difícil, pues aun cuando sea un procedimiento programado, suele estar plagado de complicaciones. La importancia de desarrollar estrategias pre-programadas para la extubación de la vía aérea difícil a fin de aumentar la seguridad del paciente y sus desenlaces se hace evidente a partir de los datos del ASA Closed Claims Analysis y del reciente Cuarto Proyecto Nacional de Auditoría del Reino Unido sobre complicaciones mayores en el manejo de la vía aérea. La clave para un manejo exitoso de los pacientes en riesgo de extubación difícil es efectuar una evaluación precisa de riesgo, aplicar estrategias apropiadas y la preparación tanto del médico como de la institución. Abstract in english A considerable amount of literature has been dedicated to the topic of difficult airway management and a number of algorithms and recommendations have been established to safely manage patients at risk for difficult intubation. Only recently, however, has extubation of the difficult airway gained mo [...] re awareness since this procedure, although elective, is often fraught with complications. The importance of developing pre-planned strategies for extubation of the difficult airway to improve patient safety and outcomes is apparent from data from both the ASA Closed Claims Analysis and the UK's recent Fourth National Audit Project of major complications of airway management. The key to successful management of patients at risk for difficult extubation is accurate risk assessment, application of appropriate strategies, and preparedness by both the individual practitioner and the institution.
Investigation of the radiochromic dye film dosimeter under process conditions, including stability, precision, accuracy, the influence of dose rate, and the influence of the environment. Part of a coordinated programme on high-dose standardization and intercomparison for industrial radiation processing
International Nuclear Information System (INIS)
In the course of the work irradiations have been performed with both Cobalt-60 gamma and electron accelerators. Readout of radiation induced optical densities has been made on various spectrophotometers. Irradiations have been performed under changing conditions of temperature, relative humidity and dose rate, investigating various types of the polyvinyl butyral dosimeters with respect to their sensitivity, stability and optical and mechanical properties. A new formulation of the solution from which dosimeters are cast has been developed. The dosimeter has been found to be rather independent of changes in absorbed dose rate. Maximum deviations are 15% in the range of 0.2 Gy/sec to 1012 Gy/sec. It has been shown that a short heat treatment after irradiation stabilizes the response and enhances it slightly. The plastic film dosimeter consisting of a radiochromic dye precursor (hexa(hydroxyethyl)pararosaniline cyanide) dissolved in a plastic matrix has been investigated and further developed. The dosimeter has been shown to be highly usable for industrial purposes, but suffers still from drawbacks, namely sensitivity to UV light and the need of frequent recalibrations, factors, however, which future work may be able to eliminate
Extending Newtonian Dynamics to Include Stochastic Processes
Zak, Michail
A paper presents further results of continuing research reported in several previous NASA Tech Briefs articles, the two most recent being Stochastic Representations of Chaos Using Terminal Attractors (NPO-41519), [Vol. 30, No. 5 (May 2006), page 57] and Physical Principle for Generation of Randomness (NPO-43822) [Vol. 33, No. 5 (May 2009), page 56]. This research focuses upon a mathematical formalism for describing post-instability motions of a dynamical system characterized by exponential divergences of trajectories leading to chaos (including turbulence as a form of chaos). The formalism involves fictitious control forces that couple the equations of motion of the system with a Liouville equation that describes the evolution of the probability density of errors in initial conditions. These stabilizing forces create a powerful terminal attractor in probability space that corresponds to occurrence of a target trajectory with probability one. The effect in configuration space (ordinary three-dimensional space as commonly perceived) is to suppress exponential divergences of neighboring trajectories without affecting the target trajectory. As a result, the post-instability motion is represented by a set of functions describing the evolution of such statistical quantities as expectations and higher moments, and this representation is stable.
Interleukin-10 paradox: A potent immunoregulatory cytokine that has been difficult to harness for immunotherapy.
Saxena, Ankit; Khosraviani, Sam; Noel, Sanjeev; Mohan, Divya; Donner, Thomas; Hamad, Abdel Rahim A
Interleukin-10 (IL-10) is arguably the most potent anti-inflammatory cytokine. It is produced by almost all the innate and adaptive immune cells. These cells also serve as its targets, indicating that IL-10 secretion and action is highly regulated and perhaps compartmentalized. Consistent with this notion, various efforts directed at systemic administration of IL-10 to modulate autoimmune diseases (type 1 diabetes, multiple sclerosis, rheumatoid arthritis, psoriasis) have produced conflicting and largely inconsequential effects. On the other hand, IL-10 can promote humoral immune responses, enhancing class II expression on B cells and inducing immunoglobulin (Ig) production. Consequently, the high IL-10 level in systemic lupus erythematosus (SLE) patients is considered pathogenic and its blockade ameliorates the disease. In this perspective, we review preclinical findings and results of recent clinical studies using exogenous IL-10 to treat the aforementioned autoimmune diseases. In addition, given the limited success of IL-10 supplementation, we suggest that future studies should be expanded beyond modulating the delivery modes to include developing new strategies to protect and replenish the endogenous sources of IL-10. As an example, we provide evidence that aberrant Fas-mediated deletion of IL-10-producing B cells subverts the immunoregulatory role of IL-10 in autoimmune diabetes and that modulation of the Fas pathway preserves the IL-10-producing B cells and completely protects NOD mice from developing the disease. PMID:25481648
Meniere?s disease: Still a mystery disease with difficult differential diagnosis
Directory of Open Access Journals (Sweden)
Vassiliou A
Full Text Available One hundred and forty-six years after its first description, the differential diagnosis of Meniere?s disease remains very challenging. The aim of the present study is to review the current knowledge on the advantages and disadvantages of the new diagnostic methods for Meniere?s disease. The importance of accurate diagnosis for primary healthcare systems is also discussed. An extensive search of the literature was performed in Medline and other available database sources. Information from electronic links and related books were also included. Controlled clinical studies, prospective cohort studies, retrospective cohort studies, cross-sectional studies, case reports, written guidelines, systematic reviews, and books were selected. The typical clinical triad of symptoms from the vestibular and cochlear systems (recurrent vertigo, fluctuating sensorineural hearing loss and tinnitus is usually the key for clinical diagnosis. Glycerol dehydration test and electrocochleography are the main diagnostic tests in current practice, while vestibular evoked myogenic potentials may be used in disease staging. Imagine techniques are not specific enough to set alone the diagnosis of Meniere?s disease, although they may be necessary to exclude other pathologies. Recently developed 3D MRI protocols can delineate the perilymphatic/endolymphatic spaces of the inner ear and aid diagnosis. Meniere?s disease is a continuous problem for the patients and affects their quality of life. Taking into account the frequent nature of the disease in certain countries, efforts for reliable diagnosis, prompt referral, and successful management are undoubtedly cost-effective for healthcare systems.
Jet grouting for a groundwater cutoff wall in difficult glacial soil deposits
Energy Technology Data Exchange (ETDEWEB)
Flanagan, R.F.; Pepe, F. Jr. [Parsons Brinckerhoff Quade & Douglas, New York, NY (United States)
Jet grouting is being used as part of a groundwater cutoff wall system in a major New York City subway construction project to limit drawdowns in an adjacent PCB contamination plume. A circular test shaft of jet grout columns was conducted during the design phase to obtain wall installation parameters. The test program also included shaft wall mapping, and measurements of; inflows, piezometric levels, ground heave and temperature, and jet grout hydraulic conductivity. An axisymmetric finite element method groundwater model was established to back calculate the in-situ hydraulic conductivities of both the surrounding glacial soils and the jet grout walls by matching observed inflows and piezometric levels. The model also verified the use of packer permeability test as a tool in the field to evaluate the hydraulic conductivities of jet grout columns. Both the test program and analytic studies indicated that adjustments to the construction procedures would be required to obtain lower hydraulic conductivities of the jet grout walls for construction. A comparison is made with the conductivities estimated from the test program/analytic studies with those from the present construction.
Inclusion-body myositis: a difficult diagnosis? / Miosite por corpos de inclusăo: um diagnóstico difícil?
Scientific Electronic Library Online (English)
Carolina da Cunha, Correia; Maria Clara de Oliveira, Magalhăes; Pedro Lucas de Mendonça, Barbosa; Eliene Dutra, Campos; Edmar, Zanoteli.
Full Text Available A miosite por corpos de inclusăo (MCI) esporádica é a miopatia mais comum acima dos 55 anos de idade. No entanto, em muitos casos, o diagnóstico é negligenciado. Os principais achados incluem fraqueza muscular progressiva, níveis séricos normais ou levemente elevados de creatinoquinase (CK) e ausęnc [...] ia de resposta ŕ imunossupressăo. A biópsia muscular evidencia reaçăo inflamatória associada com alteraçőes degenerativas das fibras musculares. Apresentamos um caso típico de MCI cujo diagnóstico foi obtido após a realizaçăo de uma terceira biopsia muscular. Discutimos os desafios para a confirmaçăo do diagnóstico histológico e os cuidados que podem evitar repetiçőes do exame. Abstract in english Sporadic inclusion-body myositis (IBM) is the most common myopathy in individuals over 55 years of age. However, in many cases, the diagnosis is neglected. Its main findings include progressive muscle weakness, normal or low levels of serum creatine kinase, and the absence of a response to immunosup [...] pression. Muscle biopsy shows inflammatory reaction in association with degenerative changes of the muscle fibers. We report a typical case of IBM, in which diagnosis was possible only after three muscle biopsies. The challenges to confirm histological diagnosis and the caution to avoid repeating tests are discussed.
Jet grouting for a groundwater cutoff wall in difficult glacial soil deposits
International Nuclear Information System (INIS)
Jet grouting is being used as part of a groundwater cutoff wall system in a major New York City subway construction project to limit drawdowns in an adjacent PCB contamination plume. A circular test shaft of jet grout columns was conducted during the design phase to obtain wall installation parameters. The test program also included shaft wall mapping, and measurements of; inflows, piezometric levels, ground heave and temperature, and jet grout hydraulic conductivity. An axisymmetric finite element method groundwater model was established to back calculate the in-situ hydraulic conductivities of both the surrounding glacial soils and the jet grout walls by matching observed inflows and piezometric levels. The model also verified the use of packer permeability test as a tool in the field to evaluate the hydraulic conductivities of jet grout columns. Both the test program and analytic studies indicated that adjustments to the construction procedures would be required to obtain lower hydraulic conductivities of the jet grout walls for construction. A comparison is made with the conductivities estimated from the test program/analytic studies with those from the present construction
Difficult decisions in times of constraint: Criteria based Resource Allocation in the Vancouver Coastal Health Authority
Directory of Open Access Journals (Sweden)
Dionne Francois
Full Text Available Abstract Objectives The aim of the project was to develop a plan to address a forecasted deficit of approximately $4.65 million for fiscal year 2010/11 in the Vancouver Communities division of the Vancouver Coastal Health Authority. For disinvestment opportunities identified beyond the forecasted deficit, a commitment was made to consider options for resource re-allocation within the Vancouver Communities division. Methods A standard approach to program budgeting and marginal analysis (PBMA was taken with a priority setting working committee and a broader advisory panel. An experienced, non-vested internal project manager worked closely with the two-member external research team throughout the process. Face to face evaluation interviews were held with 10 decision makers immediately following the process. Results The recommendations of the working committee included the implementation of 44 disinvestment initiatives with an annualized value of CAD $4.9 million, as well as consideration of possible investments if the realized savings match expectations. Overall, decision makers viewed the process favorably and the primary aim of addressing the deficit gap was met. Discussion A key challenge was the tight timeline which likely lead to less evidence informed decision making then one would hope for. Despite this, decision makers felt that better decisions were made then had the process not been in place. In the end, this project adds value in finding that PBMA can be used to cover a deficit and minimize opportunity cost through systematic application of criteria whilst ensuring process fairness through focusing on communication, transparency and decision maker engagement.
Global Climate Change for Kids: Making Difficult Ideas Accessible and Exciting
Fisher, D. K.; Leon, N.; Greene, M. P.
NASA has recently launched its Global Climate Change web site (http://climate.nasa.gov), and it has been very well received. It has now also launched in preliminary form an associated site for children and educators, with a plan for completion in the near future. The goals of the NASA Global Climate Change Education site are: To increase awareness and understanding of climate change science in upper-elementary and middle-school students, reinforcing and building upon basic concepts introduced in the formal science education curriculum for these grades; To present, insofar as possible, a holistic picture of climate change science and current evidence of climate change, describing Earth as a system of interconnected processes; To be entertaining and motivating; To be clear and easy to understand; To be easy to navigate; To address multiple learning styles; To describe and promote "green" careers; To increase awareness of NASA's contributions to climate change science; To provide valuable resources for educators; To be compliant with Section 508 of the Americans with Disabilities Act. The site incorporates research findings not only on climate change, but also on effective web design for children. It is envisioned that most of the content of the site will ultimately be presented in multimedia forms. These will include illustrated and narrated "slide shows," animated expositions, interactive concept-rich games and demonstrations, videos, animated fictionalized stories, and printable picture galleries. In recognition of the attention span of the audience, content is presented in short, modular form, with a suggested, but not mandatory order of access. Empathetic animal and human cartoon personalities are used to explain concepts and tell stories. Expository, fiction, game, video, text, and image modules are interlinked for reinforcement of similar ideas. NASA's Global Climate Change Education web site addresses the vital need to impart and emphasize Earth system science concepts at or near the beginning of the education pipeline.
Peristomal skin complications are common, expensive, and difficult to manage : A population based cost modeling study
DEFF Research Database (Denmark)
Meisner, S.; Lehur, P.-A.
Background: Peristomal skin complications (PSCs) are the most common post-operative complications following creation of a stoma. Living with a stoma is a challenge, not only for the patient and their carers, but also for society as a whole. Due to methodological problems of PSC assessment, the associated health-economic burden of medium to longterm complications has been poorly described. Aim: The aim of the present study was to create a model to estimate treatment costs of PSCs using the standardized assessment Ostomy Skin Tool as a reference. The resultant model was applied to a real-life global data set of stoma patients (n = 3017) to determine the prevalence and financial burden of PSCs. Methods: Eleven experienced stoma care nurses were interviewed to get a global understanding of a treatment algorithm that formed the basis of the cost analysis. The estimated costs were based on a seven week treatment period. PSC costs were estimated for five underlying diagnostic categories and three levels of severity.The estimated treatment costs of severe cases of PSCs were increased 2-5 fold for the different diagnostic categories of PSCs compared with mild cases. French unit costs were applied to the global data set. Results: The estimated total average cost for a seven week treatment period (including appliances and accessories) was 263€ for those with PSCs (n = 1742) compared to 215€ for those without PSCs (n = 1172). A co-variance analysis showed that leakage level had a significant impact on PSC cost from 'rarely/never' to 'always/often' p
Why is it difficult to implement e-health initiatives? A qualitative study
Directory of Open Access Journals (Sweden)
Wallace Paul
Full Text Available Abstract Background The use of information and communication technologies in healthcare is seen as essential for high quality and cost-effective healthcare. However, implementation of e-health initiatives has often been problematic, with many failing to demonstrate predicted benefits. This study aimed to explore and understand the experiences of implementers -- the senior managers and other staff charged with implementing e-health initiatives and their assessment of factors which promote or inhibit the successful implementation, embedding, and integration of e-health initiatives. Methods We used a case study methodology, using semi-structured interviews with implementers for data collection. Case studies were selected to provide a range of healthcare contexts (primary, secondary, community care, e-health initiatives, and degrees of normalization. The initiatives studied were Picture Archiving and Communication System (PACS in secondary care, a Community Nurse Information System (CNIS in community care, and Choose and Book (C&B across the primary-secondary care interface. Implementers were selected to provide a range of seniority, including chief executive officers, middle managers, and staff with 'on the ground' experience. Interview data were analyzed using a framework derived from Normalization Process Theory (NPT. Results Twenty-three interviews were completed across the three case studies. There were wide differences in experiences of implementation and embedding across these case studies; these differences were well explained by collective action components of NPT. New technology was most likely to 'normalize' where implementers perceived that it had a positive impact on interactions between professionals and patients and between different professional groups, and fit well with the organisational goals and skill sets of existing staff. However, where implementers perceived problems in one or more of these areas, they also perceived a lower level of normalization. Conclusions Implementers had rich understandings of barriers and facilitators to successful implementation of e-health initiatives, and their views should continue to be sought in future research. NPT can be used to explain observed variations in implementation processes, and may be useful in drawing planners' attention to potential problems with a view to addressing them during implementation planning.
DEFF Research Database (Denmark)
Nielsen, Birte LindstrŘm; Appleby, M.C.
The physical environment of an animal is sometimes altered if it is found to cause problems for animal welfare. These changes are commonly quite specific (making changes to space, food, water, aspects of housing design such as flooring, or to other environmental factors such as air quality) and may be effective in preventing injuries or disease. However, such measures may not be implemented in practice (usually for economic reasons), and where implemented may cause other problems, as when concern for hygiene leads to animals being kept in barren conditions. Numerous ways have also been tried to diversify feeding methods in order to improve animal welfare, but specific changes to the environment such as these often have widespread effects, some of which may be detrimental. For example, inclusion of novel pen structures meant to enrich the environment may lead to increased aggression. A more general approach is therefore appropriate. One area where this is particularly relevant is handling and transport, when animals encounter environments that are wholly new to them. For environments where animals spend more time, several studies have attempted a 'biological approach' in which a biological functioning is considered while avoiding simplistic assumptions of 'natural is best'. We consider as examples systematic tests of environmental enrichment for pigs, novel designs for loose housing of lactating sows and their litters, and furnished cages for laying hens. Stringent tests of every design feature and their interactions are necessary to produce commercial designs from such studies.
In difficult economic times, libraries become even more popular with the general public
The Santa Barbara Independent Libraries Busy in Faltering Economyhttp://www.independent.com/news/2009/jan/08/libraries-busy-faltering-economy/The Public Library Renaissancehttp://freakonomics.blogs.nytimes.com/2009/01/07/the-public-library-renaissance/Judge orders libraries to stay openhttp://www.philly.com/inquirer/local/pa/20090106_Judge_orders_libraries_to_stay_open.htmlAndrew Carnegie and Carnegie Librarieshttp://andrewcarnegie.tripod.com/Nancy Pearl's Book Lust Wikihttp://booklust.wetpaint.com/In economically challenging times, many people choose to omit certain luxuries, including pedicures, new (or used) cars, and other items. Retailers are also now reporting that consumers are also buying fewer books, CD's, and DVD's. Are people just not listening to music, turning on the television, or reading? That's definitely not the case, as the nations' libraries are reporting record numbers in terms of new library card applications and the sheer circulation numbers of their various holdings. A column in the Boston Globe reported that the checkouts of such items are up 15 percent in Modesto, 17 percent at the Newark Public Library, and that the Boise Public Library also reported a 61 percent increase in new library cards. Many people also rely on public libraries to perform job searches online, hold community meetings and forums, and as a place to spend a few hours away from inclement weather. Despite the recent uptick in public library use, there are a few ominous signs on the horizon. Many cities have been forced to cut library operating hours due to severe budget shortfalls, and Michael Nutter, the mayor of Philadelphia, even proposed closing 11 branches of the city's public library system. A recent ruling by a judge kept those branches open, but many of the challenges remain in Philadelphia and in hundreds of public library systems across the United States. The first link will take users to an article from this Thursday's Bend (OR) Bulletin that talks a bit about the increased library use at the Bend Public Library. The next link leads to a like-minded piece from the Santa Barbara Independent, which discusses the importance of their local libraries within their community. The third link whisks users away to a recent post from the "Freakonomics" weblog at the New York Times. The post talks a bit about the previously mentioned Boston Globe article and also offers link to other relevant sites on libraries. Moving on, the fourth link leads to a piece from this Tuesday's Philadelphia Inquirer about the recent ruling that requires Philadelphia to keep all of its libraries open. Those persons with an interest in the history of public libraries in the United States will enjoy the fifth link, as it contains information about the famed Carnegie libraries, paid for via the fortune of industrialist Andrew Carnegie. Finally, the last link leads to a site created by noted Seattle librarian Nancy Pearl. Here visitors can create their own book wiki, trade information on favorite books with other bibliophiles, and so on.
The videolaryngoscope is less traumatic than the classic laryngoscope for a difficult airway in an obese patient:
Maassen, R.; Lee, R.; Zundert, A.; Cooper, R.
This report describes the anesthetic management of an obese patient with a difficult airway and the merits of videolaryngoscopy, specifically in terms of the reduced risk of dental damage during intubation. A 49-year-old woman (body mass index; BMI, 36 kg·m?2), was scheduled to undergo an elective laparoscopic cholecystectomy because of cholelithiasis. Based upon the obesity of the patient and preoperative metrics (Mallampati grade IV; interdental distance of 2.9 cm; thyromental distance, ...
High fidelity medical simulation in the difficult environment of a helicopter: feasibility, self-efficacy and cost
Holland Carolyn; Williams Annette; Hinckley William R; Lindsell Christopher J; Wright Stewart W; Lewis Christopher H; Heimburger Gail
Abstract Background This study assessed the feasibility, self-efficacy and cost of providing a high fidelity medical simulation experience in the difficult environment of an air ambulance helicopter. Methods Seven of 12 EM residents in their first postgraduate year participated in an EMS flight simulation as the flight physician. The simulation used the Laerdal SimMan™ to present a cardiac and a trauma case in an EMS helicopter while running at flight idle. Before and after the simulation, ...
Aortic and Mitral Valve Replacement Through a Single Transverse Aortotomy: A Useful Approach in Difficult Mitral Valve Exposure
Carmichael, Michael J.; Denton A Cooley; Favor, Arsenio S.
Replacement of the mitral valve through a standard vertical left atriotomy in patients requiring both aortic and mitral valve replacement can be very difficult. This is especially true in patients who have undergone previous median sternotomy. Replacement of the mitral valve through the aortic root after excision of the aortic valve is described in two case reports. This is a convenient approach when traditional exposure of the mitral valve is impractical in patients requiring double valve re...
Diagnostic accuracy of anaesthesiologists' prediction of difficult airway management in daily clinical practice : a cohort study of 188 064 patients registered in the Danish Anaesthesia Database
DEFF Research Database (Denmark)
Kehlet NŘrskov, Anders; Rosenstock, C V
Both the American Society of Anesthesiologists and the UK NAP4 project recommend that an unspecified pre-operative airway assessment be made. However, the choice of assessment is ultimately at the discretion of the individual anaesthesiologist. We retrieved a cohort of 188 064 cases from the Danish Anaesthesia Database, and investigated the diagnostic accuracy of the anaesthesiologists' predictions of difficult tracheal intubation and difficult mask ventilation. Of 3391 difficult intubations, 3154 (93%) were unanticipated. When difficult intubation was anticipated, 229 of 929 (25%) had an actual difficult intubation. Likewise, difficult mask ventilation was unanticipated in 808 of 857 (94%) cases, and when anticipated (218 cases), difficult mask ventilation actually occurred in 49 (22%) cases. We present a previously unpublished estimate of the accuracy of anaesthesiologists' prediction of airway management difficulties in daily routine practice. Prediction of airway difficulties remains a challenging task, and our results underline the importance of being constantly prepared for unexpected difficulties.
To compare the accuracy of Prayer's sign and Mallampatti test in predicting difficult intubation in Diabetic patients
International Nuclear Information System (INIS)
Objective: To determine the accuracy of Prayer's sign and Mallampatti test in predicting difficult endotracheal intubation in diabetic patients. Methods: The cross-sectional study was performed at Aga Khan University Hospital, Karachi, over a period from January 2009 to April 2010, and comprised 357 patients who required endotracheal intubation for elective surgical procedures. Prayer's sign and Mallampatti tests were performed for the assessment of airway by trained observers. Ease or difficulty of laryngoscopy after the patient was fully anaesthetised with standard technique were observed and laryngoscopic view of first attempt was rated according to Cormack-Lehan grade of intubation. SPSS 15 was used for statistical analysis. Results: Of the 357 patients, 125(35%) were classified as difficult to intubate. Prayer's sign showed significantly lower accuracy, positive and negative predictive values than Mallampatti test. The sensitivity of Prayer's sign was lower 29.6 (95% Confidence Interval, 21.9-38.5) than Mallampatti test 79.3 (95% confidence interval, 70.8-85.7) while specificity of both the tests was not found to be significantly different. Conclusion: Prayer's sign is not acceptable as a single best bedside test for prediction of difficult intubation. (author)
The Difficult Airway Society 'ADEPT' guidance on selecting airway devices: the basis of a strategy for equipment evaluation.
Pandit, J J; Popat, M T; Cook, T M; Wilkes, A R; Groom, P; Cooke, H; Kapila, A; O'Sullivan, E
Faced with the concern that an increasing number of airway management devices were being introduced into clinical practice with little or no prior evidence of their clinical efficacy or safety, the Difficult Airway Society formed a working party (Airway Device Evaluation Project Team) to establish a process by which the airway management community within the profession could itself lead a process of formal device/equipment evaluation. Although there are several national and international regulations governing which products can come on to the market and be legitimately sold, there has hitherto been no formal professional guidance relating to how products should be selected (i.e. purchased). The Airway Device Evaluation Project Team's first task was to formulate such advice, emphasising evidence-based principles. Team discussions led to a definition of the minimum level of evidence needed to make a pragmatic decision about the purchase or selection of an airway device. The Team concluded that this definition should form the basis of a professional standard, guiding those with responsibility for selecting airway devices. We describe how widespread adoption of this professional standard can act as a driver to create an infrastructure in which the required evidence can be obtained. Essential elements are that: (i) the Difficult Airway Society facilitates a coherent national network of research-active units; and (ii) individual anaesthetists in hospital trusts play a more active role in local purchasing decisions, applying the relevant evidence and communicating their purchasing decisions to the Difficult Airway Society. PMID:21707562
3D seismic experiment in difficult area in Japan; Kokunai nanchiiki ni okeru sanjigen jishin tansa jikken
Energy Technology Data Exchange (ETDEWEB)
Minegishi, M.; Nakagami, K.; Tanaka, H. [Japan National Oil Corp., Tokyo (Japan). Technology Research Center
Difficult area in this context means an exploration-difficult area supposed to store oil/gas but retarded in exploration for the lack of knowledge about the geological structure due to poor quality of available seismic survey records. Discussed in this paper is a survey conducted into an area covering the southern part of Noshiro-shi, Akita-ken, and Yamamoto-cho, Yamamoto-gun, Akita-ken. An area size suitable for data collection at a target depth of 2500m is determined using an interpretation structure compiled on the basis of available well data and 2D seismic survey data. The plan for siting shock points and receiving points is modified case by case as restrictive factors come to the surface (resulting from the complicated hilly terrain, presence of pipes for agricultural water, etc.). The peculiarities of seismic waves in the terrain are studied through the interpretation of the available well data and 2D seismic survey data for the construction of a 3D velocity model for the confirmation of the appropriateness of the plan for siting shock points and receiving points. Efforts are exerted through enhanced coordination with the contractor to acquire data so that a technologically best design may be won within the limits of the budget. The quality of the data obtained from this experiment is in general better than those obtained from previous experiments, yet many problems remain to be settled in future studies about exploration-difficult areas. 4 refs., 4 figs., 1 tab.
Polarity in Conditionals and Conditional-Like Constructions
Hsieh, I-Ta Chris
This dissertation concerns the distribution of negative polarity items (henceforth, NPIs) in conditionals and conditional-like constructions. NPIs include words such as any and ever and idioms such as "give a damn" and "lift a finger"; these expressions have only a limited distribution. In this dissertation, the distribution of…
Difficult identification of Haemophilus influenzae, a typical cause of upper respiratory tract infections, in the microbiological diagnostic routine.
Hinz, Rebecca; Zautner, Andreas Erich; Hagen, Ralf Matthias; Frickmann, Hagen
Haemophilus influenzae is a key pathogen of upper respiratory tract infections. Its reliable discrimination from nonpathogenic Haemophilus spp. is necessary because merely colonizing bacteria are frequent at primarily unsterile sites. Due to close phylogenetic relationship, it is not easy to discriminate H. influenzae from the colonizer Haemophilus haemolyticus. The frequency of H. haemolyticus isolations depends on factors like sampling site, patient condition, and geographic region. Biochemical discrimination has been shown to be nonreliable. Multiplex PCR including marker genes like sodC, fucK, and hpd or sequencing of the 16S rRNA gene, the P6 gene, or multilocus-sequence-typing is more promising. For the diagnostic routine, such techniques are too expensive and laborious. If available, matrix-assisted laser-desorption-ionization time-of-flight mass spectrometry is a routine-compatible option and should be used in the first line. However, the used database should contain well-defined reference spectra, and the spectral difference between H. influenzae and H. haemolyticus is small. Fluorescence in-situ hybridization is an option for less well-equipped laboratories, but the available protocol will not lead to conclusive results in all instances. It can be used as a second line approach. Occasional ambiguous results have to be resolved by alternative molecular methods like 16S rRNA gene sequencing. PMID:25883794
Selected medical conditions and risk of pancreatic cancer.
Olson, Sara H
We review the current evidence for associations of several medical conditions with risk of pancreatic cancer, including allergies, pancreatitis, gall bladder disease, cholecystectomy, ulcers, gastrectomy, appendectomy, and tonsillectomy. There are consistent findings of reduced risk associated with presence of self-reported allergies, particularly hay fever but not asthma; data on other allergies are limited and inconclusive. Several studies provide evidence that patients with pancreatic cancer are more likely than comparison groups to report pancreatitis. Those studies that investigated the time between onset of pancreatitis and diagnosis of pancreatic cancer found that risk estimates declined with longer periods of time; however, increased risks were noted for long-term pancreatitis, indicating that this condition is both a risk factor and a sign of early disease. Increased risk was reported in association with cholelithiasis, but the few studies that considered time before diagnosis of cancer did not find increased risk for cholelithiasis diagnosed in the more distant past. There is weak evidence that cholecystectomy 2 or more years before cancer diagnosis is related to risk, but this is based on only a few studies. There is no consistent association between ulcers and risk, while gastrectomy may increase risk. Overall, study of these conditions, particularly those that are rare, presents methodologic challenges. Time between diagnoses is likely to be important but is not considered in most studies. Lack of adequate control in several studies for risk factors such as smoking and heavy alcohol use also makes it difficult to draw firm conclusions about these results. PMID:22162233
Laser surgery for selected small animal soft-tissue conditions
Bartels, Kenneth E.
With the acquisition of a Nd:YAG and a CO2 laser in the College of Veterinary Medicine at Oklahoma State University in 1989, over 100 small animal clinical cases have been managed with these modern modalities for surgical excision and tissue vaporization. Most procedures have been for oncologic problems, but inflammatory, infectious, or congenital conditions including vaporization of acral lick 'granulomas,' excision/vaporization of foreign body induced, infected draining tracts, and resection of elongated soft palates have been successfully accomplished. Laser excision or vaporization of both benign and malignant neoplasms have effectively been performed and include feline nasal squamous cell carcinoma, mast cell tumors, and rectal/anal neoplasms. Results to date have been excellent with animals exhibiting little postoperative pain, swelling, and inflammation. Investigations involving application of laser energy for tissue welding of esophageal lacerations and hepatitic interstitial hyperthermia for metastatic colorectal cancer have also shown potential. A review of cases with an emphasis on survival time and postoperative morbidity suggests that carefully planned laser surgical procedures in clinical veterinary practice done with standardized protocols and techniques offer an acceptable means of treating conditions that were previously considered extremely difficult or virtually impossible to perform.
Difficult Decisions: Euthanasia.
Parakh, Jal S.; Slesnick, Irwin L.
Focuses on the moral arguments for and against the controversial topic of voluntary active euthanasia. Discusses the question of legalization and decriminalization of the practice. Provides a student worksheet with questions to stimulate discussion on the issue. (MDH)
Conditions for supernovae driven galactic winds
Nath, Biman B.; Shchekinov, Yuri
We point out that the commonly assumed condition for galactic outflows, that supernovae (SNe) heating is efficient in the central regions of starburst galaxies, suffers from invalid assumptions. We show that a large filling factor of hot ($\\ge 10^6$ K) gas is difficult to achieve through SNe heating, irrespective of the initial gas temperature and density, and of its being uniform or clumpy. We instead suggest that correlated supernovae from OB associations in molecular clou...
Difficult cannulation as defined by a prospective study of the Scandinavian Association for Digestive Endoscopy (SADE) in 907 ERCPs
DEFF Research Database (Denmark)
Halttunen, Jorma; Meisner, SŘren
BACKGROUND: The definition of a "difficult" cannulation varies considerably in reports of endoscopic retrograde cholangiopancreatography (ERCP). AIMS: To define a difficult cannulation, which translates into higher risk of post-ERCP pancreatitis. PATIENTS AND METHODS: Prospective consecutive recording of 907 cannulations in Scandinavian centers done by experienced endoscopists. Inclusion: indication for biliary access in patients with intact papilla. Exclusion: acute non-biliary and chronic pancreatitis at time of procedure. RESULTS: The primary cannulation succeeded in 74.9%, with median values for time 0.88 min (53 s), with two attempts and with zero pancreatic passages or injections. The overall cannulation success was 97.4% and post-ERCP pancreatitis (PEP) rate was 5.3%. The median time for all successful cannulations was 1.55 min (range 0.02-94.2). If the primary cannulation succeeded, the pancreatitis rate was 2.8%; after secondary methods, it rose to 11.5%. Procedures lasting less than 5 min had a PEP rate of 2.6% versus 11.8% in those lasting longer. With one attempt, the PEP rate was 0.6%, with two 3.1%, with three to four 6.1%, and with five and more 11.9%. With one accidental pancreatic guide-wire passage, the risk of the PEP was 3.7%, and with two passages, it was 13.1%. CONCLUSIONS: If the increasing rate of PEP is taken as defining factor, the wire-guided cannulation of a native papilla can be considered difficult after 5 min, five attempts, and two pancreatic guide-wire passages when any of those limits is exceeded.
Induced Sputum Substance P in Children with Difficult-to-Treat Bronchial Asthma and Gastroesophageal Reflux: Effect of Esomeprazole Therapy
Adel Salah Bediwy; Elkholy, Mohamed Gamal A.; Mohammed Al-Biltagi; Hesham Galal Amer; Eman Farid
Objectives. To assess the induced sputum substance P (ISSP) levels in children having difficult-to-treat asthma (DA) with and without gastroesophageal reflux (GER). We aimed also to evaluate the association of GER with childhood DA, relationship of GER severity with childhood asthma control test (C-ACT), FEV1, peak expiratory flow (PEF) variability, and ISSP. Finally, we tried to evaluate esomeprazole treatment effect on C-ACT and FEV1 in children with DA. Methods. Spirometry, C-ACT, upper ga...
A simple method for the preparation of difficult 99mTc complexes using surface adsorbed stannous ions
International Nuclear Information System (INIS)
A simple new technique where stannous tin is adsorbed on the inner surface of plastic tubing and used to reduce (99mTc) pertechnetate prior to labelling radiopharmaceuticals, has been evaluated, using some lipophillic and metal containing ligands. Complexes formed using the technique had good labelling efficiency and behaved the same in rat biodistribution studies as those prepared using conventional labelling methods. The labelling efficiency of the ligands was not related to their lipophillicity suggesting that this technique may be useful for labelling lipophillic and other difficult ligands such as those containing metals, which are incompatible with free stannous ions in solution. (M.E.L.)
76 FR 32815 - Medicaid Program; Payment Adjustment for Provider-Preventable Conditions Including Health Care...
...addressing the immediate concern of the States over...NCDs in the case of dual-eligibles could...Agency for Healthcare Research and Quality (AHRQ...proposed rule and State concerns in implementing...protect the State from dual-eligible liability...quality improvement research to define...
A Comparative European View on African Integration : why it has been much more difficult in Africa than in Europe
DEFF Research Database (Denmark)
Zank, Wolfgang
In this paper I compare African and European integration. Despite some important progress, so far African integration has not been as deep as the European one. Measured on the terms of intergovernmental versus supranational cooperation, the AU is essentially an intergovernmental arrangement, with a few elements which might have supranational potentialities in the future. In its present form, the AU is more akin to the UN that to the EU. By contrast, the EU is a complex set of arrangements of both intergovernmental and supranational character. In the broad policy fields under "pillar one", the EU resembles already a federal state, with increasing tendencies in this direction. The different degree of integration has been the cause of many factors. I highlight here the importance of two basic conditions for substantial progress at supranational integration. The first one is a consensus on basic constitutional principles. Such a consensus was in place in Western Europe after World War II (democratic rule by law), whereas Africa has exhibited a broad array of incompatible constitutional models after independence. The second condition has been compatible (not identical) socio-economic systems. The Western European countries have been mixed economies with a public sector, but where economic activities were mainly coordinated by market forces. This opened the possibilities to use these market forces, e.g. by removing trade barriers, to strengthen cooperation at ground level and create pressures for further integration. Adherence to such a socio-economic model has also become an explicit criterion for EU membership. By contrast, Africa has seen all kinds of economic systems, centrally-planned socialist ones included. The last ones are incompatible with market economies. The multitude of systems has therefore created additional barriers for African integration. Today there is reason to be moderately optimistic as regards some progress at African integration. Democratic principles are much stronger rooted today than previously, and the time of sweeping social experiments seems to be over. However, in the nearer and mid-term perspective progress is more likely to be achievable on a sub-continental scale; in many cases the first step must be the reconstruction of the "failed state". A further strengthening of cooperation at AU-level is conceivable, but it will hardly acquire supra-national characteristics for many years to come.
Towards zero-configuration condition monitoring based on dictionary learning
Martin-del-campo, Sergio; Sandin, Fredrik
Condition-based predictive maintenance can significantly improve overall equipment effectiveness provided that appropriate monitoring methods are used. Online condition monitoring systems are customized to each type of machine and need to be reconfigured when conditions change, which is costly and requires expert knowledge. Basic feature extraction methods limited to signal distribution functions and spectra are commonly used, making it difficult to automatically analyze and...
Strong nucleosomes of mouse genome including recovered centromeric sequences.
Salih, Bilal F; Teif, Vladimir B; Tripathi, Vijay; Trifonov, Edward N
Recently discovered strong nucleosomes (SNs) characterized by visibly periodical DNA sequences have been found to concentrate in centromeres of Arabidopsis thaliana and in transient meiotic centromeres of Caenorhabditis elegans. To find out whether such affiliation of SNs to centromeres is a more general phenomenon, we studied SNs of the Mus musculus. The publicly available genome sequences of mouse, as well as of practically all other eukaryotes do not include the centromere regions which are difficult to assemble because of a large amount of repeat sequences in the centromeres and pericentromeric regions. We recovered those missing sequences using the data from MNase-seq experiments in mouse embryonic stem cells, where the sequence of DNA inside nucleosomes, including missing regions, was determined by 100-bp paired-end sequencing. Those nucleosome sequences, which are not matching to the published genome sequence, would largely belong to the centromeres. By evaluating SN densities in centromeres and in non-centromeric regions, we conclude that mouse SNs concentrate in the centromeres of telocentric mouse chromosomes, with ~3.9 times excess compared to their density in the rest of the genome. The remaining non-centromeric SNs are harbored mainly by introns and intergenic regions, by retro-transposons, in particular. The centromeric involvement of the SNs opens new horizons for the chromosome and centromere structure studies. PMID:24998943
Continuity of conditional expectations
International Nuclear Information System (INIS)
A condition over a sequence {An} of ?-subalgebras that assures Lp-convergence of the conditional expectations will be given. This condition is more general than the Martingale theorem condition and the O'Reilly-Fetter condition. (author). 3 refs
The videolaryngoscope is less traumatic than the classic laryngoscope for a difficult airway in an obese patient.
Maassen, Ralph; Lee, Ruben; van Zundert, André; Cooper, Richard
This report describes the anesthetic management of an obese patient with a difficult airway and the merits of videolaryngoscopy, specifically in terms of the reduced risk of dental damage during intubation. A 49-year-old woman (body mass index; BMI, 36 kg.m(-2)), was scheduled to undergo an elective laparoscopic cholecystectomy because of cholelithiasis. Based upon the obesity of the patient and preoperative metrics (Mallampati grade IV; interdental distance of 2.9 cm; thyromental distance, 5.5 cm) a difficult airway was anticipated. Classic direct laryngoscopy using a Macintosh blade size IV failed, despite three intubation attempts-each resulting in a Cormack-Lehane grade IV view. Intubation using a video-assisted Macintosh laryngoscope (V-Mac; Karl Storz, Tuttlingen, Germany) was successful upon the first attempt. The maximum force exerted on the patient's maxillary incisors was 61 N by direct laryngoscopy and 7.6 N using the indirect videolaryngoscope, both using a Macintosh blade. PMID:19685133
Difícil manejo do paciente com distonia segmentar respiratória / The difficult management of patients with respiratory segmental dystonia
Scientific Electronic Library Online (English)
Noemi Grigoletto De, Biase; Paulo Augusto de Lima, Pontes; Vanier, Santos Junior; Vanessa Pedrosa, Vieira; Priscila, Zambonato; Reinaldo Kazuo, Yazaki.
Full Text Available A forma respiratória da distonia laríngea é rara, de difícil diagnóstico e provoca restriçăo respiratória de graus variados. O objetivo deste trabalho é apresentar um caso de distonia respiratória envolvendo laringe e faringe e sua evoluçăo em relaçăo ŕ intensidade dos espasmos e seu controle. ESTUD [...] O DE CASO: Paciente de 24 anos, sexo masculino, acompanhado por 5 anos: diagnóstico por nasofibroscopia e eletromiografia e tratamento com toxina botulínica conforme necessidade de controle dos sintomas. CONCLUSĂO: O difícil manejo se deve ao fato do desconhecimento da etiologia e a pouca opçăo de tratamento, bem como do envolvimento da funçăo respiratória. Abstract in english Respiratory dystonia is a rare and difficult to diagnose disorder, that causes breathing restriction of various degrees. The objective of the study is to report the case of a patient with respiratory dystonia involving the larynx and the pharynx and its evolution concerning spasms intensity and cont [...] rol. CASE REPORT: A 24 year-old-man has been followed for 5 years. The diagnosis was made by means of nasofibroscopy and electromyography. Treatment was carried out with laryngeal and pharyngeal Botulin toxin injections, as it became necessary for symptoms control. CONCLUSION: The difficult management can be secondary to the lack of knowledge on the etiology and physiopathology of the impairment, and because of the limitations in the treatment of associated respiratory symptoms.
The effectiveness of search dogs compared with humans in searching difficult terrain at turbine sites for bat fatalities
Energy Technology Data Exchange (ETDEWEB)
Mathews, Fiona
Full text: Many wind farms in the UK and elsewhere in northern Europe are situated in habitat with dense tall vegetation such as arable fields and upland heaths. This makes surveying for bat fatalities extremely difficult. To facilitate a multi-centre study of the effects of wind turbines on British bats, we have therefore conducted controlled trials of the relative success of trained search dogs and ecologists in retrieving bat carcasses. Although dogs have been used previously in ecological surveys for bats, this is the first time they have been specifically trained for use in 'difficult to survey' habitats. Two ecologists and two Labrador dogs with handlers were each given the opportunity to retrieve up to 45 bat carcasses in a range of habitat types. Their efficiency in terms of overall search time, costs, and retrieval abilities were evaluated. Our results indicate that high rates of retrieval can be achieved by dogs, even in dense vegetation up to 75cm high. Further, a typical 100m2 search area can be surveyed in less than half the time taken by humans. The limitations of using search dogs, and their ability to detect the presence of bats that have been scavenged are also presented (presentation supported with video footage). (Author)
Radiation treatment of organic substances which are difficult to decompose for utilizing sewage water again. Radiation decomposition of lignin
International Nuclear Information System (INIS)
The sewerage model projects utilizing sewage-treated water and the sewerage model project for the future city executed in Tokyo are described. It is important to obtain the treated water which is suitable to purposes by setting up the target for control and reducing the organic contamination which is difficult to decompose. In fiscal year 1995, as to the decomposing treatment of lignin by radiation, the effect of reducing coloring and the influence when actual flowing-in sewage and treated water coexist were examined. The experimental samples were lignin aqueous solution, synthetic sewage and flowing-in sewage, treated water, and the mixture of treated water and synthetic sewage. The measurement of water quality is explained. The ? ray irradiation with a Co-60 source was carried out. The results of respective samples are reported. When total organic carbon was at the level in flowing-in sewage and treated water, irradiation was effective for eliminating coloring. The soluble organic substances which are difficult to decompose were efficiently decomposed by irradiation. (K.I.)
Adopting the good reFLEXes when generating conditional alterations in the mouse genome.
Schnütgen, Frank; Ghyselinck, Norbert B
Major advances have been made in the use of the Cre/loxP system for conditional gene targeting in the mouse. By combining the ability of Cre recombinase to invert or excise a DNA fragment, depending upon the orientation of the flanking loxP sites, and the use of wild-type loxP and variant lox511 sites, we devised an efficient and reliable Cre-mediated genetic switch, called FLEX, through which expression of a given gene can be turned off, while expression of another one can be simultaneously turned on. We discuss how this innovative, flexible and powerful approach, which virtually adapts to any kind of site-specific recombinase (e.g., Cre and Flp recombinases), can be used to easily generate, even at high throughput and genome wide scale, many genetic modifications in a conditional manner, including those which were considered as difficult or impossible to achieve. PMID:17415672
Field trials of a lifeboat in ice and open water conditions
Energy Technology Data Exchange (ETDEWEB)
Veitch, B. [University of Newfoundland, St John' s (Canada); Barker, A; Sudom, D. [Canadian Hydraulics Centre National Research Council of Canada, Ottawa (Canada); Re, Antonio Simoes; Kuczora, A.; Gifford, P. [National Research Council, Institute for Ocean Technology, St John' s (Canada)
Evacuation from offshore installations and marine vessels in Arctic regions is very challenging due to the difficult environmental conditions such as the cold temperatures or the ice-covered sea. Lifeboats have been produced as evacuation vessels from offshore structures for personnel. This paper investigated the performance capability of a 20 person conventional, totally enclosed motor-propelled survival craft (TEMPSC) in sea ice cover. A series of field trials were conducted from 2007 to 2010 under different ice conditions: fresh water ice in a lake, thin level intact ice and broken pack ice in the sea. The paper described in details the different field trials, including a description of the lifeboat, the structural and propulsion changes, the instrumentation and the trial sites. During the test campaign, the propeller and nozzle were redesigned to enhance acceleration capabilities. However the results demonstrated the difficulty of a lifeboat's moving in 7 and 9/10ths ice concentrations.
Investigaçăo de fatores associados ŕ asma de difícil controle Investigation of factors associated with difficult-to-control asthma
Directory of Open Access Journals (Sweden)
Ana Carla Sousa de Araujo
Full Text Available OBJETIVO: Pesquisar a freqüęncia dos fatores associados ŕ asma de difícil controle. MÉTODOS: Foram selecionados pacientes com diagnóstico de asma grave do ambulatório de asma do Hospital das Clínicas da Faculdade de Medicina de Ribeirăo Preto. Os pacientes foram classificados em dois grupos: asma grave controlada e asma grave de difícil controle. Após nova tentativa de otimizaçăo do tratamento para o grupo de difícil controle, foram aplicados questionário e investigaçăo complementar de fatores associados, como exposiçăo ambiental domiciliar e ocupacional, tabagismo, fatores sociais, rinossinusite, doença do refluxo gastroesofágico (DRGE, apnéia obstrutiva do sono, insuficięncia cardíaca congestiva (ICC, embolia pulmonar, fibrose cística, disfunçăo de cordas vocais, deficięncia de alfa-1 antitripsina e vasculite de Churg-Strauss. RESULTADOS: Foram selecionados 77 pacientes com asma grave, dos quais 47 apresentavam asma de difícil controle, sendo 68,1% do sexo feminino, idade média de 44,4 anos (±14,4 e volume expiratório forçado no primeiro segundo de 54,7% (±18,3%. Dos diagnósticos encontrados em associaçăo ŕ asma de difícil controle, o mais freqüente foi a pouca adesăo ao tratamento (68%. Outros foram as más condiçőes ambientais (34% e ocupacionais (17%, rinossinusite (57%, DRGE (49%, apnéia obstrutiva do sono (2%, ICC (2% e tabagismo (10%. Em todos os casos, pelo menos um desses fatores concomitantes foi diagnosticado. CONCLUSŐES: O fator mais freqüente associado ŕ asma de difícil controle nos indivíduos estudados é a pouca adesăo ŕ medicaçăo prescrita. A investigaçăo de co-morbidades é imperativa na avaliaçăo de pacientes com esta forma da doença.OBJECTIVE: To determine the prevalence of factors associated with difficult-to-control asthma. METHODS: Patients with severe asthma were selected from the outpatient asthma clinic of the Ribeirăo Preto School of Medicine Hospital das Clínicas. The patients were divided into two groups: controlled severe asthma and difficult-to-control severe asthma. After new attempts to optimize the severe asthma treatment, a questionnaire was applied, and additional tests for factors associated with difficult-to-control asthma, such as environmental and occupational exposure, smoking history, social factors, rhinitis/sinusitis, gastroesophageal reflux disease (GERD, obstructive sleep apnea, congestive heart failure (CHF, pulmonary embolism, cystic fibrosis, vocal cord dysfunction, alpha-1 antitrypsin deficiency, and Churg-Strauss syndrome, were performed. RESULTS: 77 patients with severe asthma were selected, of which 47 suffered from hard-to-control asthma, being 68.1% female, with mean age of 44.4 years (±14.4, and forced expiratory volume in one second of 54.7% (±18.3. The most factors most often associated with difficult-to-control asthma were noncompliance with treatment (68%, rhinitis/sinusitis (57%, GERD (49%, environmental exposure (34%, occupational exposure (17%, smoking history (10%, obstructive sleep apnea (2%, and CHF (2%. At least one of these factors was identified in every case. CONCLUSIONS: Noncompliance with treatment was the factor most often associated with difficult-to-control asthma, underscoring the need to investigate comorbidities in the evaluation of patients with this form of the disease.
Investigaçăo de fatores associados ŕ asma de difícil controle / Investigation of factors associated with difficult-to-control asthma
Scientific Electronic Library Online (English)
Ana Carla Sousa de, Araujo; Érica, Ferraz; Marcos de Carvalho, Borges; Joăo, Terra Filho; Elcio Oliveira, Vianna.
Full Text Available OBJETIVO: Pesquisar a freqüęncia dos fatores associados ŕ asma de difícil controle. MÉTODOS: Foram selecionados pacientes com diagnóstico de asma grave do ambulatório de asma do Hospital das Clínicas da Faculdade de Medicina de Ribeirăo Preto. Os pacientes foram classificados em dois grupos: asma gr [...] ave controlada e asma grave de difícil controle. Após nova tentativa de otimizaçăo do tratamento para o grupo de difícil controle, foram aplicados questionário e investigaçăo complementar de fatores associados, como exposiçăo ambiental domiciliar e ocupacional, tabagismo, fatores sociais, rinossinusite, doença do refluxo gastroesofágico (DRGE), apnéia obstrutiva do sono, insuficięncia cardíaca congestiva (ICC), embolia pulmonar, fibrose cística, disfunçăo de cordas vocais, deficięncia de alfa-1 antitripsina e vasculite de Churg-Strauss. RESULTADOS: Foram selecionados 77 pacientes com asma grave, dos quais 47 apresentavam asma de difícil controle, sendo 68,1% do sexo feminino, idade média de 44,4 anos (±14,4) e volume expiratório forçado no primeiro segundo de 54,7% (±18,3%). Dos diagnósticos encontrados em associaçăo ŕ asma de difícil controle, o mais freqüente foi a pouca adesăo ao tratamento (68%). Outros foram as más condiçőes ambientais (34%) e ocupacionais (17%), rinossinusite (57%), DRGE (49%), apnéia obstrutiva do sono (2%), ICC (2%) e tabagismo (10%). Em todos os casos, pelo menos um desses fatores concomitantes foi diagnosticado. CONCLUSŐES: O fator mais freqüente associado ŕ asma de difícil controle nos indivíduos estudados é a pouca adesăo ŕ medicaçăo prescrita. A investigaçăo de co-morbidades é imperativa na avaliaçăo de pacientes com esta forma da doença. Abstract in english OBJECTIVE: To determine the prevalence of factors associated with difficult-to-control asthma. METHODS: Patients with severe asthma were selected from the outpatient asthma clinic of the Ribeirăo Preto School of Medicine Hospital das Clínicas. The patients were divided into two groups: controlled se [...] vere asthma and difficult-to-control severe asthma. After new attempts to optimize the severe asthma treatment, a questionnaire was applied, and additional tests for factors associated with difficult-to-control asthma, such as environmental and occupational exposure, smoking history, social factors, rhinitis/sinusitis, gastroesophageal reflux disease (GERD), obstructive sleep apnea, congestive heart failure (CHF), pulmonary embolism, cystic fibrosis, vocal cord dysfunction, alpha-1 antitrypsin deficiency, and Churg-Strauss syndrome, were performed. RESULTS: 77 patients with severe asthma were selected, of which 47 suffered from hard-to-control asthma, being 68.1% female, with mean age of 44.4 years (±14.4), and forced expiratory volume in one second of 54.7% (±18.3). The most factors most often associated with difficult-to-control asthma were noncompliance with treatment (68%), rhinitis/sinusitis (57%), GERD (49%), environmental exposure (34%), occupational exposure (17%), smoking history (10%), obstructive sleep apnea (2%), and CHF (2%). At least one of these factors was identified in every case. CONCLUSIONS: Noncompliance with treatment was the factor most often associated with difficult-to-control asthma, underscoring the need to investigate comorbidities in the evaluation of patients with this form of the disease.
Diagnostics in low-temperature plasmas by laser spectroscopy: Expensive and difficult but worth all the trouble
International Nuclear Information System (INIS)
In recent times, novel techniques and innovations of equipment have lead to a substantial improvement of laser spectroscopic diagnostics on low-temperature plasmas. This applies especially to the detection of charged species (electrons, positive and negative ions) and neutral radicals (atoms and molecules) as well as the measurement of electric fields. Spatially and temporally resolved measurements with high spectral resolution allow the non-invasive determination of a whole list of important parameters, e.g. temperature, density, velocity distribution, degree of dissociation, diffusion and reaction rates, sticking coefficients, voltages, currents etc. Available techniques are based generally either on scattering, absorption or fluorescence. Within this general frame a large variety of alternative schemes has been developed, especially in the case of multi-photon interaction. This sometimes confusing multitude of alternatives is necessary since as a matter of fact all schemes and techniques are limited to a certain parameter range and their applicability is determined strongly by the experimental conditions. The talk intends to give an overview on recent developments by introducing selected examples. This will include basic technical aspects as well as opportunities and limits of the interpretation of raw data for understanding the physics or chemistry of the discharge under investigation. An example is given below. The discharge presented was pulsed and for each pressure the decay of the relative density in the afterglow was traced by LIF. From the exponential part of the decay curve the decay time was determined by a least mean square fit. The non-linear behavior of the pressure scaling allows the determination of the chemical reaction rate for destruction of the radical in the discharge volume. Similar measurements on CF2 in the same discharge show that quite in contrast this radical is lost only by reaction at the reactor walls. (author)
42 CFR 410.100 - Included services.
...however, maintenance therapy itself is not covered...services. (c) Occupational therapy services. These...monitoring and patient education. (f) Prosthetic...including physical therapy services, occupational therapy...
Power Flow Study Including FACTS Devices
Directory of Open Access Journals (Sweden)
T. Thyagarajan
Full Text Available The electric power industry is undergoing the most profound technical, economic and organizational changes since, its inception some one hundred years ago. This paradigm is the result of the liberalization process, stipulated by politics and followed up by industry. In countries like India with fast growing demand of electric power it is difficult to extend the transmission system in time by either building new lines or by introduction of a new voltage level. Power is therefore transmitted through weak system leading to unsatisfactory quality and reliability of power supply. So, the need for new power flow controllers capable of increasing transmission capacity and controlling power flows through predefined transmission corridors will certainly increase. For this reason, as well known in recent years a new class of controllers, Flexible AC Transmission System (FACTS controllers have rapidly met with favor. Considering the practical application of the FACTS controller, it is of importance to investigate the benefits as well as model these devices for power system steady state operation. We have performed the comprehensive modeling of most popular FACTS devices for power flow study. The effectiveness of modeling and convergence is tested with a five bus study system without any FACTS devices and further analyzed it with different FACTS controllers. The de facto standard Newton-Raphson method is used to solve the nonlinear power flow equation. Also, the study is extended for IEEE 30 bus and IEEE 118 bus system. Programming of the power flow studies stated above is implemented with MATLAB.
Human Rights promotion in Serbia: a difficult task for the European Union / A promoçăo dos Direitos Humanos na Sérvia: uma difícil missăo para a Uniăo Europeia
Scientific Electronic Library Online (English)
Teresa Maria, Cierco.
Full Text Available Este artigo explora o papel da Uniăo Europeia na proteçăo, implementaçăo e promoçăo dos direitos humanos na Sérvia. Torna-se claro que as exigęncias da Uniăo Europeia em matéria de democratizaçăo na regiăo dos Balcăs Ocidentais tęm sido fundamentais também ao nível dos direitos humanos. Os direitos [...] humanos como parte dos critérios da política de condicionalidade da Uniăo Europeia săo uma mensagem clara para os Estados que desejam a adesăo. Contudo, o progresso da Sérvia nessa área tem se debatido com questőes internas. Este paper visa analisar o processo de democratizaçăo da Sérvia no seu caminho para a Uniăo Europeia, e o seu progresso (ou năo) no que se refere ŕ proteçăo e implementaçăo dos direitos humanos. Abstract in english This article explores the role of the European Union in the human rights protection, implementation and promotion in Serbia. It is clear that the EU demands on democratisation in the region of Western Balkans are crucial to achieve the respect for human rights. The human rights standards as part of [...] the conditionality criteria of the EU is a clear message towards the countries aspiring membership. However, Serbia progress in the field has been difficult due to several internal constraints. This paper aims to uncover the democratisation process of Serbia on its path towards the EU, and its progress (or not) regarding human rights protection and implementation.
42 CFR 493.839 - Condition: Chemistry.
...2010-10-01 2010-10-01 false Condition: Chemistry. 493.839 Section 493.839 Public Health...Combination of These Tests § 493.839 Condition: Chemistry. The specialty of chemistry includes for the purposes of proficiency...
Rotator Cuff and Shoulder Conditioning Program
... muscles www.orthoinfo.org Rotator Cuff and Shoulder Conditioning Program Introduction 1 Additional Notes Purpose of Program _________________________________________________________________ ... Target Muscles: The muscle groups targeted in this conditioning program include: • Deltoids (front, back and over the ...
42 CFR 493.821 - Condition: Microbiology.
...2010-10-01 2010-10-01 false Condition: Microbiology. 493.821 Section 493.821 Public...of These Tests § 493.821 Condition: Microbiology. The specialty of microbiology includes, for purposes of proficiency...
Server-Side Includes Made Simple.
Fagan, Jody Condit
Describes server-side include (SSI) codes which allow Webmasters to insert content into Web pages without programming knowledge. Explains how to enable the codes on a Web server, provides a step-by-step process for implementing them, discusses tags and syntax errors, and includes examples of their use on the Web site for Southern Illinois…
Rock mass evaluation for predicting tunnel constructability in the preliminary investigation stage. Phenomena causing difficult tunneling and rockburst prediction
International Nuclear Information System (INIS)
For the selection of the Detailed Investigation Areas for HLW disposal, predicting the tunnel constructability is one of the requirements together with assessing long-term safety. This report is the 1st of the three papers dealing with the evaluation of tunnel constructability. This paper deals with the geological factors relating to difficult tunneling such as squeezing, rockburst, and others. Also it deals with the prediction of rockburst. The 2nd paper will deal with the prediction of squeezing. The 3rd paper deals with the engineering characteristics of rock mass through rock mass classification. This paper about difficult tunneling has been based upon analysis of more than 500 tunneling reports about 280 tunnel constructions. The causes of difficult tunneling are related to (1) underground water, (2) mechanical properties of the rock, or (3) others such as gas. The geological factors for excessive water inflow are porous volcanic product of Quarternary, fault crush zone and hydrothermally altered zone of Green Tuff area, and degenerated mixed rock in accretionary complex. The geological factors for squeezing are solfataric clay at Quarternary volcanic zone, fault crush zone and hydrothermally altered zone of Green Tuff area, mudstone and fault crush zone of sedimentary rock of Neogene and later. Information useful for predicting rockburst has been gathered from previous reports. In the preliminary investigation stage, geological survey, geophysical survey and borlogical survey, geophysical survey and borehole survey from the surface are the source of information. Therefore rock type, P-wave velocity from seismic exploration and in-situ rock stress from hydrofracturing have been considered. Majority of rockburst events occurred at granitic rock, excluding coal mine where different kind of rockburst occurred at pillars. And P-wave velocity was around 5 km/s at the rock of rockburst events. Horizontal maximum and minimum stresses SH and Sh have been tested as a criterion for rockburst. It has been inferred that SH - Sh > 30MPa is a good criterion for rockburst occurrence. When rock stress data is not available, continuous occurrence of borehole breakout is also a good indicator of rockburst. (author)
Technology enabled care services (TECS), which include technologies such as telehealth, telecare, telemedicine and self-care apps, are designed to help people manage long-term conditions and retain as much independence as possible. The NHS Commissioning Assembly has published TECS Resource for Commissioners, a toolkit that raises awareness of the range of TECS available and their benefits to patients and professionals, supports commissioners to collaborate with providers to implement TECS, and advises how to create a TECS strategy, oversee implementation plans and ensure effective evaluation. The publication is at tinyurl.com/khsebyr. PMID:25806457
Gibbs conditioning extended, Boltzmann conditioning introduced
Grendar, Marian
Conditional Equi-concentration of Types on I-projections (ICET) and Extended Gibbs Conditioning Principle (EGCP) provide an extension of Conditioned Weak Law of Large Numbers and of Gibbs Conditioning Principle to the case of non-unique Relative Entropy Maximizing (REM) distribution (aka I-projection). ICET and EGCP give a probabilistic justification to REM under rather general conditions. mu-projection variants of the results are introduced. They provide a probabilistic jus...
How FDG-PET helps making decision for surgery in various difficult subgroups of temporal lobe epilepsy?
International Nuclear Information System (INIS)
Concordant pre-surgical data are the important predictors of good surgical outcome in patients with localization-related epilepsy. Medically intractable temporal lobe epilepsy with hippocampal sclerosis (HS) and concordant pre-surgical data is straightforward and may not need functional imaging. However, in other instances for example, HS with discordant data (HSD), bilateral HS with discordant data (BHSD), temporal lobe epilepsy with dual pathology (DP), non-lesional temporal lobe epilepsy (NL) are the difficult subgroups. In these groups, functional imaging eg. brain perfusion SPECT or brain PET may play a major role for surgical decision making. To our knowledge, there was no previous data in using FDG-PET in different subgroups as mentioned. Only some previous studies in single subgroup without analyzing impact of PET findings on decision-making have been reported. We thus aim to evaluate the usefulness of FDG-PET in these 4 subgroups
A new preparation scheme for a difficult-to-float coking coal by column flotation following grinding
Scientific Electronic Library Online (English)
Yinfei, Liaoa; Yijun, Caoa; Zhongbo, Hub; Xiuxiang, Taoc.
Full Text Available A new preparation scheme for a difficult-to-float coking coal from the Kailuan Mine, Tangshan, China was investigated. The results showed that grinding followed by column flotation was beneficial for obtaining products with low ash content. The positive effect of grinding on the coal floatability is [...] attributed to the liberation of intergrowths and coal surface improvement. Tests indicated that 10 minutes was the optimum grinding time, and overgrinding resulted in a deterioration in flotation performance. With a grinding time of 10 minutes, conventional flotation had potential to yield a product with around 12.42% ash content and 69.15% combustible recovery. Column flotation can reduce the product ash content to 11.15% and increase combustible recovery to 74.47%. Consistently better flotation results reveal that column flotation is more efficient than conventional flotation for such fines.
Criteria of an estimation statodynamic stability of sportsman body and system of bodies in difficult coordination sports.
Directory of Open Access Journals (Sweden)
Boloban V.N.
Full Text Available Criteria of an estimation statodynamic stability of sportsman body and system of bodies in difficult coordination sports are developed and experimentally proved. It is established that length of the general center of pressure trajectory of a body on a support, frequency of fluctuations of a body, a parity of amplitude of fluctuations of a body and frequency, symmetry and asymmetry of movements in the course of a body pose regulation, length of a trajectory of a control point moving on a trunk in the field of a sacrum in system of cooperating bodies are authentic signs of sports orientation, an estimation of sports technics of exercises and training by it. Criteria are a criterion of an estimation of a body balance in the course of sports exercises performance; allow to carry out effective sports preparation.
Searching for a needle in the haystack: comparing six methods to evaluate heteroplasmy in difficult sequence context.
Kurelac, Ivana; Lang, Martin; Zuntini, Roberta; Calabrese, Claudia; Simone, Domenico; Vicario, Saverio; Santamaria, Monica; Attimonelli, Marcella; Romeo, Giovanni; Gasparre, Giuseppe
Mitochondrial DNA (mtDNA) mutations have been involved in disease, aging and cancer and furthermore exploited for evolutionary and forensic investigation. When investigating mtDNA mutations the peculiar aspects of mitochondrial genetics, such as heteroplasmy and threshold effect, require suitable approaches which must be sensitive enough to detect low-level heteroplasmy and, precise enough to quantify the exact mutational load. In order to establish the optimal approach for the evaluation of heteroplasmy, six methods were experimentally compared for their capacity to reveal and quantify mtDNA variants. Drawbacks and advantages of cloning, Fluorescent PCR (F-PCR), denaturing High Performance Liquid Chromatography (dHPLC), quantitative Real-Time PCR (qRTPCR), High Resolution Melting (HRM) and 454 pyrosequencing were determined. In particular, detection and quantification of a mutation in a difficult sequence context were investigated, through analysis of an insertion in a homopolymeric stretch (m.3571insC). PMID:21689740
Grey fuzzy evaluation on technical condition of canned motor pump
International Nuclear Information System (INIS)
It is difficult to assess the technical condition of the canned motor pump because of its various factors and insufficient monitor information. Considering the main failure modes and phenomena determined by FMEA, the condition monitoring is carried out correspondingly. Based on the condition monitoring results, the technical condition is comprehensively assessed by the grey fuzzy evaluation. The method gives a new approach to assess the technical condition of complicated equipment. A numerical example is given to demonstrate the rationality and applicability of the proposed method. (authors)
Relación entre electroencefalograma y neuroimagen en nińos con epilepsia focal de difícil control / Relation between electroencephalogram and neuroimaging present in children with epilepsy of difficult control
Scientific Electronic Library Online (English)
Ileana, Valdivia Álvarez; Liane, Aguilar Fabré; Alicia, Francisco Pérez.
Full Text Available INTRODUCCIÓN. Las epilepsias focales son las más frecuentes en los nińos, y la resistencia al tratamiento farmacológico puede estar presente hasta en el 30 % de los pacientes. Se realizó este estudio con el objetivo de dirigir la atención hacia la coincidencia topográfica de los paroxismos electroen [...] cefalográficos, con lesiones estructurales demostrables por neuroimagen, para facilitar el diseńo de estrategias terapéuticas futuras. MÉTODOS. Se realizó un estudio descriptivo, longitudinal prospectivo, con 44 nińos con diagnóstico de epilepsia focal de difícil control, ingresados en el Servicio de Neuropediatría del Hospital Pediátrico Docente «Juan M. Márquez», entre enero de 2003 y junio de 2007. Se realizaron estudios por electroencefalograma (EEG) al ingreso y videoelectroencefalograma, además de estudios de neuroimagen por tomografía axial o resonancia magnética nuclear. RESULTADOS. Los paroxismos en EEG involucraron el lóbulo frontal hasta en el 68 % de los pacientes. En el 48 % de los pacientes, los paroxismos electroencefalográficos coinciden con zonas de alteración estructural según neuroimagen, más frecuentes en el lóbulo frontal. En el 25 % no hay coincidencia topográfica y en el 27 % no se precisan alteraciones estructurales. CONCLUSIONES. En las epilepsias focales de difícil control se debe prestar especial atención a las zonas elocuentes con coincidencia entre el EEG y la neuroimagen, para evaluar de forma temprana las alternativas quirúrgicas de tratamiento. Abstract in english INTRODUCTION: Focal epilepsies are the more frequent conditions in children and a pharmacologic treatment resistance could be present up to 30% of patients. Aim of present paper was to direct the attention to topographic coincidence of electroencephalographic paroxysms with structural lesions by neu [...] roimaging facilitating the future therapeutical strategies design. METHODS: A descriptive, longitudinal, prospective study was conducted in 44 children diagnosed with epilepsy of difficult control admitted in Neuropediatrics Service of "Juán Manuel Márquez" Teaching Children Hospital from January, 2003 to June, 2007. At admission, we made electroencephalogram (EEG) and videoelectroencephalogram (VEEG) studies as well as neuroimaging studies by axial tomography (AT) or nuclear magnetic resonance (NMR). RESULTS: Paroxysms in EEG involved frontal lobule up to the 68% of patients. In 48%, electroencephalographic paroxysms coincide with structural alteration zones according neuroimaging, more frequent in frontal lobule. In 25% there is not topographic coincidence, and in 27% there are not specified structural alterations. CONCLUSIONS: In focal epilepsies of difficult control, we must to take care of eloquent zones with coincident between EEG and neuroimaging to assess in time the surgical treatment options.
First clinical evaluation of the C-MAC D-Blade videolaryngoscope during routine and difficult intubation.
Cavus, Erol; Neumann, Tobias; Doerges, Volker; Moeller, Thora; Scharf, Edwin; Wagner, Klaus; Bein, Berthold; Serocki, Goetz
In the present preliminary study we evaluated the C-MAC® D-Blade (Karl Storz, Tuttlingen, Germany), a new videolaryngoscopic C-MAC blade for difficult intubation, during both routine and difficult intubations. First, both the conventional direct laryngoscopy and the D-Blade were used in 15 consecutive patients with normal airways during routine induction of anesthesia. Second, the D-Blade was used as a rescue device in 20 of 300 (6.7%) consecutive patients, when conventional direct laryngoscopy failed. In the 15 patients during routine induction of anesthesia, with direct laryngoscopy, a Cormack-Lehane (C/L) grade 1 and grade 2a view was seen in 7 and 8 patients, respectively. It was possible to insert the D-Blade and to get a video view of the glottis on the first attempt in all patients; with the D-Blade, all 15 patients had a C/L 1 view. The time to successful intubation with the D-Blade was 15 (8-26) seconds (median (range)). In the 20 patients, in whom unexpected difficulty with direct laryngoscopy was observed, C/L grades 3 and 4 were present in 15 and 5 patients, respectively. With the use of the D-Blade, indirect C/L video view improved to C/L class 1 in 15 patients, and to 2a in 5 patients, respectively. The time from touching the laryngoscope to optimal laryngoscopic view was 11 (5-45) seconds and for successful intubation 17 (3-80) seconds. In all 35 patients, with the D-Blade no direct view of the glottis was possible and subsequently a semiflexible tube guide was required. PMID:21156978
Births and deaths including fetal deaths
U.S. Department of Health & Human Services — Access to a variety of United States birth and death files including fetal deaths: Birth Files, 1968-2009; 1995-2005; Fetal death file, 1982-2005; Mortality files,...
Communications circuit including a linear quadratic estimator
Energy Technology Data Exchange (ETDEWEB)
Ferguson, Dennis D.
A circuit includes a linear quadratic estimator (LQE) configured to receive a plurality of measurements a signal. The LQE is configured to weight the measurements based on their respective uncertainties to produce weighted averages. The circuit further includes a controller coupled to the LQE and configured to selectively adjust at least one data link parameter associated with a communication channel in response to receiving the weighted averages.
Gas storage materials, including hydrogen storage materials
Energy Technology Data Exchange (ETDEWEB)
Mohtadi, Rana F; Wicks, George G; Heung, Leung K; Nakamura, Kenji
A material for the storage and release of gases comprises a plurality of hollow elements, each hollow element comprising a porous wall enclosing an interior cavity, the interior cavity including structures of a solid-state storage material. In particular examples, the storage material is a hydrogen storage material, such as a solid state hydride. An improved method for forming such materials includes the solution diffusion of a storage material solution through a porous wall of a hollow element into an interior cavity.
International Nuclear Information System (INIS)
The purpose of this analysis is to describe the condition of commercial Zircaloy clad fuel as it is received at the Yucca Mountain Project (YMP) site. Most commercial nuclear fuel is encased in Zircaloy cladding. This analysis is developed to describe cladding degradation from the expected failure modes. This includes reactor operation impacts including incipient failures, potential degradation after reactor operation during spent fuel storage in pool and dry storage and impacts due to transportation. Degradation modes include cladding creep, and delayed hydride cracking during dry storage and transportation. Mechanical stresses from fuel handling and transportation vibrations are also included. This Analysis and Model Report (AMR) does not address any potential damage to assemblies that might occur at the YMP surface facilities. Ranges and uncertainties have been defined. This analysis will be the initial boundary condition for the analysis of cladding degradation inside the repository. In accordance with AP-2.13Q, ''Technical Product Development Planning'', a work plan (CRWMS M andO 2000c) was developed, issued, and utilized in the preparation of this document. There are constraints, caveats and limitations to this analysis. This cladding degradation analysis is based on commercial Pressurized Water Reactor (PWR) fuel with Zircaloy cladding but is applicable to Boiling Water Reactor (BWR) fuel. Reactor operating experience for both PWRs and BWRs is used to establish fuel reliability from reactor operation. It is limited to fuel exposed to normal operation and anticipated operational occurrences (i.e. events which are anticipated to occur within a reactor lifetime), and not to fuel that has been exposed to severe accidents. Fuel burnup projections have been limited to the current commercial reactor licensing environment with restrictions on fuel enrichment, oxide coating thickness and rod plenum pressures. The information provided in this analysis will be used in evaluating the post-closure performance of the Monitored Geologic Repository (MGR) in relation to waste form degradation
Energy Technology Data Exchange (ETDEWEB)
E. Siegmann
The purpose of this analysis is to describe the condition of commercial Zircaloy clad fuel as it is received at the Yucca Mountain Project (YMP) site. Most commercial nuclear fuel is encased in Zircaloy cladding. This analysis is developed to describe cladding degradation from the expected failure modes. This includes reactor operation impacts including incipient failures, potential degradation after reactor operation during spent fuel storage in pool and dry storage and impacts due to transportation. Degradation modes include cladding creep, and delayed hydride cracking during dry storage and transportation. Mechanical stresses from fuel handling and transportation vibrations are also included. This Analysis and Model Report (AMR) does not address any potential damage to assemblies that might occur at the YMP surface facilities. Ranges and uncertainties have been defined. This analysis will be the initial boundary condition for the analysis of cladding degradation inside the repository. In accordance with AP-2.13Q, ''Technical Product Development Planning'', a work plan (CRWMS M&O 2000c) was developed, issued, and utilized in the preparation of this document. There are constraints, caveats and limitations to this analysis. This cladding degradation analysis is based on commercial Pressurized Water Reactor (PWR) fuel with Zircaloy cladding but is applicable to Boiling Water Reactor (BWR) fuel. Reactor operating experience for both PWRs and BWRs is used to establish fuel reliability from reactor operation. It is limited to fuel exposed to normal operation and anticipated operational occurrences (i.e. events which are anticipated to occur within a reactor lifetime), and not to fuel that has been exposed to severe accidents. Fuel burnup projections have been limited to the current commercial reactor licensing environment with restrictions on fuel enrichment, oxide coating thickness and rod plenum pressures. The information provided in this analysis will be used in evaluating the post-closure performance of the Monitored Geologic Repository (MGR) in relation to waste form degradation.
Survey of Macrofungi (including Truffles in Qatar
Directory of Open Access Journals (Sweden)
Roda F Al-Thani
Full Text Available Fourteen macrofungal genera belonging to 11 families and 7 orders were identified. These were isolated from different habitats (semi- desert, gardens, park, decayed roots of dead trees and under trees in Qatar. Macrofungi are defined here as ascomycetes and basidiomycetes with large, conspicuous spore-bearing structures that form above or beneath ground. This study indicated that the distribution of macrofungi is dependent on the plant community and the environmental conditions.
Characterizing difficult-to-measure radionuclides in low level waste using the computer codes 3R-STAT and SF-STAT
International Nuclear Information System (INIS)
This paper discusses the application of the computer codes, 3R-STAT and SF-STAT, in low level waste characterization programs to determine the concentrations and quantities of the difficult-to-measure radionuclides in low level waste shipped for disposal. The radionuclides addressed by the use of these two computer codes includes: l-129 and Tc-99, Sr-90, and the transuranic radionuclides. This paper discusses the analytical models used in the codes and the justification for the models in determining the release quantities of l-129 and Tc-99, and the scaling factors for Sr-90 and the transuranic radionuclides. The validation of the computer codes is discussed as an alternative to costly and potentially less accurate sampling and measurement programs. Recent experience with the application of the two computer codes in the Italian low level waste program to characterize all of the waste which was generated by the Italian nuclear plants and which is currently is storage at the nuclear sites is discussed
Reduction of uranium in disposal conditions of spent nuclear fuel
International Nuclear Information System (INIS)
This literature study is a summary of publications, in which the reduction of uranium by iron has been investigated in anaerobic groundwater conditions or in aqueous solution in general. The basics of the reduction phenomena and the oxidation states, complexes and solubilities of uranium and iron in groundwaters are discussed as an introduction to the subject, as well as, the Finnish disposal concept of spent nuclear fuel. The spent fuel itself mainly (?96 %) consists of a sparingly soluble uranium(IV) dioxide, UO2(s), which is stable phase in the anticipated reducing disposal conditions. If spent fuel gets in contact with groundwater, oxidizing conditions might be induced by the radiolysis of water, or by the intrusion of oxidizing glacial melting water. Under these conditions, the oxidation and dissolution of uranium dioxide to more soluble U(VI) species could occur. This could lead to the mobilization of uranium and other components of spent fuel matrix including fission products and transuranium elements. The reduction of uranium back to oxidation state U(IV) can be considered as a favourable immobilization mechanism in a long-term, leading to precipitation due to the low solubility of U(IV) species. The cast iron insert of the disposal canister and its anaerobic corrosion products are the most important reductants under disposal conditions, but dissolved ferrous iron may also function as reductant. Other iron sources in the buffer or near-field rock, are also considered as possible reductants. The reduction of uranium is a very challenging phenomenon to investigate. The experimental studies need e.g. well-controlled anoxic conditions and measurements of oxidation states. Reduction and other simultaneous phenomena are difficult to distinghuish. The groundwater conditions (pH, Eh and ions) influence on the prevailing complexes of U and Fe and on forming corrosion products of iron and, thus they determine also the redox chemistry. The partial reduction of sorbed uranium by metallic iron or by its corrosion products (magnetite, green rusts) has been observed in many studies performed under anaerobic solution conditions. A longer reaction time, several months, was needed to observe UO2 crystals. The pyrite in the buffer or pyrite or micas in the near-field rock may reduce uranium to some extent, whereas, hematite, can function as a catalytic surface in the U(VI) reduction by aqueous Fe2+. The surface catalytic reaction seem to outcompete the direct enzymatic U(VI) reduction by bacteria. Some studies suggested the reduction of U(VI) to occur also by aqueous Fe2+ in solution. (orig.)
Boundary Conditions as Dynamical Fields
Karabali, Dimitra
The possibility of treating boundary conditions in terms of a bilocal dynamical field is formalized in terms of a boundary action. This allows for a simple path-integral perturbation theory approach to physical effects such as radiation from a time-dependent boundary. The nature of the action which governs the dynamics of the bilocal field is investigated for a limited case (which includes the Robin boundary conditions).
Terrorism cover in France for property damage including nuclear risks
International Nuclear Information System (INIS)
The obligation to include terrorism cover in all Property Damage policies issued on the French Market is ruled by an Act of 1986 and introduced under Section R 126-2 of the French Code of Insurance. This section stipulates that Property Damage policies must provide cover for damage resulting from acts of terrorism, with the same deductible and the same limit than that of the other damage covered in the policy. Soon after the dramatic events of September 11, 2001 in the United States and although reinsurers worldwide restricted their offer of capacities, French insurers recognized that they had to maintain this global cover for the benefit of their insurers. After difficult discussions between insurers, reinsurers, brokers, risk managers and representatives of the State, the creation of a new Pool, backed with a State guarantee, was decided in less than three months. Effective January 1, 2002 and called Gestion d'Assurance et de Reassurance des Risques Attentats et Actes de Terrorisme (GAREAT), the Pool offers a multiple layers stop-loss cover for Property Damage only, i.e. excluding TPL policies. Considering that nuclear risks should be treated in the same way as other industrial risks, it was decided that they would be covered by GAREAT as well. In the meantime, by a Decree of December 28, 2001 modifying Section R 126-2, a special provision, aiming at reducing the limit and thus the price of this cover, was introduced in the Code. The purpose of this paper is to expose the present situation applying through GAREAT and, after two years of operation to discuss future developments, including other sources of capacity for the coverage of acts of terrorism in nuclear risks insurance.(author)
Conditioned reinforcement by conditional discriminative stimuli.
Ohta, A.
A concurrent-chains schedule was used to examine how a delay to conditional discriminative stimuli affects conditioned reinforcement strength. Pigeons' key-peck responses in the initial link produced either of two terminal links according to independent variable-interval 30-s schedules. Each terminal link involved an identical successive conditional discrimination and was segmented into three links: a delay interval (green), a color conditional discriminative stimulus (blue or red), and a lin...
Condition Indicators for Gearbox Condition Monitoring Systems
P. Ve?e?; M. Kreidl; R. Šmíd
Condition monitoring systems for manual transmissions based on vibration diagnostics are widely applied in industry. The systems deal with various condition indicators, most of which are focused on a specific type of gearbox fault. Frequently used condition indicators (CIs) are described in this paper. The ability of a selected condition indicator to describe the degree of gearing wear was tested using vibration signals acquired during durability testing of manual transmission with helical ge...
Condition Indicators for Gearbox Condition Monitoring Systems
Directory of Open Access Journals (Sweden)
P. Ve?e?
Full Text Available Condition monitoring systems for manual transmissions based on vibration diagnostics are widely applied in industry. The systems deal with various condition indicators, most of which are focused on a specific type of gearbox fault. Frequently used condition indicators (CIs are described in this paper. The ability of a selected condition indicator to describe the degree of gearing wear was tested using vibration signals acquired during durability testing of manual transmission with helical gears.
Hot conditioning equipment conceptual design report
Energy Technology Data Exchange (ETDEWEB)
Bradshaw, F.W., Westinghouse Hanford
This report documents the conceptual design of the Hot Conditioning System Equipment. The Hot conditioning System will consist of two separate designs: the Hot Conditioning System Equipment; and the Hot Conditioning System Annex. The Hot Conditioning System Equipment Design includes the equipment such as ovens, vacuum pumps, inert gas delivery systems, etc.necessary to condition spent nuclear fuel currently in storage in the K Basins of the Hanford Site. The Hot Conditioning System Annex consists of the facility of house the Hot Conditioning System. The Hot Conditioning System will be housed in an annex to the Canister Storage Building. The Hot Conditioning System will consist of pits in the floor which contain ovens in which the spent nuclear will be conditioned prior to interim storage.
Hot conditioning equipment conceptual design report
International Nuclear Information System (INIS)
This report documents the conceptual design of the Hot Conditioning System Equipment. The Hot conditioning System will consist of two separate designs: the Hot Conditioning System Equipment; and the Hot Conditioning System Annex. The Hot Conditioning System Equipment Design includes the equipment such as ovens, vacuum pumps, inert gas delivery systems, etc.necessary to condition spent nuclear fuel currently in storage in the K Basins of the Hanford Site. The Hot Conditioning System Annex consists of the facility of house the Hot Conditioning System. The Hot Conditioning System will be housed in an annex to the Canister Storage Building. The Hot Conditioning System will consist of pits in the floor which contain ovens in which the spent nuclear will be conditioned prior to interim storage
Tore Supra - a new conditioning procedure in the presence of the toroidal field
International Nuclear Information System (INIS)
Wall conditioning is of major importance in Tokamak research. In some Tokamaks, glow discharges are routinely used between plasma pulses to get reproducible wall properties for successive plasma experiments. However, glow discharge efficiency for impurity and hydrogenoid atoms removal vanishes in the presence of a permanent toroidal field, such as in Tore-Supra and future devices, e.g. ITER, operating with superconducting coils. New conditioning techniques must be developed to insure the wall reconditioning during the operational day. Indeed, after a disruption the plasma restart is usually difficult without conditioning, and glow discharges are time consuming because the toroidal field has to be removed and sufficient gas injected. A new type of conditioning procedure is now used at Tore-Supra, which allows the rapid recovery of good wall conditions even in the presence of the toroidal field. This technique is based on the production of an alternating helium plasma controlled by the gas and poloidal feed-back systems. With this new procedure, only 20 to 25 minutes are necessary to restart the physics program of Tore Supra, including a final ohmic discharge, performed to fully recover and verify the wall quality. The same result requires at least 75 minutes with glow discharges cleaning, 60 minutes being used for the ramp down and up of the toroidal field. (author)
Including Students with Visual Impairments: Softball
Brian, Ali; Haegele, Justin A.
Research has shown that while students with visual impairments are likely to be included in general physical education programs, they may not be as active as their typically developing peers. This article provides ideas for equipment modifications and game-like progressions for one popular physical education unit, softball. The purpose of these…
A group of VIPs, including Orville Wright
A group of VIPs, including Orville Wright, center. Left to right bottom row ?, Walter Reiser, Elton Miller, Orville Wright, Starr Truscutt, Addison Rothrock, Eastman Jacobs, Dr. Lewis Top row Gus Crowley, Ernie Johnson, Carlton Kemper, H.J.E. Reid, Smith DeFrance, Theodore Theodorsen.
Reporte de caso: anestesia espinal multimodal en paciente pediátrico con vía aérea difícil / Case report: Multimodal spinal anesthesia in a pediatric patient with a difficult airway
Scientific Electronic Library Online (English)
William, Diaz Herrera; Hector Fidel, Osorio Zambrano; Miguel Francisco, Sandoval Cabrera.
Full Text Available Introducción: La anestesia espinal llevamás de 100 ańos en la práctica anestésica pediátrica. Actualmente viene aumentando su uso por ser eficaz, eficiente y segura. Se expone un caso exitoso en paciente con vía aérea difícil. Objetivo: Reportar un caso de anestesia espinal y sedación con remifentan [...] ilo, haciendo la revisión de la literatura incluyendo fármacos alfa 2 agonistas, para procedimientos locorregionales pediátricos. Métodos: Búsqueda bibliográfica relevante en las bases bibliográficas PubMed, MD consult y BIREME. Inicialmente se obtienen 306 artículos, seleccionando 23 considerados relevantes por los autores. Resultados: Se presenta el caso de un nińo de un ańo de edad, con vía aérea difícil predicha por un hemangioma cavernoso en labio inferior, programado para corrección quirúrgica de pie chapín bilateral. Se administra anestesia espinal con bupivacaína hiperbárica 0,5% carbonatada 5mg y clonidina 30 1g(1,3 ml total), manteniendo sedoanalgesia 3-4/6 de Ramsay con remifentanilo 0,05-0,075 1g/kg/min, con oxígeno 50% por máscara facial y ventilación espontánea sin efectos adversos hemodinámicos o respiratorios. Conclusiones: La anestesia espinal es una alternativa ante una vía aérea difícil predicha. La clonidina (alfa 2 agonista) prolonga la duración del bloqueo sin complicaciones hemodinámicas o respiratorias. El remifentanilo para sedación en los procedimientos locorregionales pediátricos es de fácil titulación, con resultados predecibles. Abstract in english Introduction: Spinal anesthesia has been part of the pediatric anesthesia practice for more than 100 years. Its use has been increasing in recent years because of its effective-ness.efficiency and safety. We report a successful case in a patient with a difficult airway. Objective: To report a case o [...] f spinal anesthesia and sedation with remifentanil, together with a review of the literature including alpha 2 agonists for locoregional procedures in pediatrics. Methods: Search of relevant references in PubMed, MD consult and BIREME. The search resulted in 306 articles, and 23 considered relevant by the authors were finally selected. Results: We present a case of a 1-year-old boy with an expected difficult airway because of the presence of a cavernous hemangioma of the lower lip, scheduled for surgical correction of bilateral club foot. Spinal anesthesia consisted of 0,5% hyperbaric carbonated bupiva-caine plus 30 g of clonidine (1.3 ml total), maintaining sedation-analgesia at 3^1/6 on the Ramsay scale with remifentanil 0,05-0,075 g/kg/min, 50% oxygen with facial mask, and spontaneous ventilation, with no hemodynamic or respiratory adverse effects. Conclusions: Spinal anesthesia is an option in cases of predicted difficult airway. Clonidine (alpha 2 agonist) prolongs blockade with no hemodynamic or respiratory complications. Remifentanil used for sedation in pediatric locoregional procedures is easy to titrate with-predictable results.
Kinase-two-hybrid: towards the conditional interactome
Ochoa, David; Beltrao, Pedro
The dynamics of the protein–protein interaction network and how it responds to biological perturbations remain difficult to assay by most traditional techniques. A novel kinase-dependent yeast two-hybrid framework by Stelzl and colleagues (Grossmann et al, 2015) provides a new prism to study how tyrosine phosphorylation regulates the changes in the interactome under varying conditions. PMID:25814556
Difficult cannulation: what should I do before EUS guided access? / Canulación difícil: żqué hacer antes de acceso guiado por EUS?
Scientific Electronic Library Online (English)
Everson L.A, Artifon; Renata N, Moura; Jose P, Otoch.
Full Text Available La canulación selectiva del conducto biliar común puede ser difícil por eso se han desarrollado diferentes estrategias para disminuir esta dificultad. La presente revisión analiza el uso de papilótomos diferentes en lugar del catéter estándar, la papilotomía con pre corte usando cuchillos o papilóto [...] mos, la septotomía papilar transpancreática y el uso de stents. La canulación biliar sigue siendo el factor más importante para considerar una ERCP como exitosa. Las indicaciones de accesos biliares alternativos y su uso es muy importante si esta falla. La punción suprapapilar es una técnica promisoria. Es importante tener en cuenta que la meta de todas las técnicas es disminuir la ocurrencia de pancreatitis aguda Abstract in english Selective cannulation of the common bile duct can be difficult, so multiple strategies have been developed to overcome the situation. In this review we analize the different strategies that can be used like different papillotome instead of the standard catheter, precut papillotomy using precut needl [...] e knives or precut papillotome, transpancreatic papillary septotomy, and stenting of the pancreatic duct. Bile duct cannulation remains an important benchmark of successful ERCP. Alternative biliary access indication and its use is very important If biliary cannulation remains unsuccessful.The suprapapillary puncture is a promissory technique. It´s important to have in mind that the goal of all techniques is to provide acute pancreatitis decrease
Drinking from the Fire Hose: Why the Flight Management System Can Be Hard to Train and Difficult to Use
Sherry, Lance; Feary, Michael; Polson, Peter; Fennell, Karl
The Flight Management Computer (FMC) and its interface, the Multi-function Control and Display Unit (MCDU) have been identified by researchers and airlines as difficult to train and use. Specifically, airline pilots have described the "drinking from the fire-hose" effect during training. Previous research has identified memorized action sequences as a major factor in a user s ability to learn and operate complex devices. This paper discusses the use of a method to examine the quantity of memorized action sequences required to perform a sample of 102 tasks, using features of the Boeing 777 Flight Management Computer Interface. The analysis identified a large number of memorized action sequences that must be learned during training and then recalled during line operations. Seventy-five percent of the tasks examined require recall of at least one memorized action sequence. Forty-five percent of the tasks require recall of a memorized action sequence and occur infrequently. The large number of memorized action sequences may provide an explanation for the difficulties in training and usage of the automation. Based on these findings, implications for training and the design of new user-interfaces are discussed.
Droit de la filiation et procréation médicalisée : une coexistence difficile Law of filiation and medically assisted procreation: difficult coexistence
Directory of Open Access Journals (Sweden)
Marie-France Nicolas-Maguin
Full Text Available Les techniques médicales ont le pouvoir de bouleverser le processus de la procréation. Le médecin en devient un acteur essentiel. Cette désincarnation de la procréation atteint les concepts de la filiation plus ou moins largement ŕ travers deux ruptures, la rupture du lien entre procréation et sexualité et la rupture temporelle que permet la congélation des gamčtes et de l'embryon. Il appartient ŕ la loi d'intégrer ou d'ignorer ces atteintes. Le droit français a fait le choix de l'intégration sélective puisque la procréation médicalement assistée est considérée comme un remčde ŕ la stérilité pathologique et non un mode alternatif de reproduction. Ce choix recčle des contradictions qui illustrent la difficulté de l'exercice.Medical technology has the power drastically impact the procreation process. The doctor becomes a major actor in this process. This disembodiment of procreation more or less affects the filiation concepts through two "kinds of breaking", breaking the link between procreation and sexuality and breaking the temporal link made possible by freezing gamets and embryo. It is task of the law to incorporate or ignore these gaps. French law has chosen selective integration since medically assisted procreation is considered as a remedy to pathological sterility and not as an alternative mode of reproduction. This choice hides contradictions showing how difficult this exercise is.
Quiste epidermoide testicular: una rara entidad de difícil diagnostico preoperatorio / Testicular epidermoid cyst: uncommon lesion of difficult preoperative diagnosis
Scientific Electronic Library Online (English)
C., Aguilera Tubet; G., López Rasines; A., Roca Edreira; B., Martín García; R., Hernández Rodríguez; J.A, Portillo Martín; J.L., Gutiérrez Bańos; M.A., Correas Gómez; J.I. del, Valle Schaan; M.A, Rado Velázquez; F., Ruiz Izquierdo; R., Ballestero Diego.
Full Text Available Los quistes epidermoides intratesticulares son tumores raros, constituyendo el 1% de todos los tumores testiculares. Se trata de tumoraciones benignas que plantean un difícil diagnóstico diferencial preoperatorio frente a los tumores malignos testiculares. La ausencia de elevación de los marcadores [...] tumorales y la apariencia ecográfica, pueden orientar hacia su diagnóstico preoperatorio y en este caso la cirugía conservadora del testículo. Se presenta el caso de un paciente de 22 ańos que consulta por una masa en el testículo izquierdo. En este caso, el diagnóstico ecográfico preoperatorio no descartaba otras patologías por lo que se procedió a la realización de orquiectomía inguinal izquierda. Abstract in english Intratesticular epidermoid cysts are rare tumours that constitute one percent of all testicular masses. They are bening lesions that make differential diagnosis from malignant testicular tumours difficult. The absence of serum markers elevation and ultrasound imaging could support these lesions bein [...] g bening epidermoid cysts, and in that case, conservative surgery is adequate. We present the case of a 22 years old patient who complains of a left testicular mass. In this case ultrasound diagnosis was non-specific and a left radical inguinal orchiectomy was performed.
Burden of major musculoskeletal conditions
Directory of Open Access Journals (Sweden)
Woolf Anthony D.
Full Text Available Musculoskeletal conditions are a major burden on individuals, health systems, and social care systems, with indirect costs being predominant. This burden has been recognized by the United Nations and WHO, by endorsing the Bone and Joint Decade 2000-2010. This paper describes the burden of four major musculoskeletal conditions: osteoarthritis, rheumatoid arthritis, osteoporosis, and low back pain. Osteoarthritis, which is characterized by loss of joint cartilage that leads to pain and loss of function primarily in the knees and hips, affects 9.6% of men and 18% of women aged >60 years. Increases in life expectancy and ageing populations are expected to make osteoarthritis the fourth leading cause of disability by the year 2020. Joint replacement surgery, where available, provides effective relief. Rheumatoid arthritis is an inflammatory condition that usually affects multiple joints. It affects 0.3-1.0% of the general population and is more prevalent among women and in developed countries. Persistent inflammation leads to joint destruction, but the disease can be controlled with drugs. The incidence may be on the decline, but the increase in the number of older people in some regions makes it difficult to estimate future prevalence. Osteoporosis, which is characterized by low bone mass and microarchitectural deterioration, is a major risk factor for fractures of the hip, vertebrae, and distal forearm. Hip fracture is the most detrimental fracture, being associated with 20% mortality and 50% permanent loss in function. Low back pain is the most prevalent of musculoskeletal conditions; it affects nearly everyone at some point in time and about 4-33% of the population at any given point. Cultural factors greatly influence the prevalence and prognosis of low back pain.
Photoactive devices including porphyrinoids with coordinating additives
Energy Technology Data Exchange (ETDEWEB)
Forrest, Stephen R; Zimmerman, Jeramy; Yu, Eric K; Thompson, Mark E; Trinh, Cong; Whited, Matthew; Diev, Vlacheslav
Coordinating additives are included in porphyrinoid-based materials to promote intermolecular organization and improve one or more photoelectric characteristics of the materials. The coordinating additives are selected from fullerene compounds and organic compounds having free electron pairs. Combinations of different coordinating additives can be used to tailor the characteristic properties of such porphyrinoid-based materials, including porphyrin oligomers. Bidentate ligands are one type of coordinating additive that can form coordination bonds with a central metal ion of two different porphyrinoid compounds to promote porphyrinoid alignment and/or pi-stacking. The coordinating additives can shift the absorption spectrum of a photoactive material toward higher wavelengths, increase the external quantum efficiency of the material, or both.
Contractively included subspaces of Pick spaces
Benhida, Chafiq; Timotin, Dan
Pick spaces are a class of reproducing kernel Hilbert spaces that generalize the classical Hardy space and the Drury--Arveson reproducing kernel spaces. We give characterizations of certain contractively included subspaces of Pick spaces. These generalize the characterization of closed invariant subspaces of Trent and McCullough, as well as results for the Drury--Arveson space obtained by Ball, Bolotnikov and Fang.
Electromagnetic transformer modelling including the ferromagnetic core
Ribbenfja?rd, David
In order to design a power transformer it is important to understand its internal electromagnetic behaviour. That can be obtained by measurements on physical transformers, analytical expressions and computer simulations. One benefit with simulations is that the transformer can be studied before it is built physically and that the consequences of changing dimensions and parameters easily can be assessed. In this thesis a time-domain transformer model is presented. The model includes core pheno...
Multiverse rate equation including bubble collisions
Salem, Michael P.
The volume fractions of vacua in an eternally inflating multiverse are described by a coarse-grain rate equation, which accounts for volume expansion and vacuum transitions via bubble formation. We generalize the rate equation to account for bubble collisions, including the possibility of classical transitions. Classical transitions can modify the details of the hierarchical structure among the volume fractions, with potential implications for the staggering and Boltzmann-br...
Nuclear reactor shield including magnesium oxide
Rouse, Carl A. (Del Mar, CA); Simnad, Massoud T. (La Jolla, CA)
An improvement in nuclear reactor shielding of a type used in reactor applications involving significant amounts of fast neutron flux, the reactor shielding including means providing structural support, neutron moderator material, neutron absorber material and other components as described below, wherein at least a portion of the neutron moderator material is magnesium in the form of magnesium oxide either alone or in combination with other moderator materials such as graphite and iron.
Electric power monthly, September 1990. [Glossary included
Energy Technology Data Exchange (ETDEWEB)
The purpose of this report is to provide energy decision makers with accurate and timely information that may be used in forming various perspectives on electric issues. The power plants considered include coal, petroleum, natural gas, hydroelectric, and nuclear power plants. Data are presented for power generation, fuel consumption, fuel receipts and cost, sales of electricity, and unusual occurrences at power plants. Data are compared at the national, Census division, and state levels. 4 figs., 52 tabs. (CK)
Model for safety reports including descriptive examples
International Nuclear Information System (INIS)
Several safety reports will be produced in the process of planning and constructing the system for disposal of high-level radioactive waste in Sweden. The present report gives a model, with detailed examples, of how these reports should be organized and what steps they should include. In the near future safety reports will deal with the encapsulation plant and the repository. Later reports will treat operation of the handling systems and the repository
Analysis of wave load combination including slamming
Dai, Yang Shan
Analysis of wave load combination including slamming It is necessary to estimate extreme sea loads when probabilistic and reliability methods are used to analyse t~e ultimate strength of ship corresponding to the modes of failure due to yielding or inelastic buckling. The ship response records taken in full-scale tests show that the vertical stress time his tory consists of a rapidly varying time history with random amplitude and frequency, oscillating about a mean value. The mean ...
Vibration Signals and Condition Monitoring for Wind Turbines
Dimitrios Koulocheris; Georgios Gyparakis; Andonios Stathis; Theodore Costopoulos
Rolling element bearings are critical parts of modern wind turbines as they carry the loads of the turning structure and the wind force. The stochastic nature of the wind loads makes it difficult to estimate the useful operational life of the bearings. Condition monitoring of these bearings in a real time environment could be very helpful in estimating their performance and in scheduling maintenance actions when a condition-based maintenance strategy is followed. This p...
Abdalla, S. A.; Abdalla, Kamal N.
Every air-conditioning system needs some fresh air to provide adequate ventilation air required to remove moisture, gases like ammonia and hydrogen sulphide, disease organisms, and heat from occupied spaces. However, natural ventilation is difficult to control because urban areas outside air is often polluted and cannot be supplied to inner spaces before being filtered. Besides the high electrical demand of refrigerant compression units used by most air-conditioning systems, and fans used to ...
Estimation of nonparametric conditional moment models with possibly nonsmooth moments
Chen, Xiaohong; Pouzo, Demian
This paper studies nonparametric estimation of conditional moment models in which the residual functions could be nonsmooth with respect to the unknown functions of endogenous variables. It is a problem of nonparametric nonlinear instrumental variables (IV) estimation, and a difficult nonlinear ill-posed inverse problem with an unknown operator. We first propose a penalized sieve minimum distance (SMD) estimator of the unknown functions that are identified via the conditional moment models. W...
Boundary conditions in theory of photothermal processes
Scientific Electronic Library Online (English)
G. N., Logvinov; Miguel Cruz, Irisson; I. M., Lashkevych; J. E., Velazquez; Yu. G., Gurevich.
Full Text Available The general boundary conditions for the thermal diffusion equation are obtained. It is shown that in the general case of a nonstationary photothermal process these boundary conditions must include both the surface thermal conductivity and surface thermal capacity. One more parameter, the surface cap [...] acity thermal impedance, appears in the boundary conditions when the photothermal process is the thermal wave propagation.
What is It? Difficult to Pigeon Hole Tremor: a Clinical–Pathological Study of a Man with Jaw Tremor
Louis, Elan D.; Bain, Peter G.; Hallett, Mark; Jankovic, Joseph; Vonsattel, Jean-Paul G.
Background The phenomenology of tremor is broad and its classification is complicated. Furthermore, the full range of tremor phenomenology with respect to specific neurological and neurodegenerative diseases has not been fully elaborated. Case Report This right-handed man had a chief complaint of jaw tremor, which began approximately 20 years prior to death at age 101 years. He had been diagnosed with essential tremor (ET) by a local doctor. His examination at age 100 years was notable for marked jaw tremor at rest in the absence of other clear features of parkinsonism, mild kinetic tremor of the hands and, in the last year of life, a score of 22/41 on a cognitive screen. A senior movement disorder neurologist raised doubt about the "ET" diagnosis. The history and videotaped examination were reviewed by three additional senior tremor experts, who raised a number of diagnostic possibilities. A complete postmortem examination was performed by a senior neuropathologist, and was notable for the presence of tufted astrocytes, AT8-labeled glial cytoplasmic inclusions, and globose neuronal tangles. These changes were widespread and definitive. A neuropathological diagnosis of progressive supranuclear palsy was assigned. Discussion This case presents with mixed and difficult to clinically classify tremor phenomenology and other neurological findings. The postmortem diagnosis was not predicted based on the clinical features, and it is possible that it does not account for all of the features. The case raises many interesting issues and provides a window into the complexity of the interpretation, nosology, and classification of tremor phenomenology. PMID:23864988
Evaluation of a Dedicated Balloon Catheter for Infrapopliteal Difficult Calcified Lesions in Diabetic Patients With Critical Limb Ischemia
International Nuclear Information System (INIS)
The purpose of this study was to assess the technical performance and immediate procedural outcome of a new balloon catheter in the treatment of calcified lesions in infrapopliteal arterial disease. Sixty-one patients (81 vessels) with infrapopliteal arterial disease were evaluated. Seventy-four of the 81 treated vessels had total occlusions. The ReeKross 18 peripheral transluminal angioplasty catheter (ClearStream, Wexford, Ireland) is an 0.018-inch guidewire system with 4F sheath compatibility and a rigid shaft intended for enhanced pushability. Only technical procedural outcomes were recorded. In 37 of 61 patients (50 infrapopliteal severely stenosed or occluded vessels), an attempt with a standard balloon was made before the ReeKross 18 was used. In 24 patients, the ReeKross 18 was used as the primary catheter in 23 cases involving crural arteries and in 8 cases involving the foot. The ReeKross 18 crossed the lesion in 55 of 59 (93.2%) patients and 72 of 77 (94.5%) vessels, respectively. Postdilatation results for the 51 patients (64 target lesions) in whom ReeKross 18 balloon dilation was achieved showed <30% residual stenosis in all but 4 patients (5 lesions). Of the patients treated with the ReeKross 18 as the primary catheter, the technical success rate (no adjunctive treatment/stent) was obtained in 20 of 24 (83.3%) patients (27 of 31 [87.1%] target lesions). In the treatment of difficult calcified lesions, the choice of a high-pushability angioplasty cathete of a high-pushability angioplasty catheter, such as the ReeKross 18, warrants consideration.
Enzyme replacement therapy started at birth improves outcome in difficult-to-treat organs in mucopolysaccharidosis I mice.
Baldo, Guilherme; Mayer, Fabiana Q; Martinelli, Bárbara Z; de Carvalho, Talita G; Meyer, Fabiola S; de Oliveira, Patrícia G; Meurer, Luise; Tavares, Angela; Matte, Ursula; Giugliani, Roberto
Since we previously observed that in patients with mucopolysaccharidosis (MPS) the storage of undegraded glycosaminoglycans (GAG) occurs from birth, in the present study we aimed to compare normal, untreated MPS I mice (knockout for alpha-l-iduronidase-IDUA), and MPS I mice treated with enzyme replacement therapy (ERT, Laronidase, 1.2mg/kg every 2 weeks) started from birth (ERT-neo) or from 2 months of age (ERT-ad). All mice were sacrificed at 6 months. Both treatments were equally effective in normalizing GAG levels in the viscera but had no detectable effect on the joint. Heart function was also improved with both treatments. On the other hand, mice treated from birth presented better outcomes in the difficult-to-treat aortas and heart valves. Surprisingly, both groups had improvements in behavior tests, and normalization of GAG levels in the brain and IDUA injection resulted in detectable levels of enzyme in the brain tissue 1h after administration. ERT-ad mice developed significantly more anti-IDUA-IgG antibodies, and mice that didn't develop antibodies had better performances in behavior tests, indicating that development of antibodies may reduce enzyme bioavailability. Our results suggest that ERT started from birth leads to better outcomes in the aorta and heart valves, as well as a reduction in antibody levels. Some poor vascularized organs, such as the joints, had partial or no benefit and ancillary therapies might be needed for patients. The results presented here support the idea that ERT started from birth leads to better treatment outcomes and should be considered whenever possible, a observation that gains relevance as newborn screening programs are being considered for MPS and other treatable lysosomal storage disorders. PMID:23562162
Methods for estimating the content of transuranium and other difficult to measure nuclides in produced rad waste from BWRs
International Nuclear Information System (INIS)
During operation of nuclear power reactors a large number of radionuclides are produced. Some of them are difficult to measure. These are alpha or beta emitting radionuclides with weak or no gamma transition(s). A number of them, for instance some of the transuranium isotopes, may have significant radiological impact. It is of interest to be able to estimate the activity levels of these nuclides in the reactor systems. It is also of significant importance to estimate their content in produced waste packages and their radiological impact. In the report sources and source strengths for uranium and transuranium isotopes as well as for selected activated corrosion products are provided. Models for estimating the activity levels of these nuclides in the reactor systems and in different waste types are proposed. It is shown that the only significant source of uranium and transuranium nuclides is dispersion of fuel during operation of a reactor with defected and degrading fuel. The total amount of uranium on the core surfaces (tramp uranium), for a reactor in which no severe fuel failures have occurred, is about 0.5 g U, containing 2 % fissile material. During operation with defected fuel, up to 400 g U has been dispersed in the reactor water and distributed in the primary system during one single fuel cycle. Models for estimations of the amount of tramp uranium on the core surfaces during operation with no defected rods and the accumulation of uranium during operation with degrading fuel are provided. These models form the basis for consequence analyses of fuel failures and estimations of the amount of alpha emitting nuclides in different types of waste. 19 refs
Ocean management plan includes array of recommendations
Showstack, Randy
When U.S. President Bill Clinton and Vice President Al Gore appeared in Monterey, California in June 1998 for a National Oceans Conference, some of the salt water spray from the Pacific Ocean must have clung to them.As a follow-up to the conference, the Clinton Administration on September 2 issued an interagency report to help guide federal efforts in establishing a comprehensive ocean policy.The report, which touches upon a number of global issues including the United Nations Convention on the Law of the Sea, contains nearly 150 recommendations.
A kicked quantum system including the continuum
International Nuclear Information System (INIS)
The behaviour of a quantum particle in a separable one-term potential with three-dimensional form factor is investigated under the influence of an external force which alters the potential strength periodically or quasiperiodically. The unperturbed system possesses one bound state and a continuum of scattering states which has treated almost analytically. First numerical results, fully including the emission channel, indicate, for certain parameter combinations with commensurate or incommensurate frequency ratios, either a regular or an irregular dynamical behaviour of the system. 17 refs.; 3 figs
Models of Procyon A including seismic constraints
Eggenberger, P.; Carrier, F.; Bouchy, F.
Detailed models of Procyon A based on new asteroseismic measurements by Eggenberger et al (2004) have been computed using the Geneva evolution code including shellular rotation and atomic diffusion. By combining all non-asteroseismic observables now available for Procyon A with these seismological data, we find that the observed mean large spacing of 55.5 +- 0.5 uHz favours a mass of 1.497 M_sol for Procyon A. We also determine the following global parameters of Procyon A: a...
MOS modeling hierarchy including radiation effects
International Nuclear Information System (INIS)
A hierarchy of modeling procedures has been developed for MOS transistors, circuit blocks, and integrated circuits which include the effects of total dose radiation and photocurrent response. The models were developed for use with the SCEPTRE circuit analysis program, but the techniques are suitable for other modern computer aided analysis programs. The modeling hierarchy permits the designer or analyst to select the level of modeling complexity consistent with circuit size, parametric information, and accuracy requirements. Improvements have been made in the implementation of important second order effects in the transistor MOS model, in the definition of MOS building block models, and in the development of composite terminal models for MOS integrated circuits
Disseminated cryptococcosis including osteomyelitis in a horse.
Lenard, Z M; Lester, N V; O'hara, A J; Hopper, B J; Lester, G D
A 4-year-old Arab mare was diagnosed with disseminated cryptococcosis, including osteomyelitis of the proximal phalanx of the left hind limb, osteomyelitis with associated soft tissue granuloma of a rib and disseminated, large cryptococcal nodules in the lungs. The lesion in the dorsoproximal aspect of the proximal phalanx had a large area of cortical lysis with spiculated periosteal new bone and extensive soft tissue swelling. The affected rib had a pathological fracture. Cryptococcal osteomyelitis has not been previously reported in horses but should be considered as a differential diagnosis, particularly in endemic regions. PMID:17300456
Collective Atomic Recoil Lasing Including Friction and Diffusion Effects
Robb, G R M; Ferraro, A; Bonifacio, R; Courteille, P W; Zimmermann, C; Courteille, Ph.W.
We extend the Collective Atomic Recoil Lasing (CARL) model including the effects of friction and diffusion forces acting on the atoms due to the presence of optical molasses fields. The results from this model are consistent with those from a recent experiment by Kruse et al. [Phys. Rev. Lett. 91, 183601 (2003)]. In particular, we obtain a threshold condition above which collective backscattering occurs. Using a nonlinear analysis we show that the backscattered field and the bunching evolve to a steady-state, in contrast to the non-stationary behaviour of the standard CARL model. For a proper choice of the parameters, this steady-state can be superfluorescent.
The effects of external conditions in turbulent boundary layers
Brzek, Brian G.
The effects of multiple external conditions on turbulent boundary layers were studied in detail. These external conditions include: surface roughness, upstream turbulence intensity, and pressure gradient. Furthermore, the combined effects of these conditions show the complicated nature of many realistic flow conditions. It was found that the effects of surface roughness are difficult to generalize, given the importance of so many parameters. These parameters include: roughness geometry, roughness regime, roughness height to boundary layer thickness, (k/delta), roughness parameter, ( k+), Reynolds number, and roughness function (Delta B+). A further complication, is the difficulty in computing the wall shear stress, tauw/rho. For the sand grain type roughness, the mean velocity and Reynolds stresses were studied in inner and outer variables, as well as, boundary layer parameters, anisotropy tensor, production term, and viscous stress and form drag contributions. To explore the effects of roughness and Reynolds number dependence in the boundary layer, a new experiment was carefully designed to properly capture the x-dependence of the single-point statistics. It was found that roughness destroys the viscous layer near the wall, thus, reducing the contribution of the viscous stress in the wall region. As a result, the contribution in the skin friction due to form drag increases, while the viscous stress decreases. This yields Reynolds number invariance in the skin friction, near-wall roughness parameters, and inner velocity profiles as k + increases into the fully rough regime. However, in the transitionally rough regime, (i.e., 5 Zagarola and Smits scaling, Uinfinitydelta*/delta, is able to remove the effects of roughness and Reynolds number from the velocity profiles in outer variables, provided there is no freestream turbulence. However, each scaling for the velocity deficit profiles results in self-similar solutions for fixed experimental conditions. When examining the Reynolds stresses in the inner region, (i.e., 0 component shows the largest influence of roughness, where the high peak near the wall was decreased and became nearly flat for the fully rough regime profiles. In addition, the Reynolds stresses in outer variables show self-similarity for fixed experimental conditions. However, as the roughness parameter, k +, increases, all Reynolds stress profiles become similar in shape indicating increased isotropy near the wall. Furthermore, the boundary layer parameters and production terms also show a considerable increase due to roughness. This study of rough wall turbulence was also combined with high freestream turbulence. The freestream turbulence was generated with the use of an active grid, which resulted in freestream turbulence levels of 6.2% and 5.2% at the two downstream measuring locations. The effect of the freestream turbulence on this rough surface significantly alters the mean velocity deficit profiles. In inner variables, the velocity profiles show a significantly reduced wake region, while in outer variables, a more full profile indicates increased momentum transport towards the wall. Furthermore, the effects of freestream turbulence are clearly identifiable in the Reynolds stress profiles. Furthermore, pressure gradient flows are also difficult to generalize, given that a significant difference in the boundary layer structure exists between different external pressure gradients, (i.e., FPG, ZPG, and APG). This was examined through the scaling of the velocity and Reynolds stresses from multiple data sets. (Abstract shortened by UMI.)
Including Dynamical Core Excitation in Reaction Models
Summers, Neil; Nunes, Filomena; Thompson, Ian
Breakup reactions for exotic nuclei often require a full quantum mechanical description including couplings to all orders. One such reaction model is the continuum discretized coupled channels (CDCC) method. Structure models used in breakup reactions for one nucleon halo nuclei are assumed to consist of an inert core plus a valence nucleon. These simplified structure models neglect the spin of the core and any dynamical excitation of the core during the reaction process. Results of breakup experiments using these simple structure models can lead to inconsistencies in the information obtained from the breakup reaction. For example, the breakup of ^8B on ^58Ni at low energies was reproduced well within an inert core structure model, while the breakup on ^208Pb at higher energies required an enhanced E2 strength to fit the data. This suggests that dynamical core excitation may play a role in the breakup reaction. We will discuss results of previous breakup reactions and show how dynamical excitation can be included within the CDCC framework.
Aerosol simulation including chemical and nuclear reactions
International Nuclear Information System (INIS)
The numerical simulation of aerosol transport, including the effects of chemical and nuclear reactions, presents a challenging dynamic accounting problem. Particles of different sizes agglomerate and settle out due to various mechanisms, such as diffusion, diffusiophoresis, thermophoresis, gravitational settling, turbulent acceleration, and centrifugal acceleration. Particles also change size, due to the condensation and evaporation of materials on the particle. Heterogeneous chemical reactions occur at the interface between a particle and the suspending medium, or a surface and the gas in the aerosol. Homogeneous chemical reactions occur within the aerosol suspending medium, within a particle, and on a surface. These reactions may include a phase change. Nuclear reactions occur in all locations. These spontaneous transmutations from one elemental form to another occur at greatly varying rates and may result in phase or chemical changes which complicate the accounting process. This paper presents an approach for inclusion of these effects on the transport of aerosols. The accounting system is very complex and results in a large set of stiff ordinary differential equations (ODEs). The techniques for numerical solution of these ODEs require special attention to achieve their solution in an efficient and affordable manner
Conditioning in Probabilistic Programming
Gretz, Friedrich; Jansen, Nils; Kaminski, Benjamin Lucien; Katoen, Joost-Pieter; Mciver, Annabelle; Olmedo, Federico
We investigate the semantic intricacies of conditioning, a main feature in probabilistic programming. We provide a weakest (liberal) pre-condition (w(l)p) semantics for the elementary probabilistic programming language pGCL extended with conditioning. We prove that quantitative weakest (liberal) pre-conditions coincide with conditional (liberal) expected rewards in Markov chains and show that semantically conditioning is a truly conservative extension. We present two program...
Management of radioactive waste from reprocessing including disposal aspects
International Nuclear Information System (INIS)
Based on a hypothetical scenario including a reactor park of 20 GWe consisting of Pressurised-Water-Reactors with a resulting annual production of 600 tonnes of heavy metal of spent fuel, all aspects of management of resulting wastes are studied. Waste streams from reprocessing include gaseous and liquid effluents, and a number of solid conditioned waste types. Disposal of waste is supposed to be performed either in a near-surface engineered repository, as long as the content of alpha-emitting radionuclides is low enough, and in a deep geological granite formation. After having estimated quantities, cost and radiological consequences, the sensitivity of results to modification in reactor park size, burn-up and the introduction of mixed-oxide fuel (MOX) is evaluated
Kinetic gold leach monitoring including cyanide speciation
Scientific Electronic Library Online (English)
P.W., Lotz; S., Janse van Rensburg; A., Swarts.
Full Text Available Traditionally, bottle roll tests have been used to optimize the extraction process for best gold extraction and recovery. Such tests typically involve exposing the ore to defined reagent concentrations (lime, cyanide and sufficient oxygen) and balance the gold input with recoveries and losses. With [...] mounting pressures to accommodate sustainability issues during development work, it became apparent that much more information would be required on the interactions and kinetic behaviour of solid and solution species during the entire leach process. This information is vital to enable proactive management of critical issues such as cyanide, arsenic, water and tailings management. Inadequate management of these aspects has led to temporary closures and, in cases of noncompliance, to the dynamically changing regulations. MINTEK's advanced leach facility (ALF) is being developed with the aim of bridging the knowledge gap between the gold leach process and the predictable environmental impacts upon discharge. The facility aims to monitor all parameters of relevance such as pH, Eh, dissolved oxygen, metals, cyanide species, and viscosity during the entire process to enable more informed decisions on practical interventions. The presented set of data reflects first experiences gained from processing a refractory gold ore concentrate. Attempts at optimizing the process were limited due to the developmental nature of the work. Data relating to leaches with differing preoxidation conditions and cyanide staging is presented.
Generating Graphoids from Generalised Conditional Probability
Wilson, Nic
We take a general approach to uncertainty on product spaces, and give sufficient conditions for the independence structures of uncertainty measures to satisfy graphoid properties. Since these conditions are arguably more intuitive than some of the graphoid properties, they can be viewed as explanations why probability and certain other formalisms generate graphoids. The conditions include a sufficient condition for the Intersection property which can still apply even if ther...
LEECH INSIDE NASAL CAVITY A DIFFICULT FOREIGN BODY AN INTERESTING CASE REPORT AND REVIEW OF LITERATUREBalasubramanian Thiagarajan
Balasubramanian Thiagarajan; Sivakumar Ethirajan
This article describes a live leech inside the nasal cavity of a patient who presented with epistaxis. This case is reported in order to create awareness of this condition as well as to discuss the practical difficulties in removing these live foreign bodies from nasal cavities. A review of published material on this subject illustrated lack of scientific model pertaining to the best removal methodology to be followed. The methods described in literature bears testimony to the innovative skil...
Directory of Open Access Journals (Sweden)
Volkov V. S.
Full Text Available The variant of the decision of a task of management of a transport resource of buses is submitted on the basis of the current information on a condition of a route. The real speed of movement of transport, change of number of the passengers is taken into account. The considered task concerns to a class of extreme tasks on networks and is complicated by a set of restrictions
International Nuclear Information System (INIS)
We point out that the commonly assumed condition for galactic outflows, that supernovae (SNe) heating is efficient in the central regions of starburst galaxies, suffers from invalid assumptions. We show that a large filling factor of hot (?106 K) gas is difficult to achieve through SNe heating, irrespective of the SN's initial gas temperature and density, its uniformity, or its clumpiness. We instead suggest that correlated supernovae from OB associations in molecular clouds in the central region can drive powerful outflows if the molecular surface density is >103 M ? pc–2
An ITS-based phylogenetic framework for the genus Vorticella: finding the molecular and morphological gaps in a taxonomically difficult group.
Sun, Ping; Clamp, John C; Xu, Dapeng; Huang, Bangqin; Shin, Mann Kyoon; Turner, Franziska
Vorticella includes more than 100 currently recognized species and represents one of the most taxonomically challenging genera of ciliates. Molecular phylogenetic analysis of Vorticella has been performed so far with only sequences coding for small subunit ribosomal RNA (SSU rRNA); only a few of its species have been investigated using other genetic markers owing to a lack of similar sequences for comparison. Consequently, phylogenetic relationships within the genus remain unclear, and molecular discrimination between morphospecies is often difficult because most regions of the SSU rRNA gene are too highly conserved to be helpful. In this paper, we move molecular systematics for this group of ciliates to the infrageneric level by sequencing additional molecular markers-fast-evolving internal transcribed spacer (ITS) regions-in a broad sample of 66 individual samples of 28 morphospecies of Vorticella collected from Asia, North America and Europe. Our phylogenies all featured two strongly supported, highly divergent, paraphyletic clades (I, II) comprising the morphologically defined genus Vorticella. Three major lineages made up clade I, with a relatively well-resolved branching order in each one. The marked divergence of clade II from clade I confirms that the former should be recognized as a separate taxonomic unit as indicated by SSU rRNA phylogenies. We made the first attempt to elucidate relationships between species in clade II using both morphological and multi-gene approaches, and our data supported a close relationship between some morphospecies of Vorticella and Opisthonecta, indicating that relationships between species in the clade are far more complex than would be expected from their morphology. Different patterns of helix III of ITS2 secondary structure were clearly specific to clades and subclades of Vorticella and, therefore, may prove useful for resolving phylogenetic relationships in other groups of ciliates. PMID:24089331
Chlorhexidine gel and less difficult surgeries might reduce post-operative pain, controlling for dry socket, infection and analgesic consumption: a split-mouth controlled randomised clinical trial.
Haraji, A; Rakhshan, V
Reports on post-surgical pain are a few, controversial and flawed (by statistics and analgesic consumption). Besides, it is not known if chlorhexidine can reduce post-extraction pain adjusting for its effect on prevention of infection and dry socket (DS). We assessed these. A total of 90 impacted mandibular third molars of 45 patients were extracted. Intra-alveolar 0·2% chlorhexidine gel was applied in a split-mouth randomised design to one-half of the sockets. None of the included patients took antibiotics or analgesics afterwards. In the first and third post-operative days, DS formation and pain levels were recorded. Predictive roles of the risk factors were analysed using fixed-effects (classic) and multilevel (mixed-model) multiple linear regressions (? = 0·05, ??0·1). In the first day, pain levels were 5·56 ± 1·53 and 4·78 ± 1·43 (out of 10), respectively. These reduced to 3·22 ± 1·41 and 2·16 ± 1·40. Pain was more intense on the control sides [both P values = 0·000 (paired t-test)]. Chlorhexidine had a significant pain-alleviating effect (P = 0·0001), excluding its effect on DS and infection. More difficult surgeries (P = 0·0201) and dry sockets were more painful (P = 0·0000). Age had a marginally significant negative role (P = 0·0994). Gender and smoking had no significant impact [P ? 0·7 (regression)]. The pattern of pain reduction differed between dry sockets and healthy sockets [P = 0·0102 (anova)]. Chlorhexidine can reduce pain, regardless of its infection-/DS-preventive effects. Simpler surgeries and sockets not affected by alveolar osteitis are less painful. Smoking and gender less likely affect pain. The role of age was not conclusive and needs future studies. PMID:25251411
Directory of Open Access Journals (Sweden)
Halit Hami OZ
Full Text Available Sector Skills are defined by state-sponsored, employer-led organizations that cover specific economic sectors in the European Union and other countries in the world to reduce skills gaps and shortages, improve productivity, boost the skills of their sector workforces and improve learning supply. The accreditation and registration systems used by professional bodies raise the profile of the profession. In many countries including the European Union, professional associations are beginning to accept practice-based accreditation, generally as an alternative to their mainstream systems. Besides studying the certain agencies in the European Union for assessing/accreditating practical abilities , Accreditation for practical abilities of Information Communication Technology and Business Management/Language domains developed by Accreditation Council for Practical abilities are also studied in detail as an example to establish a similar agency in Turkey.
CLIC expands to include the Southern Hemisphere
Roberto Cantoni
Australia has recently joined the CLIC collaboration: the enlargement will bring new expertise and resources to the project, and is especially welcome in the wake of CERN budget redistributions following the recent adoption of the Medium Term Plan. The countries involved in CLIC collaboration With the signing of a Memorandum of Understanding on 26 August 2010, the ACAS network (Australian Collaboration for Accelerator Science) became the 40th member of in the multilateral CLIC collaboration making Australia the 22nd country to join the collaboration. "The new MoU was signed by the ACAS network, which includes the Australian Synchrotron and the University of Melbourne", explains Jean-Pierre Delahaye, CLIC Study Leader. "Thanks to their expertise, the Australian institutes will contribute greatly to the CLIC damping rings and the two-beam test modules." Institutes from any country wishing to join the CLIC collaboration are invited to assume responsibility o...
Models of bovine babesiosis including juvenile cattle.
Saad-Roy, C M; Shuai, Zhisheng; van den Driessche, P
Bovine Babesiosis in cattle is caused by the transmission of protozoa of Babesia spp. by ticks as vectors. Juvenile cattle ([Formula: see text]9 months of age) have resistance to Bovine Babesiosis, rarely show symptoms, and acquire immunity upon recovery. Susceptibility to the disease varies between breeds of cattle. Models of the dynamics of Bovine Babesiosis transmitted by the cattle tick that include these factors are formulated as systems of ordinary differential equations. Basic reproduction numbers are calculated, and it is proved that if these numbers are below the threshold value of one, then Bovine Babesiosis dies out. However, above the threshold number of one, the disease may approach an endemic state. In this case, control measures are suggested by determining target reproduction numbers. The percentage of a particular population (for example, the adult bovine population) needed to be controlled to eradicate the disease is evaluated numerically using Columbia data from the literature. PMID:25715822
Grand unified models including extra Z bosons
International Nuclear Information System (INIS)
The grand unified theories (GUT) of the simple Lie groups including extra Z bosons are discussed. Under authors's hypothesis there are only SU5+m SO6+4n and E6 groups. The general discussion of SU5+m is given, then the SU6 and SU7 are considered. In SU6 the 15+6*+6* fermion representations are used, which are not same as others in fermion content, Yukawa coupling and broken scales. A conception of clans of particles, which are not families, is suggested. These clans consist of extra Z bosons and the corresponding fermions of the scale. The all of fermions in the clans are down quarks except for the standard model which consists of Z bosons and 15 fermions, therefore, the spectrum of the hadrons which are composed of these down quarks are different from hadrons at present
AMS at the ANU including biomedical applications
Energy Technology Data Exchange (ETDEWEB)
Fifield, L.K.; Allan, G.L.; Cresswell, R.G.; Ophel, T.R. [Australian National Univ., Canberra, ACT (Australia); King, S.J.; Day, J.P. [Manchester Univ. (United Kingdom). Dept. of Chemistry
An extensive accelerator mass spectrometry program has been conducted on the 14UD accelerator at the Australian National University since 1986. In the two years since the previous conference, the research program has expanded significantly to include biomedical applications of {sup 26}Al and studies of landform evolution using isotopes produced in situ in surface rocks by cosmic ray bombardment. The system is now used for the measurement of {sup 10}Be, {sup 14}C, {sup 26}Al, {sup 36}Cl, {sup 59}Ni and {sup 129}I, and research is being undertaken in hydrology, environmental geochemistry, archaeology and biomedicine. On the technical side, a new test system has permitted the successful off-line development of a high-intensity ion source. A new injection line to the 14UD has been established and the new source is now in position and providing beams to the accelerator. 4 refs.
Simple stellar population models including blue stragglers
Xin, Yu; de Grijs, Richard; Kroupa, Pavel
Observations show that nearly all star clusters and stellar populations contain blue straggler stars (BSs). BSs in a cluster can significantly enhance the integrated spectrum of the host population, preferentially at short wavelengths, and render it much bluer in photometric colours. Current theoretical simple stellar population (SSP) models constructed within the traditional framework of single and binary stellar evolution cannot fully account for the impact of these objects on the integrated spectral properties of stellar populations. Using conventional SSP models without taking into account BS contributions may significantly underestimate a cluster's age and/or metallicity, simply because one has to balance the observed bluer colours (or a bluer spectrum) with a younger age and/or a lower metallicity. Therefore, inclusion of BS contributions in SSP models is an important and necessary improvement for population synthesis and its applications. Here, we present a new set of SSP models, which include BS contr...
Critical point anomalies include expansion shock waves
International Nuclear Information System (INIS)
From first-principle fluid dynamics, complemented by a rigorous state equation accounting for critical anomalies, we discovered that expansion shock waves may occur in the vicinity of the liquid-vapor critical point in the two-phase region. Due to universality of near-critical thermodynamics, the result is valid for any common pure fluid in which molecular interactions are only short-range, namely, for so-called 3-dimensional Ising-like systems, and under the assumption of thermodynamic equilibrium. In addition to rarefaction shock waves, diverse non-classical effects are admissible, including composite compressive shock-fan-shock waves, due to the change of sign of the fundamental derivative of gasdynamics
AMS at the ANU including biomedical applications
International Nuclear Information System (INIS)
An extensive accelerator mass spectrometry program has been conducted on the 14UD accelerator at the Australian National University since 1986. In the two years since the previous conference, the research program has expanded significantly to include biomedical applications of 26Al and studies of landform evolution using isotopes produced in situ in surface rocks by cosmic ray bombardment. The system is now used for the measurement of 10Be, 14C, 26Al, 36Cl, 59Ni and 129I, and research is being undertaken in hydrology, environmental geochemistry, archaeology and biomedicine. On the technical side, a new test system has permitted the successful off-line development of a high-intensity ion source. A new injection line to the 14UD has been established and the new source is now in position and providing beams to the accelerator. 4 refs
CERN Technical Training: LABVIEW courses include RADE
HR Department
The contents of the "LabView Basic I" and "LabView Intermediate II" courses have recently been changed to include, respectively, an introduction to and expert training in the Rapid Application Development Environment (RADE). RADE is a LabView-based application developed at CERN to integrate LabView in the accelerator and experiment control infrastructure. It is a suitable solution to developing expert tools, machine development analysis and independent test facilities. The course names have also been changed to "LabVIEW Basics I with RADE Introduction" and "LabVIEW Intermediate II with Advanced RADE Application". " LabVIEW Basics I with RADE Introduction" is designed for: Users preparing to develop applications using LabVIEW, or NI Developer Suite; users and technical managers evaluating LabVIEW or NI Developer Suite in purchasing decisions; users pursuing the Certified LabVIEW Developer certification. The course pr...
CERN Technical Training: LABVIEW courses include RADE
HR Department
The contents of the "LabView Basic I" and "LabView Intermediate II" courses have recently been changed to include, respectively, an introduction to and expert training in the Rapid Application Development Environment (RADE). RADE is a LabView-based application developed at CERN to integrate LabView in the accelerator and experiment control infrastructure. It is a suitable solution to developing expert tools, machine development analysis and independent test facilities. The course names have also been changed to "LabVIEW Basics I with RADE Introduction" and "LabVIEW Intermediate II with Advanced RADE Application". " LabVIEW Basics I with RADE Introduction" is designed for: Users preparing to develop applications using LabVIEW, or NI Developer Suite; users and technical managers evaluating LabVIEW or NI Developer Suite in purchasing decisions; users pursuing the Certified LabVIEW Developer certification. The course prepares participants to develop test and measurement, da...
CERN Technical Training: LABVIEW courses include RADE
HR Department
The contents of "LabView Basic I" and "LabView Intermediate II" trainings have been recently changed to include, respectively, an introduction and an expert training on the Rapid Application Development Environment (RADE). RADE is a LabView-based application developed at CERN to integrate LabView in the accelerator and experiment control infrastructure. It is a suitable solution to develop expert tools, machine development analysis and independent test facilities. The course names have also been changed to "LabVIEW Basics I with RADE Introduction" and "LabVIEW Intermediate II with Advanced RADE Application". " LabVIEW Basics I with RADE Introduction" is designed for: Users preparing to develop applications using LabVIEW, or NI Developer Suite; users and technical managers evaluating LabVIEW or NI Developer Suite in purchasing decisions; users pursuing the Certified LabVIEW Developer certification. The course prepare...
Four phase logic systems. [including integrated microcircuits
Petersen, H. L.; Kinell, D. K. (inventors)
A four-phase logic system is provided which includes at least four logic networks connected in parallel between a single power line and a reference potential. A four-phase clock generator generates four distinct clock signals from a single-phase clock input at data rate. Each logic network comprises a pair of complementary metal-oxide-semiconductor integrated transistors (CMOST). Each metal-oxide-Semiconductor transistor (MOST) in the pair is responsive to a clock signal which turns the transistor on or off. In each network, there is also at least one MOST which is responsive to a logic signal. The logic transistor is connected in cascade with the pair of CMOSTs.
Complex shell model representation including antibound states
International Nuclear Information System (INIS)
A generalization of the complex shell model formalism is presented that includes antibound states in the basis. These states, together with bound states, Gamow states, and the continuum background, represented by properly chosen scattering waves, form a representation in which all states are treated on the same footing. Two-particle states are evaluated within this formalism, and observable two-particle resonances are defined. The formalism is illustrated in the well-known case of 11Li in its bound ground state and in 70Ca(g.s.), which is also bound. Both cases are found to have a halo structure. These halo structures are described within the generalized complex shell model. We investigated the formation of two-particle resonances in these nuclei, but no evidence of such resonances was found
Gibbs conditioning extended, Boltzmann conditioning introduced
Grendar, M
Extensions of Conditioned Weak Law of Large Numbers and Gibbs Conditioning Principle - two probabilistic results which provide a justification of the Relative Entropy Maximization (REM/MaxEnt) method - to the case of multiple REM distributions are proposed. Also, their mu-projection (Maximum Probability) alternatives are introduced.
SWIVIT - Swiss video-intubation trial evaluating video-laryngoscopes in a simulated difficult airway scenario: study protocol for a multicenter prospective randomized controlled trial in Switzerland
Background Video-laryngoscopes are marketed for intubation in difficult airway management. They provide a better view of the larynx and may facilitate tracheal intubation, but there is no adequately powered study comparing different types of video-laryngoscopes in a difficult airway scenario or in a simulated difficult airway situation. Methods/Design The objective of this trial is to evaluate and to compare the clinical performance of three video-laryngoscopes with a guiding channel for intubation (Airtraq™, A. P. Advance™, King Vision™) and three video-laryngoscopes without an integrated tracheal tube guidance (C-MAC™, GlideScope™, McGrath™) in a simulated difficult airway situation in surgical patients. The working hypothesis is that each video-laryngoscope provides at least a 90% first intubation success rate (lower limit of the 95% confidence interval >0.9). It is a prospective, patient-blinded, multicenter, randomized controlled trial in 720 patients who are scheduled for elective surgery under general anesthesia, requiring tracheal intubation at one of the three participating hospitals. A difficult airway will be created using an extrication collar and taping the patients' head on the operating table to substantially reduce mouth opening and to minimize neck movement. Tracheal intubation will be performed with the help of one of the six devices according to randomization. Insertion success, time necessary for intubation, Cormack-Lehane grade and percentage of glottic opening (POGO) score at laryngoscopy, optimization maneuvers required to aid tracheal intubation, adverse events and technical problems will be recorded. Primary outcome is intubation success at first attempt. Discussion We will simulate the difficult airway and evaluate different video-laryngoscopes in this highly realistic and clinically challenging scenario, independently from manufacturers of the devices. Because of the sufficiently powered multicenter design this study will deliver important and cutting-edge results that will help clinicians decide which device to use for intubation of the expected and unexpected difficult airway. Trial registration NCT01692535 PMID:23556410
Meta-analyses including data from observational studies.
O'Connor, Annette M; Sargeant, Jan M
Observational studies represent a wide group of studies where the disease or condition of interest is naturally occurring and the investigator does not control allocation to interventions or exposures. Observational studies are used to test hypotheses about the efficacy of interventions or about exposure-disease relationships, to estimate incidence or prevalence of conditions, and to assess the sensitivity and specificity of diagnostic assays. Experimental-study designs and randomized controlled trials (RCTs) can also contribute to the body of evidence about such questions. Meta-analyses (either with or without systematic reviews) aim to combine information from primary research studies to better describe the entire body of work. The aim of meta-analyses may be to obtain a summary effect size, or to understand factors that affect effect sizes. In this paper, we discuss the role of observational studies in meta-analysis questions and some factors to consider when deciding whether a meta-analysis should include results from such studies. Our suggestion is that one should only include studies that are not at high risk of inherent bias when calculating a summary effect size. Study design however can be a meaningful variable in assessment of outcome heterogeneity. PMID:24268538
Traffic Sign Recognition System for Roadside Images in Poor Condition
Directory of Open Access Journals (Sweden)
Thongchai Surinwarangkoon
Full Text Available Traffic sign detection and recognition is a difficult task, especially if we aim at detecting and recognizing signs in images captured under poor conditions. Complex backgrounds, obstructing objects, inappropriate distance of signs, shadow, and other lighting-related problems may make it difficult to detect and recognize signs in both rural and urban areas. In this paper we propose and test a system that employs image pre-processing, color filtering, color segmentation for traffic sign detection at the detection stage, feature extraction and trained neural networks for unique identification of signs at the recognition stage. The traffic sign detection and recognition system has been tested on actual roadside images taken under poor conditions. The images were selected in order to test the efficiency of the system under challenging conditions of inappropriate distance, traffic sign size, poor lighting and complex background. Suggestions are made for improving the performance of the system.
Seepage Model for PA Including Drift Collapse
International Nuclear Information System (INIS)
The purpose of this Analysis/Model Report (AMR) is to document the predictions and analysis performed using the Seepage Model for Performance Assessment (PA) and the Disturbed Drift Seepage Submodel for both the Topopah Spring middle nonlithophysal and lower lithophysal lithostratigraphic units at Yucca Mountain. These results will be used by PA to develop the probability distribution of water seepage into waste-emplacement drifts at Yucca Mountain, Nevada, as part of the evaluation of the long term performance of the potential repository. This AMR is in accordance with the ''Technical Work Plan for Unsaturated Zone (UZ) Flow and Transport Process Model Report'' (CRWMS M andO 2000 [153447]). This purpose is accomplished by performing numerical simulations with stochastic representations of hydrological properties, using the Seepage Model for PA, and evaluating the effects of an alternative drift geometry representing a partially collapsed drift using the Disturbed Drift Seepage Submodel. Seepage of water into waste-emplacement drifts is considered one of the principal factors having the greatest impact of long-term safety of the repository system (CRWMS M andO 2000 [153225], Table 4-1). This AMR supports the analysis and simulation that are used by PA to develop the probability distribution of water seepage into drift, and is therefore a model of primary (Level 1) importance (AP-3.15Q, ''Managing Technical Product Inputs''). The intended purpose of the Seepage Model for PA is to support: (1) PA; (2) Abstraction of Drift-Scale Seepage; and (3) Unsaturated Zone (UZ) Flow and Transport Process Model Report (PMR). Seepage into drifts is evaluated by applying numerical models with stochastic representations of hydrological properties and performing flow simulations with multiple realizations of the permeability field around the drift. The Seepage Model for PA uses the distribution of permeabilities derived from air injection testing in niches and in the cross drift to stochastically simulate the 3D flow of water in the fractured host rock (in the vicinity of potential emplacement drifts) under ambient conditions. The Disturbed Drift Seepage Submodel evaluates the impact of the partial collapse of a drift on seepage. Drainage in rock below the emplacement drift is also evaluated
Ruszczynski, Andrzej; Shapiro, Alexander
We introduce an axiomatic definition of a conditional convex risk mapping and we derive its properties. In particular, we prove a representation theorem for conditional risk mappings in terms of conditional expectations. We also develop dynamic programming relations for multistage optimization problems involving conditional risk mappings.
Corneal topography : Photokeratoscopy including the central region
DEFF Research Database (Denmark)
Andersen, J.; Koch-Jensen, P.
The central corneal zone is depicted on keratoscope photographs using a small target aperture and a large object distance. Information on the peripheral area is included by employing a hemispherical target with a dense circular and radial pattern. On a 16 mm (R = 8 mm) reference steel sphere the diameter of the innermost reflected mire is 0.20 mm and the distance between mires 0.13 mm. The standard deviation on focusing precision, determined to 0.20 mm employing a fixed object, corresponds to an error of 0.06% in linear measurements on keratographs. The variation in object distance due to the curved image plane is at most 0.55 mm within 60 deg from the optical axis of the system for the reference sphere. Nevertheless, all reflected mires are distinctly reproduced on the keratoscope photograph. For a test object the slopes of light intensity curves on the passage between black and white areas are reduced by only 1.0% with a variation in object distance of 0.55 mm around focus.
Semiclassical energy conditions
Martin-Moruno, Prado
We present and develop several nonlinear energy conditions suitable for use in the semiclassical regime. In particular, we consider the recently formulated "flux energy condition" (FEC), and the novel "trace-of-square" (TOSEC) and "determinant" (DETEC) energy conditions. As we shall show, these nonlinear energy conditions behave much better than the classical linear energy conditions in the presence of semiclassical quantum effects. Moreover, whereas the quantum extensions of these nonlinear energy conditions seem to be quite widely satisfied as one enters the quantum realm, analogous quantum extensions are generally not useful for the linear classical energy conditions.
LEECH INSIDE NASAL CAVITY A DIFFICULT FOREIGN BODY AN INTERESTING CASE REPORT AND REVIEW OF LITERATUREBalasubramanian Thiagarajan
Directory of Open Access Journals (Sweden)
Balasubramanian Thiagarajan
Full Text Available This article describes a live leech inside the nasal cavity of a patient who presented with epistaxis. This case is reported in order to create awareness of this condition as well as to discuss the practical difficulties in removing these live foreign bodies from nasal cavities. A review of published material on this subject illustrated lack of scientific model pertaining to the best removal methodology to be followed. The methods described in literature bears testimony to the innovative skills of the surgeon rather than evidence based practice. It should also be stressed that ill advised removal methods could prove counterproductive.
La enuresis nocturna: Un trastorno frecuente con una prevalencia difícil de estimar / Nocturnal enuresis: A frequent problem with a difficult estimation of its prevalence
Scientific Electronic Library Online (English)
M., Ramírez-Backhaus; S., Arlandis Guzmán; G., García Fadrique; , Martínez Agulló; R., Martínez García; J.F., Jiménez-Cruz.
Full Text Available Introducción: La enuresis nocturna es un trastorno con un interés histórico mantenido, no solo en cuanto a su patogenia, probablemente multifactorial pero todavía hoy desconocida, sino también en cuanto a su frecuencia. Objetivo: Nos planteamos revisar la literatura médica al respecto para conocer l [...] a problemática en el cálculo de su casuística. Material y método: Realizamos una búsqueda en la base de datos PubMed, mediante los términos Mesh «enuresis», «nocturnal enuresis» y «bedwetting», e incluimos en el cuadro de búsqueda los términos «epidemiology OR prevalence». Incluimos todos los trabajos en lengua inglesa o espańola. Seleccionamos los trabajos con una muestra mayor de 1.000 pacientes, e incluimos estos y los artículos de revisión. Procedemos al análisis de la metodología empleada por los grupos más relevantes, así como los resultados globales de frecuencia; además, cuando es posible, estratificamos los resultados por edad, sexo y frecuencia de los escapes. Resultados: La metodología de los trabajos analizados es heterogénea y las comparaciones se hacen, por tanto, difíciles. La prevalencia global es difícil de estimar y dar resultados globales carece de interés pues para interpretarlos es necesario pormenorizar la metodología, la muestra y los criterios diagnósticos. Conclusiones: Se hace necesario un estudio epidemiológico propio que resuelva nuestra problemática. Abstract in english Introduction: Nocturnal enuresis is a disorder with a maintained historical interest. Not only the multifactorial etiopathology, also its prevalence. Objective: We consider reviewing the literature for knowing the problematic in the calculation of the prevalence of this disease. Material and method: [...] We searched in Pubmed database with Mesh terms: "Enuresis", "Nocturnal Enuresis", we added in the search box terms bedwetting and epidemiology or prevalence. We included manuscripts in English and Spanish with more than 1000 patients as sample, we also included review papers. We analyzed the methodology and the prevalence, when it was possible, we stratified results in age, sex and the frequency of wet nights. Results: The analyzed study's methodology is heterogeneous. Therefore comparisons are difficult. Due to the difficulty within the interpretation of the overall frequency, the results are not interesting unless methodology, age range of the sample and diagnosis criteria are previously detailed. Conclusions: An own epidemiology study is necessary in order to solve our problematic.
Rayfiles including spectral and colorimetric information.
Jacobs, Valéry Ann; Audenaert, Jan; Bleumers, Johan; Durinck, Guy; Rombauts, Patrick; Hanselaer, Peter
To obtain realistic results in lighting simulation software, realistic models of light sources are needed. A near-field model of a light source is accurate, and can be obtained by a near-field goniophotometer. This type of goniophotometer is conventionally equipped with a V(?)-filter. However, the advent of new light sources with spatial- or angular color variations necessitates the inclusion of spectral information about the source. We demonstrate a method to include spectral information of a light source in ray tracing. We measured the relative angular variation of the spectrum of an OLED using a spectroradiometer mounted on a near-field goniophotometer. Principal component analysis (PCA) is exploited to reduce the amount of data that needs to be stored. Also a photometric ray file of the OLED was obtained. To construct a set of monochromatic ray files, the luminous flux in the original ray file is redistributed over a set of wavelengths and stored in separate ray files. The redistribution depends on the angle of emission and the spectral irradiance measured in that direction. These ray files are then inserted in ray tracing software TracePro. Using the OLED as a test source, the absolute spectral irradiance is calculated at an arbitrary position. The result is validated using a spectroradiometer to obtain the absolute spectral irradiance at that particular point. A good agreement between the simulated and measured absolute spectral irradiance is found. Furthermore, a set of tristimulus ray files is constructed and used in ray tracing software to generate a u'v'-color coordinate distribution on a surface. These values are in agreement with the color coordinate distribution found using the spectral ray files. Whenever spectral or color information is desired at a task area, the proposed method allows for a fast and efficient way to improve the accuracy of simulations using ray tracing. PMID:25968801
International Nuclear Information System (INIS)
The purpose of this report is to document the predictions and analyses performed using the seepage model for performance assessment (SMPA) for both the Topopah Spring middle nonlithophysal (Tptpmn) and lower lithophysal (Tptpll) lithostratigraphic units at Yucca Mountain, Nevada. Look-up tables of seepage flow rates into a drift (and their uncertainty) are generated by performing numerical simulations with the seepage model for many combinations of the three most important seepage-relevant parameters: the fracture permeability, the capillary-strength parameter 1/a, and the percolation flux. The percolation flux values chosen take into account flow focusing effects, which are evaluated based on a flow-focusing model. Moreover, multiple realizations of the underlying stochastic permeability field are conducted. Selected sensitivity studies are performed, including the effects of an alternative drift geometry representing a partially collapsed drift from an independent drift-degradation analysis (BSC 2004 [DIRS 166107]). The intended purpose of the seepage model is to provide results of drift-scale seepage rates under a series of parameters and scenarios in support of the Total System Performance Assessment for License Application (TSPA-LA). The SMPA is intended for the evaluation of drift-scale seepage rates under the full range of parameter values for three parameters found to be key (fracture permeability, the van Genuchten 1/a parameter, and percolation flux) and drift degradation shape scenarios in support of the TSPA-LA during the period of compliance for postclosure performance [Technical Work Plan for: Performance Assessment Unsaturated Zone (BSC 2002 [DIRS 160819], Section I-4-2-1)]. The flow-focusing model in the Topopah Spring welded (TSw) unit is intended to provide an estimate of flow focusing factors (FFFs) that (1) bridge the gap between the mountain-scale and drift-scale models, and (2) account for variability in local percolation flux due to stochastic hydrologic properties and flow processes
An outgoing energy flux boundary condition for finite difference ICRP antenna models
International Nuclear Information System (INIS)
For antennas at the ion cyclotron range of frequencies (ICRF) modeling in vacuum can now be carried out to a high level of detail such that shaping of the current straps, isolating septa, and discrete Faraday shield structures can be included. An efficient approach would be to solve for the fields in the vacuum region near the antenna in three dimensions by finite methods and to match this solution at the plasma-vacuum interface to a solution obtained in the plasma region in one dimension by Fourier methods. This approach has been difficult to carry out because boundary conditions must be imposed at the edge of the finite difference grid on a point-by-point basis, whereas the condition for outgoing energy flux into the plasma is known only in terms of the Fourier transform of the plasma fields. A technique is presented by which a boundary condition can be imposed on the computational grid of a three-dimensional finite difference, or finite element, code by constraining the discrete Fourier transform of the fields at the boundary points to satisfy an outgoing energy flux condition appropriate for the plasma. The boundary condition at a specific grid point appears as a coupling to other grid points on the boundary, with weighting determined by a kemel calctdated from the plasma surface impedance matrix for the various plasma Fourier modes. This boundary condition has been implemented in a finite difference solution of a simple problem in two dimensions, which can also be solved directly by Fourier transformation. Results are presented, and it is shown that the proposed boundary condition does enforce outgoing energy flux and yields the same solution as is obtained by Fourier methods
[Adult-onset Stills disease - a difficult path to diagnosis through fever and effusions of unknown origin].
Malegová, Jana; Koten, Lukáš; Horák, Pavel
Fever of unknown origin, pleural and pericardial effusions can be caused by a variety of independent agents. On the other hand, we can identify a common causative condition in other cases. Infectious diseases, malignancies and autoimmune diseases are the most common etiological factors. Considering the pleural and pericardial effusion, we also have to think of cardiovascular and pulmonary diseases. The basis of every diagnostic process is thorough medical history and detailed clinical examination followed by laboratory and imaging methods. In spite of that, the right diagnosis sometimes stays long time hidden. One of such conditions is Adult-onset Stills disease (AOSD). It is a rare inflammatory, potentially life-threatening disease with unclear pathogenesis and heterogeneous symptoms. It has some features similar to systemic form of juvenile idiopathic arthritis. Diagnosis is established so called per exclusionem by fulfilling a set of clinical criteria and ruling out other diseases with similar symptomatology. In our article, we present an example of such an arduous diagnostic journey to final diagnosis. PMID:24974758
Ocean storage, including costs and risks
International Nuclear Information System (INIS)
The long-term effectiveness of ocean storage will have to be based on theoretical understanding and models as there is no way to perform experiments on the required time and space scales for outgassing estimation. Based on observations of tracer behavior, the ventilation time of deep water has been revealed. Calibrated and constrained by these results, most of the OGCMs tell us that CO2 injected into the thermohaline circulation would not come back to the atmosphere in more than several hundred years. There are two types of concepts of ocean storage: one is a lake type concept to keep the CO2 at the ocean floor or a depression site as long as possible, and the other is to inject CO2 into the deep waters so that it is dispersed as quickly as possible. The technological concepts so far for implementation with minimum environmental impacts are much elaborated based on laboratory and computer experiments incorporating the key understanding of the CO2 clathrate properties attained in this decade. The frequently addressed concern of this technology includes the ecological modification of the ocean system. But even in the business-as-usual release of CO2 into the atmosphere, some modification might be foreseen in the deep ocean environment and could be inevitable not caused by the climate change but by the direct influence of the increase in the CO2 concentration in deep waters in future. We cannot stop the CO2 invasion into the deep ocean due to the existing of the excess C ocean due to the existing of the excess CO2 in the atmosphere. Whichever release method is used, carbon dioxide we are releasing to the atmosphere now will find its way into the deep oceans. Hence, the right scientific question is whether there exist additional risks to the deep sea environment associated with this technology. If we accept the target of a stabilization level of the atmospheric concentration of CO2, our generation's commitment to the CO2 futures anyway extends to the modification of the deep sea environment induced by the increase in atmospheric CO2 concentration level. The environmental impact of the injected CO2 in near field is manageable, in principle. The field experiment will offer the opportunity to increase and validate our ability to the environmental impact assessment of this technology
Compact Radar Transceiver with Included Calibration
McLinden, Matthew; Rincon, Rafael
The Digital Beamforming Synthetic Aperture Radar (DBSAR) is an eight-channel phased array radar system that employs solid-state radar transceivers, a microstrip patch antenna, and a reconfigurable waveform generator and processor unit. The original DBSAR transceiver design utilizes connectorized electronic components that tend to be physically large and heavy. To achieve increased functionality in a smaller volume, PCB (printed circuit board) transceivers were designed to replace the large connectorized transceivers. One of the most challenging problems designing the transceivers in a PCB format was achieving proper performance in the calibration path. For a radar loop-back calibration path, a portion of the transmit signal is coupled out of the antenna feed and fed back into the receiver. This is achieved using passive components for stability and repeatability. Some signal also leaks through the receive path. As these two signal paths are correlated via an unpredictable phase, the leakage through the receive path during transmit must be 30 dB below the calibration path. For DBSAR s design, this requirement called for a 100-dB isolation in the receiver path during transmit. A total of 16 solid-state L-band transceivers on a PCB format were designed. The transceivers include frequency conversion stages, T/R switching, and a calibration path capable of measuring the transmit power-receiver gain product during transmit for pulse-by-pulse calibration or matched filtering. In particular, this calibration path achieves 100-dB isolation between the transmitted signal and the low-noise amplifier through the use of a switching network and a section of physical walls achieving attenuation of radiated leakage. The transceivers were designed in microstrip PCBs with lumped elements and individually packaged components for compactness. Each transceiver was designed on a single PCB with a custom enclosure providing interior walls and compartments to isolate transceiver subsystems from radiated interference. The enclosure also acts as a heat sink for the voltage regulators and power amplifiers inside the system. The PCB transceiver design produces transmit pulses of 2 W with an arbitrary duty cycle. Each transceiver is fed by an external 120-MHz signal transmit and two 1,140-MHz local oscillator signals. The received signal is amplified and down-converted to 120 MHz and is fed to the data processor. The transceiver dimensions are approximately 3.5 11.5 0.6 in. (9 29 1.5 cm). The PCB transceiver design reduces the volume and weight of the DBSAR instrument while maintaining the functionality found in the original design. Both volume and weight are critical for airborne and flight remote sensing instrumentation.
Input parameters and scenarios, including economic inputs
DEFF Research Database (Denmark)
Boklund, Anette; Hisham Beshara Halasa, Tariq
Geographical locations of the farms are the core in these models. We used geographical data, number of animals and specification of herd types for the 50,853 herds in the Danish Husbandry Register (CHR) in 2007. For each herd, the daily probability of moving animals, to another herd or to the abattoir, was calculated as the sum of all registered movements off the herd in the period from October 1, 2006 to September 30, 2007 divided by 365. Swine movements originated from the Movement database for swine and cattle and sheep movements from the Danish Cattle database. From an infected herd, disease was simulated to spread via direct contacts (movements of animals), indirect contacts (trucks and persons) and local spread (mice, birds, airborne spread in limited distances). Furthermore, in some scenarios airborne spread was included. For all contact types, when a contact was simulated to take place, a receiving herd needed to be found. The distance, in which the receiving herd should be found, was calculated from movement data for animals and from data from trucks and abattoirs for movements to slaughter and milk tankers. For persons visiting herds, we used a combination of expert opinions, data from other countries and survey data. Local spread was simulated within a distance of three kilometers around infected herds, with a decreasing probability of spread with increasing distance. All epidemics were simulated to be detected on day 21. When an epidemic was detected, a three day national stand still was initiated. Furthermore, infected herds were depopulated and a 3 km detection zone and a 10 km surveillance zone were implemented around all infected herds. Within the protections zones, all herds were simulated to be clinically surveyed twice, first within 7 days after implementing the zone, and second 21 days later. Sheep within the zone were simulated to be tested. Within the surveillance zone, all herds were simulated to be clinically surveyed within 7 days, and sheep within the zone were simulated to be testedwithin 7 days and again before lifting the zone. Herds, which had received animals from an infected herd, were simulated to be traced and depopulated. Herds delivering animals to an infected herd were simulated to be traced and surveyed. In the alternative scenarios, extra control measures were added to the basic measures. Extra measures were depopulation or vaccination in ringzones of varying radii around infected herds. In alternative scenarios, we tested the effect of depopulating in zones of 500, 1000 and 1500 meters from infected herds. Depopulation was started on day 14 after detection of the first herd, or after detecting 10, 20, 30 or 50 infected herds. In some scenarios, we excluded hobby-type farms1 In the vaccination scenarios, herds within the vaccination zone were simulated to be vaccinated 14 days after detection of the first herd or when 10, 20, 30 or 50 herds were infected. All herds within the zones were simulated to be vaccinated. We used vaccination zones of either a 1, 2, 3 or 5 km. In some scenarios, hobby herds were not vaccinated. In one scenario, no sheep were vaccinated, and in another scenario no swine were vaccinated. from depopulation in zones. The resources for depopulation were estimated to 4,800 swine and 2,000 ruminants a day. Resources for depopulation in zones was shared with depopulation of infected and depopulation of traced herds, however zone depopulation would be number three on the resource list. All herds depopulated in zones would be tested before slaughter. The probability of detection was assumed to be 50% from day 0 to day 8 after the herd was infected, and increased to 1 after day 8. The outputs from the epidemiological models were used as inputs in an economic model to calculate costs and losses for each epidemic. The costs of an epidemic were divided into direct and indirect costs. The direct costs consisted of surveillance, depopulation, cleaning and disinfection, empty stable, compensation, national standstill, and vaccination costs. The indirect costs included losses
The Controversy Of Homosexuality: A critical look at the issues that make legalizing homosexuality in Malawi difficult
Malamba, Manuel
Homosexuality still remains to be one of the most controversial issues in the world today. The United Nations and other human rights bodies have postulated that all laws that discriminate against people on the basis of their sexual orientation violate human rights. However, despite this, many countries around the world including Malawi still maintain laws that object to same-sex relationships. In Malawi the issue of homosexuality was not in the public domain until recently after the arrest of...
Fundamentals for remote condition monitoring of offshore wind turbines
DEFF Research Database (Denmark)
McGugan, Malcolm; Larsen, Gunner Chr.
In the future, large wind turbines will be placed offshore in considerable numbers. Since access will be difficult and costly, it is preferable to use monitoring systems to reduce the reliance on manual inspection. The motivation for the effort reported here is to create the fundamental basis necessary for the use of sensors as a structural health monitoring system for wind turbine blades. This includes creating knowledge that will allow sensor signals to be used for remotely identifying the presence and position of any damage, the damage type and severity, and a structural condition assessment of the wind turbine blades that can integrate with existing SCADA tools to improve management of large offshore wind farms, and optimise the manual inspection/maintenance effort. Various sensor types, which have previously been identified as technically (and economically) capable of detecting the early development of significant damage in fibre reinforced composite, are investigated. In each case specific approaches have been proposed, developed and implemented in models or laboratory test specimens. The sensor approaches are based on acoustic emission (various passive and active applications including mobile sensors), fibre optics (including a new microbend transducer design and various Bragg-grating based applications), wireless approaches involving both battery and energy harvesting options, and inertia sensor based system identification approaches able to deal with linear periodic systems. In addition to the sensor investigations, a life-estimate approach for the wind turbines is described based on identifying and characterising critical material failure modes then integrating detailed models of damage progression rates into full scale models of the blade structure under operating loading regimes. The application of sensors is addressed during a full-scale blade test and recommendations are made regarding improvement to the commercial blade certification process of test and inspection, sensor use for monitoring in-service structural response, and the need for dedicated research facilities providing multi-scale and multifunctional testing of structures.
The Role of Contingency Awareness in Single-Cue Human Eyeblink Conditioning
Weidemann, Gabrielle; Best, Erin; Lee, Jessica C; Lovibond, Peter F.
Single-cue delay eyeblink conditioning is presented as a prototypical example of automatic, nonsymbolic learning that is carried out by subcortical circuits. However, it has been difficult to assess the role of cognition in single-cue conditioning because participants become aware of the simple stimulus contingency so quickly. In this experiment…
Atomic collisions under extreme conditions in space
International Nuclear Information System (INIS)
In space, atoms and molecules are often placed under the extreme conditions which are very difficult to be realized on Earth. For instance, extremely hot and dense plasmas are found in and around various stellar objects (e.g., neutron stars) on one hand and extremely cold and diffuse gases prevail in interstellar space on the other. There is so strong a magnetic field that electron clouds in atoms and molecules are distorted. The study of atomic collisions under the extreme conditions is not only helpful in understanding the astrophysical environment but also reveals new aspects of the physics of atoms and molecules. This paper is an invitation to the study. (References are not exhaustive but only provide a clue with which more details can be found.) (author)
Individual factors related to chronic condition in Portuguese adolescents: Highlights from the HBSC/WHO study
Directory of Open Access Journals (Sweden)
Teresa Santos
Full Text Available Background: Adolescence includes a period (10 to 19 years of profound biopsychosocial changes, constituting potentially difficult challenges, which may become more pronounced in the presence of a chronic condition and its limitations. Responses are not homogeneous and can be quite variable, depending on various specific individual factors. Research comparing adolescents with or without chronic illness, or comparing across different conditions, has been contradictory, not confirming a direct relationship between the degree of suffering and the chronic condition. Objective: To characterize and assess the impact of 1 having a chronic condition (CC and 2 how CC affects school participation; and its association with life satisfaction and perception of wellness, controlling for demographic factors: age, gender and family socioeconomic status (SES. Methods: 5050 Portuguese adolescents with an average age of 14 years participated in the Health Behaviour in School-aged Children/WHO (HBSC. Results: The majority of the adolescents with CC reported that their conditions did not affect school participation. Adolescents with CC who indicated that CC affected school participation felt more frequently unwell and presented lower life satisfaction. Being a boy, younger and having high family socio economic status (SES were identified as predictors of higher life satisfaction; on the other hand, being a girl, older, having lower SES, living with CC and feeling that CC affects school participation are predictors for feeling more frequently unwell. Conclusions: These adolescents showed an increased vulnerability, presenting internalized symptoms and lower life satisfaction. Furthermore, when there was simultaneous occurrence of living with CC and that CC affected school participation, the impact was even higher. Thus, it is crucial that future interventions should include the identified predictors, combined with "listen to the voice" of adolescents, throughout the adaptation process.
Method for including detailed evaluation of daylight levels in Be06
Petersen, Steffen
Good daylight conditions in office buildings have become an important issue due to new European regulatory demands which include energy consumption for electrical lighting in the building energy frame. Good daylight conditions in offices are thus in increased focus as an energy conserving measure. In order to evaluate whether a certain design is good daylight design or not building designers must perform detailed evaluation of daylight levels, including the daylight performance of dynamic sol...
Common Childhood Orthopedic Conditions
... severe because of other medical conditions. But many orthopedic (bone) conditions, just like dimples or cleft chins, ... inserting arch supports into shoes to reduce foot pain. Toe Walking Toe walking is common among toddlers ...
When Asymmetric Cosmic Bubbles Betray a Difficult Marriage: the Study of Binary Central Stars of Planetary Nebulae
Boffin, H. M. J.; Miszalski, B.
Planetary Nebulae represent a powerful window into the evolution of low-intermediate mass stars that have undergone extensive mass-loss. The nebula manifests itself in an extremely wide variety of shapes, but exactly how the mass lost is shaped into such a diverse range of morphologies is still highly uncertain despite over thirty years of vigorous debate. Binaries have long been thought to offer a solution to this vexing problem. Now, thanks to recent surveys and improved observing strategies, it appears clearly that a binary channel, in particular common-envelope (CE) evolution, is responsible for a large fraction of planetary nebulae. Moreover, as planetary nebulae are just "fresh out of the oven" compared to other post-CE systems, they provide invaluable contributions to the study of common-envelope evolution and to the formation of jets in binary systems. Our studies have also started to identify strong links between binarity and morphology, including a high proportion of bipolar nebulae and rings of low ionisation filaments resembling SN 1987A. Equally important are the newly found binary CSPN with intermediate periods, which appear linked to chemically peculiar stars whose composition was modified by binary evolution. Their study may also reveal much information on mass and angular momentum transfer processes in binary stars. Here we show examples of four PNe for which we have discovered their binary nature, including the discovery of a rare case of a barium-rich cool central star.
Including People with Intellectual Disabilities in Qualitative Research
Hall, Sarah A.
The voice of people with intellectual disabilities (ID) is needed in the literature to best understand their unique experiences and perspectives. Researchers face challenges in conducting interviews with people with ID who are limited in conceptual and verbal language skills. It can also be difficult to obtain participants with ID because of…
Hayward, Geoff
The classical value of the Hamiltonian for a system with timelike boundary has been interpreted as a quasilocal energy. This quasilocal energy is not positive definite. However, we derive a `quasilocal dominant energy condition' which is the natural consequence of the local dominant energy condition. We discuss some implications of this quasilocal energy condition. In particular, we find that it implies a `quasilocal weak energy condition'.
Supersymmetry from boundary conditions
International Nuclear Information System (INIS)
We study breaking and restoration of supersymmetry in five-dimensional theories by determining the mass spectrum of fermions from their equations of motion. Boundary conditions can be obtained from either the action principle by extremizing an appropriate boundary action (interval approach) or by assigning parities to the fields (orbifold approach). In the former, fields extend continuously from the bulk to the boundaries, while in the latter the presence of brane mass-terms cause fields to jump when one moves across the branes. We compare the two approaches and in particular we carefully compute the non-trivial jump profiles of the wavefunctions in the orbifold picture for very general brane mass terms. We also include the effect of the Scherk-Schwarz mechanism in either approach and point out that for a suitable tuning of the boundary actions supersymmetry is present for arbitrary values of the Scherk-Schwarz parameter. As an application of the interval formalism we construct bulk and boundary actions for super-Yang-Mills theory. Finally we extend our results to the warped Randall-Sundrum background
Four tumours including neuroendocrine tumour of the ileum.
Waldon, Karen; Abbas, Jonathan Raihan; Shakir, Savana; Afify, Samir
Gastroenteropancreatic neuroendocrine tumours are associated with development of further primary tumours. Certain conditions give an inherited predisposition to developing neoplasia. To the best of our knowledge, this is the first paper to report a patient with neuroendocrine tumour and three other tumours: a further bowel cancer, a brain tumour and a skin cancer. We report a case of a 42-year-old Caucasian man presenting with clinical features of intestinal obstruction who on histopathology of surgical specimen was found to have two distinct tumours of the bowel: a colonic adenocarcinoma at the splenic flexure and a well-differentiated neuroendocrine tumour of the terminal ileum. His history included a basal cell carcinoma and a benign brain tumour. He had extensive family history of neoplasia suggesting an inherited predisposition. Our case demonstrates the importance of investigating patients with known neuroendocrine tumours for further malignancy and suggests that patients with multiple primary malignancies should be referred for genetic testing. PMID:25935910
Loan Products Included in the Offer of Commercial Banks
Directory of Open Access Journals (Sweden)
Vasile Dedu
Full Text Available A bank loan is the main form of economical credit. It is for corporate activities – for medium and big companies and for retail activities – for small companies and individuals. The conditions for credit mainly depend on the quality of customers, it means their ability to perform a profitable activity and to be able to pay back the credits. For reasons which are mainly connected to marketing, bank practice has developed a large range of credit names, trying to emphasize some of the parts of the products or to take profit of some competition advantages in relation with customers' products. We are trying to include the offer of bank loans in a typology which takes into account the law, the bank field rules and the main technical features of the offered products.
Difficult diagnosis of brainstem glioblastoma multiforme in a woman: a case report and review of the literature
Directory of Open Access Journals (Sweden)
Lakhan Shaheen E
Full Text Available Abstract Introduction Brainstem gliomas are rare in adults. They most commonly occur in the pons and are most likely to be high-grade lesions. The diagnosis of a high-grade brainstem glioma is usually reached due to the presentation of rapidly progressing brainstem, cranial nerve and cerebellar symptoms. These symptoms do, however, overlap with a variety of other central nervous system disorders. Magnetic resonance imaging is the radiographic modality of choice, but can still be misleading. Case presentation A 48-year-old Caucasian woman presented with headache and vomiting followed by cerebellar signs and confusion. Magnetic resonance imaging findings were suggestive of a demyelinating process, but the patient failed to respond to therapy. Her condition rapidly progressed and she died. At autopsy, a high-grade invasive pontine tumor was identified. Histological evaluation revealed glioblastoma multiforme. Conclusion While pontine gliomas are rare in adults, those that do occur tend to be high-grade and rapidly progressive. Progression of symptoms from non-specific findings of headache and vomiting to rapid neurological deterioration, as occurred in our patient, is common in glioblastoma multiforme. While radiographic findings are often suggestive of the underlying pathology, this case represents the possibility of glioblastoma multiforme presenting as a deceptively benign appearing lesion.
A study of helicopter stability and control including blade dynamics
Zhao, Xin; Curtiss, H. C., Jr.
A linearized model of rotorcraft dynamics has been developed through the use of symbolic automatic equation generating techniques. The dynamic model has been formulated in a unique way such that it can be used to analyze a variety of rotor/body coupling problems including a rotor mounted on a flexible shaft with a number of modes as well as free-flight stability and control characteristics. Direct comparison of the time response to longitudinal, lateral and directional control inputs at various trim conditions shows that the linear model yields good to very good correlation with flight test. In particular it is shown that a dynamic inflow model is essential to obtain good time response correlation, especially for the hover trim condition. It also is shown that the main rotor wake interaction with the tail rotor and fixed tail surfaces is a significant contributor to the response at translational flight trim conditions. A relatively simple model for the downwash and sidewash at the tail surfaces based on flat vortex wake theory is shown to produce good agreement. Then, the influence of rotor flap and lag dynamics on automatic control systems feedback gain limitations is investigated with the model. It is shown that the blade dynamics, especially lagging dynamics, can severly limit the useable values of the feedback gain for simple feedback control and that multivariable optimal control theory is a powerful tool to design high gain augmentation control system. The frequency-shaped optimal control design can offer much better flight dynamic characteristics and a stable margin for the feedback system without need to model the lagging dynamics.
Dynamic Analysis of Wind Turbines Including Soil-Structure Interaction
DEFF Research Database (Denmark)
Harte, M.; Basu, B.
This paper investigates the along-wind forced vibration response of an onshore wind turbine. The study includes the dynamic interaction effects between the foundation and the underlying soil, as softer soils can influence the dynamic response of wind turbines. A Multi-Degree-of-Freedom (MDOF) horizontal axes onshore wind turbine model is developed for dynamic analysis using an Euler–Lagrangian approach. The model is comprised of a rotor blade system, a nacelle and a flexible tower connected to a foundation system using a substructuring approach. The rotor blade system consists of three rotating blades and includes the effect of centrifugal stiffening due to rotation. The foundation of the structure is modeled as a rigid gravity based foundation with two DOF whose movement is related to the surrounding soil by means of complex impedance functions generated using cone model. Transfer functions for displacement of the turbine system are obtained and the modal frequencies of the combined turbine-foundation systemare estimated. Simulations are presented for the MDOF turbine structure subjected to wind loading for different soil stiffness conditions. Steady state and turbulent wind loading, developed using blade element momentum theory and the Kaimal spectrum, have been considered. Soil stiffness and damping properties acquired from DNV/Risř standards are used as a comparison. The soil-structure interaction is shown to affect the response of the wind turbine. This is examined in terms of the turbine structural displacement and also the base shear and bending moment in the tower and the foundation. The frequency domain response of the bending moment and shear force in the foundation and the tower base, for stiffer soil condition, is shown to be characterized by peaks at multiples of the wind turbine rotational speed (3P effects). The effect of dynamic soil-structure interaction on the rotation of the foundation has also been investigated.
An integrated nuclear reactor unit for a floating low capacity nuclear power plant designed for power supply in remote areas with difficult access
International Nuclear Information System (INIS)
The paper describes the conceptual design of an integrated advanced safety nuclear reactor unit for a low capacity floating, NPP designed for power supply in areas which are remote with difficult access. The paper describes the major structural and lay-out components of the steam generator and reactor units with main technical characteristics. (author)
Comparison of the Airtraq and Truview laryngoscopes to the Macintosh laryngoscope for use by Advanced Paramedics in easy and simulated difficult intubation in manikins.
LENUS (Irish Health Repository)
Nasim, Sajid
Paramedics are frequently required to perform tracheal intubation, a potentially life-saving manoeuvre in severely ill patients, in the prehospital setting. However, direct laryngoscopy is often more difficult in this environment, and failed tracheal intubation constitutes an important cause of morbidity. Novel indirect laryngoscopes, such as the Airtraq and Truview laryngoscopes may reduce this risk.
Analytical methods under emergency conditions
International Nuclear Information System (INIS)
This lecture discusses methods for the radiochemical determination of internal contamination of the body under emergency conditions, here defined as a situation in which results on internal radioactive contamination are needed quickly. The purpose of speed is to determine the necessity for medical treatment to increase the natural elimination rate. Analytical methods discussed include whole-body counting, organ counting, wound monitoring, and excreta analysis. 12 references
Valuation Networks and Conditional Independence
Shenoy, Prakash P.
Valuation networks have been proposed as graphical representations of valuation-based systems (VBSs). The VBS framework is able to capture many uncertainty calculi including probability theory, Dempster-Shafer's belief-function theory, Spohn's epistemic belief theory, and Zadeh's possibility theory. In this paper, we show how valuation networks encode conditional independence relations. For the probabilistic case, the class of probability models encoded by valuation networks...
"In reality, it is complex and difficult": UK nurses' perspectives on "treatment as prevention" within HIV care.
Evans, Catrin; Bennett, Juliet; Croston, Michelle; Brito-Ault, Nathaniel; Bruton, Jane
Globally, clinical guidelines for HIV treatment are being altered to reflect new research showing that successful treatment with antiretroviral therapies (ART) can prevent the onward transmission of HIV. As a result, health care services are being challenged to find ways to roll out "treatment as prevention" (TasP) as a public health measure. In theory, TasP requires individuals to start ART as soon as they are diagnosed - for public health reasons - which may be some time before ART for that individual is required for clinical reasons. There is currently little research on the acceptability of TasP from a patient or provider perspective. This paper reports findings from a qualitative study that sought to explore UK nurses' views and experiences of TasP in HIV care. Ten HIV specialist nurses, purposively selected from across the country, were interviewed. Results suggest that, although positive about TasP in principle, nurses hold several reservations about its implementation in practice. Perceived benefits of TasP include reassurance for patients that their loved ones are protected and that immediate care is available. Concerns include the possibility of sexual dis-inhibition or coercion within sexual relationships. In the UK context, decisions around TasP are still being made on a highly individualised patient by patient basis, within a philosophy of holistic care and partnership working. As such, the research participants called for more resources to support information giving, risk assessment and decision-making. The results show that translating a public health treatment approach into individual patient care is complex, potentially time-consuming and may alter traditional provider-patient dynamics. The findings from this study suggest that in-depth research is needed to understand better the patient, community and provider experience as TasP becomes more widely rolled out. PMID:25650545
Shifting the criterion is not the difficult part of trial-by-trial criterion shifts in recognition memory.
Starns, Jeffrey J; Olchowski, James E
In recognition memory, participants often fail to shift their response criterion within a test even when they see cues signaling whether they should expect weak or strong memory (e.g., Stretch & Wixted Journal of Experimental Psychology: Learning, Memory, and Cognition, 24, 1397-1410, 1998b). We contrasted two possible accounts for this failure to shift. The first assumes that shifting the criterion requires effortful processing, so participants are unwilling to make shifts even when they expect different levels of strength. The second assumes that participants are unwilling to decide which strength category is indicated by the cue for each trial, so their expectations for memory strength do not change across trials. Targets appeared in different test formats ("cues") depending on whether they were studied once (weak) or five times (strong), and lures were evenly divided between the two formats. Some participants had two response keys for "old" and "new" (2-key), and others had to use different keys to respond "old" for the two strength cues (3-key). The goal of the 3-key condition was to force participants to decide which strength cue was presented on each trial. The 3-key participants had a lower false alarm rate for lures shown with the strong than with the weak cue, but the 2-key participants showed no evidence of a criterion shift. Response times were unaffected by trial-by-trial criterion shifts. We conclude that participants willingly shift their response criterion on the basis of changes in expected strength, but they are unwilling to decide which strength to expect unless they are compelled to do this by other aspects of the task. PMID:25084988
Neuromuscular Diseases and Conditions (and Oral Health)
... this condition, your dentist can prescribe a topical fluoride treatment or an artificial saliva solution to help ... includes over-the-counter medicines, vitamins and herbal supplements. Huntington's Disease Oral Effects People with Huntington's disease ...
Tracheal intubation with a flexible fibreoptic scope or the McGrath videolaryngoscope in simulated difficult airway scenarios : A randomised controlled manikin study
DEFF Research Database (Denmark)
Jepsen, Cecilie H; Gätke, Mona R
BACKGROUND: Flexible fibreoptic endoscopic (FFE) intubation is considered the 'gold-standard' when difficult airway management is anticipated. Several videolaryngoscopes have been developed to facilitate intubation by laryngoscopy. OBJECTIVE: The aim of the study was to compare the performance of the McGrath series 5 videolaryngoscope (McGrath videolaryngoscope) and the FFE for tracheal intubation in manikins with a simulated difficult airway, hypothesizing that the McGrath videolaryngoscope intubation would prove faster than FFE intubation. DESIGN: A randomised controlled study. SETTING: The Danish Institute for medical simulation between December 2009 and June 2010. PARTICIPANTS: Twenty-eight anaesthesia residents participating in the Danish mandatory 3-day airway management course. INTERVENTIONS: All participants received instructions and training in the use of the McGrath videolaryngoscope and FFE. The participants then performed tracheal intubation on a SimMan manikin once with the McGrath videolaryngoscope and once with the FFE in three difficult airway scenarios: (1) pharyngeal obstruction; (2) pharyngeal obstruction and cervical rigidity; (3) tongue oedema. MAIN OUTCOME MEASURES: We measured successful intubations, defined as intubation within 120 ?s, and time to tracheal intubation. RESULTS: The trachea was intubated within 120? s with the McGrath videolaryngoscope in 25 out of 27 (93%), 25 out of 28 (89%) and 18 out of 28 (64%) occasions compared with 11 out of 28 (40%), 11 out of 28 (40%) and 16 out of 28 (57%) with the FFE in scenarios (1), (2) and (3), respectively. Time to tracheal intubation was shorter with the McGrath videolaryngoscope in scenarios (1) and (2) than with the FFE (Wilcoxon signed rank sum test, P?0.0001). CONCLUSION: The McGrath videolaryngoscope is a valuable device with higher success rate and a quicker performance in simulated difficult airways. In patients, videolaryngoscopy may have a role in difficult airway algorithms, but the optimal device has yet to be found.
Application of DEN refinement and automated model building to a difficult case of molecular-replacement phasing: the structure of a putative succinyl-diaminopimelate desuccinylase from Corynebacterium glutamicum.
Brunger, Axel T; Das, Debanu; Deacon, Ashley M; Grant, Joanna; Terwilliger, Thomas C; Read, Randy J; Adams, Paul D; Levitt, Michael; Schröder, Gunnar F
Phasing by molecular replacement remains difficult for targets that are far from the search model or in situations where the crystal diffracts only weakly or to low resolution. Here, the process of determining and refining the structure of Cgl1109, a putative succinyl-diaminopimelate desuccinylase from Corynebacterium glutamicum, at ?3?Ĺ resolution is described using a combination of homology modeling with MODELLER, molecular-replacement phasing with Phaser, deformable elastic network (DEN) refinement and automated model building using AutoBuild in a semi-automated fashion, followed by final refinement cycles with phenix.refine and Coot. This difficult molecular-replacement case illustrates the power of including DEN restraints derived from a starting model to guide the movements of the model during refinement. The resulting improved model phases provide better starting points for automated model building and produce more significant difference peaks in anomalous difference Fourier maps to locate anomalous scatterers than does standard refinement. This example also illustrates a current limitation of automated procedures that require manual adjustment of local sequence misalignments between the homology model and the target sequence. PMID:22505259
Aircraft Abnormal Conditions Detection, Identification, and Evaluation Using Innate and Adaptive Immune Systems Interaction
Al Azzawi, Dia
Abnormal flight conditions play a major role in aircraft accidents frequently causing loss of control. To ensure aircraft operation safety in all situations, intelligent system monitoring and adaptation must rely on accurately detecting the presence of abnormal conditions as soon as they take place, identifying their root cause(s), estimating their nature and severity, and predicting their impact on the flight envelope. Due to the complexity and multidimensionality of the aircraft system under abnormal conditions, these requirements are extremely difficult to satisfy using existing analytical and/or statistical approaches. Moreover, current methodologies have addressed only isolated classes of abnormal conditions and a reduced number of aircraft dynamic parameters within a limited region of the flight envelope. This research effort aims at developing an integrated and comprehensive framework for the aircraft abnormal conditions detection, identification, and evaluation based on the artificial immune systems paradigm, which has the capability to address the complexity and multidimensionality issues related to aircraft systems. Within the proposed framework, a novel algorithm was developed for the abnormal conditions detection problem and extended to the abnormal conditions identification and evaluation. The algorithm and its extensions were inspired from the functionality of the biological dendritic cells (an important part of the innate immune system) and their interaction with the different components of the adaptive immune system. Immunity-based methodologies for re-assessing the flight envelope at post-failure and predicting the impact of the abnormal conditions on the performance and handling qualities are also proposed and investigated in this study. The generality of the approach makes it applicable to any system. Data for artificial immune system development were collected from flight tests of a supersonic research aircraft within a motion-based flight simulator. The abnormal conditions considered in this work include locked actuators (stabilator, aileron, rudder, and throttle), structural damage of the wing, horizontal tail, and vertical tail, malfunctioning sensors, and reduced engine effectiveness. The results of applying the proposed approach to this wide range of abnormal conditions show its high capability in detecting the abnormal conditions with zero false alarms and very high detection rates, correctly identifying the failed subsystem and evaluating the type and severity of the failure. The results also reveal that the post-failure flight envelope can be reasonably predicted within this framework.
Implementing a modular framework in a conditions database explorer for ATLAS
International Nuclear Information System (INIS)
The ATLAS conditions databases will be used to manage information of quite diverse nature and level of complexity. The usage of a relational database manager like Oracle, together with the object managers POOL and OKS developed in-house, poses special difficulties in browsing the available data while understanding its structure in a general way. This is particularly relevant for the database browser projects where it is difficult to link with the class defining libraries generated by general frameworks such as Athena. A modular approach to tackle these problems is presented here. The database infrastructure is under development using the LCG COOL infrastructure, and provides a powerful information sharing gateway upon many different systems. The nature of the stored information ranges from temporal series of simple values up to very complex objects describing the configuration of systems like ATLAS' TDAQ infrastructure, including also associations to large objects managed outside of the database infrastructure. An important example of this architecture is the Online Objects Extended Database BrowsEr (NODE), which is designed to access and display all data, available in the ATLAS Monitoring Data Archive (MDA), including histograms and data tables. To deal with the special nature of the monitoring objects, a plugin from the MDA framework to the Time managed science Instrument Databases (TIDB2) is used. The database browser is extended, in particular to include operationtended, in particular to include operations on histograms such as display, overlap, comparisons as well as commenting and local storage
Estimation of wave conditions at Liseleje location
Borgarino, Bruno; Brorsen, Michael
This report present the near-shore waves conditions at Liseleje. This study has been carried out as a first step to evaluate the possibility of installing an overtopping wave energy converter at Liseleje. The offshore conditions have first been calculated, using 30 years recorded wind data. Then numerical simulations have been performed to estimate the effect on the seabed on significant wave height and direction. Finally, offshore and near-shore conditions, including energy considerations, a...
Numerical implementation of isolated horizon boundary conditions
Jaramillo, J. L.; Ansorg, M.; Limousin, F.
We study the numerical implementation of a set of boundary conditions derived from the isolated horizon formalism, and which characterize a black hole whose horizon is in quasi-equilibrium. More precisely, we enforce these geometrical prescriptions as inner boundary conditions on an excised sphere, in the numerical resolution of the Conformal Thin Sandwich equations. As main results, we firstly establish the consistency of including in the set of boundary conditions a "const...
Concentrated Solar Air Conditioning for Buildings Project
McLaughlin, Rusty
This slide presentation reviews project to implement the use of solar power to provide air conditioning for NASA buildings. Included is an overall conceptual schematic, and an diagram of the plumbing and instrumentation for the project. The use of solar power to power air conditioning in buildings, particularly in the Southwest, could save a significant amount of money. DOD studies have concluded that air conditioning accounts for 30-60% of total energy expenditures.
Kinetic equations with Maxwell boundary conditions
Mischler, Ste?phane
We prove global stability results of {\\sl DiPerna-Lions} renormalized solutions for the initial boundary value problem associated to some kinetic equations, from which existence results classically follow. The (possibly nonlinear) boundary conditions are completely or partially diffuse, which includes the so-called Maxwell boundary conditions, and we prove that it is realized (it is not only a boundary inequality condition as it has been established in previous works). We ar...