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1

Face Recognition Under Difficult Lighting Conditions  

Directory of Open Access Journals (Sweden)

Full Text Available Face recognition has received a great deal of attention from the scientific and industrial communities over the past several decades owing to its wide range of applications in information security and access control, law enforcement agencies, surveillance and more generally image understanding. Most of these methods were initially developed with face images collected under relatively well-controlled conditions and in practice they have difficulty in dealing with the range of appearance variations that commonly occur in unconstrained natural images due to illumination, pose, facial expression, aging, partial occlusions, etc. Unfortunately, facial appearance depends strongly on the ambient lighting conditions. This paperpresents a robust technique for identifying the faces in the various lighting conditions. The proposed method normalizes the acquired images under different lighting conditions in the first step. In the next step it captures as much as possible of the available information with relatively few training samples. The results show that our proposed method outperforms several existing preprocessors for a range of feature sets, data sets and lighting conditions.

V.Sikanthgoud

2013-08-01

2

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

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Mechanical pressure gages under difficult conditions; Mechanische Druckmessgeraete unter schwierigen Einsatzbedingungen  

Energy Technology Data Exchange (ETDEWEB)

In spite of electronic solutions, mechanical pressure meters still find their place in reliable in-situ process pressure monitoring without external influences. Planners and users often have difficulties selecting the optimum meter for a given application, especially where difficult operating conditions are concerned. The contribution presents a neutral and practical guide. (orig.)

Nieswandt, T. [Wika Alexander Wiegand GmbH und Co. KG, Klingenberg (Germany)

2008-05-15

4

Difficult Asthma  

Directory of Open Access Journals (Sweden)

Full Text Available 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.

Ahmet Uslu

2003-03-01

5

Converter-controlled belt conveyor systems under the difficult conditions; Umrichtergesteuerte Bandanlagen unter schwierigen Bedingungen  

Energy Technology Data Exchange (ETDEWEB)

Panel 572 is located at a depth of 1,200 m in the Girondelle seam at the West mine. The panel has a mean thickness of 2.5 m and is designed as a shearer loader face with a length of 460 m. Coal is conveyed to the shaft by six belts with a total length of about 6 km and a total lifting height of 396 m. The main conveyor belt 1 with an installed power of 3 MW links the panel to a bunker. Conveyor belts 2 to 4 each with 500 kW drive power have operated in a stable manner since the start of working of the panel. Due to in-seam drivage with a selective-cut machine of type AM 85 an area with a marked trough was produced in the coal conveyor road. This area is traversed by belt 5. The planning and control of the conveyor belt in this difficult geological environment impose high demands on drive and control technology. To ensure stable operation under different loads a raft of measures was resolved and implemented. The contribution examines the problem and describes the implemented measures in detail. (orig.)

Horz, Michael-Josef [RAG Deutsche Steinkohle, Herne (Germany). Abt. Elektrotechnik unter Tage; Mueller, Uwe [RAG Deutsche Steinkohle, Herne (Germany). Servicebereich Technik- und Logistikdienste

2010-05-15

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A simplified intensity modulated radiation therapy technique for difficult clinical cancer condition  

International Nuclear Information System (INIS)

DCRT is unable to meet clinical requirements and condition for which IMRT requires more than 25 segments but still can not significantly improve the treatment outcome. It provides a clinical solution with high ratio of performance-to- cost benefit. Further check-up by radiation colleaques is advised. (authors)

7

Geotechnical and technological problems of operating an overburden conveyor bridge under difficult geological conditions in the Profen area  

Energy Technology Data Exchange (ETDEWEB)

The overburden conveyor bridge introduced in 1972 in the open cast mine of Profen GDR, has been problematic due to unfavourable mining conditions which hinder continuous operation. These conditions, analysed in detail, such as deformed layers, difficult water removal, danger of soil creep, clay and quartzite layers caused sliding of the spoil, reduced slope stability, sinking of the bridge tracks and a subsequent reduction in bridge stability, higher water content of the coal etc. The measures taken to overcome these problems and continue operating the bridge are discussed in detail, such as stabilising the tracks of the conveyor bridge and the angles of repose in the mine, increased water removal using the horizontal drilling method and removing layers of stone separately. (In German)

Bilkenroth, K.; Wiesner, H.

1978-06-01

8

Phytoremediation of phenol using Polygonum orientale, including optimized conditions.  

Science.gov (United States)

Removing phenol from wastewater has become a major challenge of international concern. Phytoremediation is a novel and eco-friendly method and is attracting an increasing amount of attention for treating phenol in wastewater. We studied the ability of Polygonum orientale, which is frequently present around water bodies and in wetlands in China, to phytoremediate phenol. We determined the inhibition concentration for phenol on P. orientale using emergency toxicology experiments and morphological observations. Isothermal and kinetic models were created to assess the adsorption process involved in phenol removal. Comparison tests in sterile conditions demonstrated that metabolic removal was the main way in which the phenol concentrations were decreased, and removal by adsorption played a smaller role. An orthogonal test was performed to determine the optimum conditions under which P. orientale will remove phenol, and these were found to be an initial phenol concentration of 5 mg L(-1), 100 % natural light, and a 13-day treatment time. These results provide a theoretical basis for increasing our understanding of the mechanisms involved in the removal of phenol by P. orientale and will help in developing its application in the greening of urban areas to provide both phytoremediation and esthetic landscaping. PMID:25208519

Wang, Kai; Cai, Jin; Feng, Jia; Xie, Shulian

2014-12-01

9

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.

10

Confidence in Airline Performance in Difficult Market Conditions: An Analysis of JetBlue's Financial Market Results  

Science.gov (United States)

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.

Flouris, Triant; Walker, Thomas

2005-01-01

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A job description for the effective self-management of a long-term condition: experiences of living with difficult asthma.  

Science.gov (United States)

This paper concerns a study exploring the salience of a 'job description' for the effective self-management of a long-term condition to the experiences of a group of women living with difficult asthma. This is a life-threatening disease. It has been claimed that sufferers are a marginalised, misunderstood, mistreated and vulnerable group. The method involved secondary analysis of focus group data. The job description has been developed as a tool to enable nurses to facilitate and support effective self-management. This study was designed to examine the application of this tool to a particular case. Long-term conditions are a growing feature of the developed world and are strongly implicated in health inequalities. They are more prevalent in socially and economically disadvantaged populations and therefore add further burden to already vulnerable people. Effective self-management is critical to adapting and adjusting to the experience of a long-term condition and nurses have a responsibility to promote this process. PMID:23721390

Deacon, Maureen; Rickards, Emma

2013-04-01

12

Measurement of Infant Difficultness.  

Science.gov (United States)

The Infant Characteristics Questionnaire (ICQ) was developed as a short, factor-analytic screening device for difficultness. Responses of 322 mothers of four- to six-month-old infants suggested that they regard fussy, hard-to-soothe, labile infants as difficult. Mother characteristics may affect perceptions of infant difficultness with…

Bates, John E.; And Others

1979-01-01

13

Management of "difficult" wounds.  

Science.gov (United States)

Pressure sores (PSs) and wounds in immunocompromised children are rather rare conditions. No doubt, their management is often complex and difficult, even for experienced pediatric plastic surgeons. As there are no algorithms for standard care, the therapeutic approach is individual.Successful PS management always implies primary and secondary prevention. With a PS present, rapid relief of pressure is crucial. If local wound care fails to restore skin integrity within a short period of time, surgical defect closure is mandatory. Overall, full-thickness skin grafts and local flap surgery are the most suitable methods regarding result quality, procedure complexity, and risks. Negative pressure wound therapy (NPWT) plays an instrumental role in wound bed preparation before definitive coverage. Recurrence rate is high (the complication). It does not much depend on the surgical technique employed, but rather depends on whether the various pathogenic factors leading to PS can be eliminated or alleviated.In both temporarily and permanently immunocompromised children, wound healing is significantly impaired. At the same time, these patients have no or low host defense activity. Thus, they are at high risk not only for local wound infection but also for potentially life threatening septic complications. Rapid and definitive wound closure is therefore essential. When conservative therapy fails, simple surgical techniques granting rapid and definitive wound closure should be used. PMID:24008551

Neuhaus, Kathrin; Meuli, Martin; Koenigs, Ingo; Schiestl, Clemens

2013-10-01

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Difficult colon polypectomy  

Directory of Open Access Journals (Sweden)

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.

Klaus Vormbrock

2012-01-01

15

[Unanticipated difficult extubation].  

Science.gov (United States)

Complications at extubation remain an important risk factor in anaesthesia. Airway related complications at extubation are relatively frequent but are usually dealt with by simple basic measures. We report a new case of respiratory complications associated with tracheal extubation in a 59-year-old woman. Her medical history included obesity, no criteria difficult intubation and no adverse events during her previous anesthetic procedures. At the end of surgery, immediately after extubation, the patient developed respiratory distress requiring reintubation. A second extubation performed in postoperative recovery room was complicated by a new respiratory distress with reintubation. The patient was then admitted to the ICU. The examination on admission was unremarkable. Chest X-ray and a chest CT scan were performed in search of an etiology. Both tests showed a large thyroid "goitre plongeant" (plunging goiter) and compressive. In the suites, a thyroidectomy was performed with excision of a large cervical plunging goiter para- and retropharyngeal bilateral chest, allowing extubation successfully. The postoperative course was uneventful. PMID:23707204

Badaoui, R; Abou Arab, O; Bernard, E; Vouriot, D; Popov, I; Dupont, H

2013-06-01

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Included yet Excluded? : Conditions for Inclusive Teaching in Physical Education and Health  

Digital Repository Infrastructure Vision for European Research (DRIVER)

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...

A?stro?m, Peter

2013-01-01

17

Difficult mask ventilation.  

Science.gov (United States)

Mask ventilation is the most fundamental skill in airway management. In this review, we summarize the current knowledge about difficult mask ventilation (DMV) situations. Various definitions for DMV have been used in the literature. The lack of a precise standard definition creates a problem for studies on DMV and causes confusion in data communication and comparisons. DMV develops because of multiple factors that are technique related and/or airway related. Frequently, the pathogenesis involves a combination of these factors interacting to cause the final clinical picture. The reported incidence of DMV varies widely (from 0.08% to 15%) depending on the criteria used for its definition. Obesity, age older than 55 yr, history of snoring, lack of teeth, the presence of a beard, Mallampati Class III or IV, and abnormal mandibular protrusion test are all independent predictors of DMV. These signs should, therefore, be recognized and documented during the preoperative evaluation. DMV can be even more challenging in infants and children, because they develop hypoxemia much faster than adults. Finally, difficult tracheal intubation is more frequent in patients who experience DMV, and thus, clinicians should be familiar with the corrective measures and management options when faced with a challenging, difficult, or impossible mask ventilation situation. PMID:19923516

El-Orbany, Mohammad; Woehlck, Harvey J

2009-12-01

18

High mortality in an internally displaced population in Ituri, Democratic Republic of Congo, 2005: results of a rapid assessment under difficult conditions.  

Science.gov (United States)

The ongoing conflict in Ituri, Democratic Republic of Congo (DRC), has led to more than 50,000 deaths, more than 500,000 displaced civilians and continuing, unacceptably high, mortality since 1999. In February 2005, after a resurgence of violence and further displacements, Médecins Sans Frontières (MSF) launched an emergency response in three internally displaced persons (IDP) camps in Ituri. We performed a rapid health assessment in April 2005 in one of the IDP camps to evaluate mortality (due to violence or disease) and camp living conditions. The retrospective mortality survey, covering a recall period from 18 December 2004 to 27 March 2005, indicated a crude mortality rate of 4.1 deaths/10,000/day (95% CI: 2.8-5.4) and an under-five mortality rate of 6.9 deaths/10,000/day (95% CI: 4.4-9.4). Living conditions in the camp were extremely poor (average 286 persons per latrine). Despite efforts of the international community and humanitarian organizations, the security situation continues to deteriorate. Regular assessments should be undertaken to monitor the situation. PMID:19153907

Ahoua, L; Tamrat, A; Duroch, F; Grais, R F; Brown, V

2006-01-01

19

Making marketing difficult  

DEFF Research Database (Denmark)

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.

Meyer, Gitte

2005-01-01

20

Robust Face Recognition under Difficult Lighting Conditions  

Directory of Open Access Journals (Sweden)

Full Text Available — This paper addresses the problem of illumination effects on Face recognition and works for an approach to reduce their effect on recognition performance. More broadly, a simple and efficient preprocessing chain that eliminates most of the effects of changing illumination while still preserving the essential appearance details that are needed for recognition.Using local ternary patterns (LTP, a generalization of the local binary pattern (LBP local texture descriptor that is more discriminant and less sensitive to noise in uniform regions. We also show that replacing comparisons based on local spatial histograms with a distance transform based similarity metric further improves the performance of LBP/LTP based face recognition; and Robustness is still improved by adding Kernel principal component analysis (PCA feature extraction.

S.S. Ghatge

2012-08-01

 
 
 
 
21

Management of difficult urticaria  

Directory of Open Access Journals (Sweden)

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.

Yadav Sudha

2009-01-01

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A difficult beginning  

Directory of Open Access Journals (Sweden)

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!

Suneth Agampodi

2013-10-01

23

76 FR 32815 - Medicaid Program; Payment Adjustment for Provider-Preventable Conditions Including Health Care...  

Science.gov (United States)

...and outpatient health care settings where...implement provider self reporting through...the term ``health care-acquired conditions...for provider self-reporting...the provider self-reporting...definition of health care- acquired...

2011-06-06

24

Upgrading during difficult times  

International Nuclear Information System (INIS)

The Co-op Upgrader is part of an integrated refinery and upgrader complex in Regina, Saskatchewan. The upgrader processes 50,000 bbl/d heavy sour crude oil, mostly Fosterton and dilute Lloydminster crude, via hydrogen addition and carbon rejection, desulfurization, demetallization, and denitrification to yield a synthetic crude blend. The synthetic crude is refined to produce gasoline and diesel fuel. Byproducts from the integrated operation include 100,000 tonnes/y of petroleum coke, 65,000 tonnes/y of sulfur, propane, butane, fuel oil, and metals (Ni and V) in the form of spent catalysts. Recent operational and economic challenges faced by the upgrader are reviewed. Technical challenges include operating the upgrader's high-temperature high-pressure heavy oil hydrotreating unit and distillate hydrogenation unit, removal and replacement of the desulfurization catalyst, waste management, and producing coke of sufficient quality. Economic challenges include the shrinking differential between light and heavy oil, higher prices for natural gas (the main raw material for hydrogen production for upgrading), seasonal changes in product specifications, and lower prices for sulfur and metal byproducts. The upgrader is also affected by interest rates since borrowing costs are the single largest expenditure after crude oil purchases. 4 figs

25

Difficult to control atopic dermatitis  

DEFF Research Database (Denmark)

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.

Darsow, Ulf; Wollenberg, Andreas

2013-01-01

26

Evaluation of the novel passive sampler for cyanobacterial toxins microcystins under various conditions including field sampling.  

Science.gov (United States)

In the present study, we have evaluated the effectiveness of a passive sampler for polar organic chemicals to accumulate a group of widespread and hazardous tumor-promoting toxins produced in cyanobacterial water blooms-microcystins (MC). The previously optimized configuration of the sampler based on polycarbonate membrane and Oasis HLB sorbent (2.75 mg/cm(2)) was validated under various exposure scenarios in laboratory and field. Calibration of the passive sampler conducted under variable conditions and concentrations of MC revealed linearity of the sampling up to 4 weeks. The sampling rates of microcystins for two different exposure scenarios were derived (e.g., MC-LR: R (s) = 0.017 L/day under static and 0.087 L/d under turbulent conditions). R (s) values were further used for calculations of time-weighted average concentrations in natural water. Improved sensitivity and selectivity of the in-house-made sampler was observed in comparison with the commercially available Polar Organic Compound Integrative Sampler (POCIS). Comparisons of grab and passive sampling methods were performed during cyanobacterial water bloom season in the Brno reservoir, Czech Republic in 2008. Data obtained by passive sampling provided a more relevant picture of the situation and enabled better assessment of potential risks. The present study demonstrated that the modification of POCIS is suitable for monitoring of occurrence and retrospective estimations of microcystin water concentrations, especially with respect to the control of drinking water quality. PMID:20225057

Kohoutek, Jirí; Marsálek, Blahoslav; Bláha, Ludek

2010-05-01

27

The difficult neck in facelifting.  

Science.gov (United States)

The management of the neck often presents the most challenging aspect of the facelift procedure. The aesthetic neck has a well-defined jaw line, a pleasing and adequate cervicomental angle, and visible definitions of the deeper lateral and midline structures, such as the sternocleidomastoid muscles and trachea. Several unfavorable anatomic characteristics will present that will compound the challenge. These characteristics are contrasted with ideal features and include the following: an excess of adipose tissue, an excess of either thin or thick inelastic skin, marked relaxation of the suspension structures of the neck with resultant platysma banding and jowling, and unfavorable skeletal features such as microgenia and hyoid malposition. These patients present for rhytidectomy with inadequate chin projection, an obtuse cervicomental angle, sagging skin, and a heavy neck. To maximize rhytidectomy results in these patients with difficult neck anatomy, special attention to the anatomy and application of recognized techniques in an individualized manner is recommended. This article reviews the issues encountered in the management of the difficult neck in facelifting, with special attention given to patients with a heavy neck. PMID:25076452

Fedok, Fred G; Chaikhoutdinov, Irina; Garritano, Frank

2014-08-01

28

A Boundary Condition Relaxation Algorithm for Strongly Coupled, Ablating Flows Including Shape Change  

Science.gov (United States)

Implementations of a model for equilibrium, steady-state ablation boundary conditions are tested for the purpose of providing strong coupling with a hypersonic flow solver. The objective is to remove correction factors or film cooling approximations that are usually applied in coupled implementations of the flow solver and the ablation response. Three test cases are considered - the IRV-2, the Galileo probe, and a notional slender, blunted cone launched at 10 km/s from the Earth's surface. A successive substitution is employed and the order of succession is varied as a function of surface temperature to obtain converged solutions. The implementation is tested on a specified trajectory for the IRV-2 to compute shape change under the approximation of steady-state ablation. Issues associated with stability of the shape change algorithm caused by explicit time step limits are also discussed.

Gnoffo, Peter A.; Johnston, Christopher O.

2011-01-01

29

Specificity of psychomotor reactions in the conditions of support deprivation including effects of countermeasures  

Science.gov (United States)

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.

Nichiporuk, Igor; Ivanov, Oleg

30

40 CFR 142.307 - What terms and conditions must be included in a small system variance?  

Science.gov (United States)

...What terms and conditions must be included in a small system variance? 142.307 Section 142.307 Protection...REGULATIONS IMPLEMENTATION Variances for Small System Review of Small System Variance Application § 142.307 What...

2010-07-01

31

Thoracic radiotherapy in stereotactic conditions: difficulties met when starting up and proposed solutions; Radiotherapie thoracique en conditions stereotaxiques: difficultes rencontrees lors de la mise en route et solutions proposees  

Energy Technology Data Exchange (ETDEWEB)

The authors report the study of difficulties met when starting up a thoracic irradiation in stereotactic conditions with respiratory feedback by means of a spirometry system. Eight patients have been selected. Images have been acquired in deep-inspiration breath-hold. Various dose levels have delivered in four sessions on the 80-per-cent isodose. It appears that this technique is constrained by the patient's physical capacities and the available technical means. Solutions are the use of a suitable support system, the screening of harmful positioning, and a training phase to respiratory feedback. Short communication

Halley, A.; Assouline, A.; Belghith, B.; Hemery, C.; Cuenca, X.; Lang, P.; Boisserie, G.; Simon, J.M.; Mazeron, J.J.; Feuvret, L. [Groupe hospitalier Pitie-Salpetriere, assistance Publique-Hopitaux de Paris, Paris (France)

2011-10-15

32

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

33

Unexpected difficult airway with hypogonadotropic hypogonadism  

Directory of Open Access Journals (Sweden)

Full Text Available Ferda Yaman,1 Bengi Arslan,2 Ercan Yuvanç,3 Ünase Büyükkoçak1 1Anesthesiology and Reanimation Department, 2Otorhinolaryngology Head and Neck Surgery Department, 3Urology Department, Faculty of Medicine, Kirikkale University, Kirikkale, Turkey Background: A critical aspect of safe general anesthesia is providing adequate ventilation and oxygenation. Failed endotracheal intubation and inadequate ventilation with insufficient oxygenation may lead to serious complications, even death. Anesthesiologists rarely encounter unexpected difficult airway problems in daily routine. Management of an unexpectedly difficult airway consists of laryngeal mask ventilation, gum-elastic bougie and video laryngoscopy-assisted intubation. Gum-elastic bougie is the easiest and cheapest tool used in case of an unexpected difficult intubation occurring in the operating room. Case: A 53-year-old male patient with hypogonadotropic hypogonadism presented as an unexpected difficult intubation after the induction of anesthesia. No pathological finding or predictor of difficult intubation was present. In addition, bag-mask ventilation was poor and inadequate. The patient was finally successfully intubated with a gum-elastic bougie. Conclusion: A difficult airway has been described in patients with a variety of endocrine disorders, including pituitary diseases, but not with hypogonadism. There may be an unrevealed relationship between hypogonadism and difficult airway. Gum-elastic bougie is still the most attainable and effective tool in the operation room in this situation. Keywords: airway management, intubation, hypogonadism

Yaman F

2014-04-01

34

Unexpected difficult airway with hypogonadotropic hypogonadism  

Science.gov (United States)

Background A critical aspect of safe general anesthesia is providing adequate ventilation and oxygenation. Failed endotracheal intubation and inadequate ventilation with insufficient oxygenation may lead to serious complications, even death. Anesthesiologists rarely encounter unexpected difficult airway problems in daily routine. Management of an unexpectedly difficult airway consists of laryngeal mask ventilation, gum-elastic bougie and video laryngoscopy-assisted intubation. Gum-elastic bougie is the easiest and cheapest tool used in case of an unexpected difficult intubation occurring in the operating room. Case A 53-year-old male patient with hypogonadotropic hypogonadism presented as an unexpected difficult intubation after the induction of anesthesia. No pathological finding or predictor of difficult intubation was present. In addition, bag-mask ventilation was poor and inadequate. The patient was finally successfully intubated with a gum-elastic bougie. Conclusion A difficult airway has been described in patients with a variety of endocrine disorders, including pituitary diseases, but not with hypogonadism. There may be an unrevealed relationship between hypogonadism and difficult airway. Gum-elastic bougie is still the most attainable and effective tool in the operation room in this situation. PMID:24741333

Yaman, Ferda; Arslan, Bengi; Yuvanç, Ercan; Büyükkoçak, Ünase

2014-01-01

35

Effective communication during difficult conversations.  

Science.gov (United States)

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

Polito, Jacquelyn M

2013-06-01

36

DIFFICULT AIRWAY IN THYROID SURGERY  

Directory of Open Access Journals (Sweden)

Full Text Available Background: Thyroid surgery has been considered as a risk factor for the management of difficult airway.Method: We review the relevant literature related to the difficult airway and thyroid surgery.Comments: Endothoracic goiter, deformity of the airway, compression of the airway and thyroid cancer do not appear to have an influence on the difficulty for intubation.Classical parameters have a better predictive value: mouth opening less than 35 mm, Mallampati II-IV, short neck, neck movility less than 80 degrees, thyromental distance less than 60 mm, retrognathia, Cormack index III-IV, macroglossia, inability to protude the teeth and body mass index (BMI greater than 35 Kg/m2.Conclusions: According to the literature, thyroid disease does not increase the risk for a difficult airway (ventilation / intubation.The risk of an unexpected difficult airway (false negative cannot be eliminated.All patients must undergo an assessment of the airway

Cuello-Azcárate JJ

2011-12-01

37

Difficult diagnoses in the skeletal radiology  

International Nuclear Information System (INIS)

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.

38

Self-Consistent Simulation of a Bunched Electron Beam Including Radiation, Space-Charge and Boundary Conditions  

CERN Document Server

High power Free Electron Laser (FEL) designs require high-brightness beams. These beams may suffer beam quality degradation during transport through bending sections from effects that were previously insignificant at low bunch charges. Potential mechanisms include microbunching from longitudinal space-charge and transverse emittance dilution from coherent synchrotron radiation. The effects are not well-understood in the transient state, in the presence of conducting boundaries or when these effects operate together and in conjunction with the beam dynamics. A simulation method applicable under the conditions of a MW-class average power FEL driver has been developed that accounts for radiation, space-charge and boundary conditions in a self-consistent manner. This simulation may be useful in evaluating design concepts under consideration including chicane bunch compressors and energy recovery bending arcs.

Gillingham, D R

2005-01-01

39

Children with deafblindness : difficult differential diagnostics  

DEFF Research Database (Denmark)

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.

Dammeyer, Jesper Herup

2008-01-01

40

Nurses' perceptions of difficult patients  

Directory of Open Access Journals (Sweden)

Full Text Available The purpose of this article was to explain and describe how professional nurses in the health services experience difficult patients. Opsomming Die doel van hierdie artikel was om te verduidelik en te beskryf hoe professionele verpleegkundiges in gesondheidsdienste moeilike pasiënte ervaar. *Please note: This is a reduced version of the abstract. Please refer to PDF for full text.

Janetta H Roos

2005-01-01

 
 
 
 
41

Teaching Difficult Topics with Primary Sources  

Science.gov (United States)

"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…

Potter, Lee Ann

2011-01-01

42

Applications of the conjugate gradient FFT method in scattering and radiation including simulations with impedance boundary conditions  

Science.gov (United States)

The theoretical and computational aspects related to the application of the Conjugate Gradient FFT (CGFFT) method in computational electromagnetics are examined. The advantages of applying the CGFFT method to a class of large scale scattering and radiation problems are outlined. The main advantages of the method stem from its iterative nature which eliminates a need to form the system matrix (thus reducing the computer memory allocation requirements) and guarantees convergence to the true solution in a finite number of steps. Results are presented for various radiators and scatterers including thin cylindrical dipole antennas, thin conductive and resistive strips and plates, as well as dielectric cylinders. Solutions of integral equations derived on the basis of generalized impedance boundary conditions (GIBC) are also examined. The boundary conditions can be used to replace the profile of a material coating by an impedance sheet or insert, thus, eliminating the need to introduce unknown polarization currents within the volume of the layer. A general full wave analysis of 2-D and 3-D rectangular grooves and cavities is presented which will also serve as a reference for future work.

Barkeshli, Kasra; Volakis, John L.

1991-01-01

43

[Bipolar disorder in children and adolescents: a difficult diagnosis].  

Science.gov (United States)

Bipolar disorder (BD) is a severe mental condition with neurodevelopmental features that clinically results in pathological fluctuations of mood. Whereas it was classically or traditionally considered as an adult-onset disorder, recent findings suggest that BD may occur very early in the life course, thus, determining what is now called Juvenile bipolar disorder (JBD). One of the reasons for which JBD has been so difficult to identify is that JBD primary symptoms vary much from the typical adulthood BD clinical expression. Euphoric mood is rare in JBD, while irritability mood, aggressive temper, mixed manic state onset, rapid cycling, anger outbursts and chronic course of symptoms are much more frequent. This specific clinical presentation makes JBD difficult to differentiate from other diagnoses related to pathological externalizing behaviours, including conduct disorder, oppositional provocative disorder, and attention deficit-hyperactivity disorder. PMID:24935683

Geoffroy, Pierre Alexis; Jardri, Renaud; Etain, Bruno; Thomas, Pierre; Rolland, Benjamin

2014-09-01

44

Difficult Bond. Derrida and Jewishness  

DEFF Research Database (Denmark)

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.

Siegumfeldt, Inge Birgitte

2013-01-01

45

Styrene-spaced copolymers including anthraquinone and ?-O-4 lignin model units: synthesis, characterization and reactivity under alkaline pulping conditions.  

Science.gov (United States)

A series of random copoly(styrene)s has been synthesized via radical polymerization of functionalized anthraquinone (AQ) and ?-O-4 lignin model monomers. The copolymers were designed to have a different number of styrene spacer groups between the AQ and ?-O-4 lignin side chains aiming at investigating the distance effects on AQ/?-O-4 electron transfer mechanisms. A detailed molecular characterization, including techniques such as size exclusion chromatography, MALDI-TOF mass spectrometry, and (1)H, (13)C, (31)P NMR and UV-vis spectroscopies, afforded quantitative information about the composition of the copolymers as well as the average distribution of the AQ and ?-O-4 groups in the macromolecular structures. TGA and DSC thermal analysis have indicated that the copolymers were thermally stable under regular pulping conditions, revealing the inertness of the styrene polymer backbone in the investigation of electron transfer mechanisms. Alkaline pulping experiments showed that close contact between the redox active side chains in the copolymers was fundamental for an efficient degradation of the ?-O-4 lignin model units, highlighting the importance of electron transfer reactions in the lignin degradation mechanisms catalyzed by AQ. In the absence of glucose, AQ units oxidized phenolic ?-O-4 lignin model parts, mainly by electron transfer leading to vanillin as major product. By contrast, in presence of glucose, anthrahydroquinone units (formed by reduction of AQ) reduced the quinone-methide units (issued by dehydration of phenolic ?-O-4 lignin model part) mainly by electron transfer leading to guaiacol as major product. Both processes were distance dependent. PMID:22530612

Megiatto, Jackson D; Cazeils, Emmanuel; Ham-Pichavant, Frédérique; Grelier, Stéphane; Gardrat, Christian; Castellan, Alain

2012-05-14

46

Current Trends in the Management of Difficult Urinary Catheterizations  

Directory of Open Access Journals (Sweden)

Full Text Available Routine urinary catheter placement may cause trauma and poses a risk of infection. Male catheterization, in particular, can be difficult, especially in patients with enlarged prostate glands or other potentially obstructive conditions in the lower urinary tract. Solutions to problematic urinary catheterization are not well known and when difficult catheterization occurs, the risk of failed catheterization and concomitant complications increase. Repeated and unsuccessful attempts at urinary catheterization induce stress and pain for the patient, injury to the urethra, potential urethral stricture requiring surgical reconstruction, and problematic subsequent catheterization. Improper insertion of catheters also can significantly increase healthcare costs due to added days of hospitalization, increased interventions, and increased complexity of follow-up evaluations. Improved techniques for catheter placement are essential for all healthcare personnel involved in the management of the patient with acute urinary retention, including attending emergency physicians who often are the first physicians to encounter such patients. Best practice methods for blind catheter placement are summarized in this review. In addition, for progressive clinical practice, an algorithm for the management of difficult urinary catheterizations that incorporates technology enabling direct visualization of the urethra during catheter insertion is presented. This algorithm will aid healthcare personnel in decision making and has the potential to improve quality of care of patients.

Paul A Willette

2012-12-01

47

Tough Choices in Difficult Times.  

Science.gov (United States)

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…

Scheer, Sage Ann

2002-01-01

48

Adaptation of Pseudomonas aeruginosa to various conditions includes tRNA-dependent formation of alanyl-phosphatidylglycerol.  

Science.gov (United States)

The opportunistic bacterium Pseudomonas aeruginosa synthesizes significant amounts of an additional phospholipid, identified as 2' alanyl-phosphatidylglycerol (A-PG), when exposed to acidic growth conditions. At pH 5.3 A-PG contributed up to 6% to the overall lipid content of the bacterium. Sequence analysis of P. aeruginosa revealed open reading frame PA0920 showing 34% sequence identity to a protein from Staphylococcus aureus involved in tRNA-dependent formation of lysyl-phosphatidylglycerol. The P. aeruginosa deletion mutant DeltaPA0920 failed to synthesize A-PG. Heterologous overproduction of PA0920 in Escherichia coli resulted in the formation of significant amounts of A-PG, otherwise not synthesized by E. coli. Consequently, the protein encoded by PA0920 was named A-PG synthase. The enzyme was identified as an integral component of the inner membrane. The protein was partially purified by detergent solubilization and subjected to an in vitro activity assay. tRNA(Ala)-dependent catalysis was demonstrated. Transcriptional analysis of the corresponding gene in P. aeruginosa using lacZ reporter gene fusion under various pH conditions indicated a 4.4-fold acid-activated transcription. A phenotype microarray analysis was used to identify further conditions for A-PG function. PMID:19087229

Klein, Stefanie; Lorenzo, Carlos; Hoffmann, Sonja; Walther, Johannes M; Storbeck, Sonja; Piekarski, Tanja; Tindall, Bryan J; Wray, Victor; Nimtz, Manfred; Moser, Jürgen

2009-02-01

49

Clostridium difficile phages: still difficult?  

Directory of Open Access Journals (Sweden)

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.

MarthaRebecca JaneClokie

2014-04-01

50

Solving difficult hepatobiliary problems in children  

Scientific Electronic Library Online (English)

Full Text Available SciELO South Africa | Language: English Abstract in english 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.

A J W, Millar.

51

Difficult intubation--when can we predict it?  

Directory of Open Access Journals (Sweden)

Full Text Available Anaesthetists at times encounter difficult intubation in an apparently normal individual in spite of using the best possible positioning and most profound relaxation. This study was carried out to find out the most simple and easy measurement that may predict a difficult intubation. The study was conducted in three groups of patients of twenty each. The first group consisted of patients in whom intubation was easy. Second group consisted of anticipated difficult intubation. Cases in whom very difficult intubation was encountered were analyzed retrospectively and were included in third group. An attempt has been made to predict difficult intubation with the roentgenographic study of lateral view of mandible along with the measurement of distance from chin to thyroid cartilage. Of all the parameters, ratio of effective mandibular length to posterior mandibular depth and distance from chin to thyroid cartilage were found to be important to predict difficult intubation.

Kamath S

1991-01-01

52

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

53

Pulmonary rehabilitation program including respiratory conditioning for chronic obstructive pulmonary disease (COPD): Improved hyperinflation and expiratory flow during tidal breathing  

Science.gov (United States)

Background Pulmonary rehabilitation has generally relieved symptoms, strengthened exercise endurance and improved health-related quality of life (QOL) in patients with COPD, but recovery of pulmonary function remains questionable. This analysis of our innovative rehabilitation program is directed at documenting changes in patients’ expiratory airflow limitation, pulmonary symptoms and QOL. This program is designed to provide “respiratory conditioning”, a physical therapist-assisted intensive flexibility training that focuses on stretching and rib cage mobilization. Methods Thirty-one patients with COPD who attended rehabilitation sessions at Juntendo University Hospital from 1999 to 2006 were analyzed. Pulmonary function, expiratory flow limitation during tidal breathing, six minute walk distance (6MWD), respiratory muscle strength, and St. George Respiratory Questionnaire (SGRQ) were measured before and after pulmonary rehabilitation. Results In participants ages 68±7 years, the FEV1% predicted was 39.3±15.7%. 6MWD, SGRQ and respiratory muscle strength were significantly improved after pulmonary rehabilitation. Although neither FEV1% predicted nor FEV1/FVC was affected to a significant extent, indicating little effect on airflow limitation, expiratory flow limitation in supine as well as seated during tidal breathing improved significantly. Moreover, rehabilitation significantly diminished TLC% predicted, FRC% predicted, RV% predicted and RV/TLC values, thus indicating a reduction of hyperinflation of the lungs at rest. Conclusions The present results suggest that our rehabilitation program with respiratory conditioning significantly lowered the hyperinflation of lungs at rest as well as the expiratory flow limitation during tidal breathing. In patients with COPD, overall pulmonary function improved, exercise endurance increased and health-related QOL was enhanced. PMID:22754664

Ueki, Jun; Seyama, Kuniaki; Takizawa, Makiko; Yamaguchi, Seiko; Kitahara, Eriko; Fukazawa, Shinji; Takahama, Yukiko; Ichikawa, Masako; Takahashi, Kazuhisa; Fukuchi, Yoshinosuke

2012-01-01

54

Correlates of Difficult Temperament in Infancy.  

Science.gov (United States)

Examines possible correlates of difficult temperament by testing 152 adopted and 120 nonadopted infants at 12 and 24 months. Finds no significant relationships between parental reports of difficult temperament and other aspects of infant development, the home environment, or parental personality. Questions the utility of the construct of difficult…

Daniels, Denise; And Others

1984-01-01

55

Difficult treatment decisions in autoimmune hepatitis  

Directory of Open Access Journals (Sweden)

Full Text Available Treatment decisions in autoimmune hepatitis are complicated by the diversity of its clinical presentations, uncertainties about its natural history, evolving opinions regarding treatment end points, varied nature of refractory disease, and plethora of alternative immunosuppressive agents. The goals of this article are to review the difficult treatment decisions and to provide the bases for making sound therapeutic judgments. The English literature on the treatment problems in autoimmune hepatitis were identified by Medline search up to October 2009 and 32 years of personal experience. Autoimmune hepatitis may have an acute severe presentation, mild inflammatory activity, lack autoantibodies, exhibit atypical histological changes (centrilobular zone 3 necrosis or bile duct injury, or have variant features reminiscent of another disease (overlap syndrome. Corticosteroid therapy must be instituted early, applied despite the absence of symptoms, or modified in an individualized fashion. Pursuit of normal liver tests and tissue is the ideal treatment end point, but this objective must be tempered against the risk of side effects. Relapse after treatment withdrawal requires long-term maintenance therapy, preferably with azathioprine. Treatment failure or an incomplete response warrants salvage therapy that can include conventional medications in modified dose or empirical therapies with calcineurin inhibitors or mycophenolate mofetil. Liver transplantation supersedes empirical drug therapy in decompensated patients. Elderly and pregnant patients warrant treatment modifications. Difficult treatment decisions in autoimmune hepatitis can be simplified by recognizing its diverse manifestations and individualizing treatment, pursuing realistic goals, applying appropriate salvage regimens, and identifying problematic patients early.

Albert J Czaja

2010-02-01

56

Extended PCR conditions to reduce drop-out frequencies in low template STR typing including unequal mixtures.  

Science.gov (United States)

Forensic laboratories employ various approaches to obtain short tandem repeat (STR) profiles from minimal traces (Identifiler(®) amplification parameters are changed to an annealing time of 20 min during all 28 cycles, the drop-out frequency is reduced for both pristine DNA and single or multiple donor mock case work samples. In addition, increased peak heights and slightly more drop-ins are observed while the heterozygous peak balance remains similar as with the conventional Identifiler protocol. By this extended protocol, full DNA profiles were obtained from only 12 sperm heads (which corresponds to 36 pg of DNA) that were collected by laser micro dissection. Notwithstanding the improved detection, allele drop-outs do persist, albeit in lower frequencies. Thus a LT interpretation strategy such as deducing consensus profiles from multiple independent amplifications is appropriate. The use of extended PCR conditions represents a general approach to improve detection of unequal mixtures as shown using four commercially available kits (AmpF?STR(®) Identifiler, SEfiler Plus, NGM and Yfiler). The extended PCR protocol seems to amplify more of the molecules in LT samples during PCR, which results in a lower drop-out frequency. PMID:21454145

Weiler, Natalie E C; Matai, Anuska S; Sijen, Titia

2012-01-01

57

Current Trends in the Management of Difficult Urinary Catheterizations  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Routine urinary catheter placement may cause trauma and poses a risk of infection. Male catheterization, in particular, can be difficult, especially in patients with enlarged prostate glands or other potentially obstructive conditions in the lower urinary tract. Solutions to problematic urinary catheterization are not well known and when difficult catheterization occurs, the risk of failed catheterization and concomitant complications increase. Repeated and unsuccessful attempts at urinary ca...

Willette, Paul A.; Coffield, Scott K.

2012-01-01

58

Difficult patients: their construction in group therapy.  

Science.gov (United States)

Written from the perspective of intersubjective theory, this article addresses how the leader and group members co-construct the difficult patient. Too often, therapists and patients have tended to attribute difficulties in therapy groups to "the difficult patient" without appreciating how they themselves contribute to the construction, the needs this construction serves, and the potential value of such patients to the group. Mistakes in group leadership, vicissitudes of intersubjectivity, disturbing intrapsychic defenses, and whole-group dynamics interact to produce the difficult patient. Also discussed is the group member who is difficult but who no longer meets the criteria for patienthood. By exploring the factors involved in the co-construction of the difficult patient, the authors hope to guide clinicians in the deconstruction of such impediments, thus allowing the difficult patient to become "just another group patient." PMID:9661312

Gans, J S; Alonso, A

1998-07-01

59

Thermal power stations in the interplay of difficult boundary conditions  

International Nuclear Information System (INIS)

Thermal power stations must be reliable, economic and harmless to the environment, and must supply process steam and heat, separate or combined. The author investigates how requirements for supply reliability, and from acceptance tests, aims of energy policy and protective measures required by the public for the environment, have an effect. He discusses in detail heat consumption and generation costs in dependence on the thermodynamic arrangement, in the case exhaust-gas desulphurisation and with different cooling systems, as well as the effects of different fuel prices, and the generation costs of bituminous-coal and nuclear power stations. (orig.)

60

Navigating the Difficult Robotic Assisted Pyeloplasty  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Pyeloplasty is the gold standard therapy for ureteropelvic junction obstruction. Robotic assisted pyeloplasty has been widely adopted by urologists with and without prior laparoscopic pyeloplasty experience. However, difficult situations encountered during robotic assisted pyeloplasty can significantly add to the difficulty of the operation. This paper provides tips for patient positioning, port placement, robot docking, and intraoperative dissection and repair in patients with the difficult ...

Thiel, David D.

2012-01-01

 
 
 
 
61

Guide for Operational Configuration Management Program including the adjunct programs of design reconstitution and material condition and aging management. Part 2  

Energy Technology Data Exchange (ETDEWEB)

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.

1993-11-01

62

Factors associated with difficult neuraxial blockade  

Directory of Open Access Journals (Sweden)

Full Text Available Tomislav Ružman,1,2 Danijela Gulam,1,2 Ivana Haršanji Drenjan?evi?,1,2 Darija Venžera-Azeni?,1 Nataša Ružman,3 Jelena Burazin3 1Department of Anesthesiology, Resuscitation, and Intensive Care Unit, University Hospital Osijek, 2Faculty of Medicine, University of Osijek, 3Institute of Public Health for Osijek-Baranya County, Osijek, Croatia Abstract: Spinal and epidural blocks are common practice in anesthesia and are usually used for various surgical or endoscopic procedures. Correct identification and puncture of the epidural or subarachnoid space determine the success or failure of the technique. Multiple attempts and difficult access to the epidural or subarachnoid space is a frequent problem in operating theaters and may be hazardous due to a number of possible acute or long-term complications. In addition, multiple punctures are associated with increased pain and patient discomfort. The aim of this study was to determine the factors associated with a difficult spinal or epidural block, dependent on the patient (age, gender, height, weight, body mass index, and quality of anatomical landmarks, the technique (type of blockade, needle gauge, and patient positioning, and the provider (level of experience. The study was conducted at the Department of Anesthesiology, Resuscitation, and Intensive Care Unit of University Hospital Osijek (Osijek, Croatia and it included 316 patients who underwent a range of different surgical procedures in neuraxial blocks. There were 219 cases of first puncture success, while the overall success of neuraxial blocks was 97.5%. Five patients (1.6% were submitted to the alternative technique, ie, general anesthesia. In three patients (0.9%, neuraxial block was partial so they required supplementation of intravenous anesthetics and analgesics. Furthermore, it was found that first puncture success was associated with younger age (P=0.007, lower weight (P=0.032, and body mass index (P=0.020. Spine deformity (P=0.015, poor identification of interspinous space (P=0.005, recumbent patient position during the puncture (P=0.001, and use of a paramedian approach were associated with first puncture failure. Adequate preoperative prediction of difficulties can help to reduce the incidence of multiple attempts, rendering the technique more acceptable and less risky to the patient, and consequently leading to improvement of medical care quality. The attending anesthesiologist should consider an alternative technique (general anesthesia or peripheral nerve block for a patient if certain difficulties can be predicted. Keywords: spinal anesthesia, epidural anesthesia, difficulty, first punctures success

Ružman T

2014-10-01

63

Innovation and the difficult gallbladder: tread lightly.  

Science.gov (United States)

Innovation has advanced the treatment of biliary disease significantly, but further progress is needed to improve safety. An uncommonly used technique is described, which could potentially prevent serious complications for the difficult gallbladder. PMID:25435297

Margulies, Daniel R

2014-12-01

64

Difficult asthma and its treatment in pediatrics  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Difficult asthma which constitutes less than 5% of all childhood asthma cases is defined as presence of daily symptoms, frequent oral corticosteroid requirement and frequent exacerbations for longer than six months, despite the use of inhaled steroid equivalent to 500 mcg fluticasone propionate, long acting beta 2 agonist or theophylline and leukotriene antagonists. Difficult asthma is not expected in childhood due to the absence of remodelling, rapid restoration of the airway, use of efficac...

Hasan Yüksel

2010-01-01

65

Having Difficult Conversations: The Advanced Practitioner's Role.  

Science.gov (United States)

Throughout the course of their disease, patients with cancer and their families look to the oncology advanced practitioner (AP) for support and guidance as they struggle with the emotional impact of a life-limiting illness, complex treatment decisions, and the challenge of sustaining hope while maintaining realistic goals. At various points along the disease trajectory, difficult conversations between the AP and the patient are essential. In this case report of a 43-year-old woman with metastatic breast cancer, we model the use of various strategies available for the AP to help make these difficult conversations as productive, relevant, and emotionally safe for the patient as possible. PMID:25031980

Svarovsky, Therese

2013-01-01

66

Medical Students' Personal Determinants of Overcoming Strategies in Difficult Situations  

Directory of Open Access Journals (Sweden)

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.

Veretelnikova Yu.Ya.

2013-03-01

67

Difficult asthma and its treatment in pediatrics  

Directory of Open Access Journals (Sweden)

Full Text Available Difficult asthma which constitutes less than 5% of all childhood asthma cases is defined as presence of daily symptoms, frequent oral corticosteroid requirement and frequent exacerbations for longer than six months, despite the use of inhaled steroid equivalent to 500 mcg fluticasone propionate, long acting beta 2 agonist or theophylline and leukotriene antagonists. Difficult asthma is not expected in childhood due to the absence of remodelling, rapid restoration of the airway, use of efficacious inhaled techniques and steroids and absence of occupational exposures. Therefore, it may be thought that “pediatric difficult asthma” is a differential diagnosis and treatment adherence problem. It has been shown that difficult asthma cases that have been filtered from this aspect have a non-eosinophilic inflammatory phenotype characterized by defective beta 2 receptor responses and high steroid resistance. Increased thickness of the basal membrane supports the view that dysfunctional mechanisms play a more important role than inflammatory mechanisms. Environmental control and elimination of risk factors should be achieved in these cases and proper education for treatment modalities and inhalation techniques need to be provided. (Turk Arch Ped 2010; 45: 80th Year: 1-5

Hasan Yüksel

2010-05-01

68

Qualitative analysis of unanticipated difficult airway management  

DEFF Research Database (Denmark)

Unanticipated difficult airway management (DAM) is a major challenge for the anaesthesiologist and is associated with a risk of severe patient damage. We analysed 24 cases of unanticipated DAM for actual case management and anaesthesiologists knowledge, technical and non-technical skills. Anaesthesiologists' opinions, as well as environmental factors of importance for DAM proficiency, were also assessed.

Rosenstock, C; Hansen, E G

2006-01-01

69

PRAISE: Christians Educators and the Difficult Student  

Directory of Open Access Journals (Sweden)

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.

Beth E. Ackerman

2008-05-01

70

Resistance, Reactance, and the Difficult Client.  

Science.gov (United States)

Describes effect of client resistance and reactance in counseling and methods for assessing these phenomena. Conceptualizes client symptoms as ego-syntonic, where symptom is consonant with client's self-image, or ego-dystonic, where it is not. Uses concepts in deriving counseling strategies for working with difficult clients according to model…

Dowd, E. Thomas; Sanders, Daniel

1994-01-01

71

Difficult airway management and the novice physician  

Directory of Open Access Journals (Sweden)

Full Text Available Background: Selection of the ideal airway device in patients with difficult airways (DA or potentially difficult airways remains controversial, especially, for a novice anesthesia physician (NP who must deviate from conventional direct laryngoscopy with a rigid laryngoscope following a failed intubation and employ one of the several alternative devices. The author determines and compares tracheal intubation success rates, times to success and complications of a novice physician using four alternative airway devices in 20 obese (BMI more than 27.5 patients who may be more difficult to intubate than normal weight patients. Materials and Methods: In this prospective randomized experimental study the author investigates a novice physician?s use of the Bullard™, Fiberoptic™, Fastrach™and Trachlight™ comparing reliability, rapidity and safety of orotracheal intubations. Following induction of anesthesia the NP was allowed up to a maximum of two attempts per device at oral intubation. Mean intubation times plus/minus SD, per cent success rates and postoperative complications were evaluated for each device. Results: The Fastrach™ was successful 100% of the time on the first attempt requiring a mean time of 55 seconds plus/minus 6.6. All intubations were unsuccessful following two attempts with the Fiberoptic™. A success rate of 20% (one of five was achieved with the Trachlight™ on first attempt after 95 seconds. The Bullard™ was successful in 40 % (two of five of the patients after a mean time 60 seconds plus/minus five, but was the only device to result in mild oral discomfort one day post operatively. Conclusions: In the hands of a novice physician managing a difficult or potentially difficult airway, often encountered in obese patients, the Fastrach™ demonstrated the highest success rate.

Aikins Noble

2010-01-01

72

Recent advances in endoscopic management of difficult bile duct stones.  

Science.gov (United States)

Endoscopic treatment is now recognized worldwide as the first-line treatment for bile duct stones. Endoscopic sphincterotomy combined with basket and/or balloon catheter is generally carried out for stone extraction. However, some stones are refractory to treatment under certain circumstances, necessitating additional/other therapeutic modalities. Large bile duct stones are typically treated by mechanical lithotripsy. However, if this fails, laser or electrohydraulic lithotripsy (EHL) is carried out under the guidance of conventional mother-baby cholangioscopy. More recently, direct cholangioscopy using an ultrathin gastroscope and the newly developed single-use cholangioscope system - the SpyGlass direct visualization system - are also used. In addition, extracorporeal shock wave lithotripsy has also been used for stone fragmentation. Such fragmentation techniques are effective in cases with impacted stones, including Mirizzi syndrome. Most recently, endoscopic papillary large balloon dilationhas been introduced as an easy and effective technique for treating large and multiple stones. In cases of altered anatomy, it is often difficult to reach the papilla; in such cases, a percutaneous transhepatic approach, such as EHL or laser lithotripsy under percutaneous transhepatic cholangioscopy, can be a treatment option. Moreover, enteroscopy has recently been used to reach the papilla. Furthermore, an endoscopic ultrasound-guided procedure has been attempted most recently. In elderly patients and those with very poor general condition, biliary stenting only is sometimes carried out with or without giving subsequent dissolution agents. PMID:23650878

Yasuda, Ichiro; Itoi, Takao

2013-07-01

73

Protection of mineral deposits - a way towards difficult compromises  

Science.gov (United States)

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.

Radwanek-B?k, Barbara; Nie?, Marek

2014-05-01

74

Integrated modeling of CO2 storage and leakage scenarios including transitions between super- and sub-critical conditions, and phase change between liquid and gaseous CO2  

Energy Technology Data Exchange (ETDEWEB)

Storage of CO{sub 2} in saline aquifers is intended to be at supercritical pressure and temperature conditions, but CO{sub 2} leaking from a geologic storage reservoir and migrating toward the land surface (through faults, fractures, or improperly abandoned wells) would reach subcritical conditions at depths shallower than 500-750 m. At these and shallower depths, subcritical CO{sub 2} can form two-phase mixtures of liquid and gaseous CO{sub 2}, with significant latent heat effects during boiling and condensation. Additional strongly non-isothermal effects can arise from decompression of gas-like subcritical CO{sub 2}, the so-called Joule-Thomson effect. Integrated modeling of CO{sub 2} storage and leakage requires the ability to model non-isothermal flows of brine and CO{sub 2} at conditions that range from supercritical to subcritical, including three-phase flow of aqueous phase, and both liquid and gaseous CO{sub 2}. In this paper, we describe and demonstrate comprehensive simulation capabilities that can cope with all possible phase conditions in brine-CO{sub 2} systems. Our model formulation includes: (1) an accurate description of thermophysical properties of aqueous and CO{sub 2}-rich phases as functions of temperature, pressure, salinity and CO{sub 2} content, including the mutual dissolution of CO{sub 2} and H{sub 2}O; (2) transitions between super- and subcritical conditions, including phase change between liquid and gaseous CO{sub 2}; (3) one-, two-, and three-phase flow of brine-CO{sub 2} mixtures, including heat flow; (4) non-isothermal effects associated with phase change, mutual dissolution of CO{sub 2} and water, and (de-) compression effects; and (5) the effects of dissolved NaCl, and the possibility of precipitating solid halite, with associated porosity and permeability change. Applications to specific leakage scenarios demonstrate that the peculiar thermophysical properties of CO{sub 2} provide a potential for positive as well as negative feedbacks on leakage rates, with a combination of self-enhancing and self-limiting effects. Lower viscosity and density of CO{sub 2} as compared to aqueous fluids provides a potential for self-enhancing effects during leakage, while strong cooling effects from liquid CO{sub 2} boiling into gas, and from expansion of gas rising towards the land surface, act to self-limit discharges. Strong interference between fluid phases under three-phase conditions (aqueous - liquid CO{sub 2} - gaseous CO{sub 2}) also tends to reduce CO{sub 2} fluxes. Feedback on different space and time scales can induce non-monotonic behavior of CO{sub 2} flow rates.

Pruess, K.

2011-05-15

75

Difficult treatment decisions in autoimmune hepatitis  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Treatment decisions in autoimmune hepatitis are complicated by the diversity of its clinical presentations, uncertainties about its natural history, evolving opinions regarding treatment end points, varied nature of refractory disease, and plethora of alternative immunosuppressive agents. The goals of this article are to review the difficult treatment decisions and to provide the bases for making sound therapeutic judgments. The English literature on the treatment problems in autoimmune hepat...

Czaja, Albert J.

2010-01-01

76

Difficult airway equipment: a survey of standards across metropolitan Perth.  

Science.gov (United States)

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

Alakeson, N; Flett, T; Hunt, V; Ramgolam, A; Reynolds, W; Hartley, K; Hegarty, M; von Ungern-Sternberg, B S

2014-09-01

77

Transaortic double valve replacement in difficult mitral valve exposure  

Directory of Open Access Journals (Sweden)

Full Text Available Adequate open exposure of the mitral valve is necessary to accomplish reconstruction or replacement of the diseased mitral valve apparatus. The technique employed by most cardiac surgeons for mitral valve access involves median sternotomy and vertical left atriotomy posterior to the interatrial sulcus. However, certain conditions can sometimes make this approach very difficult. Different approaches are discussed with particular emphasis on our case in which the transaortic double valve replacement have been performed.

?ukanovi? B.

2005-01-01

78

Chernobyl: Chronicle of difficult weeks [videorecording  

International Nuclear Information System (INIS)

1. Chernobyl : chronicle of difficult weeks. Shevchenko's film crew was the first in the disaster zone following the meltdown of the core of the Chernobyl nuclear power plant in 1986. They shot continuously for more than three months. Portions of the film are exposed with white blotches - a radiation leakage. The film demonstrates how authorities and volunteers dealt with the accident, shows the efforts to get the fire under control, to take care of patients with radiation injuries, and to evacuate about 100,000 inhabitants of the area. 2. The BAM zone : permanent residents. The Baikal-Amur Mainline (BAM) railroad in Siberia is called the longest monument to the stagnation of the Brezhnev years. The film shows the lives and fates of the people in contrast to the marches and songs praising the project

79

Corrosion in boilers with difficult fuels  

Energy Technology Data Exchange (ETDEWEB)

Waste-to-energy (WTE) plants may be considered power plants with 'difficult fuels'. The waste, biomass and processed waste, i.e. biogenic fuels, used by these plants present great challenges to process engineering due to the corrosion damage on heat transfer surfaces hit by the flue gas. The corrosion processes, which are generally influenced by the fuel properties, the firing system and the heat transfer in the boiler, have a direct impact on investment and maintenance costs, availability, and achievable energy efficiency in WTE plants. This contribution reviews the causes and mechanisms of this corrosion, giving a survey of the current research aimed at maximising energy efficiency and availability in WTE plants. (orig.)

Spiegel, Wolfgang; Herzog, Thomas; Magel, Gabriele; Mueller, Wolfgang; Schmidl, Werner [CheMin GmbH, Augsburg (Germany)

2011-05-15

80

A chemical kinetically based ignition delay correlation for iso-octane covering a wide range of conditions including the NTC region  

Energy Technology Data Exchange (ETDEWEB)

An ignition delay correlation has been developed for iso-octane based on the functional behavior exhibited by a detailed chemical kinetic mechanism. The correlation employs a traditional Arrhenius-based, power law formulation, {tau}=A{phi}{sup {alpha}}p{sup {beta}}{chi}{sub O{sub 2}}{sup {gamma}} x exp ({lambda}), including dependencies for equivalence ratio ({phi}), pressure (p) and oxygen percentage ({chi}{sub O2}). However the exponents for these parameters, {alpha}, {beta}, and {gamma}, respectively, are expressed as third-order polynomials with respect to temperature in order to capture changes in functionality seen across different regimes. At very low temperatures {alpha}, {beta}, and {gamma} are forced to a constant value, as seen within the mechanism. The activation energy term, {lambda}, is written as a combination of two quadratic expressions so that the behavior in the negative temperature coefficient (NTC) region can be captured. A pressure-dependent term is also included in the expression for {lambda} in order to reduce the activation energy at higher pressures in the NTC region due to increased low temperature reactivity, and the appearance of cool flame, or low temperature heat release (LTHR). The resulting expression contains 37 constants. The new correlation is applicable over a wide range of conditions and can be used for data comparisons and mechanism evaluation, as well as systems-level engineering simulations. In this work experimental data from rapid compression machines (RCM) and shock tubes (ST) are compared through normalizing features of the correlation, and the performance of a detailed kinetic mechanism is evaluated based on the functional behavior of the {alpha}, {beta}, {gamma} and {lambda} parameters. Six hundred and sixty-one (661) data points have been used to fit the 37 constants of the expression where the experimental conditions cover {phi}=0.2-2.0, p=1-60atm, {chi}{sub O{sub 2}} and T=650-2000 K. Data normalized through the correlation indicate a standard deviation of {+-}4%. Departures from the correlation can be attributed to an incomplete description of the functional dependencies, some inconsistencies with regard to diluent composition, experimental uncertainties, and facility-influenced phenomena. The experimental points have also been simulated using the LLNL detailed iso-octane mechanism, where the computed ignition delay times have been fit to the new correlation. Agreement and differences between the correlated experimental and simulation {alpha}, {beta}, {gamma} and {lambda} functions are highlighted, where it is noted that there is a substantial discrepancy concerning the increased low temperature chemistry at high pressure. Implications for future engine design are discussed. (author)

Goldsborough, S. Scott [Department of Mechanical Engineering, Marquette University, Milwaukee, WI 53201-1881 (United States)

2009-06-15

 
 
 
 
81

Rigid fibrescope Bonfils: use in simulated difficult airway by novices  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Background The Bonfils intubation fibrescope is a promising alternative device for securing the airway. We examined the success rate of intubation and the ease of use in standardized simulated difficult airway scenarios by physicians. We compared the Bonfils to a classical laryngoscope with Macintosh blade. Methods 30 physicians untrained in the use of rigid fibrescopes but experienced in airway management performed endotracheal intubation in an airway manikin (SimMan, Laerdal, Kent, UK with three different airway conditions. We evaluated the success rate using the Bonfils (Karl Storz, Tuttlingen, Germany or the Macintosh laryngoscope, the time needed for securing the airway, and subjective rating of both techniques. Results In normal airway all intubations were successful using laryngoscope (100% vs. 82% using the Bonfils (p Conclusion The Bonfils can be successfully used by physicians unfamiliar with this technique in an airway manikin. The airway could be secured with at least the same success rate as using a Macintosh laryngoscope in difficult airway scenarios. Use of the Bonfils did not delay intubation in the presence of a difficult airway. These results indicate that intensive special training is advised to use the Bonfils effectively in airway management.

Piepho Tim

2009-07-01

82

Breast screening technologists: When is a difficult case truly difficult and for whom?  

Science.gov (United States)

Each year almost all film readers in the UK Breast Screening Programme voluntarily read a set of difficult mammographic cases as a means of self-assessing their film reading skills. We set out to investigate what case characteristics, if any, actually constituted a 'difficult' or 'easy' case in the opinion of radiological experts. We also examined how UK Breast Screening personnel performed on those cases which the experts deemed were difficult, in order to build up a profile of the types of cases that provide film readers with the most problems. We examined two main elements of case diagnosis, case classification and case features and investigated if there were any group differences in terms of case difficulty and the percentage of incorrectly reported cases. Data from over 15 radiological experts and approximately 400 film readers were compared on 180 cases. Significant differences were found between the expert and screening populations (p < .05) in terms of these case characteristics. These data contribute to the understanding of just what constitutes a difficult case as considered by experts and other film-readers, with a view to elucidating the type of cases most appropriate for advanced mammographic training.

Scott, Hazel J.; Gale, Alastair G.

2005-04-01

83

Clinical situations associated with difficult-to-control hypertension.  

Science.gov (United States)

There is no doubt that patients with high blood pressure (BP) are at higher cardiovascular and death risk than those subjects whose BP levels are below the admitted normal threshold. However, most of the epidemiological surveys show that BP is uncontrolled in more than fifty percent of hypertensive subjects. There are several reasons that can justify this lack of hypertension control, some of them depending on the patient, such as therapeutic adherence, or some related to the doctor, due to therapeutic inertia or reluctance to increment the number and doses of antihypertensive drugs. Sometimes the efficacy or adverse effects related to the antihypertensive drugs underlie the uncontrolled hypertension. And, finally, there are some clinical conditions that are associated with difficult-to-control hypertension. Among them, comorbidities such as diabetes, obesity, obstructive sleep apnoea syndrome or chronic kidney disease, but also drug-related hypertension or resistant hypertension. In this article we review the epidemiology and the conditions which are related to poorly controlled hypertension and that can explain why hypertension may become difficult-to-treat. PMID:23389084

Oliveras, Anna; Schmieder, Roland E

2013-03-01

84

Fundraising in Difficult Economic Times: Best Practices  

Science.gov (United States)

Christian institutions of higher education, as with other American nonprofits, are under considerable financial stress. The purpose of this research, which included both a survey of development officers and conversations with a sample of CCCU presidents, vice presidents of development, or provosts, was to identify best practices in fundraising.…

Curry, Janel; Rodin, Scott; Carlson, Neil

2012-01-01

85

Enhanced Quantum Procedures that Resolve Difficult Problems  

CERN Document Server

A careful study of the classical/quantum connection with the aid of coherent states offers new insights into various technical problems. This analysis includes both canonical as well as closely related affine quantization procedures. The new tools are applied to several examples including: (1) A quantum formulation that is invariant under arbitrary classical canonical transformations of coordinates; (2) A toy model that for all positive energy solutions has singularities which are removed at the classical level when the correct quantum corrections are applied; (3) A fairly simple model field theory with nontrivial classical behavior that, when conventionally quantized, becomes trivial, but nevertheless finds a proper solution using the enhanced procedures; (4) A model of scalar field theories with nontrivial classical behavior that, when conventionally quantized, becomes trivial, but nevertheless finds a proper solution using the enhanced procedures; (5) A viable formulation of the kinematics of quantum gravi...

Klauder, John R

2012-01-01

86

Maxillofacial trauma patient: coping with the difficult airway  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Establishing a secure airway in a trauma patient is one of the primary essentials of treatment. Any flaw in airway management may lead to grave morbidity and mortality. Maxillofacial trauma presents a complex problem with regard to the patient's airway. By definition, the injury compromises the patient's airway and it is, therefore, must be protected. In most cases, the patient undergoes surgery for maxillofacial trauma or for other, more severe, life-threatening injuries, and securing the airway is the first step in the introduction of general anaesthesia. In such patients, we anticipate difficult endotracheal intubation and, often, also difficult mask ventilation. In addition, the patient is usually regarded as having a "full stomach" and has not been cleared of a C-spine injury, which may complicate airway management furthermore. The time available to accomplish the task is short and the patient's condition may deteriorate rapidly. Both decision-making and performance are impaired in such circumstances. In this review, we discuss the complexity of the situation and present a treatment approach.

Barak Michal

2009-05-01

87

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.

?.?. ??????

2010-01-01

88

Guide for Operational Configuration Management Program including the adjunct programs of design reconstitution and material condition and aging management. Part 1  

Energy Technology Data Exchange (ETDEWEB)

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.

1993-11-01

89

Development of a kinetic model, including rate constant estimations, on iodine and caesium behaviour in the primary circuit of LWR's under accident conditions  

International Nuclear Information System (INIS)

In this report, a kinetic model has been developed with the aim to try to reproduce the chemical phenomena that take place in a flowing system containing steam, hydrogen and iodine and caesium vapours. The work is divided into two different parts. The first part consists in the estimation, through the Activited Complex Theory, of the reaction rate constants, for the chosen reactions, and the development of the kinetic model based on the concept of ideal tubular chemical reactor. The second part deals with the application of such model to several cases, which were taken from the Phase B 'Scoping Calculations' of the Phebus-FP Project (sequence AB) and the SFD-ST and SFD1.1 experiments. The main conclusion obtained from this work is that the assumption of instantaneous equilibrium could be inacurrate in order to estimate the iodine and caesium species distribution under severe accidents conditions

90

Scar contracture of anterior tonsillar pillar leading to difficult intubation  

Science.gov (United States)

Unanticipated difficult intubations on the operation table have often tested all the anesthetists’ intubation skill. The understanding of the causative factor and accordingly using the correct instrument from the difficult intubation kit requires experience and thorough knowledge on the part of the anesthetist. We describe a case of difficult intubation due to scar contracture of anterior tonsillar pillar formed after a previous surgery.

Kapoor, Hemlata; Mokashi, Suhas

2014-01-01

91

A pacemaker powered by an implantable biofuel cell operating under conditions mimicking the human blood circulatory system--battery not included.  

Science.gov (United States)

Biocatalytic electrodes made of buckypaper were modified with PQQ-dependent glucose dehydrogenase on the anode and with laccase on the cathode and were assembled in a flow biofuel cell filled with serum solution mimicking the human blood circulatory system. The biofuel cell generated an open circuitry voltage, Voc, of ca. 470 mV and a short circuitry current, Isc, of ca. 5 mA (a current density of 0.83 mA cm(-2)). The power generated by the implantable biofuel cell was used to activate a pacemaker connected to the cell via a charge pump and a DC-DC converter interface circuit to adjust the voltage produced by the biofuel cell to the value required by the pacemaker. The voltage-current dependencies were analyzed for the biofuel cell connected to an Ohmic load and to the electronic loads composed of the interface circuit, or the power converter, and the pacemaker to study their operation. The correct pacemaker operation was confirmed using a medical device - an implantable loop recorder. Sustainable operation of the pacemaker was achieved with the system closely mimicking human physiological conditions using a single biofuel cell. This first demonstration of the pacemaker activated by the physiologically produced electrical energy shows promise for future electronic implantable medical devices powered by electricity harvested from the human body. PMID:23519144

Southcott, Mark; MacVittie, Kevin; Halámek, Jan; Halámková, Lenka; Jemison, William D; Lobel, Robert; Katz, Evgeny

2013-05-01

92

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

93

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)

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.

Andresen, Elisa, E-mail: Elisa.Andresen@uni-konstanz.de [University of Konstanz, Department of Biology, D-78457 Konstanz (Germany); Opitz, Judith, E-mail: Daniela.Opitz@uni-konstanz.de [University of Konstanz, Department of Biology, D-78457 Konstanz (Germany); Thomas, George, E-mail: George.Thomas@uni-konstanz.de [University of Konstanz, Department of Biology, D-78457 Konstanz (Germany); Stärk, Hans-Joachim, E-mail: Ha-Jo.Staerk@ufz.de [UFZ – Helmholtz Centre for Environmental Research, Department of Analytical Chemistry, Permoserstr. 15, D-04318 Leipzig (Germany); Dienemann, Holger, E-mail: Holger.Dienemann@smul.sachsen.de [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: Kerstin.Jenemann@smul.sachsen.de [Sächsisches Landesamt für Umwelt, Landwirtschaft und Geologie, Abteilung Wasser, Boden, Wertstoffe, Zur Wetterwarte 11, D-01109 Dresden (Germany); Dickinson, Bryan C., E-mail: Bryan.Dickinson@gmail.com [Harvard University, Department of Chemistry and Chemical Biology, 12 Oxford Street, Cambridge, MA 02138 (United States); Küpper, Hendrik, E-mail: Hendrik.Kuepper@uni-konstanz.de [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)

2013-10-15

94

Temperature and moisture conditions for life in the extreme arid region of the Atacama desert: four years of observations including the El Nino of 1997-1998  

Science.gov (United States)

The Atacama along the Pacific Coast of Chile and Peru is one of the driest and possibly oldest deserts in the world. It represents an extreme habitat for life on Earth and is an analog for life in dry conditions on Mars. We report on four years (September 1994-October 1998) of climate and moisture data from the extreme arid region of the Atacama. Our data are focused on understanding moisture sources and their role in creating suitable environments for photosynthetic microorganisms in the desert surface. The average air temperature was 16.5 degrees C and 16.6 degrees C in 1995 and 1996, respectively. The maximum air temperature recorded was 37.9 degrees C, and the minimum was -5.7 degrees C. Annual average sunlight was 336 and 335 W m(-2) in 1995 and 1996, respectively. Winds averaged a few meters per second, with strong fohn winds coming from the west exceeding 12 m s(-1). During our 4 years of observation there was only one significant rain event of 2.3 mm, which occurred near midnight local time. We suggest that this event was a rainout of a heavy fog. It is of interest that the strong El Nino of 1997-1998 brought heavy rainfall to the deserts of Peru, but did not bring significant rain to the central Atacama in Chile. Dew occurred at our station frequently following high nighttime relative humidity, but is not a significant source of moisture in the soil or under stones. Groundwater also does not contribute to surface moisture. Only the one rain event of 2.3 mm resulted in liquid water in the soil and beneath stones for a total of only 65-85 h over 4 years. The paucity of liquid water under stones is consistent with the apparent absence of hypolithic (under-stone) cyanobacteria, the only known primary producers in such extreme deserts.

McKay, Christopher P.; Friedmann, E. Imre; Gomez-Silva, Benito; Caceres-Villanueva, Luis; Andersen, Dale T.; Landheim, Ragnhild

2003-01-01

95

Implications of the KONVERGENCE Model for Difficult Cleanup Decisions  

Energy Technology Data Exchange (ETDEWEB)

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.

Piet, Steven James; Dakins, Maxine Ellen; Gibson, Patrick Lavern; Joe, Jeffrey Clark; Kerr, Thomas A; Nitschke, Robert Leon

2002-08-04

96

Penile Corporeal Reconstruction during Difficult Placement of a Penile Prosthesis  

Directory of Open Access Journals (Sweden)

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.

Sherif R. Aboseif

2008-11-01

97

Percutaneous transhepatic cholelithotripsy for difficult common bile duct stones.  

DEFF Research Database (Denmark)

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.

Stage, J G; Moesgaard, F

1998-01-01

98

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-users relative to other supply/transport options which may now be viable economic alternatives. figs

99

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)

100

Use of difficult signals at vertical sounding of an ionosphere  

Directory of Open Access Journals (Sweden)

Full Text Available In the real work questions of sounding of an ionosphere are considered by difficult signals. Efficiency of use of signals with big base on an alignment with signals with base about 1 is estimated. It is shown that when using difficult signals it is possible to lower significantly capacity at preservation of invariable level of permission.

Molostova S. V.

2013-01-01

 
 
 
 
101

Delivering Difficult News to Parents: Guidelines for School Counselors  

Science.gov (United States)

School counselors often have to give difficult news to parents, a process that can be stressful and troubling for everyone involved. While the reaction of each parent is unique, research indicates that many parents who have been given difficult news about their children feel that the information was delivered poorly. This article provides…

Auger, Richard W.

2006-01-01

102

Core indicators of nutritional state for difficult-to-sample populations.  

Science.gov (United States)

Previous expert working groups have concluded that common descriptors and measurements are needed for all types of population groups to provide improved and expanded coverage and comparable and compatible data among surveys monitoring the nutritional and dietary status of the U.S. population. This report summarizes the discussions of an ad hoc Expert Panel charged with identifying core indicators to assess the nutritional status of difficult-to-sample populations. Members of the Expert Panel had wide research experience including survey design, food security, food consumption, nutritional status, health-related conditions associated with nutritional status, and nutrition and public policy. The varied backgrounds of the Panel members led to consideration of the concept of core indicators of nutritional status from a broad perspective. Early in their discussions the Expert Panel recognized that public health officials and policymakers use information on nutritional status for the purposes of problem identification, program planning and resource direction, and program and policy evaluation. This recognition raised several issues which formed the conceptual framework for subsequent discussions, study conclusions, and research recommendations. These issues centered on the following concepts: the purpose for which data are used determines the suitability of indicators; the scope of information required varies for the purposes identified above; a broad range of indicators is needed to supply information useful for public policy decisions on nutrition; that is, assessment of the nutritional status of populations by measurement of dietary intakes of nutrients and anthropometric, biochemical, and clinical indices can provide only a portion of the information needed for these purposes in the United States; nutritional problems in the U.S. general population may signal some, but not all, anticipated nutritional concerns for difficult-to-sample populations; and, adequate coverage and suitable sampling methods are overriding concerns for obtaining interpretable data and appear to be a larger issue than suitable measures for nutritional assessment in the case of difficult-to-sample populations. Guided by consideration of these issues, the Expert Panel recognized that they could not provide a comprehensive design for the evaluation of nutritional status for all difficult-to-sample populations that would be appropriate for all public health and policy purposes. Therefore, the Expert Panel concentrated their discussions on enumeration of the various issues that must be considered in planning any effort to evaluate the nutritional concerns for such populations.(ABSTRACT TRUNCATED AT 400 WORDS) PMID:2243305

1990-11-01

103

The Difficult Chore of Measuring Coordination by EXAFS  

International Nuclear Information System (INIS)

Neither the theory nor the interpretation of Extended X-Ray-Absorption Fine-Structure (EXAFS) spectroscopy requires assumptions of crystalline symmetry or periodicity. As a result, EXAFS is a tool applied to a wide range of scientific disciplines and to a wide variety of experimental systems. A simple enumeration of the atoms in the coordination environment of the absorber is often the primary goal of an EXAFS experiment. There are, however, a number of pitfalls in the way of an accurate determination of coordination number (CN). These include statistical limitations of the EXAFS fitting problem, empirical effects due to sample preparation, and the assumptions made about the physical structure surrounding the absorber in the course of data analysis. In this paper we examine several of these pitfalls and their effects upon the determination of CN. Where possible, we offer suggestions for avoiding or mitigating the pitfalls. We hope this paper will help guide the general EXAFS practitioner through the difficult chore of accurately determining CN

104

Pet dander and difficult-to-control asthma: Therapeutic options.  

Science.gov (United States)

The prevalence of sensitization to cat and dog allergens is high in the general population and poses a challenge to the physician managing allergic asthma. Adequate allergen avoidance is difficult to achieve because of the physical characteristics of airborne animal allergens and patient noncompliance. Allergen-specific high-dose subcutaneous immunotherapy has shown benefit in cat-allergic patients with asthma and rhinoconjunctivitis, whereas the data for dog-allergic patients are not as convincing. Alternative immunotherapy approaches including the sublingual route or allergen-derived peptide-based immunotherapy remain experimental. Pharmacotherapy of pet-allergic asthmatic patients requires a stepwise approach following established asthma management guidelines. In addition to short-acting beta-agonists and inhaled corticosteroids, prophylactic antihistamines before anticipated pet exposure, the use of intranasal steroids, and the use of leukotriene antagonists may also be considered as adjunctive therapy in pet-allergic patients with asthma and/or allergic rhinitis. Omalizumab appears to have particular efficacy in pet allergen-induced asthma. Novel therapies such as Fcgamma-Fel d 1 chimeric proteins still have to be evaluated in the human setting. PMID:20929605

Ling, Morris; Long, Aidan A

2010-01-01

105

How libraries make tough choices in difficult times purposeful abandonment  

CERN Document Server

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

Stern, David

2013-01-01

106

Management of difficult airway by retrograde tracheal intubation  

International Nuclear Information System (INIS)

A case of difficult intubation is presented in a patient of adenoid carcinoma with a large right-sided facial defect. She was managed with radiotherapy and a myocutaneous flap reconstruction was done with retrograde tracheal intubation. (author)

107

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)

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.

Pruess, K.

2011-04-01

108

Difficult diagnoses in the skeletal radiology; Schwierige Diagnosen in der Skelettradiologie  

Energy Technology Data Exchange (ETDEWEB)

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.

Freyschmidt, Juergen [Klinikum Bremen-Mitte (Germany). Beratungsstelle und Referenz-Zentrum fuer Osteoradiologie

2013-11-01

109

How to optimally manage unhappy, anxious, and difficult patients.  

Science.gov (United States)

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

Malakouti, Mona; Brown, Gabrielle; Wang, Eva; Leon, Argentina; Koo, John

2014-01-01

110

Developing Difficult Dialogues: An Evaluation of Classroom Implementation  

Science.gov (United States)

The University of Missouri (MU) participated in the Ford Foundation's Difficult Dialogues Initiative (DDI) supporting faculty development projects at over 40 institutions of higher education from 2006-2010. This paper reports findings from an evaluation conducted with instructors who not only engaged in faculty development workshops but also…

Placier, Peggy; Kroner, Crystal; Burgoyne, Suzanne; Worthington, Roger

2012-01-01

111

Cultural Differences in Children's Emotional Reactions to Difficult Situations.  

Science.gov (United States)

Two studies examined beliefs about revealing emotion among children from Brahman, Tamang and American cultures. Findings indicated three distinct cultural patterns: Tamang were more likely to appraise difficult situations in terms of shame, while the others endorsed anger. Brahmins were more likely not to communicate negative emotion. Americans…

Cole, Pamela M.; Bruschi, Carole J.; Tamang, Babu L.

2002-01-01

112

Social support and support of children in difficult situations  

Directory of Open Access Journals (Sweden)

Full Text Available The article describes the results of sociological investigation. It is devoted to the problem of social assistance for the children in difficult life situation. Social accompaniment and social support are very important either for the children or their families.

Lavrenova T. I.

2011-09-01

113

Difficult intubation due to chronic hiccup: a case report  

Directory of Open Access Journals (Sweden)

Full Text Available Hiccup is described as a spasm of the diaphragm that causes a sudden inhalation followed by rapid closure of the glottis that produces a sound. Hiccup cause difficulties for medical procedures such as surgery, endoscopy or magnetic resonance imaging. In the literature, hiccup is presented as a situation that is seen due to anesthesia and most studies describe to manage anesthesia-related hiccup. The data about difficult intubation because of hiccup is lacking. Hereby, we present a case of difficult intubation due to chronic hiccup. The patient had a chronic hiccup associated with grade 3 esophagitis and hiatal hernia. Laparoscopic Nissen fundoplication and thoracoscopic phrenic nerve ablation was performed. Our patient was hiccupping during surgery. However, the severity and the frequency of the hiccup attacks were decreased after surgery.

Ismail Hakki Hamzaoglu

2011-01-01

114

Difficult factors in Management of Impacted Dental Prosthesis in Esophagus  

Directory of Open Access Journals (Sweden)

Full Text Available A dental prosthesis which ingested and impacted in esophagus, is an emergency case and life threatening, so require immediate esophagoscopy intervention for removing. The objective of this study is to assess some factors can caused dtfficulties in diagnosing and treating the ingested and impacted dental prosthesis in the esophagus and their complications. This retrospective study analyzed patient’s chart whose underwent esophagoscopy for removing the impacted dental prosthesis in Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia during a period between January 1997 and December 2003. Neck-chest X-ray and esophagoscopy were performed in all patients to identify the existence of the dental prosthesis as a diagnostic and treatment procedure. The length of time for removing the dental prosthesis was recorded and stated as a less difficult esophagoscopy when it takes time less than 60 minutes and as a difficult  esophagoscopy takes 60 minutes or longer. Some risk difficulties factors were statistically analyzed. There were 53 patients of ingested dental prosthesis in esophagus. Only 51 cases were analyzed According to the length of time for removing the dental prosthesis by esophagoscopy, 22 patients were recorded as less difficult cases and 29 patients as difficult cases. Two cases among the cases needed cervicotomy after unsuccessful esophagoscopy removal. The difficulties to diagnose an impacted dental prosthesis in the esophagus caused by unreliable clinical history, unclear signs and symptoms, unable to be detected by X-ray and was not found during esophagoscopy. The difficulties in treating due to mucosal laceration, edema, bleeding, failure of the first extraction and conformity with the size and shape, the wire outside the dental prosthesis and the length of time stayed in the esophagus. (Med J Indones 2005; 14: 33-6Keywords: ingested dental prosthesis, radioluscent foreign body, length of time of esophagoscopy

Efiaty A. Soepardi

2005-02-01

115

An improved method to spot-weld difficult junctions  

Science.gov (United States)

Recent advances in spot-welding technology such as high frequency direct current inverter welders provide an improved and reproducible method to spot-weld difficult junctions. The importance of removing the oxide layers on metal surfaces, accurately delivering the weld pulse profile, and controlling the force applied to the materials during the welding process are discussed in the context of resistance spot-welding a molybdenum crystal to a tantalum loop and attaching a tungsten-rhenium thermocouple to the crystal.

Ferrenz, Elizabeth E.; Amare, Andinet; Arumainayagam, Christopher R.

2001-12-01

116

Difficult airway equipment in departments of emergency medicine in Ireland: results of a national survey.  

LENUS (Irish Health Repository)

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.

Walsh, K

2012-02-03

117

Legal issues when a doctor's relationship with a "difficult" patient breaks down.  

Science.gov (United States)

The legal duties of a doctor attending a "difficult" patient with a serious condition do not end at the last consultation, especially in a small rural community. Doctors have a continuing obligation to ensure that the patient's health is not impaired because the clinical relationship has ended. This article suggests some steps that a doctor could take to fulfil the legal obligation in such a case. PMID:25222461

Skene, Loane L C

2014-09-15

118

Cystic hygroma: A difficult airway and its anaesthetic implications  

Digital Repository Infrastructure Vision for European Research (DRIVER)

A 2-month-old child presented with gross and huge swelling on the left side of the neck with difficulty in feeding. It was diagnosed to be cystic hygroma and a decision was made to excise the swelling to enable the child thrive better. Difficult intubation was anticipated and the child was intubated with inhalation induction. The intra-operative period was smooth and the tumour was excised completely. Post-operatively, it was decided to ventilate the child because of airway difficulties.

Gurulingappa; Awati, M. N.; Aleem, Md Asif

2011-01-01

119

Occupational medicine and the construction of "difficult reputations".  

Science.gov (United States)

The creation of "difficult reputations" is a collective act of disparagement often undertaken to diminish the influence of the target individual or group for political reasons. This process can be observed in efforts to discredit the field of occupational medicine and the American College of Occupational and Environmental Medicine (ACOEM) by revising its history. Examples are given from Draper's 'The Company Doctor: Risk, Responsibility, and Corporate Professionalism' and LaDou, in which new sources of historical information do not support the allegations or impressions conveyed. This tendency is inimical to progress in occupational health in general and may be highly destructive to the field if not recognized and discouraged. PMID:18826878

Guidotti, Tee L

2008-01-01

120

Visual Impairment, Including Blindness  

Science.gov (United States)

... a primary information-gathering tool for children with visual impairments. So are the senses of smell, touch, taste, and hearing. Until the ... to the environment where a child with a visual impairment lives, works, or plays makes evident sense, but it may be difficult for families, daycare ...

 
 
 
 
121

Role of Anterior Neck Soft Tissue Quantifications by Ultrasound in Predicting Difficult Laryngoscopy  

Science.gov (United States)

Background The aim of this study was to determine if ultrasound (US) measurements of anterior neck soft tissue thickness at hyoid bone (DSHB), thyrohyoid membrane (DSEM), and anterior commissure (DSAC) levels can be used to predict difficult laryngoscopy. Material/Methods We included 203 patients age 20–65 years scheduled to undergo general anesthesia in this prospective observational study. Correlation analysis and receiver operating characteristic curve (ROC) analysis were used to determine the roles of screening tests [interincisor gap (IIG), thyromental distance (TMD), modified Mallampati score (MMS)] and US measurements (DSHB, DSEM, DSAC) in predicting difficult laryngoscopy. Results There were 28 out of 203 patients categorized as difficult laryngoscopy. DSHB, DSEM, DSAC, and MMS were greater in the difficult laryngoscopy group (P<0.0001). There was a strong positive correlation between DSEM and DSHB (r=0.74); moderate positive correlations between DSEM and DSAC (r=0.60), DSHB and DSAC (r=0.69); small positive correlations between MMS and DSHB (r=0.32), MMS and DSEM (r=0.27), MMS and DSAC (r=0.32), all P values ?0.0001; very small positive correlation between TMD and IIG (r=0.18, P=0.0089); small negative correlation between IIG and MMS (r=?0.27, P=0.0001); and very small negative correlations between MMS and TMD (r=?0.20, P=0.004), IIG and DSAC (r=?0.18, P=0.011), IIG and DSHB (r=?0.15, P=0.034). The areas under the ROC curve (AUCs) of MMS, DSHB, DSEM, and DSAC were significantly larger compared with the reference line (P<0.0001). Conclusions Anterior neck soft tissue thicknesses measured by US at hyoid bone, thyrohyoid membrane, and anterior commissure levels are independent predictors of difficult laryngoscopy. Combinations of those screening tests or risk factors with US measurements might increase the ability to predict difficult laryngoscopy. PMID:25403231

Wu, Jinhong; Dong, Jing; Ding, Yingchun; Zheng, Jijian

2014-01-01

122

Role of anterior neck soft tissue quantifications by ultrasound in predicting difficult laryngoscopy.  

Science.gov (United States)

Background The aim of this study was to determine if ultrasound (US) measurements of anterior neck soft tissue thickness at hyoid bone (DSHB), thyrohyoid membrane (DSEM), and anterior commissure (DSAC) levels can be used to predict difficult laryngoscopy. Material and Methods We included 203 patients age 20-65 years scheduled to undergo general anesthesia in this prospective observational study. Correlation analysis and receiver operating characteristic curve (ROC) analysis were used to determine the roles of screening tests [interincisor gap (IIG), thyromental distance (TMD), modified Mallampati score (MMS)] and US measurements (DSHB, DSEM, DSAC) in predicting difficult laryngoscopy. Results There were 28 out of 203 patients categorized as difficult laryngoscopy. DSHB, DSEM, DSAC, and MMS were greater in the difficult laryngoscopy group (Pvalues £0.0001; very small positive correlation between TMD and IIG (r=0.18, P=0.0089); small negative correlation between IIG and MMS (r=-0.27, P=0.0001); and very small negative correlations between MMS and TMD (r=-0.20, P=0.004), IIG and DSAC (r=-0.18, P=0.011), IIG and DSHB (r=-0.15, P=0.034). The areas under the ROC curve (AUCs) of MMS, DSHB, DSEM, and DSAC were significantly larger compared with the reference line (P<0.0001). Conclusions Anterior neck soft tissue thicknesses measured by US at hyoid bone, thyrohyoid membrane, and anterior commissure levels are independent predictors of difficult laryngoscopy. Combinations of those screening tests or risk factors with US measurements might increase the ability to predict difficult laryngoscopy. PMID:25403231

Wu, Jinhong; Dong, Jing; Ding, Yingchun; Zheng, Jijian

2014-01-01

123

Determination of difficult-to-measure actinides in evaporator concentrate  

International Nuclear Information System (INIS)

Radiochemical separation of americium, neptunium and plutonium was tested on model solution of evaporator concentrate sample for isolation of each of them for alpha-spectrometry analysis. A good chemical separation of radionuclides of interest from the matrix and interfering radionuclides is required, once the relatively small difference in alpha-particle energy makes it difficult to spectrometrically separate the peaks. This paper describes use of the molecular recognition technology product AnaLig®Pu-01 gel from IBC Advanced Technologies, Inc. to effectively and selectively pre-concentrate, separate and recover americium, neptunium and plutonium from model solution of evaporator concentrate samples from Nuclear Power Plant 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. (author)

124

How can schools build learning organisations in difficult education contexts?  

Directory of Open Access Journals (Sweden)

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.

Kholeka Constance Moloi

2010-01-01

125

Cylindrical plunge grinding of difficult to grind materials  

International Nuclear Information System (INIS)

Cylindrical plunge grinding processes of titanium alloy and nickel-base superalloys with various kinds of conventional grinding wheels, which are known as difficult to grind materials, are experimentally investigated, analyzing size generation process, grinding force, surface roughness, wheel wear, grinding ratio and so on. For grinding titanium alloy Ti-6Al-4V, GC grinding wheel yields most superior grinding results which leads to lower grinding force, smaller residual stock, less wheel wear and higher grinding ratio up to about 3 with GC 80 L 9 V wheel. Then, for grinding nickelbase superalloys Waspaloy and Rene 41, WA 150 L 9 V wheel yields better grinding results in surface roughness, wheel wear, grinding ratio without chatter vibration though grinding force is higher, and the grinding ratio about 3 is obtained. Furthermore, higher plunge speed and speed ratio result in higher grinding efficiency though grinding force, surface roughness, wheel wear increase for grinding titanium alloy and nickel-base superalloys. (author)

126

A Difficult Choice for Newspapers: Advertisers or Readers?  

Directory of Open Access Journals (Sweden)

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.

Bar?? Bulunmnaz

2012-03-01

127

Soft annealing: A new approach to difficult computational problems  

CERN Document Server

I propose a new method to study computationally difficult problems. I consider a new system, larger than the one I want to simulate. The original system is recovered by imposing constraints on the large system. I simulate the large system with the hard constraints replaced by soft constraints. I illustrate the method in the case of the ferromagnetic Ising model and in the case the three dimensional spin-glass model. I show that in both models the phases of the soft problem have the same properties as the phases of the original model and that the softened model belongs to the same universality class as the original one. I show that correlation times are much shorter in the larger soft constrained system and that it is computationally advantageous to study it instead of the original system. This method is quite general and can be applied to many other systems.

Jarvis, M J; Cohen, A S; Röttgering, H J A; Kassim, N E

2004-01-01

128

Performance specifications: the nearly impossible versus the merely difficult  

Science.gov (United States)

Affordability is the objective of acquisition reform. The institution of 'performance' specifications in lieu of 'design' specifications is a key strategy. Design of a cockpit display, for example, is left to the prime contractor based on a performance requirement stated by the government. The prime delegates to the integrator. The integrator develops the display and bill of materials provided by vendors. There is no feedback loop from the vendors to the ultimate customer, the government. As a result of this situation a communication gap exists: the government, primes, and integrators have concluded that they should pay commodity prices for custom displays. One step in the closing of this gap is the establishment of cross- cutting common reference performance specifications for aerospace and defense displays. The performance specification for cockpit displays is nearly impossible to achieve -- the last ounce of technology and more is required. Commodity markets, such as consumer notebook computers, are based on but a fraction of currently available technology -- companies 'bank' technology and roll it out across several 18-month product generations. Ruggedized consumer displays can be used in aerospace and defense applications other than the cockpit, such as mission crew stations. The performance specification for non-cockpit aerospace and defense applications is merely difficult. Acquisition reform has been defined by the Secretary of Defense to mean DoD should leverage the commercial market to the maximal extent possible. For the achievement of this end, an entirely different approach is wanted for cockpit displays versus large platform mission displays. That is, the nearly impossible requires a different design and business approach from the merely difficult.

Hopper, Darrel G.

2000-08-01

129

Usage of I++ Simulator to Program Coordinate Measuring Machines when Common Programming Methods are difficult to apply  

Science.gov (United States)

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

G?ska, A.; Szewczyk, D.; G?ska, P.; Gruza, M.; S?adek, J.

2014-02-01

130

Prediction is difficult, preparation is critical and possible  

DEFF Research Database (Denmark)

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.

MØller, Kristian

131

Fotodepilación: Áreas de difícil tratamiento / Photoepilation: treatment of difficult areas  

Scientific Electronic Library Online (English)

Full Text Available SciELO Spain | Language: Spanish Abstract in spanish La Fotodepilación, ha permitido ampliar las posibilidades de aumentar las indicaciones de la depilación; pero junto a ello, existen contraindicaciones, efectos secundarios y complicaciones a su uso que han ido delimitándose en función de los años de experiencia de esta técnica en su aplicación clíni [...] ca Al igual que con otras tecnologías, la fotodepilación debe tener en cuenta que existen casos con mayor dificultad de tratamiento según la localización, riesgos, tipo de pelo y la posible patología inductora del hirsutismo o hipertricosis. El objetivo de este trabajo es exponer aquellos casos en que por su localización se genera mayor dificultad en el tratamiento del pelo, así como de qué manera plantear las posibles alternativas a la fotodepilación a fin de obtener eficacia de resultados y bajas complicaciones. Se trata de localizaciones como el área de las cejas, área periocular, nasal, auricular , anal, escrotal, vulvar y otras zonas cutáneas de especial fragilidad, buscando la máxima eficacia del tratamiento y evitando efectos secundarios o complicaciones. Este artículo aborda las limitaciones de la técnica. Abstract in english Photoepilation has made it possible to broad the possibilities of increasing indications of epilation. But, at the same time, some contraindications, side effects and complications have delimited in accordance with the years of experience of this technique, its clinical application. As in other tech [...] nologies, photoepilation must take into account cases that are more difficult to treat, according to hair location, complications, skin type and possible associated pathology leading to hirutism of hypertrichosis. The aim of this paper is to present cases whose location leads to greater treatment difficulties as well as how to approach possible alternatives treatment in order to obtain good efficacy and few complications. Locations such as the eyebrows and periocular region, the nose, ears, anus, scrotum, vulva and prominent areas, must be regarded in photoepilation as being the most difficult ones to treat, in search of the highest efficacy, avoiding side effects and complications. This article deals with limitations of the tecnique.

M., Vélez González.

2010-06-01

132

Abatacept in difficult-to-treat juvenile idiopathic arthritis  

Directory of Open Access Journals (Sweden)

Full Text Available Jasmin B Kuemmerle-Deschner1, SM Benseler21Pediatric Rheumatology Clinics, Dept of Pediatrics, University Hospital Tübingen, Germany; 2Dept of Pediatric Rheumatology, The Hospital for Sick Children, Toronto, CanadaAbstract: Juvenile idiopathic arthritis (JIA is the most common chronic rheumatic disease in children and an important cause of short-term and long-term disability. Gene changes in the immune system can predispose to JIA and regulation of the immune system is crucial in the pathogenesis. The goal of therapy is complete disease control using disease-modifying antirheumatic drugs (DMARDS. Activated T-cells may play a role in the immunopathology of JIA. Therefore, targeting T-cell activation is a rational approach for the treatment of JIA. Abatacept (ABA, a selective co-stimulation modulator, has been shown to be effective in treating all JIA subtypes and is generally safe and well tolerated in JIA. Neutralizing antibodies were found in 6/9 (67% of seropositive patients, but anti-ABA antibodies did not appear to be associated with disease flare, serious adverse events, acute infusional adverse events, hypersensitivity, autoimmune disorders, or low ABA serum concentrations. Anti-ABA antibodies were more frequent when ABA concentrations were below therapeutic levels. Although information on ABA in JIA is still limited, available data suggest a potential role in difficult to treat JIA patients previously treated with other biologic agents and for non-responders to TNF-blockade.Keywords: abatacept, juvenile idiopathic arthritis (JIA, biologics

Jasmin B Kuemmerle-Deschner

2009-02-01

133

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)

134

QUALIFYING LEGACY BY PARTICULAR TITLE – A DIFFICULT TASK  

Directory of Open Access Journals (Sweden)

Full Text Available The current Civil Code in force, unlike the previous one, succeeds into making a clear and natural distinction between will – as a whole – and legacy – as the main testamentary provision. Unfortunately, it does not also provide flawless regulations in terms of the categories of legacies, which are classified according to their object (universal legacies, legacies by universal title and legacies by particular title. In what the legacy by universal title is concerned, the Civil Code in force contains some controversial provisions at article 1056 paragraph (2 letter c, which interfere also with the correct qualification of legacy by particular title. Then, the regulations of the legal regime applicable to the legatee by particular title also evince flaws, for instance at article 1114 article (3 letter b of the Civil Code, so that it becomes more and more difficult to qualify certain legacies, as being by particular or by universal title. The current work aims to point out the provisions of the Civil Code mentioned before, which generate or can generate potential controversies, but also to propose certain remedies.

Ilioara GENOIU

2014-06-01

135

QUALIFYING LEGACY BY PARTICULAR TITLE – A DIFFICULT TASK  

Directory of Open Access Journals (Sweden)

Full Text Available The current Civil Code in force, unlike the previous one, succeeds into making a clear and natural distinction between will – as a whole – and legacy – as the main testamentary provision. Unfortunately, it does not also provide flawless regulations in terms of the categories of legacies, which are classified according to their object (universal legacies, legacies by universal title, legacies by particular title. In what the legacy by universal title is concerned, the Civil Code in force contains some controversial provisions at article 1056 paragraph (2 letter c, which interfere also with the correct qualification of legacy by particular title. Then, the regulations of the legal regime applicable to the legatee by particular title also evince flaws, for instance at article 1114 article (3 letter b of the Civil Code, so that it becomes more and more difficult to qualify certain legacies, as being by particular or by universal title. The current work aims to point out the provisions of the Civil Code mentioned before, which generate or can generate potential controversies, but also to propose certain remedies.

Ilioara GENOIU

2014-05-01

136

Radionuclides difficult to measure in waste packages. Final report  

International Nuclear Information System (INIS)

In this study nuclide specific correlation analyses between key nuclides that can be easily measured and nuclides that are difficult to measure are presented. Data are taken from studies and data compilations from various countries. The results of this study can serve to perform assays of the nuclide specific radionuclide contents in waste packages by gamma measurements of 60Co and 137Cs and calculation of the contents of other nuclides via the correlation analyses, sometimes referred to as 'scaling factor method'. It can thus be avoided to have to take samples from the waste for separate analysis. An attempt is made to also investigate the physical and chemical backgrounds behind the proposed correlations. For example, a formation pathway common to the two nuclides to be correlated can be regarded as an explanation, if a good correlation is found. On the other hand, if the observed correlation is of poor quality, reasons may possibly lie in different behaviour of the two nuclides in the water system of the nuclear plant. This implies not only chemical solubility, transfer constants etc. in the water system, which would not only affect the proportionality between the two nuclides, but a different behavior in different parts of the water system must be assumed (e.g. different filter efficiencies etc). 47 refs, 57 figs, 40 tabs

137

The Difficult Empowerment in Danish Hospital: Power to the nurses!?  

DEFF Research Database (Denmark)

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.

Witt, Flemming; Nielsen, JØrn Flohr

2005-01-01

138

Percutaneous lithotripsy for removing difficult bile duct stones using endoscopy  

Energy Technology Data Exchange (ETDEWEB)

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.

Kim, See Hyung; Sohn, Chul Ho; Kim, Young Hwan [Dongsan Medical Center, Keimyung University College of Medicine, Daegu (Korea, Republic of)

2008-03-15

139

Radionuclides difficult to measure in waste packages. Final report  

Energy Technology Data Exchange (ETDEWEB)

In this study nuclide specific correlation analyses between key nuclides that can be easily measured and nuclides that are difficult to measure are presented. Data are taken from studies and data compilations from various countries. The results of this study can serve to perform assays of the nuclide specific radionuclide contents in waste packages by gamma measurements of {sup 60}Co and {sup 137}Cs and calculation of the contents of other nuclides via the correlation analyses, sometimes referred to as `scaling factor method`. It can thus be avoided to have to take samples from the waste for separate analysis. An attempt is made to also investigate the physical and chemical backgrounds behind the proposed correlations. For example, a formation pathway common to the two nuclides to be correlated can be regarded as an explanation, if a good correlation is found. On the other hand, if the observed correlation is of poor quality, reasons may possibly lie in different behaviour of the two nuclides in the water system of the nuclear plant. This implies not only chemical solubility, transfer constants etc. in the water system, which would not only affect the proportionality between the two nuclides, but a different behavior in different parts of the water system must be assumed (e.g. different filter efficiencies etc). 47 refs, 57 figs, 40 tabs.

Thierfeldt, S.; Deckert, A. [Brenk Systemplanung, Aachen (Germany)

1995-11-01

140

[Treatment of inguinal hernia in a difficult environment: feasibility and efficacy of ilioinguinal and iliohypogastric blocks].  

Science.gov (United States)

Hernia repair is a very frequent surgical procedure; it is estimated that one African in five undergoes this procedure during his lifetime. Patients and methods. We evaluated the feasibility of this surgery under ilioinguinal and iliohypogastric nerve blocks in difficult environments. The medical-surgical group supporting Operation Unicorn has treated 48 inguinal hernias as medical aid to population, including 34 with these nerve blocks. Results. The block did not fail in any case. The mean time until discharge was 6.85 h, which meant that outpatient surgery was possible. Discussion and conclusion. This type of anesthesia is interesting in difficult environments. It is a safe, inexpensive, and easy to learn technique. These qualities should promote its use in countries with a low GNP. PMID:23803581

Goutorbe, P; Lacroix, G; Pauleau, G; Daranda, E; Goin, G; Bordes, J; Meaudre, E; Balandraud, P

2013-05-01

 
 
 
 
141

Anti-reflux procedure for difficult-to-treat asthmatic children, case report and literature review  

Directory of Open Access Journals (Sweden)

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.

Hu Zhi-Wei

2012-09-01

142

Recknagel/Sprenger/Hoenmann: Pocket book for heating and air conditioning including service water heating and refrigeration engineering 92/93. Recknagel/Sprenger/Hoenmann: Taschenbuch fuer Heizung und Klimatechnik einschliesslich Warmwasser- und Kaeltetechnik 92/93  

Energy Technology Data Exchange (ETDEWEB)

The book comprises the following chapters: 1. Fundamentals of heating and air conditioning; 2. Heating engineering; 3. Ventilation and air conditioning engineering; 4. Service water heating; 5. Industrial forced ventilation systems; 6. Refrigeration engineering; 7. Appendix (laws, books, journals, associations, societies, schools, institutes, standards, legal regulations, etc.). (orig./HW) With 2082 figs., 356 tabs.

Schramek, E.R. (Dortmund Univ. (Germany)) (ed.)

1992-01-01

143

Recknagel/Sprenger/Hoenmann: Pocket book for heating and air conditioning including service water heating and refrigeration engineering 88/89. 64. ed. Recknagel/Sprenger/Hoenmann: Taschenbuch fuer Heizung und Klimatechnik einschl. Brauchwassererwaermung und Kaeltetechnik 88/89  

Energy Technology Data Exchange (ETDEWEB)

The book comprises the following chapters: 1. Fundamentals of heating and air conditioning; 2. Heating engineering; 3. Ventilation and air conditioning engineering; 4. Service water heating; 5. Industrial forced ventilation systems; 6. Refrigeration engineering; 7. Appendix (laws, books, journals, associations, societies, schools, institutes, standards, legal regulations, etc.). (orig./HW) With 2068 figs., 347 tabs.

Hoenmann, W. (ed.)

1987-01-01

144

The Difficult Way of Social Psychology in Russia  

Directory of Open Access Journals (Sweden)

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.

Galina M. Andreeva

2009-01-01

145

Riedel's goitre - rare and difficult to diagnose reason  

International Nuclear Information System (INIS)

w-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)

146

Optimization of difficult cycles of ship gas-turbine installations  

Directory of Open Access Journals (Sweden)

Full Text Available Possibilities to increase in specific work and effective efficiency of a complex thermodynamic cycle of ship gas-turbine installations with one-stage intermediate cooling and regeneration of heat of exhausted gases are considered in the paper. Necessary conditions for this purpose are described: additional intermediate heating, achievement of an optimum degree of pressure increase and optimum degree of regeneration.

Ivanov Vadim Aleksandrovich

2011-12-01

147

Optimization of difficult cycles of ship gas-turbine installations  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Possibilities to increase in specific work and effective efficiency of a complex thermodynamic cycle of ship gas-turbine installations with one-stage intermediate cooling and regeneration of heat of exhausted gases are considered in the paper. Necessary conditions for this purpose are described: additional intermediate heating, achievement of an optimum degree of pressure increase and optimum degree of regeneration.

Ivanov Vadim Aleksandrovich

2011-01-01

148

Interstitial ectopic pregnancy: A rare and difficult clinicosonographic diagnosis  

Directory of Open Access Journals (Sweden)

Full Text Available Ectopic pregnancy in the interstitial part of the fallopian tube is a rare event. This condition presents a challenge for clinical as well as radiological diagnosis. Although routine two-dimensional ultrasound can be suggestive, three-dimensional ultrasound is highly accurate in diagnosis. Hence, the authors report a rare case of interstitial ectopic pregnancy diagnosed preoperatively by three-dimensional ultrasound and managed laparoscopically.

Rastogi R

2008-01-01

149

Cardiac tamponade--still a difficult clinical diagnosis.  

Science.gov (United States)

A 51-year-old man with multiple risk factors for ischaemic heart disease attended the emergency department (ED) with sudden-onset chest pain, dizziness and breathlessness. He was tachycardic but had normal heart sounds and normal QRS complexes on ECG. Bedside ultrasound was performed, revealing a pericardial effusion. Emergent pericardiocentesis was performed with excellent outcome. This case highlights the importance of early detection of cardiac tamponade as well as the role of bedside ultrasound in diagnosis and management of the condition. PMID:24997706

Ni Leidhin, Caoilfhionn; Moran, Suzanne; MacLean, Alastair

2014-07-01

150

What Makes Biology Learning Difficult and Effective: Students' Views  

Science.gov (United States)

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…

Cimer, Atilla

2012-01-01

151

Hydraulically actuated fuel injector including a pilot operated spool valve assembly and hydraulic system using same  

Science.gov (United States)

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.

Shafer, Scott F. (Morton, IL)

2002-01-01

152

Adult-type rhabdomyoma of larynx: A rare cause of difficult tracheal intubation  

Directory of Open Access Journals (Sweden)

Full Text Available Adult-type rhabdomyoma is a rare benign mesenchymal tumor seen in adults that becomes symptomatic after a long period of time because it grows very slowly. It almost always originates from the tissues of the head and neck containing striated muscle. The symptoms of rhabdomyoma include dysphagia, hoarseness, and globus. This article, which presents a case of isolated adult-type rhabdomyoma of the piriform sinus that presented with dyspnea and difficult tracheal intubation, emphasizes the importance of evaluating patients with an upper airway obstruction for laryngeal masses before intubation.

Bar?? Erdo?an

2013-03-01

153

Severe Plastic Deformation of Difficult-to-Deform Materials at Near-Ambient Temperatures  

Science.gov (United States)

Plane-strain machining can be used to impart large plastic strains in alloys that are difficult to deform by other severe plastic deformation (SPD) processes. By cutting at low speeds, the heating caused by friction with the tool can be reduced to insignificant levels. The utility of this approach for characterizing microstructure development in SPD is demonstrated using a variety of commercial alloys that exhibit different deformation behaviors and strengthening mechanisms, including CP-titanium, aluminum alloy 6061-T6, nickel-base superalloy IN-718, and pearlitic plain-carbon steel.

Ravi Shankar, M.; Verma, R.; Rao, B. C.; Chandrasekar, S.; Compton, W. D.; King, A. H.; Trumble, K. P.

2007-09-01

154

Vía respiratoria difícil en paciente obstétrica acondroplásica / A difficult airway in an obstetrics patient presenting with achondroplasia  

Scientific Electronic Library Online (English)

Full Text Available SciELO Cuba | Language: Spanish Abstract in spanish 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 pequeña 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 años 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.

Lisette Elena, Llanos Palmira; Sahily Irene, López Rabasa; Alejandro, Fonseca León; Gonzalo Santos, González Rodríguez; Jorge Humberto, Díaz Rodríguez.

2012-08-01

155

Vía respiratoria difícil en paciente obstétrica acondroplásica / A difficult airway in an obstetrics patient presenting with achondroplasia  

Scientific Electronic Library Online (English)

Full Text Available SciELO Cuba | Language: Spanish Abstract in spanish 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 pequeña 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 años 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.

Lisette Elena, Llanos Palmira; Sahily Irene, López Rabasa; Alejandro, Fonseca León; Gonzalo Santos, González Rodríguez; Jorge Humberto, Díaz Rodríguez.

156

Newer trends in the management of psoriasis at difficult to treat locations: Scalp, palmoplantar disease and nails  

Directory of Open Access Journals (Sweden)

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.

Handa Sanjeev

2010-01-01

157

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

158

Biogenic hardparts: Difficult archives of the geological past (Invited)  

Science.gov (United States)

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.

Immenhauser, A.; Schone, B. R.; Hoffmann, R.; Niedermayr, A.

2013-12-01

159

Including All the Lines  

CERN Document Server

I present a progress report on including all the lines in the linelists, including all the lines in the opacities, including all the lines in the model atmosphere and spectrum synthesis calculations, producing high-resolution, high-signal-to-noise atlases that show (not quite) all the lines, so that finally we can determine the properties of stars from a few of the lines.

Kurucz, Robert L

2009-01-01

160

Difficult to swallow: patient preferences for alternative valproate pharmaceutical formulations  

Science.gov (United States)

Objective: 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. PMID:19936158

Bhosle, Monali; Benner, Joshua S; DeKoven, Mitch; Shelton, Jeff

2009-01-01

 
 
 
 
161

The Lula Government’s First Year: The Difficult Transition  

Directory of Open Access Journals (Sweden)

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.

Sonia Fleury

2004-05-01

162

Clostridium difficile infection: management strategies for a difficult disease.  

Science.gov (United States)

Clostridium difficile was first described as a cause of diarrhea in 1978 and in the last three decades has reached an epidemic state with increasing incidence and severity in both healthcare and community settings. There also has been a rise in severe outcomes from C. difficile infection (CDI). There have been tremendous advancements in the field of CDI with the identification of newer risk factors, recognition of CDI in populations previously thought not at risk and development of better diagnostic modalities. Several treatment options are available for CDI apart from metronidazole and vancomycin, and include new drugs such as fidaxomicin and other options such as fecal microbiota transplantation. This review discusses the epidemiology, risk factors and outcomes from CDI, and focuses primarily on existing and evolving treatment modalities. PMID:24587820

Khanna, Sahil; Pardi, Darrell S

2014-03-01

163

Nager acrofacial dysostosis: management of a difficult airway.  

Science.gov (United States)

Nager acrofacial dysostosis, first described by Nager and deReynier in 1948, is a rare syndrome characterized by mandibulofacial dysostosis with associated radial defects. The facial features include downward slanting palpebral fissures, absent eyelashes in the medial third of the lower lids, mandibular and malar hypoplasia, dysplastic ears with conductive deafness, and variable degrees of palatal clefting. Upper limb malformation is a constant feature of Nager syndrome and ranges from thumb hypoplasia to absence of the radial ray. The maxillo-mandibular hypoplasia and associated retroplaced tongue set the stage for early and significant upper airway obstruction. The craniofacial anomalies and associated trismus make emergent airway intubation challenging. We present a case of Nager syndrome with life threatening airway obstruction unresponsive to conservative management. This case and a review of the literature emphasize the importance of early tracheotomy for these patients. PMID:8882111

Friedman, R A; Wood, E; Pransky, S M; Seid, A B; Kearns, D B

1996-03-01

164

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)

165

Difficult to swallow: patient preferences for alternative valproate pharmaceutical formulations  

Directory of Open Access Journals (Sweden)

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

Monali Bhosle

2009-06-01

166

Management of difficult-to-treat patients with ulcerative colitis: focus on adalimumab  

Directory of Open Access Journals (Sweden)

Full Text Available Alessandro Armuzzi, Daniela Pugliese, Olga Maria Nardone, Luisa Guidi IBD Unit, Complesso Integrato Columbus, Catholic University, Rome, Italy Abstract: The treatment of ulcerative colitis has changed over the last decade, with the introduction of biological drugs. This article reviews the currently available therapies for ulcerative colitis and the specific use of these therapies in the management of patients in different settings, particularly the difficult-to-treat patients. The focus of this review is on adalimumab, which has recently obtained approval by the European Medicines Agency and the US Food and Drug Administration, for use in treating adult patients with moderate-to-severe, active ulcerative colitis, who are refractory, intolerant, or who have contraindications to conventional therapy, including corticosteroids and thiopurines. Since the results emerging from the pivotal trials have been subject to some debate, the aim of this review was to summarize all available data on the use of adalimumab in ulcerative colitis, focusing also on a retrospective series of real-life experiences. Taken together, the current evidence indicates that adalimumab is effective for the treatment of patients with different types of ulcerative colitis, including biologically naïve and difficult-to-treat patients. Keywords: randomized controlled trials, real-life experiences

Armuzzi A

2013-04-01

167

METHODOLOGY OF DETERMINATION OF ADMISSIBLE SPEEDS OF TRAIN MOVEMENT ON DIFFICULT SECTIONS OF RAILROAD PLAN  

Directory of Open Access Journals (Sweden)

Full Text Available Purpose. Determination of improvement ways of admissible speeds of train movement on the difficult sections of ? railroad plan. Methodology. Mathematical modeling of the train traffic is used to achieve the purpose of research. The average weighted speed and elevation of outer rail is predicted on this basis. Findings. The case analysis of the speeds determination in curved sections of track was carried out. The above mentioned track sections adversely affect the ride comfort and the intensity of the way disorder, as well as the reasons that contribute to the speed limits traffic on the railways of Ukraine. The technique of performing the calculations for determining the permissible train speeds was developed and tested on real curves of railways, were the accelerated movement of trains was introduced. Proposals on automate calculations in distances and services by way of determining the permissible speeds in curves were developed. Originality. Methodology of determining the permissible motion speeds and elevation of outer rails on the difficult sections of the railway plan was developed. This approach allows you to get a rational decisions on reorganization of plan based on local conditions. Practical value. The developed technique of definition of admissible speeds of motion in curves was implemented as a program DopShvid. The program was tested on real railway sections, where the accelerated train motion was introduced.

M. B. Kurhan

2014-03-01

168

Prediction is Difficult, Especially the Future: A Progress Report  

Directory of Open Access Journals (Sweden)

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.

Andrew Booth

2007-03-01

169

Meeting the challenge of constructing a uniquely difficult barrier wall  

International Nuclear Information System (INIS)

A soil-bentonite vertical barrier wall with intersecting and round corners was constructed in complex geology and steep terrain to enclose and dewater a 1.4 hectare (3.5 acre) area once used for hazardous waste lagoons and landfills at the Queen City Farms (QCF) Superfund site in Maple Valley, Washington. The barrier system, including cap and barrier wall, was designed to contain light non-aqueous phase liquid (LNAPL), in addition to subsurface soil and ground water contaminated with chromium, polychlorinated biphenyls, polyaromatic hydrocarbons, trichloroethylene, dichloroethylene and vinyl chloride in the dissolved-phase. These contaminants threaten a drinking water aquifer beneath the site. Constructing the vertical barrier was a challenge due to steep slopes of 20 percent along the alignment (19.2 meter elevation change in the top of the wall), a 22.5 meter (75 foot) design wall depth, heavily consolidated clays and silts, open works gravels (gravel without finer soils), and geologic discontinuity. The barrier wall is keyed into either a glacial till or thin clayey-silt aquitard. Extensive earth moving, stepped walls and many construction techniques were used to enable construction of this barrier wall. Commonly accepted constructability criteria would have discouraged the construction of this wall

170

Difficult OptEase Filter Retrievals After Prolonged Indwelling Times  

International Nuclear Information System (INIS)

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

171

Meniere's disease: Still a mystery disease with difficult differential diagnosis.  

Science.gov (United States)

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. PMID:21633608

Vassiliou, A; Vlastarakos, P V; Maragoudakis, P; Candiloros, D; Nikolopoulos, T P

2011-01-01

172

Pocket book for heating and air conditioning technology 05/06 including warm water and refrigeration technology. 72. ed.; Taschenbuch fuer Heizung und Klimatechnik 05/06 einschliesslich Warmwasser- und Kaeltetechnik  

Energy Technology Data Exchange (ETDEWEB)

This pocket book, also termed ''The Recknagel'' according to the author's name always presents the state of the art of technology. Its history mirrors the development in the described field of technology. With its clear structure it informs about the basics of current techniques and it provides an outlook to the future. Apart from the necessary adaptations the following sections were re-written: (a) ''Hygienic principles'' and ''Principles of energy economy'' have been re-written or revised to a large extent. The section ''Principles facility management - planning, set-up, utilization with the new under-sections ''Principles, technical building management, inspection requirement of HLK plants and simulation'' etc were newly added. (b) Heating: The section ''Space heating, calculation of heating load and design'' should be emphasized, which had to be re-written because of principal changes in the field of standardization. The sections ''Indoor swimming pools with heat pump and heating rooms'' have been updated according to current state of technology. (c) Ventilation and air conditioning: The following sections were revised and re-written: ''Basics of air technology, ventilation and air conditioning systems clean-room technology, indoor swimming pools and animal stables. (d) Warm water supply and refrigeration technology: updated according to current state of technology. (e) Appendix: apart from updates of the German federal and state legislation the comment on the EnEV is to be mentioned (f) English terminology: Based upon the wish of many readers the glossary also contains for the first time the English terms of a large part of the words listed. (orig.)

Schramek, E.R. (ed.) [Dortmund Univ. (Germany); Recknagel, H.; Sprenger, E.

2005-07-01

173

THE EFFECTS OF SONIC ENVIRONMENT OF INDIVIDUALIZED INSTRUCTION IN LEARNING DIFFICULT AND EASY TASKS BY HIGH ACHIEVERS.  

Science.gov (United States)

THE SIXTH-GRADE STUDENTS OBTAINING THE 80 HIGHEST MEAN SCORES ON THE METROPOLITAN ACHIEVEMENT TEST FORM D WERE RANDOMLY ASSIGNED TO GROUPS OF EASY OR DIFFICULT TASKS WITHIN EACH OF FIVE DECIBEL LEVEL GROUPS. THE LEARNING TASKS WERE TAKEN FROM THE MEANINGFULNESS OF ALL POSSIBLE CVC TRIGRAMS (ARCHER, 1960). THE APPARATUS INCLUDED A TAPE RECORDING OF…

MCCARTHY, EDWARD H.

174

Sugammadex use in difficult intubation due to ankylosing spondylitis and severe restrictive respiratory disease  

Directory of Open Access Journals (Sweden)

Full Text Available We describe anesthesia management of a 50-year-old man scheduled for thoracic spinal reconstruction, presenting with severe restrictive respiratory disease and difficult airway due to ankylosing spondilitis. The patient was unable to extend his head, had difficulty in breathing and sleeping in supine position due to thoracal deformities. The patient was intubated using intubating laryngeal mask airway to overcome the difficulties of limited mouth opening and head extension. He was extubated following administration of sugammadex to obtain optimal conditions in terms of respiratory muscle function and to prevent hypersecretion and bronchospasm. J Clin Exp Invest 2012; 3 (3: 398-400Key words: Restrictive lung disease, airway management, laryngeal masks, sugammadex, ankylosing spondylitis

Yakup Tomak

2012-09-01

175

Diversity of life. Effects of power generation and transmission on biodiversity difficult to assess  

Energy Technology Data Exchange (ETDEWEB)

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.)

Hongisto, M.; Nikula, A.

1996-11-01

176

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.)

177

A Qualitative Study of the Types and Characteristics of Difficult Patrons in University Libraries  

Directory of Open Access Journals (Sweden)

Full Text Available The phrase “difficult patron” is often associated with troubles and habitually abnormal behavior from patrons. From the viewpoint of organization, the existence of difficult patrons might signal dissatisfaction with services, collections, facilities, or with specific individual librarians. But difficult patron’s complaints may also be regarded as valuable opportunities to improve customer service and satisfaction. Hence, for the circulation librarians, learning how to interact with difficult patrons is quite important. This article reports findings from a qualitative study which investigated types and behavioral characteristics of difficult patrons in university libraries in Taiwan. Semi-structured interviewing method was used to investigate 23 circulation librarians’ experiences with difficult patrons. Based on the findings, this article discusses why some patrons are difficult as well as service strategies for dealing with difficult patrons in university libraries.

Chen Su-may Sheih

2009-12-01

178

Listening to Include  

Science.gov (United States)

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.…

Veck, Wayne

2009-01-01

179

Disarming Contankerous People: Coping with Difficult Personalities in ECE Work Settings  

Science.gov (United States)

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…

Hernandez, Luis; Smith, Connie Jo

2009-01-01

180

Prehospital Glidescope video laryngoscopy for difficult airway management in a helicopter rescue program with anaesthetists.  

Science.gov (United States)

The objective of this study was to analyze the prehospital use of a Glidescope video laryngoscope (GSVL) due to anticipated and unexpected difficult airway in a helicopter emergency medical service setting in which emergency physicians (EP) are experienced anesthetists. Retrospective observational study and survey of the experiences of EP were conducted for more than a 3-year period (July 2007-August 2010). In 1675 missions, 152 tracheal intubations (TI) were performed. GSVL was used in 23 cases (15%). A total of 17 patients presented with multiple traumas, including nine with cervical spine immobilization, three with burns, and three with nontraumatic diagnoses. Eight patients experienced previously failed TI with conventional laryngoscopy (five by nonhelicopter emergency medical service EP). In two patients, the EP required two attempts with GSVL to obtain a successful TI. Since the introduction of the GSVL, no other backup airway device was necessary. GSVL may be a valuable support instrument in the prehospital management of difficult airways in emergency patients. PMID:21430543

Struck, Manuel Florian; Wittrock, Maike; Nowak, Andreas

2011-10-01

 
 
 
 
181

On modeling epidemics Including latency, incubation and variable susceptibility  

Science.gov (United States)

A cellular automata model for an epidemic is given.It includes inhomogeneous mixing, latency, incubation andvariable suscepibility to the disease. These features are shown to be extremely difficult to be studied using differential equations.

Ahmed, E.; Agiza, H. N.

182

New U.S. presidential science advisor steps in at difficult moment  

Science.gov (United States)

John Marburger, III, who became science advisor to U.S. President George W. Bush and head of the White House Office of Science and Technology Policy (OSTP) on October 23, steps in at a difficult period for the nation. In an exclusive interview on November 7, Marburger told Eos that following the events of September 11, his office's “major challenge is to combat terrorism.”However, Marburger said that while he and OSTP are involved in initiatives to harness science and technology to fight terrorism, he also is focusing on other key priorities. These include helping to ensure the nation's strength in basic research, providing advice on significant science issues such as climate change and space endeavors, and adding an important “sound science” component to the Bush administration, which was earlier criticized for making some science-sensitive decisions based more on politics than science.

Showstack, Randy

183

Statistical optimization of gold recovery from difficult leachable sulphide minerals using bacteria  

Energy Technology Data Exchange (ETDEWEB)

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.)

Ahmed, Hussin A.M. [King Abdulaziz Univ., Jeddah (Saudi Arabia). Mining Engineering Dept.; El-Midany, Ayman A. [King Saud Univ., Riyadh (Saudi Arabia)

2012-07-01

184

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.

Waltham,A.C.

2005-01-01

185

IMRT dose fractionation for head and neck cancer: Variation in current approaches will make standardisation difficult  

International Nuclear Information System (INIS)

Introduction. Altered fractionation has demonstrated clinical benefits compared to the conventional 2 Gy/day standard of 70 Gy. When using synchronous chemotherapy, there is uncertainty about optimum fractionation. IMRT with its potential for Simultaneous Integrated Boost (SIB) adds further to this uncertainty. This survey will examine international practice of IMRT fractionation and suggest possible reasons for diversity in approach. Material and methods. Fourteen international cancer centres were surveyed for IMRT dose/fractionation practised in each centre. Results. Twelve different types of dose fractionation were reported. Conventional 70-72 Gy (daily 2 Gy/fraction) was used in 3/14 centres with concurrent chemotherapy while 11/14 centres used altered fractionation. Two centres used >1 schedule. Reported schedules and number of centres included 6 fractions/week DAHANCA regime (3), modest hypofractionation (=2.2 Gy/fraction) (3), dose-escalated hypofractionation (=2.3 Gy/fraction) (4), hyperfractionation (1), continuous acceleration (1) and concomitant boost (1). Reasons for dose fractionation variability include (i) dose escalation; (ii) total irradiated volume; (iii) number of target volumes; (iv) synchronous systemic treatment; (v) shorter overall treatment time; (vi) resources availability; (vii) longer time on treatment couch; (viii) variable GTV margins; (ix) confidence in treatment setup; (x) late tissue toxicity and (xi) use of lower neck anterior fields. d (xi) use of lower neck anterior fields. Conclusions. This variability in IMRT fractionation makes any meaningful comparison of treatment results difficult. Some standardization is needed particularly for design of multi-centre randomized clinical trials

186

Identifying and Investigating Difficult Concepts in Engineering Mechanics and Electric Circuits. Research Brief  

Science.gov (United States)

This study extends ongoing work to identify difficult concepts in thermal and transport science and measure students' understanding of those concepts via a concept inventory. Two research questions provided the focal point: "What important concepts in electric circuits and engineering mechanics do students find difficult to learn?"…

Streveler, Ruth; Geist, Monica; Ammerman, Ravel; Sulzbach, Candace; Miller, Ronald; Olds, Barbara; Nelson, Mary

2007-01-01

187

The Study of Difficult Temperament: A Reply to Kagan, Rothbart, and Plomin.  

Science.gov (United States)

Based on comments by Kagan (1982), Rothbart (1982), and Plomin (1982) in response to an article on difficult temperament by Thomas, Chess, and Korn (1982), the author concludes that the study of temperamentally difficult children has a favorable prognosis. (Author/MP)

Thomas, Alexander

1982-01-01

188

Classified directory of the field of refrigeration and air conditioning technology 2006. Register of the expert companies in the field of refrigeration and air conditioning plants craft including a supply and service list - register of the suppliers in the field of refrigeration and air conditioning technology including the complete ranges of material groups offered - register of expert schools, technical experts, technical expert information and norms; Branchenbuch der Kaelte- und Klimatechnik 2006. Verzeichnis der Fachbetriebe des Kaelte- und Klimaanlagenbauerhandwerks mit Liefer- und Leistungsangebot - Verzeichnis der Lieferanten von Kaelte- und Klimatechnik mit vollstaendigem Warengruppenangebot - Verzeichnis von Fachschulen, Sachverstaendigen u.v.a. - Technische Fachinformationen und Normen  

Energy Technology Data Exchange (ETDEWEB)

The present edition of the ''Classified directory of the field of refrigeration and air conditioning technology'' 2006 contains useful addresses, data and facts of the field: (a) approximately 1.500 addresses of expert companies in the field of refrigeration and air conditioning technology; (b) a register of suppliers and material groups in the field of refrigeration and air conditioning technology; (c) a technical part containing the most important norms of the field, laws and regulations in order to inform the reader for his daily work. The reference book is supposed to provide a good overview for the work in the field of technical building equipment. (orig./AKF)

NONE

2006-07-01

189

[Non convulsive status epilepticus: an heterogeneous disease with a difficult diagnosis. Report of 2 cases with unusual presentation].  

Science.gov (United States)

Non convulsive status epilepticus is a heterogeneous condition consisting of very different electroclinical syndromes. It is difficult to make the diagnosis and identify common factors among patients. We report two cases with an unusual presentation. A 31 years old woman having discoid lupus presented with a prolonged exogenous psychosis that lasted two and half months, associated to echolalia. After the episode the patient remained with a severe frontal syndrome that could be the consequence of a non convulsive status epilepticus. A 60 years old woman with an epilepsy diagnosed at the age of 30, presented with recurrent episodes of aphasia. During one of these crises, the electroencephalogram showed continuous epileptiform activity. PMID:14635593

Lawson, Balduin; Quintana, Juan Carlos

2003-09-01

190

Sensitivity and noise in GC-MS: Achieving low limits of detection for difficult analytes  

Science.gov (United States)

Gas chromatography-mass spectrometry (GC-MS) instrument limit of detection (LOD) is typically listed by major vendors as that of octafluoronaphthalene (OFN). Most current GC-MS instruments can achieve LODs in the low femtogram range. However, GC-MS LODs for realistic analytes in actual samples are often a few orders of magnitude higher than OFN's. Users seldom encounter 1 pg LOD in the single ion monitoring mode in their applications. We define this detectability difference as the "OFN gap." In this paper, we demonstrate and discuss how the OFN gap can be significantly reduced by the use of GC-MS with supersonic molecular beams (SMB). Experimental results were obtained with a recently developed GC-MS with SMB named 1200-SMB, that is based on the conversion of the Varian 1200 system into a GC-MS-MS with SMB. With this 1200-SMB system, the LOD of all types of analytes, including OFN, in real samples is significantly improved through the combination of: (a) enhanced molecular ion; (b) elimination of vacuum background noise; (c) elimination of mass independent noise; (d) elimination of ion source peak tailing and degradation; (e) significantly increased range of thermally labile and low volatility compounds that are amenable for analysis through lower sample elution temperatures; (f) reduced column bleed and ghost peaks through sample elution at lower temperatures; (g) improved compatibility with large volume injections; and (h) reduced matrix interferences through the combination of enhanced molecular ion and MS-MS. As a result, the 1200-SMB LODs of common and/or difficult compounds are much closer to its OFN LOD, even in complex matrices. We crossed the 400 for methomyl, and >2000 for C32H66. In general, the harder the compound analysis, the greater is the gain in sample detectability using the 1200-SMB versus traditional GC-MS. Thus, the 1200-SMB lowers LOD, particularly for difficult analytes that are normally sacrificed in methods, and the detectability gains can amount to a few orders of magnitude over traditional GC-MS in real-world applications.

Fialkov, Alexander B.; Steiner, Urs; Lehotay, Steven J.; Amirav, Aviv

2007-01-01

191

Novel drugs in the management of difficult-to-treat hepatitis C genotypes  

Directory of Open Access Journals (Sweden)

Full Text Available Emily J Cartwright, Lesley MillerDepartment of Medicine, Emory University School of Medicine, Atlanta, GA, USABackground: Hepatitis C virus (HCV infection is the most common chronic bloodborne infection in the United States, with approximately 3.2 million Americans being chronically infected. Rates of HCV-related end-stage liver disease and its associated morbidity and mortality have yet to peak, so there is a pressing need for more effective and tolerable HCV treatment. HCV genotypes 1, 4, 5, and 6 are considered difficult to treat, and the need for improved therapies is especially great for persons infected with these genotypes.Current strategies for HCV treatment: Current therapy for genotype 1 HCV infection includes triple therapy with pegylated interferon, ribavirin, and a NS3/4A protease inhibitor. Sustained virologic response (SVR rates with triple therapy range from 42% to 75%, a vast improvement over pegylated interferon and ribavirin therapy alone. However, response rates remain suboptimal, and triple therapy is associated with significant adverse effects and is only indicated for genotype 1 HCV infection.Novel drugs for HCV treatment: HCV drug development is proceeding at a rapid pace to meet this need. Novel direct acting antiviral agents in several classes, including new NS3/4A serine protease inhibitors, NS5A replication complex inhibitors, NS5B polymerase inhibitors, interferon lambda, and microRNAs, are in varying stages of development. These new therapeutic agents promise SVR rates of up to 100% with durations as short as 12 weeks and, often, fewer adverse effects.Conclusion: New drug development in HCV is proceeding at an unprecedented pace. Novel agents promise higher SVR rates, shorter duration of therapy, and fewer adverse effects than have been possible with HCV therapy to date.Keywords: hepatitis C, direct acting antivirals, genotype

Cartwright EJ

2013-08-01

192

Modeling and Forecasting of Transitions Between Levels of Hierarchies in Difficult Formalized Systems  

Directory of Open Access Journals (Sweden)

Full Text Available Situations at different levels of functioning difficult formalized systems are modelled by the fuzzy situational network, allowing to analyze as strong, as weak hierarchies. At forecasting of transitions the force of communication is considered.

Svetlana P. Vovk

2012-05-01

193

A STERILIZATION STANDARD FOR ENDOSCOPES AND OTHER DIFFICULT TO CLEAN MEDICAL DEVICES  

Science.gov (United States)

An array of difficult to clean devices are used for diagnostic and surgical procedures involving various degrees of invasiveness. These range from prophylaxis angles used for cleaning and polishing teeth to flexible fiberoptic endoscopes for surgical procedures that penetrate the...

194

Randomized controlled trial of the Pentax AWS, Glidescope, and Macintosh laryngoscopes in predicted difficult intubation.  

LENUS (Irish Health Repository)

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.

Malik, M A

2009-11-01

195

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.

196

Difficult intubation in a parturient with syringomyelia and Arnold–Chiari malformation: Use of Airtraq™ laryngoscope  

Digital Repository Infrastructure Vision for European Research (DRIVER)

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.

Mustapha, Bensghir; Chkoura, K.; Elhassani, M.; Ahtil, R.; Azendour, H.; Kamili, N. Drissi

2011-01-01

197

Condition Number Regularized Covariance Estimation.  

Science.gov (United States)

Estimation of high-dimensional covariance matrices is known to be a difficult problem, has many applications, and is of current interest to the larger statistics community. In many applications including so-called the "large p small n" setting, the estimate of the covariance matrix is required to be not only invertible, but also well-conditioned. Although many regularization schemes attempt to do this, none of them address the ill-conditioning problem directly. In this paper, we propose a maximum likelihood approach, with the direct goal of obtaining a well-conditioned estimator. No sparsity assumption on either the covariance matrix or its inverse are are imposed, thus making our procedure more widely applicable. We demonstrate that the proposed regularization scheme is computationally efficient, yields a type of Steinian shrinkage estimator, and has a natural Bayesian interpretation. We investigate the theoretical properties of the regularized covariance estimator comprehensively, including its regularization path, and proceed to develop an approach that adaptively determines the level of regularization that is required. Finally, we demonstrate the performance of the regularized estimator in decision-theoretic comparisons and in the financial portfolio optimization setting. The proposed approach has desirable properties, and can serve as a competitive procedure, especially when the sample size is small and when a well-conditioned estimator is required. PMID:23730197

Won, Joong-Ho; Lim, Johan; Kim, Seung-Jean; Rajaratnam, Bala

2013-06-01

198

Condition Number Regularized Covariance Estimation*  

Science.gov (United States)

Estimation of high-dimensional covariance matrices is known to be a difficult problem, has many applications, and is of current interest to the larger statistics community. In many applications including so-called the “large p small n” setting, the estimate of the covariance matrix is required to be not only invertible, but also well-conditioned. Although many regularization schemes attempt to do this, none of them address the ill-conditioning problem directly. In this paper, we propose a maximum likelihood approach, with the direct goal of obtaining a well-conditioned estimator. No sparsity assumption on either the covariance matrix or its inverse are are imposed, thus making our procedure more widely applicable. We demonstrate that the proposed regularization scheme is computationally efficient, yields a type of Steinian shrinkage estimator, and has a natural Bayesian interpretation. We investigate the theoretical properties of the regularized covariance estimator comprehensively, including its regularization path, and proceed to develop an approach that adaptively determines the level of regularization that is required. Finally, we demonstrate the performance of the regularized estimator in decision-theoretic comparisons and in the financial portfolio optimization setting. The proposed approach has desirable properties, and can serve as a competitive procedure, especially when the sample size is small and when a well-conditioned estimator is required. PMID:23730197

Won, Joong-Ho; Lim, Johan; Kim, Seung-Jean; Rajaratnam, Bala

2012-01-01

199

Guidelines on uncomplicated urinary tract infections are difficult to follow: perceived barriers and suggested interventions  

Directory of Open Access Journals (Sweden)

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.

Zegers-van Schaick Judith M

2010-06-01

200

Characterization methodology for Difficult To Measure nuclides in the Type B rad waste from the ITER  

International Nuclear Information System (INIS)

In general, it is not possible to directly detect beta rays from the rad waste in the field measurement due to their extremely low penetration through the materials. Only lab-scale measurements with proper shield and detecting system are available for the nondestructive assay. However, the disposal sites in many countries require the determination of inventories of the difficult to-measure (DTM) nuclides in the waste before their acceptance for disposal. Many sites that generate rad wastes thus are adapting the indirect method to characterize the DTM nuclides in the rad waste to be disposed. The rad waste from the operation of an international thermonuclear experimental reactor (ITER) will be sent to the hot cell building (HCB) after packing it to the basket and they are then treated into the disposal form as well as characterized through the nondestructive assay. The rad waste properties from the ITER are that high density material such as a steel, a copper, and a tungsten accounts for the main substance and many nuclides due to the neutron irradiation including the DTM nuclides exists in that waste. Therefore, the ITER is also facing with the problem for the characterization of DTM nuclides. The scaling factor for the radiological relationship between the gamma and the beta nuclides is one of the indirect measurements to characterize the DTM nuclides in the waste. The methodology of the scaling factor to apply this method to the characterization the Type B rad waste from the ITER are presented in this paper. There are several types of the in-vessel components (IVCs) in a Tokamak which will be activated by neutron and they will be divided into different types of the rad waste such as the divertor cassette, blanket module, and port plugs. In this paper, the characterization of DTM nuclides will be focused on the rad waste from a blanket module out of IVCs

 
 
 
 
201

Financial abuse of older people by a family member: a difficult terrain for service providers in Australia.  

Science.gov (United States)

Financial abuse by a family member is the most common form of abuse experienced by older Australians, and early intervention is required. National online surveys of 228 chief executive officers and 214 aged care service providers found that, while they were well placed to recognize financial abuse, it was often difficult to intervene successfully. Problems providers encountered included difficulties in detecting abuse, the need for consent before they could take action, the risk that the abusive family member would withdraw the client from the service, and a lack of resources to deal with the complexities inherent in situations of financial abuse. PMID:24779540

Adams, Valerie Margaret; Bagshaw, Dale; Wendt, Sarah; Zannettino, Lana

2014-01-01

202

The difficult patients in pain therapy: how to recognize and manage them  

Directory of Open Access Journals (Sweden)

Full Text Available When physicians experience negative reactions to patients, they often perceive the patients as "difficult". Such patients make up 15% to 30% of primary care practice populations. They are those whom most physicians dread. The dependency of difficult patients heavily influences the doctor-patient relationship and the outcome of the treatment. These patients often present with physical symptoms that could not be medically explained. Pain is the most frequent complaint, though unrecognized psychopatological disorders are more prevalent among these patients.Conversely, difficult patients are rather common in chronic pain syndromes, particularly in back pain, failed back syndrome and atypical facial pain. Diagnosis can be achieved on phenomenological, psychopathological and psychodynamic grounds. The management of difficult patients can prove to be a tough task for both physicians and nurses, as they are time-consuming, draining the emotional resources of the therapist, and evoke feelings of aversion and frustration.Appropriate use of patient-doctor communication skills and an effort to improve relations with the patient through empathy, tolerance and non-judgemental listening are suggested as ways of transform a difficult encounter into a workable patient doctor relationship.

G. De Benedittis

2005-11-01

203

Conditional Probability  

Science.gov (United States)

This site, created by the Department of Statistics at Yale University gives an explanation, a definition and an example of conditional probability. Topics include the probabilities of intersections of events and Bayes' formula. Overall, this is a great resource for any mathematics classroom studying statistics.

Lacey, Michelle

2008-12-23

204

Febre de etiologia indeterminada: encruzilhada de diagnósticos / Fever of unknown origin: a difficult diagnostic problem  

Scientific Electronic Library Online (English)

Full Text Available SciELO Portugal | Language: Portuguese Abstract in portuguese Introdução: 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 claudicação 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 avaliação por Cardiologia evidenciou ectasia coronária, tendo iniciado imunoglobulina intravenosa (IGIV) por suspeita de Doença de Kawasaki atípica (DKa). Por persistência da febre invocou-se o diagnóstico mais provável de Artrite Idiopática Juvenil sistémica (AIJs). Discussão: Após a exclusão de outras causas, o diagnóstico diferencial entre DKa e AIJs é difícil pela inespecificidade dos achados. A suspeita de DKa, justifica a terapêutica com IGIV, mas a refractariedade a esta não a exclui (10% de casos refractários). Por outro lado, está descrita a presença de dilatações coronárias em contexto de quadro inflamatório sistémico, tornando este achado sugestivo mas não 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.

Manuel, Oliveira; Carla, Meireles; Patrícia, Costa; Margarida, Guedes; Ana Luísa, Lobo.

205

Colecistectomía laparoscópica difícil, estrategias de manejo / Difficult laparoscopic cholecystectomy, management strategies  

Scientific Electronic Library Online (English)

Full Text Available SciELO Colombia | Language: Spanish Abstract in spanish 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 diseñar estrategias de manejo intraoperatorio que nos permitan resolver favorablemente estos casos. En este artículo, el cual se presenta acompañado 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.

Luis Fernando, Álvarez; Diego, Rivera; Miguel Evaristo, Esmeral; Marta Cecilia, García; Diego Fernando, Toro; Olga Lucía, Rojas.

2013-07-01

206

Making difficult decisions how to be decisive and get the business done  

CERN Document Server

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

Shaw, Peter J A

2010-01-01

207

The Bonds and Burdens of Family Life: Using Narrative Analysis to Understand Difficult Relationships  

Directory of Open Access Journals (Sweden)

Full Text Available 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 reinforce family roles while simultaneously drawing upon alternative narratives of identity and morality. Investigating narratives of difficult family relationships reveals the influence of dominant social norms on the negotiation of social identities through personal stories.

Mary Breheny

2011-01-01

208

Musculoskeletal ultrasound including definitions for ultrasonographic pathology  

DEFF Research Database (Denmark)

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.

Wakefield, RJ; Balint, PV

2005-01-01

209

Issues in the Assessment of Difficult Temperament: A Reply to Thomas, Chess, and Korn.  

Science.gov (United States)

Responds to Thomas, Chess, and Korn (Merrill-Palmer Quarterly; v28 n1 p1-20 Jan 1982) by arguing that empirical and theoretical considerations call into question the assumption that parent reports of their own child's difficult temperament are essentially measures of characteristics residing within the child. (BJD)

Bates, John E.

1983-01-01

210

The Psychometric Properties of the Difficult Behavior Self-Efficacy Scale  

Science.gov (United States)

The study was designed to estimate the psychometric properties of Hastings and Brown's (2002a) Difficult Behavior Self-efficacy Scale. Participants were two samples of physical educators teaching in Korea (n = 229) and the United States (U.S.; n = 139). An initial translation of the questionnaire to Korean and pilot study were conducted along with…

Oh, Hyun-Kyoung; Kozub, Francis M.

2010-01-01

211

History Museums and Social Cohesion: Building Identity, Bridging Communities, and Addressing Difficult Issues  

Science.gov (United States)

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…

Rosenberg, Tracy Jean

2011-01-01

212

"Chalepa Ta Kala," "Fine Things Are Difficult": Socrates' Insights into the Psychology of Teaching and Learning  

Science.gov (United States)

The proverb "chalepa ta kala" ("fine things are difficult") is invoked in three dialogues in the Platonic corpus: "Hippias Major," "Cratylus" and "Republic." In this paper, I argue that the context in which the proverb arises reveals Socrates' considerable pedagogical dexterity as he uses the proverb to rebuke his interlocutor in one dialogue but…

Mintz, Avi I.

2010-01-01

213

A 'comb' reflectometer: A simple device for determining the peak density in difficult experimental situations  

International Nuclear Information System (INIS)

A simple 'comb' reflectometer which can provide some information on the electron density in difficult experimental situations is described. Results obtained with a four channel device which probes the X point region on JET are presented. Possible further developments are briefly discussed. (author). 2 refs, 3 figs

214

Queer(y)ing Religion and Spirituality: Reflections from Difficult Dialogues Exploring Religion, Spirituality, and Homosexuality  

Science.gov (United States)

This article describes a student affairs practitioner's experience with co-instructing a course entitled, "Queer(y)ing Religion and Spirituality". The ways practitioners can facilitate difficult dialogues with students about the intersection of spirituality and GLBT issues are explored.

LePeau, Lucy

2007-01-01

215

Providing Dental Services for People with Disabilities: Why Is It So Difficult?  

Science.gov (United States)

This article examines why it is difficult for individuals with disabilities to obtain dental services. It discusses inadequate preparation of dentists, cultural norms that create social, attitudinal, economic, and environmental barriers, and limited participation in the Medicaid dental program. The need for changes in dental school curricula is…

Waldman, H. Barry; Perlman, Steven P.

2002-01-01

216

Confronting Challenges: Motivational Beliefs and Learning Strategies in Difficult College Courses  

Science.gov (United States)

Motivational beliefs and learning strategies have a significant effect upon student learning. This study compared motivational beliefs and learning strategies of freshman and upper class students in a normative cross section of college classes with freshman and upper class students in their self-reported most difficult course. Results from "The…

Lynch, Douglas J.

2008-01-01

217

INFORMATION-CONTROLLING SYSTEM STRUCTURE SYNTHESIS OF OPERATION SUPPORT OF DIFFICULT TECHNICAL SYSTEMS  

Directory of Open Access Journals (Sweden)

Full Text Available  The system approach to formation of a functional-structural level of the information-controlling systems intended for support of operation of difficult technical systems on the expanded interval of an operational stage of their life cycle is offered.

Valeriy I. Chepizhenko

2009-04-01

218

Power Parenting for Children with ADD/ADHD: A Practical Parent's Guide for Managing Difficult Behaviors.  

Science.gov (United States)

The first step in dealing with an attention deficit disorder (ADD/ADHD) child's difficult behavior is to understand its origins. This book presents behavior management techniques to help parents care for their ADD child while ensuring that the child continues to develop positive, healthy self-esteem. The guide shows how to: (1) ensure an accurate…

Flick, Grad L.

219

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)

Full Text Available SciELO Spain | Language: Spanish Abstract in spanish 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 diffic

L. M., Charco Roca; V. E., Ortiz Sánchez; P., Cuesta Montero; A., Soria Quiles; L., Bonmati García.

2013-10-01

220

"DIFFICULT AIRWAY MANAGEMENT IN A PATIENT WITH TREACHER-COLLIN’S SYNDROME WITH INTUBATING LARYNGEAL MASK AIRWAY "  

Directory of Open Access Journals (Sweden)

Full Text Available Treacher Collin’s syndrome (TCS is a rare inherited condition characterized by bilateral and symmetric abnormalities of structures within the first and second bronchial arches. Patients with TCS present a serious problem to anesthetists maintaining their airway as upper airway obstruction and difficult tracheal intubation due to severe facial deformity. Because of retrognathia, airway management of these patients is often challenging. We report the case of a 25-yr-old patient with TCS undergoing microtia repair under general anesthesia twice. In the first time he could not be intubated via direct laryngoscopy and was intubated via blind nasal intubation. In the second time, he was intubated through an ILMA using endotracheal tube.

M. Gharebaghian

2006-08-01

 
 
 
 
221

Kenyan women adult literacy learners: why their motivation is difficult to sustain.  

Science.gov (United States)

Kenya, like other Third World countries, has illiteracy rates for women which are twice those of men (in 1978, 35% of males and 70% of females aged 15 and above were illiterate). Since the beginning of the country's literacy campaign in 1979, women have comprised more than 70% of attendees. While this situation remains the case, the overall enrolment figures for the program have shown a gradual decline from 1979 to 1990 due to a lack of emphasis on individual motivation. Women dominate the literacy programs for several reasons: 1) women historically had less access to formal education than men; 2) the changing economy has forced women to assume extra responsibilities outside the home which make the women want to acquire formal skills; 3) women's schedules are often flexible enough to allow them to attend classes; 4) literacy classes provide women with needed socialization opportunities; and 5) in some communities cultural norms prevent men from attending classes with women. Women also have many obstacles which make their desire to become adult learners difficult to sustain. They have responsibilities which range from child-bearing to management of their family farms which leave them little time for study or class attendance. There is also little encouragement offered the women either at home or in their classes. At home they are confronted with a myriad of demands on their time. Their classes take place in conditions which are not very conducive to learning (classrooms designed for children or open air centers). The literacy teachers are, for the most part, unqualified. They must meet only minimal requirements and receive no training. The women also have less opportunities to practice their new skills outside of the classroom. Women have less time then men to read, and they are less fluent then men in English and Kiswahili, the 2 official languages of Kenya. Because Kenyan society is male-dominated, there is little encouragement given to women who attempt to acquire literacy. Also, men tend to dominate the position of authority in the literary programs and also make up 66% of the cadre of full-time teachers, giving the women few role models and fewer opportunities to work with an instructor who would be particularly sensitive to their needs. Since there is a demonstrated positive correlation between formal education and better health practices and agricultural productivity, there is a real need to attract more women to the literacy program and to motivate them to remain in the program. The best way to accomplish this would be to improve the status of women in Kenyan society. Until this occurs, however, measures can be taken to increase the number of women in administrative and teaching positions and to improve the quality of teachers through training and proper remuneration. The literacy program itself can be used to improve the status of women in society. PMID:12345290

Mwiria, K

1993-05-01

222

Determination of difficult concepts in the interpretation of musculoskeletal radiographs using a web-based learning/teaching tool  

Energy Technology Data Exchange (ETDEWEB)

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.

Nunn, Heidi, E-mail: heidi@imageinterpretation.co.uk [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)

2011-11-15

223

Some origins of the 'difficult' child: the Brazelton scale and the mother's view of her new-born's character.  

Science.gov (United States)

Thirty-two mothers and their new-born babies were studied in order to consider, in a limited way, the manner in which a mother comes to attribute personality traits to her infant. The child's expected 'difficulty' was rated by means of a standardized inventory. In addition, a semi-structured interview was conducted with the mother, and her baby was examined by means which have been described by Brazelton. The circumstances of birth were taken from hospital records. Mothers who did not expect the child to be difficult showed a 'general flexibility' which probably related to coping ability. Babies who were seen as unlikely to be difficult had high scores on 'state control' and 'physiological response to stress'. These measures include ratings for habituation and seem to reflect an efficient means of dealing with stimuli. These infantile factors did not correlate with the maternal one, suggesting that a genetic explanation of the findings was not likely. The effect of the circumstances of birth was not strong, but medication level seemed important. The transcripts of the mothers' interviews were consistent with the view that the mother's assessment of her infant's character was not only influenced by a fine observation of the infant's behaviour but also by something like 'projective identification'. The transcripts also suggested that mechanisms which have been seen as important in the development of identity in adolescence may be operating from the first days of life. PMID:7059536

Meares, R; Penman, R; Milgrom-Friedman, J; Baker, K

1982-03-01

224

Optimal body balance disturbance tolerance skills as a methodological basis for selection of firefighters to solve difficult rescue tasks.  

Science.gov (United States)

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 (pcorrelated indicators of SRT (0.860 and 0.844), while the 6 indicators of RT only 2 (0.396 and 0.381; pcorrelation 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. PMID:24738515

Jagie??o, W?adys?aw; Wójcicki, Zbigniew; Barczy?ski, Bart?omiej J; Litwiniuk, Artur; Kalina, Roman Maciej

2014-01-01

225

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.

226

An Exploratory Study on Coping Strategies of Confronting Difficult Patrons: The Case of University Circulation Librarians  

Directory of Open Access Journals (Sweden)

Full Text Available The coping strategies utilized by front-line serving circulation librarians might positively or negatively affect the image of a certain library organization. And every tactic adopted is in fact integrated with the manipulation and modification of the circulation librarian’s emotional labor. Therefore, from the perspective on “emotional labor”, this study attempts to employ semi-structured in-depth interviews with 23 university circulation librarians in Taiwan, thereby analyzing their coping strategies when encountering different types of difficult patrons. In doing so, this study aims to better university library administrators’ understanding of circulation librarians’ circumstance of dealing with difficult patrons and of their emotional labor, thus enhancing appropriate organizational strategies for emotional management and overall quality of library service.

Chen Su-may Sheih

2012-12-01

227

Defense Waste Management Plan for buried transuranic-contaminated waste, transuranic-contaminated soil, and difficult-to-certify transuranic waste  

International Nuclear Information System (INIS)

GAO recommended that DOE provide specific plans for permanent disposal of buried TRU-contaminated waste, TRU-contaminated soil, and difficult-to-certify TRU waste; cost estimates for permanent disposal of all TRU waste, including the options for the buried TRU-contaminated waste, TRU-contaminated soil, and difficult-to-certify TRU waste; and specific discussions of environmental and safety issues for the permanent disposal of TRU waste. Purpose of this document is to respond to the GAO recommendations by providing plans and cost estimates for the long-term isolation of the buried TRU-contaminated waste, TRU-contaminated soil, and difficult-to-certify TRU waste. This report also provides cost estimates for processing and certifying stored and newly generated TRU waste, decontaminating and decommissioning TRU waste processing facilities, and interim operations

228

On the Improvement of Multi-Legged Locomotion over Difficult Terrains using a Balance Stabilization Method  

Digital Repository Infrastructure Vision for European Research (DRIVER)

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...

Javaid Iqbal; Umar Asif

2012-01-01

229

Analysis of residual stresses induced by dry turning of difficult-to-machine materials  

Digital Repository Infrastructure Vision for European Research (DRIVER)

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...

Outeiro, J. C.; Pina, J. C.; Saoubi, R. M.; Pusavec, F.; Jawahir, I. S.

2008-01-01

230

Simple solution for difficult face mask ventilation in children with orofacial clefts.  

Science.gov (United States)

Significant air leak from the facial cleft predisposes to difficult mask ventilation. The reported techniques of use of sterile gauze, larger face mask and laryngeal mask airway after intravenous induction have limited application in uncooperative children. We describe the use of dental impression material molded to the facial contour to cover the facial defect and aid ventilation with an appropriate size face mask in a child with a bilateral Tessier 3 anomaly. PMID:25196287

Veerabathula, Prardhana; Patil, Manajeet; Upputuri, Omkar; Durga, Padmaja

2014-10-01

231

“Passive-bending colonoscope” significantly improves cecal intubation in difficult cases  

Directory of Open Access Journals (Sweden)

Full Text Available Colonoscopy sometimes causes pain during insertion, especially in difficult cases. Over-insufflation of air causes elongation or acute angulations of the colon, making passage of the scope difficult and causing pain. We previously reported a sedative-risk-free colonoscopy insertion technique, namely, “Water Navigation Colonoscopy”. Complete air suction after water infusion not only improves the vision, but also makes water flow down to the descending colon, while the sigmoid colon collapses and shortens. While non-sedative colonoscopy can be carried out without pain in most cases, some patients do complain of pain. Most of these patients have abnormal colon morphology, and the pain is caused while negotiating the “hairpin” bends of the colon. The “hairpin” bends of the colon should be negotiated by gently pushing the full-angled colonoscope. The proximal 10-20 cm from the angulated part of the conventional colonoscope is stiff, with a wide turning radius, therefore, a conventional colonoscope cannot be negotiated through the “hairpin” bends of the colon without stretching them and causing pain. The “passive-bending colonoscope” has a flexible tip with a narrow turning radius, so that the scope can be negotiated through the “hairpin” bends of the colon with a minimum turning radius and minimal discomfort. Therefore, the intubation and pain-reducing performance of the “passive-bending colonoscope” was assessed in difficult cases.

Takeshi Mizukami

2012-01-01

232

Does time ever fly or slow down? The difficult interpretation of psychophysical data on time perception  

Directory of Open Access Journals (Sweden)

Full Text Available Time perception is studied with subjective or semi-objective psychophysical methods. With subjective methods, observers provide quantitative estimates of duration and data depict the psychophysical function relating subjective duration to objective duration. With semi-objective methods, observers provide categorical or comparative judgments of duration and data depict the psychometric function relating the probability of a certain judgment to objective duration. Both approaches are used to study whether subjective and objective time run at the same pace or whether time flies or slows down under certain conditions. We analyze theoretical aspects affecting the interpretation of data gathered with the most widely used objective methods, including single-presentation and paired-comparison methods. For this purpose, a formal model of psychophysical performance is used in which subjective duration is represented via a psychophysical function and the scalar property. This provides the timing component of the model, which is invariant across methods. A decisional component that varies across methods reflects how observers use subjective durations to make judgments and give the responses requested under each method. Application of the model shows that psychometric functions in single-presentation methods are uninterpretable because the various influences on observed performance are inextricably confounded in the data. In contrast, data gathered with paired-comparison methods permit separating out those influences. Prevalent approaches to fitting psychometric functions to data are also discussed and shown to be inconsistent with widely accepted principles of time perception, implicitly assuming instead that subjective time equals objective time and that observed differences across conditions do not reflect differences in perceived duration but criterion shifts. These analyses prompt evidence-based recommendations for best methodological practice in studies on time perception.

Miguel A García-Pérez

2014-06-01

233

Image-guided ablation of painful metastatic bone tumors: a new and effective approach to a difficult problem  

Energy Technology Data Exchange (ETDEWEB)

Painful skeletal metastases are a common problem in cancer patients. Although external beam radiation therapy is the current standard of care for cancer patients who present with localized bone pain, 20-30% of patients treated with this modality do not experience pain relief, and few further options exist for these patients. For many patients with painful metastatic skeletal disease, analgesics remain the only alternative treatment option. Recently, image-guided percutaneous methods of tumor destruction have proven effective for treatment of this difficult problem. This review describes the application, limitations, and effectiveness of percutaneous ablative methods including ethanol, methyl methacrylate, laser-induced interstitial thermotherapy (LITT), cryoablation, and percutaneous radiofrequency ablation (RFA) for palliation of painful skeletal metastases. (orig.)

Callstrom, Matthew R.; Charboneau, J. William; Atwell, Thomas D.; Farrell, Michael A.; Welch, Timothy J.; Maus, Timothy P. [Mayo Clinic, Department of Radiology, Rochester, MN (United States); Goetz, Matthew P.; Rubin, Joseph [Mayo Clinic, Department of Oncology, Rochester, MN (United States)

2006-01-01

234

Image-guided ablation of painful metastatic bone tumors: a new and effective approach to a difficult problem  

International Nuclear Information System (INIS)

Painful skeletal metastases are a common problem in cancer patients. Although external beam radiation therapy is the current standard of care for cancer patients who present with localized bone pain, 20-30% of patients treated with this modality do not experience pain relief, and few further options exist for these patients. For many patients with painful metastatic skeletal disease, analgesics remain the only alternative treatment option. Recently, image-guided percutaneous methods of tumor destruction have proven effective for treatment of this difficult problem. This review describes the application, limitations, and effectiveness of percutaneous ablative methods including ethanol, methyl methacrylate, laser-induced interstitial thermotherapy (LITT), cryoablation, and percutaneous radiofrequency ablation (RFA) for palliation of painful skeletal metastases. (orig.)

235

Notícias difíceis e o posicionamento dos oncopediatras: revisão bibliográfica / Difficult news and the standpoint of pediatric oncologists: a bibliographical review  

Scientific Electronic Library Online (English)

Full Text Available SciELO Public Health | Language: Portuguese Abstract in portuguese Com objetivo de discutir e compreender as experiências de oncopediatras diante da tarefa de comunicar notícias difíceis (ND) a pacientes e familiares procedeu-se uma revisão 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 produção sobre o tema. Os artigos disponíveis, avaliados pela análise temática, evidenciam as seguintes questões: carência de estudos focando a percepção dos profissionais sobre as notícias difíceis; a comunicação como estratégia pela qual, aspectos psicossociais, culturais, bioéticos, legais e emocionais são tratados; expectativa de habilidades médicas para as quais esses profissionais não foram treinados. Observou-se também que informações e treinamento dos profissionais sobre estratégias a cerca dos modos de lidar com a comunicação de ND são insuficientes para acompanhar o dinamismo das ocorrências e das relações 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.

Selene Beviláqua Chaves, Afonso; Maria Cecília de Souza, Minayo.

236

Investigation of difficult component effects on FEM vibration prediction for the AH-1G helicopter  

Science.gov (United States)

Under the NASA-sponsored Design Analysis Methods for Vibrations program, a series of ground vibration tests and NASTRAN finite element model correlations were conducted on the Bell AH-1G helicopter gunship to investigate the effects of difficult components on the vibration response of the airframe. Secondary structure and damping were found to have significant effects on the frequency response of the airframe above 15 Hz. The nonlinear effects of thrust stiffening and elastomeric mounts on the low-frequency pylon modes below the main rotor were also significant.

Dompka, Robert V.

1988-01-01

237

Has it become more difficult for young households in rental housing to become homeowners?  

DEFF Research Database (Denmark)

It has been feared that the steep rise in house prices in the 0s would reduce ownership affordability for the young generations. In fact, homeownership among young Danish households has been falling. This development can be explained partly by postponement of family formation and partly by increased income inequality. In this paper we present calculations of the number of month it takes for an average young wage earner family that is presently in a tenant position to save 10 per cent of the average dwelling value. Our calculations show that it has become more difficult for young families to save the required amount to enter into homeownership during the 0s.

Skak, Morten; Bloze, Gintautas

2013-01-01

238

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)

239

Evaluation Of Treatment Modalities For Vitiligo At Sites Difficult To Treat-A Preliminary Report  

Directory of Open Access Journals (Sweden)

Full Text Available The treatment of vitiligo involving the mucosae, acral areas, palms and soles is an arduous challenge. No definite treatment guideline exists for these patients. The preliminary results of evaluation of four different treatment regimens in these patients are presented. Forty patients were alternatively assigned to 4 regimens comprising of PUVASOL: PUVASOL with levamisole: topical corticosteroids and topical corticosteroids with levamisole. All the four regimens gave comparable results. PUVASOL and topical corticosteroids used alone or in combination with levamisole are all equally effective in treating the so called â€?difficult to treat or resistant” sites in vitiligo with cosmetically acceptable results (25.50% pigmentation after 6 months of therapy.

Nagrath Naresh

2003-01-01

240

Treatment of difficult PIP joint fractures with a mini-external fixation device.  

Science.gov (United States)

Closed intra-articular proximal interphalangeal (PIP) joint fractures--often with accompanying joint subluxation--constitute a difficult treatment problem. This article presents an alternative method consisting of closed treatment of complex PIP joint fractures with a mini-external fixator. The method utilizes the traction principle without necessitating a complex outrigger system. Immobilization is reduced to 3 weeks and monitored with a mini-fluoro unit. The three cases presented had 1- to 2-year follow-up and excellent clinical results despite suboptimal roentgenographic appearance. PMID:8316425

Stark, R H

1993-05-01

 
 
 
 
241

Temperature Logging in Difficult Environments: Examples from the Ocean Drilling Program  

Science.gov (United States)

In the past 10 years, the Ocean Drilling Program (ODP) has drilled several medium to high temperature environments (T = 150-312 deg C). These environments include the Costa Rica Rift (Legs 140 and 148), the Middle Valley of the northern Juan de Fuca Ridge (Legs 139 and 169), the Trans-Atlantic Geotraverse (TAG) area (Leg 158), and the Manus Basin (Leg 193). Wireline and memory temperature probes deployed in high-temperature environments measured profiles of thermal history, and thus structural features controlling active fluid flow, in several of these environments. These experiences illustrate the importance of measuring in situ borehole temperatures while drilling and logging operations are underway. Hole cooling is one successful strategy that relies on the circulation of cool fluids and allows other downhole measurements to be made. However, hole cooling also adversely affects the stability of the drill hole. Temperature sensors built into the wireline cablehead provide additional information that decreases the risk of instrument damage due to high temperatures that can be encountered while logging. Likewise, a newly-developed core barrel device provides essential information for assessing temperature conditions that reduce the risk of instrument damage while drilling. These strategies are critical for acquiring wireline and logging-while-drilling (LWD) logs in high temperature environments. We discuss the technical approaches used to make these high temperature measurements and evaluate their success as well as their potential for future use in marine and continental scientific drilling.

Iturrino, G. J.; Goldberg, D.; Guerin, G.; Masterson, W.; Meltser, A.; Myers, G.; Scholz, E.

2001-05-01

242

Identification of abnormal operating conditions and intelligent decision system  

Science.gov (United States)

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.

Li, Xiuliang; Jiang, Junjie; Su, Hongye; Chu, Jian

2011-12-01

243

On the Improvement of Multi-Legged Locomotion over Difficult Terrains using a Balance Stabilization Method  

Directory of Open Access Journals (Sweden)

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.

Javaid Iqbal

2012-03-01

244

Application of cyanoacrylate in difficult-to-arrest acute non-variceal gastrointestinal bleeding  

Science.gov (United States)

Gastrointestinal bleeding is a common medical emergency. Although endoscopic treatment is effective in controlling non-variceal upper gastrointestinal bleeding, in cases of persistent bleeding radiological or surgical interventions are required. Application of cyanoacrylate for treatment of difficult-to-arrest non-variceal upper gastrointestinal bleeding is poorly investigated. We describe patients in whom cyanoacrylate for acute non-variceal gastrointestinal bleeding was used to stop the bleeding after failure of conventional endoscopic treatment. Five patients were treated with cyanoacrylate application (injection and/or spraying) for persistent bleeding (duodenal ulcer in 3, gastric ulcer in 1 and gastric Dieulafoy's lesion in 1) despite conventional endoscopic therapies. Hemostasis was achieved in all patients (100%). One patient (20%) developed recurrent bleeding 4 days after initial treatment. No complications or adverse events attributed to the cyanoacrylate application during the follow-up period of 57 days were observed. Application of cyanoacrylate is a safe and effective method to achieve immediate hemostasis when conventional endoscopic treatment is unsuccessful. This technique is easy to perform and should be considered in cases of patients with difficult-to-arrest acute non-variceal upper gastrointestinal bleeding. PMID:25337181

Baniukiewicz, Andrzej; Swidnicka-Siergiejko, Agnieszka; Dabrowski, Andrzej

2014-01-01

245

Malignant lymphomas (including myeloproliferative disorders)  

International Nuclear Information System (INIS)

This chapter deals with the radiotherapy and cytotoxic chemotherapy of the malignant lymphomas. Included within this group are Hodgkin's disease, non-Hodgkin's lymphoma, mycosis fungoides, and chronic lymphatic leukaemia. A further section deals with the myeloproliferative disorders, including granulocytic leukaemia, polycythaemia vera, and primary thrombocythaemia. Excluded are myeloma and reticulum cell sarcoma of bone and acute leukaemia. With regard to Hodgkin's disease, the past 25 years have seen general recognition of the curative potential of radiotherapy, at least in the local stages, and, more recently, awareness of the ability to achieve long-term survival after combination chemotherapy in generalised or in recurrent disease. At the same time the importance of staging has become appreciated and the introduction of procedures such as lymphography, staging laparotomy, and computer tomography (CT) has enormously increased its reliability. Advances have not been so dramatic in the complex group of non-Hodgkins's lymphomas, but are still very real

246

Neuroimagen en niños con epilepsia de difícil control / Children with epilepsy of difficult control: Neuroimaging  

Scientific Electronic Library Online (English)

Full Text Available SciELO Cuba | Language: Spanish Abstract in spanish INTRODUCCIÓN. Los actuales estudios de neuroimagen representan un gran avance para el diagnóstico etiológico y pronóstico de la epilepsia infantil. El objetivo del presente estudio fue describir los hallazgos por tomografía axial y resonancia magnética en niños con epilepsias de difícil control y co [...] mparar los resultados de estas técnicas. MÉTODOS. Se realizó un estudio descriptivo, longitudinal prospectivo, de 108 niños con diagnóstico de epilepsia de difícil control, ingresados en el Servicio de Neuropediatría del Hospital Pediátrico Docente «Juan Manuel Márquez» entre enero de 2002 y junio de 2006. Se realizaron técnicas imagenológicas por tomografía computarizada (TC) y resonancia magnética nuclear (RM). RESULTADOS. Se encontraron alteraciones estructurales del cerebro en el 88 % de los niños, y hubo predominio de lesiones prenatales en la fosa posterior, trastornos de la migración y atrofias secundarias a hipoxia perinatal. Se diagnosticó atrofia cortical localizada, mediante RM, hasta en el 28 % de los niños. CONCLUSIONES. La RM es la técnica de elección para el estudio de pacientes con epilepsia de difícil control, por su especificidad, mayor resolución y relativa inocuidad. Los pacientes con zonas localizadas de atrofia requieren estudios funcionales del cerebro para descartar displasias corticales focales. Abstract in english INTRODUCTION: Current studies of Neuroimaging are a great advance to etiologic and prognostic diagnosis of children epilepsy. The aim of present paper was to describe findings by axial tomography (AT) and magnetic resonance (MR) in children with epilepsy of difficult control, and to compare results [...] of both techniques. METHODS: A descriptive, longitudinal and prospective study was made in 108 children diagnosed with epilepsy of difficult control, admitted in Neuropediatrics Service of "Juán Manual Márquez" Teaching Children Hospital from January, 2002 to June, 2006. The techniques used were: computed tomography (CT) and nuclear magnetic resonance (NMR). RESULTS: There were brain structural alterations in 88% of children and predominance of prenatal lesions in posterior fossa, migration disorders and atrophies secondary to perinatal hypoxia. They had a diagnosis of localized cortical atrophy by MR up to 28% of children. CONCLUSIONS: MR is the choice technique to study patients with epilepsy of difficult control due to its specificity, a great resolution, and relative harmless. Patients with located zones of epilepsy need brain functional studies to rule out focal cortical dysplasias.

Ileana, Valdivia Álvarez; Rogelio, Odales Ibarra.

2009-09-01

247

Neuroimagen en niños con epilepsia de difícil control Children with epilepsy of difficult control: Neuroimaging  

Directory of Open Access Journals (Sweden)

Full Text Available INTRODUCCIÓN. Los actuales estudios de neuroimagen representan un gran avance para el diagnóstico etiológico y pronóstico de la epilepsia infantil. El objetivo del presente estudio fue describir los hallazgos por tomografía axial y resonancia magnética en niños con epilepsias de difícil control y comparar los resultados de estas técnicas. MÉTODOS. Se realizó un estudio descriptivo, longitudinal prospectivo, de 108 niños con diagnóstico de epilepsia de difícil control, ingresados en el Servicio de Neuropediatría del Hospital Pediátrico Docente «Juan Manuel Márquez» entre enero de 2002 y junio de 2006. Se realizaron técnicas imagenológicas por tomografía computarizada (TC y resonancia magnética nuclear (RM. RESULTADOS. Se encontraron alteraciones estructurales del cerebro en el 88 % de los niños, y hubo predominio de lesiones prenatales en la fosa posterior, trastornos de la migración y atrofias secundarias a hipoxia perinatal. Se diagnosticó atrofia cortical localizada, mediante RM, hasta en el 28 % de los niños. CONCLUSIONES. La RM es la técnica de elección para el estudio de pacientes con epilepsia de difícil control, por su especificidad, mayor resolución y relativa inocuidad. Los pacientes con zonas localizadas de atrofia requieren estudios funcionales del cerebro para descartar displasias corticales focales.INTRODUCTION: Current studies of Neuroimaging are a great advance to etiologic and prognostic diagnosis of children epilepsy. The aim of present paper was to describe findings by axial tomography (AT and magnetic resonance (MR in children with epilepsy of difficult control, and to compare results of both techniques. METHODS: A descriptive, longitudinal and prospective study was made in 108 children diagnosed with epilepsy of difficult control, admitted in Neuropediatrics Service of "Juán Manual Márquez" Teaching Children Hospital from January, 2002 to June, 2006. The techniques used were: computed tomography (CT and nuclear magnetic resonance (NMR. RESULTS: There were brain structural alterations in 88% of children and predominance of prenatal lesions in posterior fossa, migration disorders and atrophies secondary to perinatal hypoxia. They had a diagnosis of localized cortical atrophy by MR up to 28% of children. CONCLUSIONS: MR is the choice technique to study patients with epilepsy of difficult control due to its specificity, a great resolution, and relative harmless. Patients with located zones of epilepsy need brain functional studies to rule out focal cortical dysplasias.

Ileana Valdivia Álvarez

2009-09-01

248

Ultrasonography and computed tomography in patients with right lower quadrant pain: Difficult cases of appendicitis  

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Full Text Available Adrienne van Randen1,2, Wytze Laméris1,2, Marja A Boermeester2, Julien BCM Puylaert3, Jaap Stoker11Department of Radiology; 2Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; 3Department of Radiology, Westeinde Hospital, The Hague, The NetherlandsAbstract: Acute appendicitis is a common cause of acute abdomen and both computed tomography (CT and ultrasonography (US are used in the diagnostic work-up of these patients. In general, imaging has high accuracy in diagnosing acute appendicitis. Although the imaging features of appendicitis are well known, in some patients findings are less conclusive. This pictorial essay will give an overview of difficult US and CT cases of patients suspected of acute appendicitis. Keywords: acute appendicitis, ultrasonography, CT

Adrienne van Randen

2009-04-01

249

Myoid hamartoma of the breast that proved difficult to diagnose: a case report  

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Full Text Available Abstract Myoid hamartomas of the breast are extremely rare breast lesions, with a poorly understood pathogenesis. We describe the case of a 38-year-old premenopausal woman who presenting with a mass in the left breast. Mammography revealed an oval mass that was partly indistinct, and ultrasonography showed a hypoechoic mass with a slightly irregular margin. Bilateral breast dynamic magnetic resonance imaging was performed for a more detailed evaluation. The images showed rapid initial enhancement and a microlobulated margin. Because the suspicion of malignancy was strong at that time, core needle biopsy was performed. Histologically, the tumor was identified as fibroadenoma. A case of myoid hamartoma of the breast that proved difficult to diagnose is reported, and discussed with reference to the literature.

Mizuta Naruhiko

2012-01-01

250

Voltage is the Most Difficult Subject for Students in Physics by Inquiry's Electric Circuits Module  

Science.gov (United States)

We report on the investigation of multiple sets of data from an electric circuits Physics by Inquiry course on students' ranking of topic difficulty. Students ranked the difficulty of the preceding class almost every class day and they ranked the difficulty of various course sections on a diagnostic (one diagnostic per section). In the OSU Physics by Inquiry (PbI) class, studentsâa majority of education undergraduatesâwork in groups, and are checkpointed as they do experiments in a section. In addition, there is a question of the day at the beginning of almost every class. Here, students are also asked to rank the difficulty, but of the preceding day's classwork. These âdifficulty rankingsâ and student grades (used as a measure of performance) constitute our dataset. We compiled data from four sections of the Spring 2006 and one section of the Spring 2007 Physics by Inquiry electric circuits class. The sections on potential difference appear to be the most difficult.

Bowman, Carol; Aubrecht Ii., Gordon J.

2009-07-06

251

980nm laser for difficult-to-treat basal cell carcinoma  

Science.gov (United States)

Begin basal cell carcinoma (BCC) is most common skin cancer over the world. There are around 20 modalities for BCC treatment. Laser surgery is uncommon option. We demonstrate our long term follow up results. Aim: To evaluate long term efficacy of a 980nm diode laser for the difficult-to-treat basal cell carcinoma. Materials and Methods: 167 patients with 173 basal cell carcinoma on the nose were treated with a 980 nm diode laser from May 1999 till May 2005 at Latvian Oncology center. All tumors were morphologically confirmed. 156 patients were followed for more than 5 years. Results: The lowest recurrence rate was observed in cases of superficial BCC, diameterConclusions: 980 nm diode laser is useful tool in dermatology with high long term efficacy, good acceptance by the patients and good cosmetics results.

Derjabo, A. D.; Cema, I.; Lihacova, I.; Derjabo, L.

2013-06-01

252

Methods to ease the release of thin polydimethylsiloxane films from difficult substrates  

DEFF Research Database (Denmark)

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.

Vudayagiri, Sindhu; Skov, Anne Ladegaard

2013-01-01

253

Pulmonary arteriovenous malformations presenting as difficult-to-control asthma: a case report  

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Full Text Available Abstract Introduction Although pulmonary arteriovenous malformations are relatively rare disorders, they are an important part of the differential diagnosis of common pulmonary problems, such as hypoxemia, dyspnea on exertion and pulmonary nodules. Case presentation An 11-year-old Croatian boy of Mediterranean origin with a history of asthma since childhood was admitted to our hospital for evaluation of difficult-to-control asthma during the previous six months. A chest X-ray showed a homogeneous soft tissue mass in the lingual area. Computed tomography angiography of the thorax showed two pulmonary arteriovenous malformations, one on each side of the lungs. Diagnosis of hereditary hemorrhagic telangiectasia was made clinically by Curaçao criteria. Genetic analysis revealed a mutation in the endoglin gene. The patient was treated with embolotherapy with good clinical outcome. Conclusion We present a case of pulmonary arteriovenous malformations masquerading as refractory asthma.

Navratil Marta

2013-01-01

254

Mechanized ultrasonic testing of material configurations and complex geometries which are difficult to test  

International Nuclear Information System (INIS)

During the last few years, there was great progress in the field of mechanized ultrasonic testing. For material combinations which are difficult to test, such as Austenitic or mixed compounds and for complex geometries of components to be tested, there are great requirements for the test and evaluation systems. Faults must not only be found, but should also be clearly characterized. New analysis processes and suitably qualified staff are required for this. In future, the automation of evaluation and support of the tester by expert systems will gain in importance. From practical repeat tests in nuclear powerstations, solutions from the areas of test planning, execution of tests (manipulation) and evaluation are introduced. Experience in the use of the SAFT technique is also discussed. (orig.)

255

Use of Laryngeal Mask Airway in the Management of a Difficult Airway: A Case Report  

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Full Text Available Background: Difficulty in management of the airway occurs most frequently in patients who have Mallampati grade III and IV, and other unfavourable airway findings like short neck, restriction in range of motion of the temporoman-dibular joints and inadequate neck flexion and extension. Because of unavailability of fibreoptic bronchoscopes or inexperience in their use, laryngeal mask airway (LMA has become a common and acceptable airway management option. This is a case report of a postmenopausal woman who had her airway managed with LMA following initial failed intubation necessitating a rescheduling of the operation. Result: The patient had a successful surgery and postoperative recovery was uneventful. Conclusion: The LMA is a useful option in the management of an anticipated or unexpected difficult airway, especially in resource-poor settings where fibreoptic bronchoscopes may not be readily available.

Elizabeth Ogboli-Nwasor

2013-03-01

256

Difficult airway management following severe gasoline burn injury: a case report.  

Science.gov (United States)

Airway management following severe gasoline burn injury can be difficult. Because patients with severe burns may be treated at a variety of hospitals that provide emergent care, it is valuable for Certified Registered Nurse Anesthetists who work in such facilities to have an understanding of the care of these patients. Airway management is an extremely important consideration in the care of burn victims. If not done in a timely manner, lethal complications may result. This article reports the experience of caring for a female who was involved in an altercation, doused with gasoline, and set on fire. Consequently, airway obstruction developed and progressively worsened. Airway management interventions began with bag-valve-mask-assisted ventilation and progressed through orotracheal intubation attempts, attempts to insert a laryngeal mask airway, cricothyrotomy, emergency tracheostomy, and surgical tracheostomy. PMID:23251995

Greathouse, Jeffrey S; Stuart, Jamie L; White, William A

2012-08-01

257

The family context of relational aggression in "difficult to treat" female juvenile offenders.  

Science.gov (United States)

Female juvenile offenders often engage in socially aggressive behaviors that make them more difficult to treat than male juvenile offenders. This social (i.e., relational) aggression may be developed or maintained through transactions with family members. To investigate this issue, we measured relational aggression in the family interactions of 140 adolescents divided by gender and offender status into four equal-sized groups (female juvenile offenders, male juvenile offenders, female nonoffenders, and male nonoffenders). Adolescents and caregivers completed a family discussion task, and raters coded relationally aggressive behaviors at the dyadic level. Results showed that female juvenile offenders and their mothers directed more relational aggression toward each other than did mother-adolescent dyads in the other groups. Implications of these results for treatment and research are discussed. PMID:24750046

Taylor, Erin K; Borduin, Charles M

2014-07-01

258

Treatment options for refractory and difficult to treat seizures: focus on vigabatrin.  

Science.gov (United States)

Complex partial seizures are often refractory to current pharmacological therapies. These difficult to treat seizures are typically managed using multiple antiepileptic drugs (AEDs). AEDs as a group are frequently associated with significant adverse drug effects, multiple drug interactions, and numerous potential clinical complications due to their individual pharmacokinetic profiles and unique drug properties. Recently, the approval of vigabatrin by the US Food and Drug Administration has necessitated that clinicians re-evaluate these risk-benefit relationships and determine where the drug fits within the treatment scheme for the management of complex partial seizures. This review will facilitate that re-evaluation through a brief review of AEDs used in the treatment of complex partial seizures, followed by a focused discussion on vigabatrin. PMID:21941443

Tolman, Justin A; Faulkner, Michele A

2011-01-01

259

Treatment options for refractory and difficult to treat seizures: focus on vigabatrin  

Directory of Open Access Journals (Sweden)

Full Text Available Justin A Tolman, Michele A FaulknerSchool of Pharmacy and Health Professions, Creighton University, Omaha, Nebraska, NE, USAAbstract: Complex partial seizures are often refractory to current pharmacological therapies. These difficult to treat seizures are typically managed using multiple antiepileptic drugs (AEDs. AEDs as a group are frequently associated with significant adverse drug effects, multiple drug interactions, and numerous potential clinical complications due to their individual pharmacokinetic profiles and unique drug properties. Recently, the approval of vigabatrin by the US Food and Drug Administration has necessitated that clinicians re-evaluate these risk-benefit relationships and determine where the drug fits within the treatment scheme for the management of complex partial seizures. This review will facilitate that re-evaluation through a brief review of AEDs used in the treatment of complex partial seizures, followed by a focused discussion on vigabatrin.Keywords: vigabatrin, complex partial seizures, refractory seizures, risk evaluation and mitigation strategy, epilepsy

Tolman JA

2011-09-01

260

Establishment of dual C/S systems at Monju difficult-to-access area  

International Nuclear Information System (INIS)

The Prototype Fast Breeder Reactor 'Monju' is designed to use plutonium for fuel and sodium for coolant to avoid moderating neutrons while effectively utilizing fast neutrons. There are two areas, core and Ex-Vessel Fuel Storage Tank, where fuel assemblies are in liquid sodium and this design makes safeguards for Monju unique. Since the fuel assemblies in these areas cannot be visually confirmed, these areas are designated as a difficult-to-access-area' by the IAEA. To satisfy the inspection goal specified in 1991-1995 IAEA Safeguards Criteria, a dual C/S system consisting of two monitoring devices that are functionally independent has been requested. In this paper, efforts and development of two radiation monitors installed in Monju, Core Monitor and Ex-Vessel Fuel Storage Tank Monitor, are presented. (author)

 
 
 
 
261

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 fig

262

Characteristic aspects of the housing and utilitiescomplex as a difficult organizational and economic system  

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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.

Butyrin Andrey Yur'evich

2014-02-01

263

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.

264

Theorizing "Difficult Knowledge" in the Aftermath of the "Affective Turn": Implications for Curriculum and Pedagogy in Handling Traumatic Representations  

Science.gov (United States)

This essay draws on the concept of "difficult knowledge" to think with some of the interventions and arguments of affect theory and discusses the implications for curriculum and pedagogy in handling traumatic representations. The author makes an argument that affect theory enables the theorization of difficult knowledge as an…

Zembylas, Michalinos

2014-01-01

265

Sensitivity of Palm Print, Modified Mallampati Score and 3-3-2 Rule in Prediction of Difficult Intubation  

Science.gov (United States)

Background: This study evaluated the performance of modified Mallampati score, 3-3-2 rule and palm print in prediction of difficult intubation. Methods: In a prospective descriptive study, data from 500 patients scheduled for elective surgery under general anesthesia were collected. An anesthesiologist evaluated the airway using mentioned tests and another anesthesiologist evaluated difficult intubation. Laryngoscopic views were determined by Cormack and Lehane score. Grades 3 and 4 were defined as difficult intubation. Sensitivity, specificity, positive predictive value, negative predictive value and Youden index were determined for all tests. Results: Difficult intubation was reported in 8.9% of the patients. There was a significant correlation between body mass index and difficult intubation (P : 0.004); however, other demographic characteristics didn’t have a significant correlation with difficult intubation. Among three tests, palm print was of highest specificity (96.46%) and modified Mallampati of highest sensitivity (98.40%). In a combination of the tests, the highest specificity, sensitivity and Youden index were observed when using all three tests together. Conclusions: Palm print has a high specificity for prediction of difficult intubation, but the best way for prediction of difficult intubation is using all three tests together. PMID:24130949

Mahmoodpoor, Ata; Soleimanpour, Hassan; Nia, Kavous Shahsavari; Panahi, Jafar Rahimi; Afhami, Mohammadreza; Golzari, Samad EJ; Majani, Karim

2013-01-01

266

Awake fiberoptic or awake video laryngoscopic tracheal intubation in patients with anticipated difficult airway management : a randomized clinical trial  

DEFF Research Database (Denmark)

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.

Rosenstock, Charlotte Vallentin; ThØgersen, Bente

2012-01-01

267

Brake assembly including torque monitor  

International Nuclear Information System (INIS)

This patent describes a brake assembly for selectively braking rotation of an input shaft extending from a control rod drive having a longitudinal centerline axis, the shaft being rotatable for selectively inserting and withdrawing a control rod in a nuclear reactor vessel. It comprises a stationary base; an annular bearing mounted to the base; a brake mounted to the bearing; a backing plate mounted to the bearing; a first braking pad fixedly joined to the backing plate; a rotor disc fixedly connected to the input shaft and disposed adjacent to the first pad; a second braking pad disposed adjacent to the rotor disc; and means for selectively clamping the first and second pads against the rotor disc for braking the input shaft; means for torsionally restraining the brake including: a pin extending outwardly from the backing plate toward the base; and a spring extending from the base to the pin and generally perpendicular to the centerline axis; and means for monitoring the angle for monitoring braking torque capability of the brake

268

High fidelity medical simulation in the difficult environment of a helicopter: feasibility, self-efficacy and cost  

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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.

Holland Carolyn

2006-10-01

269

Application of the Akinfiev-Diamond equation of state to neutral hydroxides of metalloids (B(OH)3, Si(OH)4, As(OH)3) at infinite dilution in water over a wide range of the state parameters, including steam conditions  

Science.gov (United States)

The Akinfiev and Diamond (2003) equation of state (EoS) for aqueous nonelectrolytes was employed to describe hydroxides of metalloids (B(OH)3, Si(OH)4, As(OH)3) over a wide temperature and pressure ranges, including steam conditions. The EoS is based on the accurate knowledge of solvent (H2O) properties and requires only three empirical parameters to be fitted to experimental data, and these are independent of temperature and pressure. For nonvolatile components thermodynamic properties of species in the ideal gas state were evaluated using quantum chemical computations. The proposed approach has been tested to predict the whole set of thermodynamic properties of solutes (the chemical potential, entropy, molar volume, and molar heat capacity) over a wide range of temperatures (273-1200 K) and pressures (0.1-1000 MPa), including the near-critical region and both low and high density regions of the solvent. Thus it can be used for modeling various geochemical processes over a whole range of solvent densities, including processes in boiling fluids and a vapor phase as well. solubility data in a low density aqueous fluid (?1? 1 mol kg-1) where polymerization effects may take place (Newton and Manning, 2003); the rest of data, containing the majority of quartz solubility points at 293-1273 K, 0.1-1000 MPa. Only the 3rd part of experimental quartz solubility data has been used in the fitting procedure. Thermodynamic properties of Si(OH)4 in the ideal gas state were recently determined by the analysis of the relevant experimental data in Plyasunov (2011b). The temperature dependence of heat capacity of the molecule was adopted from comprehensive study of Rutz and Bockhorn (2005)where DFT calculations at different levels of theory including CBS-QBS and G3MP2 methods, as well as corrections for hindered rotations and scaling for vibration frequencies were employed. The adopted Cpo (T = 300-1500 K) values for gaseous Si(OH)4 were approximated by a function and used in the treatment of data, see Table 1. The fitting procedure to evaluate the parameters of the Akinfiev-Diamond model also included the values of ?fGo and S° of Si(OH)4 in ideal gas state at standard state conditions.First, to fit the EoS parameters, the dataset for g2? (Si(OH)4(aq)) has been generated using accepted experimental data on quartz solubility in water according to the reaction SiO2(quartz) + 2H2O = Si(OH)4(aq), as g2?(SiOH(aq)(T,P)=g(quartz)(T,P)+2g(HO)(T,P)-RTlnm, where mSi corresponds to the molality of silica in the solution. Thermodynamic properties of quartz were adopted from SUPCRT database (Johnson et al., 1992), while g(H2O)(T, P) was computed using the Hill (1990) and/or Wagner and Pruß (2002) formulations.The fitting procedure was organized as described below. It is known that partial molar properties of dilute solutes close to the critical point of water are governed by the Krichevskii parameter, AKr (Levelt Sengers, 1991). Plyasunov (2012) recommended for Si(OH)4AKr = -190 ± 10 MPa evaluated from the available relevant data. We have used this value as an anchor while fitting. So, the fitting procedure was iterative. After any initial approximation for ?, values of the a, b parameters of the EoS together with ?fGo298(g) and So298(g) of Si(OH)4 were determined by a linear regression of the available g2? (Si(OH)4(aq)) experimental data. Then the ? parameter was modified in compliance with the adopted AKr value (Eq. A7), and the fitting cycle was repeated until ? ceased changing.The finally retrieved values for gaseous Si(OH)4 are ?fGo298 = -1239.66 ± 1.7 kJ mol-1, So298 = 346.37 ± 3.5 J mol-1 K-1, and the EoS parameters are ? = -1.8933; a = 0.9285 ± 1.1 cm3 g-1; b = -0.9409 ± 0.97 cm3 K0.5 g-1 (2? confidence) (Table 1). Evaluated in this work values of ?fGo298 and So298 for Si(OH)4 in the ideal gas state are very close to the data given in Plyasunov (2011b) on the basis of the analysis of the solubility amorphous silica and quartz in low-density steam:

Akinfiev, Nikolay N.; Plyasunov, Andrey V.

2014-02-01

270

Interactive film scenes for tutor training in problem-based learning (PBL: dealing with difficult situations  

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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.

Kirschfink Michael

2010-07-01

271

[Resilience and responses to the experience of trauma--a fascinating but difficult study area].  

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The notion of resilience, which attempts to explain the phenomenon of positive adaptation (coping) of people exposed to adversities or traumatic events, is becoming a significant area of research in Poland. It is a complex and multidimensional notion, on the borderline between genetics, neurophysiology, anthropology of culture, sociology, medicine, political science, developmental psychology and psychiatry. The phenomenon of resilience is interactive (as it combines the experience of trauma with adaptation to it), it is difficult to measure and it raises serious methodological concerns. They tend to be so significant that some researchers consider resilience to be a construct of dubious scientific value. Such a view seems to be overly critical, however it indicates the magnitude of methodological difficulties. This article discusses some of them: problems with definitions and terminology, measurement difficulties associated with the interactive nature of resilience, the need to search for complex interactions between biological, psychological, social and environmental factors (rather than overly simplistic focus on individual factors which support good adaptation). The methodological issues have been divided into the following research areas: the nature of traumatic experiences, response to trauma, factors which impact the reporting of the reaction to trauma, developmental problems. PMID:25204101

Szwajca, Krzysztof

2014-01-01

272

Desmoplastic round small cell tumor: a case report of a neoplasm of difficult diagnosis  

International Nuclear Information System (INIS)

Desmoplastic Small Round Cell Tumor (DSRCT) is a rare neoplasm of difficult diagnosis, recently described by Gerald et al. There are reports of nearly 101 cases in the literature, being the intra-abdominal region its most common location and children and young adults its preferred age group. This paper reports a case of DSRCT in a young adult of 24 years of age. This patient presented unspecific symptoms of nausea, vomiting and a single episode of haematemesis. Upon physical examination a solid mass on the epigastrium and left hypochondrium was found. Image diagnostic procedures confirmed the existence of the expansive process and also revealed enlarged retroperitoneal lymphonodes. Diagnosis was achieved through videolaparoscopic biopsy. Histologic sections stained with hematoxylin/eosin were inconclusive and immunohistochemical analysis was required to establish the diagnosis. This analysis revealed positivity to epithelial and mesenchymal markers and weak positivity to chromogranin A, characteristic results of DSRCT. Due to the fact that the disease was locally advanced, the patient was treated with chemotherapy (cyclophosphamide and paclytaxel). However, since there was only partial response to the treatment, the patient refused to undergo any second line option of therapy. Presently, the patient is being submitted only to supportive care, within an 18-month follow-up program. (author)

273

Measuring competition in plant communities where it is difficult to distinguish individual plants  

DEFF Research Database (Denmark)

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.

Damgaard, Christian

2011-01-01

274

Measuring competition in plant communities where it is difficult to distinguish individual plants  

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Full Text Available 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 neighbouring plants on plant performance and the estimation of parameters that describe the ecological processes of plant-plant 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.

Christian Damgaard

2011-09-01

275

Reconciliation as narrative: Witnessing against a too easy and a too difficult reconciliation  

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Full Text Available Reconciliation as narrative: Witnessing against a too easy and a too difficult reconciliationAfter the dawn of democracy in South Africa in 1994 diverse paradigms on reconciliation have appeared on the scene. In this article these paradigms are not discredited so much for being downright unproductive, but they are found to be either too prescriptive as is the case with the TRC or too limited as is the case with the three paradigms of which mere sketches are offered.The main thrust of the article is a proposal on developing reconciliation as narrative in contradistinction to a dogmatic, technical approach to reconciliation as something to be organised, to be prescribed and engineered. The basic thesis of the article is that narrative can potentially create vast space for story-telling and for many more voices to be heard on the issue of reconciliation. The notion of narrative is advanced as a serious academic category and not an intellectual fad. A further issue is illustrating how issues like remembering, forgiveness and justice need to be brought into discourse with reconciliation.

N Botha

2008-06-01

276

Damaging Prediction of Difficult-to-Work Aluminum Alloys During Equal Channel Angular Pressing  

Science.gov (United States)

Severe plastic deformation (SPD) is a well-established method in the recent years for grain refinement in metallic materials. Equal channel angular pressing (ECAP) is one of the most effective SPD techniques. Inherent failures of ECAP, consisting in billet damage, take place if not made a correct process design. In this article, the evolution of damaging for a difficult-to-work Al-Mg alloy during ECAP was investigated. A tridimensional finite element analysis was performed for four different die designs to study the influence of die geometry and process parameters on billet damaging. To validate modeling we used, load level and strain distribution were depicted. Experimental tests were performed to test the numerical prediction. The results show that cracking may be reduced or eliminated by inner fillet corner of the die channels. It was demonstrated that the predicted results were in good agreement with experimental data obtained for 5052 aluminum alloy. The direct effect of knowledge about load and damaging during ECAP is to prevent both tool and billet damage.

Comaneci, Radu; Zaharia, Luchian; Chelariu, Romeu

2012-03-01

277

Why do Family Physicians find it difficult to apply clinical guidelines?  

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Full Text Available The aging of the population, in Italy as well as in all the countries of the European Union, and the increasing prevalence of chronic diseases pose challenges to the development and application of clinical guidelines. Guidelines have been developed to improve the quality of health care. Anyway, Family Physicians sometimes find many obstacles in integrating guidelines into medical practice. In the care of older individuals with several comorbid diseases, application of clinical guidelines is not only difficult, but may also lead to undesirable effects. In this article, the Author take a review, published in JAMA, as a starting point to discuss the role and the importance of guidelines in patients with comorbid disease in the Italian context. The review analyses the hypothetical case of a 79-year-old woman with chronic obstructive pulmonary disease, type 2 diabetes, osteoporosis, hypertension and osteoarthritis, and describes the situation of the aggregated recommendations from the most relevant guidelines. The conclusion is that, to improve the care of older patients with complex comorbidities, developing new measures and new guidelines is extremely necessary.

Andrea Pizzini

2013-01-01

278

Diagnostic methods. Current best practices and guidelines for identification of difficult-to-culture pathogens in infective endocarditis.  

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IE is a serious, life-threatening disease. Because treatment must often be adapted to the pathogen involved, rapid identification of the etiologic agent is critical to successful management of each patient. When difficult-to-culture pathogens are involved, routine microbiologic tests, including blood culture, may remain negative. Because such cases may account for up to 31% of all IE cases, alternative diagnostic approaches are necessary. Among the etiologic agents of culture-negative endocarditis, C burnetii and Bartonella spp play a major role; each is responsible for up to 3% of episodes of IE. The authors therefore recommend the systematic use of specific serologies in all cases of clinically suspected endocarditis. The cross-reactivity between C burnetii, Bartonella spp, and Chlamydia spp is of diagnostic importance because all are potential etiologic agents of endocarditis. However, given that the levels of specific antibodies observed in Bartonella endocarditis are extremely high, low-level cross-reactions with other antigens should not lead to misdiagnosis, provided serology for all suspected agents is performed. When serologic test results are negative for both Bartonella spp and C burnetii, special staining by the Gram, Giemsa, Gimenez, PAS, Warthin-Starry, and Grocott methods may guide the use of new diagnostic tools such as PCR and tissue culture for isolation and identification of the causative agent. Such novel approaches may lead to more comprehensive patient evaluations and the discovery of new etiologic agents of IE. PMID:12874894

Houpikian, Pierre; Raoult, Didier

2003-05-01

279

I-123 iofetamine single photon emission tomography in school-age children with difficult-to-control seizures  

International Nuclear Information System (INIS)

Interictal I-123 iofetamine (IMP) single photon emission tomography (SPECT) was performed in 15 children with difficult-to-control partial or generalized seizures. SPECT studies were compared with magnetic resonance imaging and CT in seven patients, with magnetic resonance imaging only in five, and with CT only in three. Electroencephalography was performed on all subjects, including invasive studies in nine. SPECT was abnormal in six patients. Magnetic resonance and/or CT studies were abnormal in two of the six patients. The other four patients with abnormal SPECT imaging studies had four magnetic resonance and two CT studies that were normal. The SPECT abnormality corresponded to EEG localization in each of the six cases. Lesions localized on SPECT were in or near the temporal lobes. Five other patients with normal SPECT had well-localized abnormalities on EEG. Four magnetic resonance and five CT studies were also negative in these five cases. Four patients whose EEGs did not show adequate lateralization had four normal SPECT, two normal CT, and three normal magnetic resonance studies. In children as in adults, IMP SPECT imaging shows promise in the localization of seizure foci in or near the temporal lobes

280

Comparison of a disposable bougie versus a newly designed malleable bougie in the intubation of a difficult manikin airway.  

Science.gov (United States)

The endotracheal bougie is used for difficult intubations when only a minimal glottic view is obtained. Standard bougies are designed for use during direct, line-of-sight viewing of the glottic opening. With videolaryngoscopy, intubators "see around the corner", thus requiring a bougie which can be shaped to follow a significant curve. A malleable bougie with an imbedded internal wire was created to enable intubators to shape the curve to best fit a difficult airway. This pilot study examined the malleable bougie compared to the SunMed bougie in a simulated difficult airway intubation using video laryngoscopy. PMID:21335760

Boedeker, Ben H; Bernhagen, Mary; Miller, David J; Murray, W Bosseau

2011-01-01

 
 
 
 
281

Science Teachers’ and Students’ Perceived Difficult Topics in the Integrated Science Curriculum of Lower Secondary Schools in Barbados  

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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.

Babalola Ogunkola

2011-10-01

282

The approach to the difficult urethral catheterization among urology residents in the United States  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: English Abstract in english PURPOSE: To determine the prevalence of different approaches to the difficult urethral catheterization (DUC) among urology residents (UR) in the United States (US). MATERIALS AND METHODS: An email invitation to participate in an online survey regarding DUC was sent to 267 UR and to 22 urology progra [...] m coordinators for them to forward to their residents. 142 UR completed the survey. RESULTS: After the initial unsuccessful attempt by a nurse, 92% of UR attempted a catheter prior to resorting to other modalities. The most common choice of the first catheter was a Coude (76%) size 18F (51%). For situations where multiple sizes and types of catheters (12 - 20F) were used without success, 3 scenarios were proposed: 1) Catheter passed the bulbomembranous urethra (BMU) and patient had previous history of transurethral resection of the prostate or radical retropubic prostatectomy, 2) Catheter passed the BMU and no urologic history, 3) Catheter did not pass the BMU and no urologic history. Flexible cystoscopy was used in 74%, 62% and 63%; blind passage of a glidewire was second with 15%, 23% and 20%; and blind use of filiforms and followers was chosen in 7%, 9% and 9% of the scenarios respectively. CONCLUSIONS: The most common approach to the DUC among UR in the US involves using an 18F Coude catheter first. After trying one or more urethral catheters, UR most commonly resort to flexible cystoscopy as opposed to the blind placement of glide wires or filiforms/followers.

Carlos, Villanueva; George P., Hemstreet III.

2010-12-01

283

Exposure in difficult total knee arthroplasty using coronal tibial tubercle osteotomy.  

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Full Text Available Exposure in a total knee arthroplasty can be challenging regardless of whether it is a difficult primary or a revision. Various techniques both proximal and distal to the patella have been described and implemented to gain exposure and improve knee flexion. When patella eversion is not possible due to previous surgery or severe preoperative knee flexion contracture, a coronal tibial tubercle osteotomy may be utilized. We present successful results utilizing the coronal tibial tubercle osteotomy procedure. The technique involved in this series is based on that described by Whiteside. It involves the development of a long lateral musculoperiosteal flap incorporating the tibial tubercle and anterior tibia, and leaving the proximal tibial cortex intact. This is extended along the tibia distally for 10 cm. It finishes by gradually osteotomising the anterior surface of the tibial crest. The tubercle is reattached with wires at the end of the procedure. This technique minimizes complications that have been associated with the tibial tubercle osteotomy. The 10 knees in 9 patients, who had total knee arthroplasty with a coronal tibial tubercle osteotomy, were reviewed pre and postoperatively. All knees were assessed using the Hospital for Special Surgery knee score (HSS. The scores averaged 43.6 preoperatively (range, 29 57 and 79.2 postoperatively (range, 67 90, and the mean range of motion was 59.5 degrees preoperatively and 78.0 degrees postoperatively. There were no cases of extension lag. Fixed flexion deformity was present in 3 cases postoperatively. Average time to union at the proximal and distal ends of the osteotomy was 8 and 24 weeks respectively. There was no evidence of nonunion and no other significant complications occurred.

Bruce WJ

2000-06-01

284

Automatic mesh adaptivity for CADIS and FW-CADIS neutronics modeling of difficult shielding problems  

International Nuclear Information System (INIS)

The CADIS and FW-CADIS hybrid Monte Carlo/deterministic techniques dramatically increase the efficiency of neutronics modeling, but their use in the accurate design analysis of very large and geometrically complex nuclear systems has been limited by the large number of processors and memory requirements for their preliminary deterministic calculations and final Monte Carlo calculation. Three mesh adaptivity algorithms were developed to reduce the memory requirements of CADIS and FW-CADIS without sacrificing their efficiency improvement. First, a macro-material approach enhances the fidelity of the deterministic models without changing the mesh. Second, a deterministic mesh refinement algorithm generates meshes that capture as much geometric detail as possible without exceeding a specified maximum number of mesh elements. Finally, a weight window coarsening algorithm de-couples the weight window mesh and energy bins from the mesh and energy group structure of the deterministic calculations in order to remove the memory constraint of the weight window map from the deterministic mesh resolution. The three algorithms were used to enhance an FW-CADIS calculation of the prompt dose rate throughout the ITER experimental facility. Using these algorithms resulted in a 23.3% increase in the number of mesh tally elements in which the dose rates were calculated in a 10-day Monte Carlo calculation and, additionally, increased the efficiency of the Monte Carlo simulation by a factor of at least 3.4. The three algorithms enabled this difficult calculation to be accurately solved using an FW-CADIS simulation on a regular computer cluster, obviating the need for a world-class super computer. (authors)

285

Combined precut in difficult biliary cannulation / Precorte combinado en la canulación biliar difícil  

Scientific Electronic Library Online (English)

Full Text Available SciELO Spain | Language: English Abstract in english 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.

Jesús, Espinel-Díez; Eugenia, Pinedo-Ramos; Luis, Vaquero-Ayala; Begoña, Álvarez-Cuenllas; Vanesa, Ojeda-Marrero.

2013-06-01

286

Laparoscopia no abdome agudo inflamatório de difícil diagnóstico Laparoscopy in inflamatory acute abdomen of difficult diagnosis  

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Full Text Available OBJETIVOS: O objetivo deste estudo foi analisar a eficácia do método laparoscópico em casos de abdome agudo inflamatório de difícil avaliação, quanto à 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 não esclarecedores, foram submetidos à laparoscopia diagnóstica e/ou terapêutica. RESULTADOS: A precisão diagnóstica do exame foi de 96,5%. Com relação à terapêutica, 58,6 % dos doentes foram tratados por laparoscopia, 34,4% clinicamente e 6,8 % por laparotomia. A taxa de complicação foi de 10,3%, com ausência de mortalidade nesta série. Os doentes submetidos ao tratamento laparoscópico, tiveram alta hospitalar em média 36 horas após o procedimento. CONCLUSÕES: A laparoscopia mostrou-se um método de elevada acurácia diagnóstica, que permitiu manejo terapêutico satisfatório, associado à baixa morbidez e à recuperação 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.

Antonio Carlos Valezi

2003-08-01

287

Optimal Testing with Easy or Difficult Items in Computerized Adaptive Testing  

Science.gov (United States)

Computerized adaptive tests (CATs) are individualized tests that, from a measurement point of view, are optimal for each individual, possibly under some practical conditions. In the present study, it is shown that maximum information item selection in CATs using an item bank that is calibrated with the one- or the two-parameter logistic model…

Eggen, Theo J. H. M.; Verschoor, Angela J.

2006-01-01

288

Breaking the cycle: how I manage difficult atopic dermatitis / Romper o ciclo: minha conduta em casos difíceis de dermatite atópica  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: English Abstract in portuguese Esta revisão 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 não propiciam um alívio adequado aos pacientes, o que leva a uma alternativa dispendiosa, ou seja, um atitude que vis [...] a procurar alergias e complica ainda mais o tratamento desses pacientes. Se nós, como dermatologistas, oferecermos um aconselhamento racional sobre prevenção e cuidados com a pele, junto com uma terapia antiinflamatória eficaz e estável, nossos pacientes irão parar de procurar abordagens irracionais. O novo fluxo de informações 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 à dermatite atópica e asma possam ser atenuados com medidas simples e seguras. Abstract in english 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 f [...] or 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.

Jon M., Hanifin.

2007-02-01

289

Breaking the cycle: how I manage difficult atopic dermatitis Romper o ciclo: minha conduta em casos difíceis de dermatite atópica  

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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 revisão 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 não 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 prevenção e cuidados com a pele, junto com uma terapia antiinflamatória eficaz e estável, nossos pacientes irão parar de procurar abordagens irracionais. O novo fluxo de informações 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 à dermatite atópica e asma possam ser atenuados com medidas simples e seguras.

Jon M. Hanifin

2007-02-01

290

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

291

Trombosis venosa cerebral de difícil diagnóstico / Cerebral venous thrombosis of difficult diagnosis  

Scientific Electronic Library Online (English)

Full Text Available SciELO Peru | Language: Spanish Abstract in spanish Introducción: La trombosis venosa cerebral, una enfermedad cerebro vascular rara, afecta fundamentalmente niños y mujeres en edad fértil. Caso clínico: Paciente de sexo femenino, 45 años 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.

David, Lira; Nilton, Custodio; Eder, Herrera-Pérez; Liza, Núñez del Prado; Erik, Guevara-Silva; Sheila, Castro-Suárez; Rosa, Montesinos.

2014-04-01

292

Trombosis venosa cerebral de difícil diagnóstico / Cerebral venous thrombosis of difficult diagnosis  

Scientific Electronic Library Online (English)

Full Text Available SciELO Peru | Language: Spanish Abstract in spanish Introducción: La trombosis venosa cerebral, una enfermedad cerebro vascular rara, afecta fundamentalmente niños y mujeres en edad fértil. Caso clínico: Paciente de sexo femenino, 45 años 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.

David, Lira; Nilton, Custodio; Eder, Herrera-Pérez; Liza, Núñez del Prado; Erik, Guevara-Silva; Sheila, Castro-Suárez; Rosa, Montesinos.

293

Open Boundary Conditions for Dissipative MHD  

International Nuclear Information System (INIS)

In modeling magnetic confinement, astrophysics, and plasma propulsion, representing the entire physical domain is often difficult or impossible, and artificial, or 'open' boundaries are appropriate. A novel open boundary condition (BC) for dissipative MHD, called Lacuna-based open BC (LOBC), is presented. LOBC, based on the idea of lacuna-based truncation originally presented by V.S. Ryaben'kii and S.V. Tsynkov, provide truncation with low numerical noise and minimal reflections. For hyperbolic systems, characteristic-based BC (CBC) exist for separating the solution into outgoing and incoming parts. In the hyperbolic-parabolic dissipative MHD system, such separation is not possible, and CBC are numerically unstable. LOBC are applied in dissipative MHD test problems including a translating FRC, and coaxial-electrode plasma acceleration. Solution quality is compared to solutions using CBC and zero-normal derivative BC. LOBC are a promising new open BC option for dissipative MHD.

294

Open Boundary Conditions for Dissipative MHD  

Energy Technology Data Exchange (ETDEWEB)

In modeling magnetic confinement, astrophysics, and plasma propulsion, representing the entire physical domain is often difficult or impossible, and artificial, or 'open' boundaries are appropriate. A novel open boundary condition (BC) for dissipative MHD, called Lacuna-based open BC (LOBC), is presented. LOBC, based on the idea of lacuna-based truncation originally presented by V.S. Ryaben'kii and S.V. Tsynkov, provide truncation with low numerical noise and minimal reflections. For hyperbolic systems, characteristic-based BC (CBC) exist for separating the solution into outgoing and incoming parts. In the hyperbolic-parabolic dissipative MHD system, such separation is not possible, and CBC are numerically unstable. LOBC are applied in dissipative MHD test problems including a translating FRC, and coaxial-electrode plasma acceleration. Solution quality is compared to solutions using CBC and zero-normal derivative BC. LOBC are a promising new open BC option for dissipative MHD.

Meier, E T

2011-11-10

295

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)

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.

Gamal E. Esmat

2013-09-01

296

Condition numbers and scale free graphs  

CERN Document Server

In this work we study the condition number of the least square matrix corresponding to scale free networks. We compute a theoretical lower bound of the condition number which proves that they are ill conditioned. Also, we analyze several matrices from networks generated with the linear preferential attachment model showing that it is very difficult to compute the power law exponent by the least square method due to the severe lost of accuracy expected from the corresponding condition numbers.

Acosta, G; Pinasco, J P; Acosta, Gabriel; Gra\\~na, Mat\\'{\\i}as; Pinasco, Juan Pablo

2006-01-01

297

Defining Child Exposure to Domestic Violence as Neglect: Minnesota's Difficult Experience  

Science.gov (United States)

Policymakers are increasingly focusing on children exposed to domestic violence. The 1999 Minnesota legislature amended the definition of child neglect to include a child's exposure to family violence. What was initially seen as a simple change to bring more attention to children exposed to domestic violence resulted in great turmoil across…

Edleson, Jeffrey L.; Gassman-Pines, Jenny; Hill, Marissa B.

2006-01-01

298

Maintaining the Quality of Pharmaceutical Education during Difficult Times. The 1982 Argus Commission Report.  

Science.gov (United States)

Forces influencing the quality of pharmaceutical education are examined, including: development of school leadership; changing composition of faculty; faculty development and reward; student quality and mix; school extramural activities related to research funding, accreditation agencies, the pharmaceutical industry, and foundations; and…

Goyan, Jere E.; And Others

1982-01-01

299

Tromboembolismo pulmonar e asma de difícil controlo / Pulmonary embolism and difficult-to-treat asthma  

Scientific Electronic Library Online (English)

Full Text Available SciELO Portugal | Language: Portuguese Abstract in portuguese O controlo da asma é um factor crucial na abordagem do doente: a mais recente actualização do GINA considera que uma "asma difícil de tratar" é uma asma para investigar. O não cumprimento da terapêutica, a DPOC concomitante, o tabagismo, a rinossinusite, o refluxo gastroesofágico e a obesidade são 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 terapêutica optimizada, apresentavam asma "não 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 "não controlada" - 35% (n=6) por má adesão à terapêutica; 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: insuficiência venosa periférica (40%), HTA (40%) e deficiência de proteína C e S funcionais (20%). Todos os doentes efectuaram terapêutica anticoagulante (80% ainda mantém), referindo-se que, após o início da anticoagulação, 40% dos doentes alcançaram o controlo da doença e 40% têm, actualmente, asma "parcialmente controlada", não se tendo verificado novos internamentos por agudização da doença. Os resultados do presente trabalho apoiam a inclusão 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 u

Catarina Teles, Martins; Carlos, Lopes; Alda, Manique; Dolores, Moniz; Renato, Sotto-Mayor; A Bugalho de, Almeida.

2007-12-01

300

Fixed Future and Uncertain Past: Theorems Explain Why It Is Often More Difficult to Reconstruct the Past Than to Predict the Future  

Science.gov (United States)

At first glance. it may seem that reconstructing the past is, in general, easier than predicting the future, because the past has already occurred and it has already left its traces, while the future is still yet to come, and so no traces of the future are available. However, in many real life situations, including problems from geophysics and celestial mechanics, reconstructing the past is much more computationally difficult than predicting the future. In this paper, we give an explanation of this difficulty. This explanation is given both on a formal level (as a theorem) and on the informal level (as a more intuitive explanation).

Alefeld, Goetz; Koshelev, Misha; Mayer, Guenter

1997-01-01

 
 
 
 
301

Factors Significantly Contributing to a Failed Conventional Endoscopic Stone Clearance in Patients with "Difficult" Choledecholithiasis: A Single-Center Experience  

Science.gov (United States)

The objective of this study is to retrospectively evaluate factors significantly contributing to a failed stone extraction (SE) in patients with difficult to extract bile duct stones (BDS). Patients and Methods. During a 10-year period 1390 patients with BDS underwent successfully endoscopic sphincterotomy. Endoscopic SE was graded as easy; relatively easy; difficult; and failed. Difficult SE was encountered in 221 patients while failed SE was encountered in 205. A retrospective analysis of the criteria governing the difficulty of endoscopic SE following the index endoscopic intervention was performed to evaluate their significance in determining failure of complete SE among patients with difficult to extract bile duct stones. Results. Age ? 85 years, periampullary diverticula, multiple CBD stones (>4), and diameter of CBD stones (?15 mm) were all significant contributing factors to a failed SE in univariate statistical tests. In the definitive multivariate analysis age, multiple stones and diameter of stones were found to be the significant, independent contributors. Conclusion. Failed conventional endoscopic stone clearance in patients with difficult to extract BDS is more likely to occur in overage patients, in patients with multiple CBD stones >4, and in patients with CBD stone(s) diameter ?15 mm. PMID:25349470

Christoforidis, Emmanuel; Vasiliadis, Konstantinos; Tsalis, Konstantinos; Patridas, Dimitrios; Blouhos, Konstantinos; Pramateftakis, Manousos-Georgios; Moysidis, Moysis; Lazaridis, Charalampos

2014-01-01

302

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

303

Power Flow Study Including FACTS Devices  

Digital Repository Infrastructure Vision for European Research (DRIVER)

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 th...

Thyagarajan, T.; Dash, S. S.; Sahoo, A. K.

2010-01-01

304

Modeling temperature and moisture fields in conditioned spaces using zonal approach, including sorption phenomena in buildings materials; Modelisation thermo-hydro-aeraulique des locaux climatises selon l'approche zonale (prise en compte des phenomenes de sorption d'humidite)  

Energy Technology Data Exchange (ETDEWEB)

Building simulation models represent in our days an important tool for building conception and performance analysis. Although moisture interacts in many ways with the whole building affecting therefore its behavior, frequently these models neglects the interactions between them. In addition, in most of them, indoor air conditions are considered uniform, which is a non-realistic assumption in conditioned spaces. In this work, a model to predict temperature and moisture fields in conditioned spaces, using zonal approach, is proposed. This method is based in dividing spatially a room in a relative small number of zones, typically on the order of tens to hundreds, where the state variables of air are considered uniform, with the exception of pressure that varies hydrostatically. While not as fine-grained as CFD simulation, zonal models do give useful information about temperature and moisture distributions that is important in comfort analysis. The proposed model was structured in three groups of sub-models representing the three building domains: indoor air, envelope and HVAC system. The indoor air sub-model is related to the indoor air space, where airflow speed can be considered weak. The envelope sub-model is related to the radiation exchanges between envelope and its neighborhood, and to the simultaneous heat and mass transfers across the envelope material. This latest can be represented by four sub-models of different complexity levels, with two of them taking into account moisture adsorption and desorption by building materials. Concerning to the HVAC system model, it refers to the whole system that means equipment, control and specific airflow from equipment. All sub-models were coupled into a modular simulation environment, SPARK, well-adapted to compare different models. The applicability of the proposed model is shown by two examples. The first one shows the importance of considering moisture sorption phenomena in the prediction of indoor air conditions, while the second shows the impact of the external environment in the behavior of a conditioned space and in its HVAC system performance. (author)

Cordeiro Mendoca, K.

2004-05-15

305

[Network activity of frontal and motor cortex in situations of simple and difficult decision-making in cats].  

Science.gov (United States)

The organization of frontal and motor cortex network activity in situations with simple (without a choice) and difficult decision-making when there is a possibility of behavior choice strategy is shown. At development of delay reflexes with one reinforcement (without a choice) animals did not differ on behavior and showed high criterion of right answers. The strategy of behavior of the same animals in the complicated situation, with "right" choice food reinforcement, was different and animals showed different abilities of problem solution. Distinctions in neuron ensembles organization of frontal and motor cortex in situations with simple and difficult decision-making was revealed. In difficult decision-making situation, the number of exciting interneuron interactions in motor cortex was decreased that assumed the organization of inhibition chains. In the same situation, frontal network activity was not changed, and the tendency to increase of these parameters was observed only in erroneous reactions. PMID:23431763

Sidorina, V V; Kuleshova, E P; Merzhanova, G Kh

2012-11-01

306

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

307

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)

Full Text Available SciELO Spain | Language: Spanish Abstract in spanish 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 año 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 señalar 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 años 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 señalar 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

Carmen, González Enguita; Jesús, Gómez Muñoz; Cristina, Martín Vivas; Leticia, López Martín; Luis Fernándo, Susanibar Napuri; Simona, Alexandro; Carlos, Caramelo Díaz; Remigio, Vela Navarrete.

308

Modeling of tamped and decoupled explosions in salt (simulation is easy. Prediction is difficult exclamation point)  

International Nuclear Information System (INIS)

We compare predictions of the strain hardening model of Glenn (1990), with and without damage, to free field and seismic observations of SALMON, STERLING, and 64 kt (tamped) and 8 kt (decoupled) explosions in an Azgir salt dome in the former Soviet Union (FSU). We find good agreement between the model (without damage) and observations of both SALMON and STERLING. In contrast, the average spectral ratio of the tamped to decoupled Azgir explosions is systematically smaller than predicted by the strain hardening model without damage. Much better agreement is obtained when damage is included in the model of the decoupled Azgir explosion

309

 Evidence Based Surgery: How Difficult is the Implication in Routine Practice?  

Directory of Open Access Journals (Sweden)

Full Text Available  Surgery as a discipline has perhaps been slower than others pecialties to embrace evidence based principles. Today, surgeons all over Asia are prepared to challenge the dogma of yesterday. Surgical science which rests on a strong foundation of laboratory and clinical research can now be broadened to include the armamentarium of evidence based practice to advance surgical knowledge. The sheer volume of easily accessed information creates a new challenge. This article discusses keeping up with new information and finding the best available answers to specific questions amidst all the other information.

Namrata Maheshwari

2012-01-01

310

Comparison of Laryngoscopic View and Hemodynamic Changes with Flexitip McCoy and Macintosh Laryngoscope Blade in Predicted Easy and Difficult Airway  

Directory of Open Access Journals (Sweden)

Full Text Available Objective: To compare the laryngoscopic view and the hemodynamic changes by using flexitip McCoy laryngoscope with Macintosh laryngoscope. Method: Study design-Prospective randomized controlled study. A total of 220 patients were included in the study. Patients were allocated on the basis of their airway anatomy in to two groups, one is predicted easy group and the other one was predicted difficult airway group. Among each group, half of the patient intubation was performed with Macintosh blade and the other half was intubated with the help of McCoy blade. The airway prediction was done on the basis of Mallampati grade, thyromental distance, inter incisor gap, jaw protrusion and weight of the patient. Larygoscopic view and hemodynamic changes were recorded. Results: The change in pulse rate was significantly (p = 0.01 higher among the patients of Group B (85.02 ± 10.13 as compared to Group A (79.20 ± 13.11 after induction in predicted easy patients. Similar observation was found for pulse rate after laryngoscopy among both predicted easy and difficult patients. The diastolic blood pressure was significantly (p = 0.0001 higher in Group B (86.34 ± 9.78 than Group A (77.12 ± 11.66 after induction among predicted easy patients. However, diastolic blood pressure was significantly (p = 0.0004 higher in Group A (82.00 ± 10.98 compared with Group B (75.00 ± 9.06 after induction among predicted difficult patients. The average time taken during laryngoscopy was in-significantly (p > 0.05 higher in Group B (13.90 ± 5.95 compared with Group A (12.42 ± 3.58 among predicted easy patients. However, the time taken was significantly (p = 0.0001 higher in Group A (20.83 ± 2.47 than Group B (12.66 ± 3.0 in predicted difficult patients. A majority of the patients of both the groups were in Grade I (Group A = 61.8%, Group B = 81.8% followed by Grade II (Group A = 38.2%, Group B = 18.2% among predicted easy patients. Conclusion: It was concluded that the McCoy blade may be an answer to Macintosh blade in difficult airway cases, but not the substitute of Macintosh blade in every case. The McCoy blade improved laryngeal view in patients with limited neck extension.

Zia Arshad

2013-07-01

311

Comparison of the glidescope(R), flexible fibreoptic intubating bronchoscope, iPhone modified bronchoscope, and the Macintosh laryngoscope in normal and difficult airways: a manikin study  

Science.gov (United States)

Background Smart phone technology is becoming increasingly integrated into medical care. Our study compared an iPhone modified flexible fibreoptic bronchoscope as an intubation aid and clinical teaching tool with an unmodified bronchoscope, Glidescope® and Macintosh laryngoscope in a simulated normal and difficult airway scenario. Methods Sixty three anaesthesia providers, 21 consultant anaesthetists, 21 registrars and 21 anaesthetic nurses attempted to intubate a MegaCode Kelly™ manikin, comparing a normal and difficult airway scenario for each device. Primary endpoints were time to view the vocal cords (TVC), time to successful intubation (TSI) and number of failed intubations with each device. Secondary outcomes included participant rated device usability and preference for each scenario. Advantages and disadvantages of the iPhone modified bronchoscope were also discussed. Results There was no significant difference in TVC with the iPhone modified bronchoscope compared with the Macintosh blade (P?=?1.0) or unmodified bronchoscope (P?=?0.155). TVC was significantly shorter with the Glidescope compared with the Macintosh blade (P?difficult to use, similar proportions of consultants (14/21), registrars (15/21) and nurses (15/21) indicated that they would be prepared to use the iPhone modified bronchoscope in their clinical practice. The Glidescope was rated easiest to use (P?difficult airway scenario. Conclusions The iPhone modified bronchoscope, in its current configuration, was found to be more difficult to use compared with the Glidescope® and unmodified bronchoscope; however it offered several advantages for teaching fibreoptic intubation technique when video-assisted bronchoscopy was unavailable. PMID:24575885

2014-01-01

312

phenix.mr_rosetta: a new tool for difficult molecular replacement problems  

Energy Technology Data Exchange (ETDEWEB)

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.

Terwilliger, Thomas C [Los Alamos National Laboratory; Read, Randy [UNIV OF CAMBRIDGE; De Maio, Frank [UNIV OF WASHINGTON; Baker, David [UNIV OF WASHINGTON

2011-01-12

313

Why is it so difficult to get rid of bad guidelines?  

Directory of Open Access Journals (Sweden)

Full Text Available No abstract available. Article truncated at 150 words. My colleagues and I recently published a manuscript in the Southwest Journal of Pulmonary and Critical Care examining compliance with the Joint Commission of Healthcare Organization (Joint Commission, JCAHO guidelines (1. Compliance with the Joint Commission’s acute myocardial infarction, congestive heart failure, pneumonia and surgical process of care measures had no correlation with traditional outcome measures including mortality rates, morbidity rates, length of stay and readmission rates. In other words, increased compliance with the guidelines was ineffectual at improving patient centered outcomes. Most would agree that ineffectual outcomes are bad. The data was obtained from the Veterans Healthcare Administration Quality and Safety Report and included 485,774 acute medical/surgical discharges in 2009 (2. This data is similar to the Joint Commission’s own data published in 2005 which showed no correlation between guideline compliance and hospital mortality and a number of other publications which have failed to show a correlation with the …

Robbins RA

2011-11-01

314

Mistrust of numbers: the difficult development of psychiatric epidemiology in France, 1940-80.  

Science.gov (United States)

This article uses archival as well as published materials to trace the development of psychiatric epidemiology in France from 1945 to 1980. Although a research programme in this field was launched in the early 1960s at the National Institute of Medical Research (INH, later renamed INSERM), psychiatric epidemiology remained an embryonic field in France during the next two decades. French researchers in this field were hampered by limited resources, but their work was primarily characterized by a deep engagement with the epistemological challenges of psychiatric epidemiology. The history of French psychiatric epidemiology in the 1960s and 1970s can be seen as an attempt to create a specifically French way of doing psychiatric epidemiology research. In the first part of this article, the author relates this unique history to internal professional dynamics during the development of psychiatric research and, more broadly, to the biomedical institutional context in which epidemiological work was being done. The next part of this article examines the conditions under which the INH research team framed epidemiological research in psychiatry in the 1960s. The last part focuses on INH's flagship psychiatric epidemiology programme, developed in cooperation with pioneers of French community psychiatry in Paris's 13th arrondissement in the 1960s. PMID:24929183

Henckes, Nicolas

2014-08-01

315

Important mechanical aspects when digging difficult unconsolidated rock with bucket wheel excavators; Wichtige mechanische Aspekte zur Gewinnung von schwer baggerbarem Lockergestein mit Schaufelradbaggern  

Energy Technology Data Exchange (ETDEWEB)

During excavation of unconsolidated rock classified as digging grades IV and V considerable additional impression forces are produced which cause deformation of the cutting teeth, cutting edges and intermediate cutters of conventional buckets with pyramidal teeth. In actual practice the significance and magnitude of these forces could not be ascertained when excavating unconsolidated rock of lower digging grades. The large impression forces that occur during digging of difficult unconsolidated rock present problems when conventional buckets are used. When designing and constructing new buckets for difficult digging conditions the effect of these forces must therefore be taken into account. Bucket wheel excavator KWK 1200 M/K-14 at Turov opencast mine served as an example to determine the values of these forces. During excavation of difficult unconsolidated rock the impression forces are often many times greater than the cutting force at the bucket wheel circumference. (orig./MSK) [Deutsch] Beim Abbau von Lockergestein aus der IV. und V. Gewinnungsklasse entstehen erhebliche zusaetzliche Abdruckskraefte, die die Reisszaehne, Messer und Vormesser der herkoemmlichen Eimer mit pyramidenfoermigen Zaehnen deformieren. Die Bedeutung und die Groesse dieser Kraefte waren praktisch nicht bemerkbar beim Abbau von Lockergestein niedrigerer Gewinnungsklassen. Die grossen Abdruckskraefte bei schwer baggerbarem Lockergestein stehen dem Einsatz konventioneller Eimer entgegen. Die Wirkung der Abdruckskraefte muss bei der Projektierung und Fertigung von neuen Eimern fuer schwere Abbaubedingungen beruecksichtigt werden. Am Beispiel des Schaufelradbaggers KWK 1200 M/K-14 aus dem Tagebau Turow hat man die Werte dieser Kraefte bestimmt. Beim Abbau von schwer baggerbarem Lockergestein sind die Abdruckskraefte oft mehrfach groesser als die Schneidkraft auf dem Umfang des Schaufelrades. (orig./MSK)

Wocka, N.; Kolber, K. [SKW Biuro Projektowo, Zgorzelec (Poland)

1998-11-01

316

Drought Monitor: Current Conditions  

Science.gov (United States)

The US Department of Agriculture recently released these updated data summaries for temperature, precipitation, and vegetation condition in the US. Data summaries include the Palmer Drought Severity Index (PDSI), Crop Moisture Index, Standardized Precipitation Index, Drought Impacts in the US, Percent of Normal Rainfall, Daily Streamflow Map, Snowpack, Soil Moisture, Daily Soil Moisture Anomaly, and the Vegetation and the Temperature Condition Index.

317

[A case of spermatic granuloma difficult to differentiate from malignant tumor].  

Science.gov (United States)

A 33-year-old man visited our hospital with complaint of painless left intrascrotal mass. A hard and rough induration in contact with the left testis was palpable. The laboratory data including beta-human churionic gonadotropin, alpha fetoprotein and lactate dehydrogenase were normal. Ultrasound sonography showed a large hypoechoic lesion at the left epididymis. Surgical exploration of this lesion indicated a malignant tumor of the epididymis or spermatic cord, and left high orchiectomy was performed. A milk-white nodule 6 cm in diameter was found in the resected specimen. Pathological diagnosis was spermatic granuloma. Fourteen cases of spermatic granuloma have been reported in the last twenty years in Japan. All of them were relatively small nodules and epididymectomy was performed for most of them. We selected radical orchiectomy because of a large nodule with suspicion of malignant lesion. PMID:12402481

Wada, Naoki; Kato, Yuji; Iwata, Tatsuya; Numata, Atsushi; Yamaguchi, Satoshi; Hashimoto, Hiroshi; Yachiku, Sunao

2002-09-01

318

Robotic intra-abdominal vasectomy reversal: A new approach to a difficult problem  

Science.gov (United States)

The management of obstructive azoospermia resulting from intra-abdominal vasal obstruction poses a formidable surgical challenge. A number of surgical methods have been described to address this problem, including both open and laparoscopic approaches to mobilize and sometimes even re-route the abdominal vas deferens prior to performing a re-anastamosis. We present the first report, to our knowledge, of robotic intra-abdominal vasectomy reversal used to repair obstructive azoospermia resulting from prior laparoscopic vasectomy. In doing so, we summarize the techniques described previously in the literature and build upon this body of surgical experience by combining robotic-assisted laparoscopic mobilization of the vas with robotic vasovasostomy. We believe this novel approach for repairing intra-abdominal vasal defects minimizes morbidity, while at the same time obviating the need for the operating microscope, and thus represents a practical alternative to existing techniques. PMID:25024801

Barazani, Yagil; Kaouk, Jihad; Sabanegh, Edmund S.

2014-01-01

319

Education and training in radiation protection: a challenge in passing on a difficult and intricate message  

Energy Technology Data Exchange (ETDEWEB)

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)

Sabol, Jozef; Hudzietzova, Jana; Rosina, Jozef, E-mail: j.sabol44@gmail.com, E-mail: hudzijan@fbmi.cvut.cz, E-mail: rosina@fbmi.cvut.cz [Faculty of Biomedical Engineering, Czech Technical University in Prague (Czech Republic)

2013-07-01

320

Pseudotumoral autoimmune pancreatitis mimicking a pancreatic cancer: a very difficult disease to diagnose  

Directory of Open Access Journals (Sweden)

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.

Nizar Miloudi

2012-10-01

 
 
 
 
321

Analysis of Smart Composite Structures Including Debonding  

Science.gov (United States)

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.

Chattopadhyay, Aditi; Seeley, Charles E.

1997-01-01

322

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

323

Novel use of an exchange catheter to facilitate intubation with an Aintree catheter in a tall patient with a predicted difficult airway: a case report  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Introduction The Aintree intubating catheter (Cook® Medical Inc., Bloomington, IN, USA has been shown to successfully facilitate difficult intubations when other methods have failed. The Aintree intubating catheter (Cook® Medical Inc., Bloomington, IN, USA has a fixed length of 56 cm, and it has been suggested in the literature that it may be too short for safe use in patients who are tall. Case presentation We present the case of a 32-year-old, 180 cm tall Caucasian woman with a predicted difficult airway who presented to our facility for an emergency cesarean section. After several failed intubation attempts via direct laryngoscopy, an airway was established with a laryngeal mask airway. After delivery of a healthy baby, our patient's condition necessitated tracheal intubation. A fiber-optic bronchoscope loaded with an Aintree intubating catheter (Cook® Medical Inc., Bloomington, IN, USA was passed through the laryngeal mask airway into the trachea until just above the carina, but was too short to safely allow for the passage of an endotracheal tube. Conclusions We present a novel technique in which the Aintree intubating catheter (Cook® Medical Inc., Bloomington, IN, USA was replaced with a longer (100 cm exchange catheter, over which an endotracheal tube was passed successfully into the trachea.

Gruenbaum Shaun E

2012-04-01

324

Fiberoptic intubation through laryngeal mask airway for management of difficult airway in a child with Klippel-Feil syndrome  

Science.gov (United States)

The ideal airway management modality in pediatric patients with syndromes like Klippel-Feil syndrome is a great challenge and is technically difficult for an anesthesiologist. Half of the patients present with the classic triad of short neck, low hairline, and fusion of cervical vertebra. Numerous associated anomalies like scoliosis or kyphosis, cleft palate, respiratory problems, deafness, genitourinary abnormalities, Sprengel's deformity (wherein the scapulae ride high on the back), synkinesia, cervical ribs, and congenital heart diseases may further add to the difficulty. Fiberoptic bronchoscopy alone can be technically difficult and patient cooperation also becomes very important, which is difficult in pediatric patients. Fiberoptic bronchoscopy with the aid of supraglottic airway devices is a viable alternative in the management of difficult airway in children. We report a case of Klippel-Feil syndrome in an 18-month-old girl posted for cleft palate surgery. Imaging of spine revealed complete fusion of the cervical vertebrae with hypoplastic C3 and C6 vertebrae and thoracic kyphosis. We successfully managed airway in this patient by fiberoptic intubation through classic laryngeal mask airway (LMA). After intubation, we used second smaller endotracheal tube (ETT) to stabilize and elongate the first ETT while removing the LMA. PMID:25191201

Bhat, Ravi; Mane, Rajesh S.; Patil, Manjunath C.; Suresh, S. N.

2014-01-01

325

The Routing and Re-Routing of Difficult Knowledge: Social Studies Teachers Encounter "When the Levees Broke"  

Science.gov (United States)

The author explores the articulations of six social studies student/teachers after a viewing of "When the Levees Broke: A Requiem in Four Acts". The film, a documentary about the aftermath of Hurricane Katrina on the people in and around New Orleans, constitutes an encounter with what Deborah Britzman (1998) calls "difficult…

Garrett, H. James

2011-01-01

326

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

327

Trial of instrumental delivery in theatre versus immediate caesarean section for anticipated difficult assisted births  

Science.gov (United States)

Background The majority of women have spontaneous vaginal births, but some women need assistance in the second stage with delivery of the baby, using either the obstetric forceps or vacuum extraction. Rates of instrumental vaginal delivery range from 5% to 20% of all births in industrialised countries. The majority of instrumental vaginal deliveries are conducted in the delivery room, but in a small proportion (2% to 5%), a trial of instrumental vaginal delivery is conducted in theatre with preparations made for proceeding to caesarean section. Objectives To determine differences in maternal and neonatal morbidity between women who, due to anticipated difficulty, have trial of instrumental vaginal delivery in theatre and those who have immediate caesarean section for failure to progress in the second stage. Search methods We searched the Cochrane Pregnancy and Childbirth Group’s Trials Register (28 June 2012). Selection criteria Randomised controlled trials comparing trial of instrumental vaginal delivery (vacuum extraction or forceps) in operating theatre to immediate caesarean section for women with failure to progress in the second stage (active second stage more than 60 minutes in primigravidae). Data collection and analysis We identified no studies meeting our inclusion criteria. Main results No studies were included. Authors’ conclusions There is no current evidence from randomised trials to influence practice. PMID:23076915

Majoko, Franz; Gardener, Glenn

2014-01-01

328

Jet grouting for a groundwater cutoff wall in difficult glacial soil deposits  

Energy Technology Data Exchange (ETDEWEB)

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.

Flanagan, R.F.; Pepe, F. Jr. [Parsons Brinckerhoff Quade & Douglas, New York, NY (United States)

1997-12-31

329

Long-term outcome of the difficult nephrotic syndrome in children.  

Science.gov (United States)

To determine the long-term outcome of nephrotic syndrome (NS) in children, we studied 48 patients with the NS aged seven months to 12 years at onset and followed for a long period (3-9 years). Consanguinity was positive in 31.2%. Patients' history of atopy was present in 25%, while family history of allergy was present in 18 (37.5%) patients. Renal impairment at initial presentation was observed in 12.5% of the patients. Among 32 biopsied patients, 11 (34.3%) had focal segmental glomerulosclerosis and eight (25%) revealed mesangial IgM nephropathy. Outcome at two years of presentation showed 41.6% patients as frequent relapsers, 39.5% as steroid dependent and 18.7% as steroid resistant. Forty-three patients were available for follow-up after ten years of presentation, 22 (51%) patients had complete remission, 15 (34.8%) were steroid dependent, two (4.6%) developed chronic renal failure and two (4.6%) died. Two patients (4.6%) developed insulin-dependent diabetes mellitus, two (4.6%) had cataract and one (2.3%) had documented peritonitis. In conclusion, the high incidence of steroid-dependent, frequent relapses and steroid resistance in children can be explained by different factors, including consanguinity, atopy and severe presentation at onset of disease. We suggest longer initial treatment at onset for this group of patients. The low incidence of infection in this group needs to be addressed in future studies. PMID:22982908

Al Salloum, Abdullah A; Muthanna, Ahmad; Bassrawi, Rolan; Al Shehab, Aziza A; Al Ibrahim, Alia; Islam, Mohammed Zahidul; Al Hasan, Khalid

2012-09-01

330

Meniere?s disease: Still a mystery disease with difficult differential diagnosis  

Directory of Open Access Journals (Sweden)

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.

Vassiliou A

2011-01-01

331

Constituição e política: uma relação difícil Constitution and politics: a difficult relationship  

Directory of Open Access Journals (Sweden)

Full Text Available O presente artigo busca analisar as tensas e complexas relações entre política e Constituição, desde a célebre polêmica sobre o antagonismo entre democracia e constitucionalismo, passando pelos paradoxos da formalização excessiva do direito constitucional, o direito político por excelência. O método exclusivamente jurídico do direito público vai ser posto em xeque no debate da República de Weimar pela nova Teoria da Constituição, que busca incluir o político na análise constitucional. No segundo pós-guerra, o debate se dará entre as teorias materiais e processuais da constituição, buscando dirigir ou excluir a política da Constituição. Tendência esta de exclusão que chega ao ápice com os tribunais constitucionais e o esvaziamento do debate sobre política e legitimidade no direito constitucional contemporâneo, que necessita, na opinião do autor, de uma "volta à política" para sair do impasse em que se encontra.The article explores the tense and complex relationships between Politics and Constitution, from the famous discussion about democracy and constitutionalism, through the paradoxes of the juridical formalism of Constitutional Law, the Political Law par excellence. The exclusively juridical method of Public Law was contested in the Weimar Republic debate on the new Theory of Constitution, which strove for include the Political in the constitutional analysis. In the second Post-war period, the debate has oscillated between Substantive and Procedural theories of the Constitution, both striving for conducting Politics or excluding it from the Constitution. This trend culminates in the Constitutional Courts and the empting of the debate about politics and legitimacy in contemporary Constitutional Law, which needs, according to the author, the "return to Politics" to get out of its present deadlock.

Gilberto Bercovici

2004-01-01

332

Constituição e política: uma relação difícil / Constitution and politics: a difficult relationship  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: Portuguese Abstract in portuguese O presente artigo busca analisar as tensas e complexas relações entre política e Constituição, desde a célebre polêmica sobre o antagonismo entre democracia e constitucionalismo, passando pelos paradoxos da formalização excessiva do direito constitucional, o direito político por excelência. O método [...] exclusivamente jurídico do direito público vai ser posto em xeque no debate da República de Weimar pela nova Teoria da Constituição, que busca incluir o político na análise constitucional. No segundo pós-guerra, o debate se dará entre as teorias materiais e processuais da constituição, buscando dirigir ou excluir a política da Constituição. Tendência esta de exclusão que chega ao ápice com os tribunais constitucionais e o esvaziamento do debate sobre política e legitimidade no direito constitucional contemporâneo, que necessita, na opinião do autor, de uma "volta à política" para sair do impasse em que se encontra. Abstract in english The article explores the tense and complex relationships between Politics and Constitution, from the famous discussion about democracy and constitutionalism, through the paradoxes of the juridical formalism of Constitutional Law, the Political Law par excellence. The exclusively juridical method of [...] Public Law was contested in the Weimar Republic debate on the new Theory of Constitution, which strove for include the Political in the constitutional analysis. In the second Post-war period, the debate has oscillated between Substantive and Procedural theories of the Constitution, both striving for conducting Politics or excluding it from the Constitution. This trend culminates in the Constitutional Courts and the empting of the debate about politics and legitimacy in contemporary Constitutional Law, which needs, according to the author, the "return to Politics" to get out of its present deadlock.

Gilberto, Bercovici.

333

Peristomal skin complications are common, expensive, and difficult to manage : A population based cost modeling study  

DEFF Research Database (Denmark)

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

Meisner, S.; Lehur, P.-A.

2012-01-01

334

Global Climate Change for Kids: Making Difficult Ideas Accessible and Exciting  

Science.gov (United States)

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.

Fisher, D. K.; Leon, N.; Greene, M. P.

2009-12-01

335

Difficult decisions in times of constraint: Criteria based Resource Allocation in the Vancouver Coastal Health Authority  

Directory of Open Access Journals (Sweden)

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.

Dionne Francois

2011-07-01

336

Modelling classroom conditions with different boundary conditions  

DEFF Research Database (Denmark)

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.

Marbjerg, Gerd; Jeong, Cheol-Ho

2014-01-01

337

Robust Solution to Difficult Hydrogen Issues When Shipping Transuranic Waste to the Waste Isolation Pilot Plant  

International Nuclear Information System (INIS)

The Waste Isolation Pilot Plant (WIPP) has been open, receiving, and disposing of transuranic (TRU) waste since March 26, 1999. The majority of the waste has a path forward for shipment to and disposal at the WIPP, but there are about two percent (2%) or approximately 3,020 cubic meters (m3) of the volume of TRU waste (high wattage TRU waste) that is not shippable because of gas generation limits set by the U.S. Nuclear Regulatory Commission (NRC). This waste includes plutonium-238 waste, solidified organic waste, and other high plutonium-239 wastes. Flammable gases are potentially generated during transport of TRU waste by the radiolysis of hydrogenous materials and therefore, the concentration at the end of the shipping period must be predicted. Two options are currently available to TRU waste sites for solving this problem: (1) gas generation testing on each drum, and (2) waste form modification by repackaging and/or treatment. Repackaging some of the high wattage waste may require up to 20:1 drum increase to meet the gas generation limits of less than five percent (5%) hydrogen in the inner most layer of confinement (the layer closest to the waste). (This is the limit set by the NRC.) These options increase waste handling and transportation risks and there are high costs and potential worker exposure associated with repackaging this high-wattage TRU waste. The U.S. Department of Energy (DOE)'s Carlsbad Field Office (CBFO) is pursuing a twofold approach ice (CBFO) is pursuing a twofold approach to develop a shipping path for these wastes. They are: regulatory change and technology development. For the regulatory change, a more detailed knowledge of the high wattage waste (e.g., void volumes, gas generation potential of specific chemical constituents) may allow refinement of the current assumptions in the gas generation model for Safety Analysis Reports for Packaging for Contact-Handled (CH) TRU waste. For technology development, one of the options being pursued is the use of a robust container, the ARROW-PAK(trademark) System. (1) The ARROW-PAK(trademark) is a macroencapsulation treatment technology, developed by Boh Environmental, LLC, New Orleans, Louisiana. This technology has been designed to withstand any unexpected hydrogen deflagration (i.e. no consequence) and other benefits such as criticality control

338

Why is it difficult to implement e-health initiatives? A qualitative study  

Directory of Open Access Journals (Sweden)

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.

Wallace Paul

2011-01-01

339

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

340

Engineering classification of karst ground conditions  

Digital Repository Infrastructure Vision for European Research (DRIVER)

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...

Waltham, A. C.; Fookes, P. G.

2005-01-01

 
 
 
 
341

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

342

Electron Microprobe Analysis of Hf in Zircon: Suggestions for Improved Accuracy of a Difficult Measurement  

Science.gov (United States)

It is not commonly recognized as such, but the accurate measurement of Hf in zircon is not a trivial analytical issue. This is important to assess because Hf is often used as an internal standard for trace element analyses of zircon by LA-ICPMS. The issues pertaining to accuracy revolve around: (1) whether the Hf Ma or the La line is used; (2) what accelerating voltage is applied if Zr La is also measured, and (3) what standard for Hf is used. Weidenbach, et al.'s (2004) study of the 91500 zircon demonstrated the spread (in accuracy) of possible EPMA values for six EPMA labs, 2 of which used Hf Ma, 3 used Hf La, and one used Hf Lb, and standards ranged from HfO2, a ZrO2-HfO2 compound, Hf metal, and hafnon. Weidenbach, et al., used the ID-TIMS values as the correct value (0.695 wt.% Hf.), for which not one of the EPMA labs came close to that value (3 were low and 3 were high). Those data suggest: (1) that there is a systematic underestimation error of the 0.695 wt% Hf (ID-TIMS Hf) value if Hf Ma is used; most likely an issue with the matrix correction, as the analytical lines and absorption edges of Zr La, Si Ka and Hf Ma are rather tightly packed in the electromagnetic spectrum. Mass absorption coefficients are easily in error (e.g., Donovan's determination of the MAC of Hf by Si Ka of 5061 differs from the typically used Henke value of 5449 (Donovan et al, 2002); and (2) For utilization of the Hf La line, however, the second order Zr Ka line interferes with Hf La if the accelerating voltage is greater than 17.99 keV. If this higher keV is used and differential mode PHA is applied, only a portion of the interference is removed (e.g., removal of escape peaks), causing an overestimation of Hf content. Unfortunately, it is virtually impossible to apply an interference correction in this case, as it is impossible to locate Hf-free Zr probe standard. We have examined many of the combinations used by those six EPMA labs and concluded that the optimal EPMA is done with Hf La with the accelerating voltage under 18 keV (e.g. 17 keV is optimal), and also with synthetic stoichiometric hafnon as the standard. We have developed useful standards that are to be distributed to the community for those researchers working on this problem and can be obtained from the second author at jhanchar@mun.ca. The standards include synthetic stoichiometric undoped zircon and hafnon, and synthetic zircon doped with 2 wt. % Hf. Donovan et al. (2002) Probe for Windows: User's Guide and Reference Wiedenbeck, M., et al. (2004) Further characterisation of the 91500 zircon crystal. Geostandards and Geoanatytical Research, 28: 9-39.

Fournelle, J.; Hanchar, J. M.

2013-12-01

343

In difficult economic times, libraries become even more popular with the general public  

Science.gov (United States)

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.

344

Effect of a difficult calving on the vigour of the calf, the onset of maternal behaviour, and some behavioural indicators of pain in the dam.  

Science.gov (United States)

The neonate's development and survival is dependent upon being vigorous at birth and receiving appropriate maternal care. However, difficulty at delivery can result in less vigorous offspring and maternal care can be altered, probably as a consequence of exhaustion, pain and human intervention. The first 3h after expulsion of the calf were observed continuously from videos following twelve natural calvings and sixteen calvings assisted by farm staff (including four malpresentations) from Holstein cows. Calvings were balanced within groups for parity of the dam, genetic group, sex and birth weight of the calf, calving pen and calving season. Assisted calves were less vigorous with higher latencies to attempt to stand, achieve standing, walk and reach the udder than unassisted calves (P0.05), indicating no delayed onset or impaired expression of maternal behaviour in dams given assistance at delivery. Study of potential pain-related behaviours revealed that assisted dams spent less time self-grooming (P=0.033) than dams delivering naturally, which could suggest greater pain. However, there were no significant differences in any of the other pain-related behaviours. Our results suggest that, although maternal behaviour was unaffected by a difficult delivery, dairy calves born following difficult calvings have lower vigour in the first 3h after birth than unassisted calves. This might have longer-term effects on the health and survival of the calves. PMID:21958900

Barrier, A C; Ruelle, E; Haskell, M J; Dwyer, C M

2012-03-01

345

Why do young adults with Type 1 diabetes find it difficult to manage diabetes in the workplace?  

Science.gov (United States)

This article explores how and why workplace environments impact diabetes management for adults people with Type 1 diabetes, 23-30 years of age. Interviews were conducted with 35 young adults, 29 women and 6 men. The majority of these interviewees worked in sectors such as banking, technology and administration. Young adults found it difficult to manage diabetes in the workplace for two main reasons: work-related time pressures and the non-routine nature of interviewees' work and working environment. Young adults also found it difficult to get the time to exercise both inside and outside of work. Young adults with Type 1 diabetes need to be provided with the tools and technologies that they need to manage diabetes in modern flexible workplaces. PMID:24480739

Balfe, Myles; Brugha, Ruairi; Smith, Diarmuid; Sreenan, Seamus; Doyle, Frank; Conroy, Ronan

2014-03-01

346

Mental Health Professionals' Perceptions of Difficult Psychiatric Situations: A Brief Report on Development of the Psychiatric Situations Scale  

Directory of Open Access Journals (Sweden)

Full Text Available Background: Few measures have been developed to assess staff perceptions with difficult interpersonal situations. The authors sought to develop a reliable instrument that could measure staff perceptions of difficult interpersonal situations encountered in mental health care. Method: This study presents the preliminary construction and analysis of reliability for a scale measuring discomfort with situations often encountered in mental health care. The Psychiatric Situations Scale was administered to 115 participants in medical, mental health, and administrative disciplines. Results: A 42-item scale was derived from 69 initial items, with an internal reliability of .93. Total scores on the scale were significantly lower for the administrative group than medical or mental health disciplines, suggesting that situations were perceived to be less distressing for the administrative group. Conclusion: The 42-item version of the Psychiatric Situations Scale has good internal reliability. Additional reliability and validity studies are needed to determine further utility of the measure.

Palmer, Glen A.

2006-01-01

347

Bayesian Sampling using Condition Indicators  

DEFF Research Database (Denmark)

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.

Faber, Michael H.; SØrensen, John Dalsgaard

2002-01-01

348

Some grammatical rules are more difficult than others: The case of the generic interpretation of the masculine.  

Digital Repository Infrastructure Vision for European Research (DRIVER)

In this paper we argue that the generic use of the masculine represents a grammatical rule that might be easy to learn but difficult to apply when understanding texts. This argument is substantiated by reviewing the relevant literature as well as the recent work conducted by the GREL Group (Gender Representation in Language) on the interaction between stereotypical and grammatical information in the construction of a representation of gender when reading role names. The studies presented in t...

Gygax, Pascal; Gabriel, Ute; Sarrasin, Oriane; Garnham, Alan; Oakhill, Jane

2014-01-01

349

Difficult life situations of the minors and the parent involvement in interdepartmental interaction addressing to solving problems of children  

Directory of Open Access Journals (Sweden)

Full Text Available The article examines the theoretical and methodological problems of establishing inter-agency cooperation in providing social assistance to minors. The author proposes a principles for the model of the mobilization of parents to solve problems of their children. To analyze the structure of social and pedagogical work, distinguished types of difficult life situations that require special efforts to ensure children's education. Proceedings of the publication permit to develop and implement social technologies.

Dudkin A. S.

2011-03-01

350

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)

351

Difficult Decisions: Euthanasia.  

Science.gov (United States)

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)

Parakh, Jal S.; Slesnick, Irwin L.

1992-01-01

352

Difficult wounds: radiation wounds  

International Nuclear Information System (INIS)

In an era of modern radiotherapy, problems associated with the indiscriminate treatment of benign disease have largely disappeared. Skin sparing effects of super voltage radiation equipment make the problems previously seen with orthovoltage equipment less frequent. Vigilance on the part of the workers in the field, in general, protects from the disasters that befell Thomas Edison's laboratory assistant. Despite these modern advances, the reconstructive surgeon often faces problems of managing acute local radiation injury from accident following planned therapeutic radiation or the ulcerations and breakdowns seen months or years after radiation therapy. The single most serious hazard to surgery in radiated tissue is the lodgment of bacteria in this tissue rendered avascular by the radiation and secondary necrosis from the infection itself. The principles of management are no different from those used for other chronic granulating wounds: local wound care, appropriate topical antibacterial therapy, systemic antibiotics during the perioperative period and, most importantly, adequate soft tissue coverage

353

A difficult beginning  

Digital Repository Infrastructure Vision for European Research (DRIVER)

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 c...

Suneth Agampodi; Sisira Siribaddana

2013-01-01

354

Difficult marketing; Schwierige Vermarktung  

Energy Technology Data Exchange (ETDEWEB)

With the new edition of the Renewable Energy Law (EEG) at 1st January 2012, the market premium model becomes effective in order to implement the green electricity into the electricity market better. With this, the operators of photovoltaic power plants switched from the fixed EEG compensation for electricity to direct marketing. The market premium model provides that only 90% of the power generated by large photovoltaic power plants on roofs of buildings are compensated via EEG corresponding to 0.15 Euro/kWh. The remaining 10% is compensated only with 0.045 Euro/kWh which complies with the actual stock exchange value. If one is not very happy with this solution, one has to consume the excess power by its own or to sell the excess power to third parties. The own consumption would be the easier solution. But the own consumption is usually not possible because the most large photovoltaic power plants are installed on roofs of commercial and public buildings. Consequently, the operators of these photovoltaic power plants have to sell the excess power to third parties. This is associated with many imponderables and additional costs.

Rentzing, Sascha

2013-02-15

355

Condition Monitoring and Diagnostics for Complex System using Neural Networks  

Directory of Open Access Journals (Sweden)

Full Text Available A rule-based expert system is a traditional approach in condition monitoring and diagnostics for complex system. However, the rule-based expert system is not only difficult to be established but also difficult to be renewed along with the changed circumstances. Neural networks provide a data based approach to condition monitoring and diagnostics for complex system such as rotating machinery. By developing associations between neural networks and a rotating machine consisting of gears, bearings and shafts for the first time, a number of advantageous aspects are identified in this study. Fundamental and harmonic frequencies relating to the components, as well as sideband and cepstrum information, were used as input parameters. Outputs of the networks were given as severity levels of system components. Neural networks demonstrated the capability for use in identifying the location and severity of numerous different machinery faults, including multiple component faults. And neural network is not just easy to be established but also easy to be renewed along with the changed circumstances.

Zhong Yang

2013-01-01

356

Speed of processing explains the picture-word asymmetry in conditional naming.  

Science.gov (United States)

In this study, we investigated picture (Experiments 1 and 2) and word (Experiments 3 and 4) processing using different tasks. In Experiments 1 and 3, easy and difficult conditional naming tasks were compared to a free naming task. In Experiments 2 and 4, easy and difficult conditional naming tasks were compared to easy and difficult manual forced-choice semantic decision tasks. For pictures, we showed that a difficult semantic categorization determined a cost for the conditional naming with respect to the free naming (Experiment 1). Also, we found that the difference in RTs between the easy and difficult conditional naming tasks was much smaller than the difference between the easy and difficult forced-choice semantic decision tasks (Experiment 2). For words, results showed that free reading was faster than easy conditional reading, which in turn was faster than difficult conditional reading (Experiment 3). An analogous pattern of results was obtained when the easy and difficult conditional reading tasks were compared to the easy and difficult forced-choice semantic decision tasks (Experiment 4). Globally, the results showed that whether a cost is observed or not depends upon the relative timing of the classification and name retrieval processes. A theoretical framework has been proposed. PMID:19002713

Mulatti, Claudio; Lotto, Lorella; Peressotti, Francesca; Job, Remo

2010-01-01

357

Eigenvalue patterned condition numbers  

Science.gov (United States)

We continue the study started in [Noschese and Pasquini, Eigenvalue condition numbers: zero-structured versus traditional. J. Comput. Appl. Math. 185 (2006) 174-189] concerning the sensitivity of simple eigenvalues of a matrix A to perturbations in A that belong to a chosen subspace of matrices. In [Noschese and Pasquini, Eigenvalue condition numbers: zero-structured versus traditional. J. Comput. Appl. Math. 185 (2006) 174-189] the zero-structured perturbations have been considered. Here we focus on patterned perturbations, and the cases of the Toeplitz and of the Hankel matrices are investigated in detail. Useful expressions of the absolute patterned condition number of the eigenvalue [lambda] and of the analogue of the matrix yxH, which leads to the traditional condition number of [lambda], are given. MATLAB codes are defined to compare traditional, zero-structured and patterned condition numbers. A report on significant numerical tests is included.

Noschese, S.; Pasquini, L.

2007-09-01

358

The difficult patient: drug interaction and the influence of concomitant diseases on the treatment of hypothyroidism O paciente difícil: interação entre drogas e influência de doenças concomitantes no tratamento do hipotiroidismo  

Directory of Open Access Journals (Sweden)

Full Text Available Although most hypothyroid patients do well with one single tablet of thyroxine daily, approximately 10% are dissatisfied and another important group of patients is difficult to control. We reviewed the most common causes for frequent-dose adjustment or high-dose requirement, including poor compliance with therapy and inadequate medication. Since these two causes have been ruled out, drug interaction and other concomitant diseases need to be investigated. Requirements of thyroxine increase in all conditions characterized by impaired gastric acid secretion. Proton-pump inhibitors, antacids and a long list of drugs may decrease thyroxine absorption. In addition, a series of diseases including celiac disease and chronic inflammatory intestinal diseases, as well as nutritional habits may be important in patient control. Finally, we mention the effects of a growing list of drugs and thyroid disruptors that may also affect thyroid hormone metabolism at many levels.Embora a maior parte dos pacientes com hipotiroidismo fique bem com um único comprimido diário de tiroxina, aproximadamente 10% não ficam satisfeitos e outro importante grupo de pacientes apresenta controle difícil. Foram revistas as causas mais comuns para necessidades frequentes de ajuste de dose ou uso de dose elevadas, incluindo falta de adesão à terapia e medicação inadequada. Descartando-se essas duas causas, é necessário investigar o uso de drogas e a presença de doenças concomitantes. Existe necessidade maior de tiroxina quando diminui a secreção ácida do estômago. Inibidores de bomba de prótons, antiácidos e uma longa lista de drogas podem dificultar a absorção da tiroxina. Várias doenças, incluindo a doença celíaca e as doenças intestinais inflamatórias crônicas, além dos hábitos alimentares, são importantes no controle do paciente hipotiroideo. Finalmente, foram mencionados os efeitos de uma lista crescente de drogas e disruptores que podem afetar o metabolismo tiroidiano em diferentes níveis.

Laura S. Ward

2010-01-01

359

Induced Sputum Substance P in Children with Difficult-to-Treat Bronchial Asthma and Gastroesophageal Reflux: Effect of Esomeprazole Therapy  

Digital Repository Infrastructure Vision for European Research (DRIVER)

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...

2011-01-01

360

The night sky brightness at Potsdam-Babelsberg including overcast and moonlit conditions  

Science.gov (United States)

We analyze the results of 2 years (2011-2012) of night sky photometry performed at the Leibniz Institute for Astrophysics in Potsdam-Babelsberg. This institute is located 23 km to the southwest of the center of Berlin. Our measurements have been performed with a Sky Quality Meter. We find night sky brightness values ranging from 16.5 to 20.3 magSQM arcsec-2; the latter value corresponds to 4.8 times the natural zenithal night sky brightness. We focus on the influence of clouds and of the moon on the night sky brightness. It turns out that Potsdam-Babelsberg, despite its proximity to Berlin, still shows a significant correlation of the night sky brightness with the lunar phases. However, the light-pollution-enhancing effect of clouds dominates the night sky brightness by far: overcast nights (up to 16.5 magSQM arcsec-2) are much brighter than clear full moon nights (18-18.5 magSQM arcsec-2).

Puschnig, Johannes; Schwope, Axel; Posch, Thomas; Schwarz, Robert

2014-05-01

 
 
 
 
361

76 FR 9283 - Medicaid Program; Payment Adjustment for Provider-Preventable Conditions Including Health Care...  

Science.gov (United States)

...requirements for provider self-reporting of HCACs...the provision of health care are not limited to...negative consequence of care that results in unintended...both the public and health care providers.'' NQF's...establish provider self-reporting...

2011-02-17

362

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.)

363

The effectiveness of search dogs compared with humans in searching difficult terrain at turbine sites for bat fatalities  

Energy Technology Data Exchange (ETDEWEB)

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)

Mathews, Fiona

2011-07-01

364

Investigação de fatores associados à asma de difícil controle Investigation of factors associated with difficult-to-control asthma  

Directory of Open Access Journals (Sweden)

Full Text Available OBJETIVO: Pesquisar a freqüência dos fatores associados à 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 Ribeirão Preto. Os pacientes foram classificados em dois grupos: asma grave controlada e asma grave de difícil controle. Após nova tentativa de otimização do tratamento para o grupo de difícil controle, foram aplicados questionário e investigação complementar de fatores associados, como exposição ambiental domiciliar e ocupacional, tabagismo, fatores sociais, rinossinusite, doença do refluxo gastroesofágico (DRGE, apnéia obstrutiva do sono, insuficiência cardíaca congestiva (ICC, embolia pulmonar, fibrose cística, disfunção de cordas vocais, deficiência 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 associação à asma de difícil controle, o mais freqüente foi a pouca adesão ao tratamento (68%. Outros foram as más condições 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. CONCLUSÕES: O fator mais freqüente associado à asma de difícil controle nos indivíduos estudados é a pouca adesão à medicação prescrita. A investigação de co-morbidades é imperativa na avaliação 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 Ribeirão 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.

Ana Carla Sousa de Araujo

2007-10-01

365

Alternativas a la intubación orotraqueal ANTE UNA VÍA Aérea difícil en nuestro medio / Alternatives for the orotracheal intubation in case of a difficult airway in our environment  

Scientific Electronic Library Online (English)

Full Text Available SciELO Cuba | Language: Spanish Abstract in spanish Introducción: El control de la vía aérea en el quirófano es una responsabilidad del anestesiólogo, por lo que al finalizar su formación debe haber desarrollado las habilidades necesarias para atender esta exigencia. El control adecuado de la vía aérea para garantizar una correcta ventilación y oxige [...] nación no sólo es indispensable en muchos procedimientos anestésico-quirúrgicos sino también en todas aquellas situaciones en las que la función respiratoria está comprometida. En los últimos años se ha producido una proliferación de nuevos dispositivos y se han mejorado las técnicas antiguas de intubación y ventilación proporcionándonos una gran ayuda en el manejo de la vía aérea difícil. Objetivo: Evaluar el empleo de nuevos instrumentales para la intubación difícil. Desarrollo: Se realizó una revisión bibliográfica sobre los nuevos instrumentos para intubación difícil recién llegados a nuestro hospital como estilete luminoso, guía de Eschmann o gum elastic bougie, combitubo, con el fin de adquirir los elementos teóricos para aplicarlo en la práctica clínica. Conclusiones. De acuerdo a la experiencia con estos instrumentos y la literatura revisada, la primera opción es la utilización del combitubo, la guía de Eschmann o gum elastic bougie en segundo lugar y el estilete luminoso en tercer lugar. Abstract in english The anesthesiologist is responsible for the control of the airway in the operating theatre who ending its training must to have developed the skills necessary to manage this demand. The appropriate control of the airway to guarantee a proper ventilation and oxygenation not only is essential in many [...] anesthetic-surgical procedures but also in all those situations where the respiratory function is involved. In past years there has been appeared new devices and an improvement in past techniques of intubation and ventilation allowing us a great help in the management of this difficult airway. Objective: To assess the use of new tools for a difficult intubation. Development: A bibliographic review was carried out on the new tools for a difficult intubation now available in our hospital including a bright stylet, Eschmann's guide or gum elastic bougie, combitube to acquire the theoretical elements to be applied in the clinical practice. Conclusions: According to experience with these tools and the reviewed literature, the first option is the use of the combitube, the Eschmann guide or gum elastic bougie in the second place, and the bright stylet in the third one.

Antonio, Cárdenas González; Humberto, Fernández Ramos; José Antonio, Pozo Romero; Mayda, Correa Borrell.

366

A Comparative European View on African Integration : why it has been much more difficult in Africa than in Europe  

DEFF Research Database (Denmark)

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.

Zank, Wolfgang

2007-01-01

367

Magnetic Boundary Conditions at Non-Conducting Planetary Bodies: Applications to Ganymede  

Science.gov (United States)

The interaction of planetary bodies with their surrounding magnetized plasma can often be described with the magneto-hydrodynamic (MHD) equations, which are commonly solved by numerical models. For these models it is necessary to define physically correct boundary conditions. Many planetary bodies have electrically non-conductive surfaces, which do not allow electric current to penetrate their surfaces. Magnetic boundary conditions, which correctly consider that the associated radial electric current at the planetary surface is zero, are however difficult to implement because they include the curl of the magnetic field. Here we derive new boundary conditions for the magnetic field at non-conducting surfaces by a decomposition of the magnetic field in poloidal and toroidal components and their spherical harmonics expansions. We find that the toroidal part of the magnetic field needs to vanish at the surface of the isolator. For the spectral spherical harmonics coefficients of the poloidal part we derive a Cauchy boundary condition, which includes the Gauss coefficients of a possible intrinsic field. Our non-conducting boundary condition can thus additionally include intrinsic dynamo fields as well as induction fields within electrically conductive subsurface layers such as subsurface oceans. We implement the new boundary condition in the MHD simulation code ZEUS-MP using spherical geometry. We apply these new magnetic boundary conditions to a model for Ganymede's plasma environment. With this model we can describe the in-situ observations by the Galileo spacecraft and Hubble Space Telescope observations of Ganmyede's aurora very well.

Saur, J.; Duling, S.; Seufert, M.; Wicht, J.

2013-12-01

368

76 FR 10489 - Special Conditions: Bell Helicopter Textron Canada Limited Model 407 Helicopter, Installation of...  

Science.gov (United States)

...operations, failure conditions, or failure effects are difficult to comprehend...methods (for example, FTA, Failure Modes and Effect Analysis, FHA). System Design Integrity Requirements Each of the failure condition categories...

2011-02-25

369

Physical conditions  

DEFF Research Database (Denmark)

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.

Nielsen, Birte LindstrØm; Appleby, M.C.

2011-01-01

370

Difficult diagnosis of gout: the benefit of dual energy computed tomography, initial experience in routine clinical practice  

Directory of Open Access Journals (Sweden)

Full Text Available Gout, one of the most common inflammatory arthritides in humans, is still difficult to diagnose in challenging situations, when fluid for arthrocentesis or an apparent tophus are absent and, for example, an infection as differential diagnosis has to be ruled out. Dual energy computed tomography (DECT is an established tool for detection and characterisation of uric acid stones in the urinary tract and has recently been used to detect and display urate deposits. Our first experiences with DECT as a diagnostic tool in routine clinical practice show, that DECT is a promising imaging technique which allows the detection of monosodium urate deposits and benefits the routine diagnosis of tophaceous gout particularly in diffuse soft tissue swelling of the limbs, without the possibility of needle aspiration. However, DECT does not seem suitable to detect dissolved urate crystals, neither in vitro nor in vivo.

Vera Lo?ckmann

2013-01-01

371

Criteria of an estimation statodynamic stability of sportsman body and system of bodies in difficult coordination sports.  

Directory of Open Access Journals (Sweden)

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.

Boloban V.N.

2012-04-01

372

An intra-abdominal desmoid tumor difficult to distinguish from a gastrointestinal stromal tumor: report of two cases.  

Science.gov (United States)

Desmoid tumors are benign fibroblastic neoplasms with no metastatic potential, but a propensity for local recurrence even after complete surgical resection. These lesions can develop at any site in the body, and commonly occur in the intra-abdominal area. Intra-abdominal desmoid tumors usually occur at the mesentery or retroperitoneum, and may morphologically mimic gastrointestinal stromal tumors (GISTs). Distinguishing between these tumors is important, because the therapies differ substantially, but is often difficult even with the use of CD117 staining. We herein report the cases of two patients with sporadic intra-abdominal desmoid tumors that were differentiated from GIST by immunohistological examination using beta-catenin and CD34. Desmoid tumors specifically express nuclear beta-catenin, and show no expression of CD34. We recommend staining for beta-catenin and CD34 when an intra-abdominal desmoid tumor is suspected. PMID:23955477

Ogawa, Norihito; Iseki, Hideaki; Tsunozaki, Hidefumi; Hayashi, Mikiko; Baba, Hironobu; Matsuyama, Takatoshi; Uetake, Hiroyuki; Sugihara, Kenichi

2014-11-01

373

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

374

[Maternal blood intrauterine transfusions in the therapy of red-cell alloimmunization performed in three difficult cases].  

Science.gov (United States)

Maternal alloimmunization can lead to hemolytic anemia, hydrops fetalis and even fetal or neonatal death. Intrauterine treatment is possible and effective even though it is associated with some risk. We present a rare method of maternal blood intrauterine transfusions in the therapy of three difficult cases of erythroblastosis fetalis. The aim of this report was to present an alternative to volunteer donors. In severe cases, i.e. in the absence of matching blood types from the donor in the presence of multiple alloantibodies in the pregnant woman or if multiple transfusions are required, this can be the only therapeutic option. To the best of our knowledge, this has been the first publication on maternal blood donation for intrauterine transfusion in the Polish literature. PMID:25322544

Kuci?ska-Chahwan, Anna; Massalska, Diana; Bijok, Julia; Rudzi?ska, Magdalena; Kope?, Izabella; Rzymkiewicz, Lech; Jakiel, Grzegorz; Roszkowski, Tomasz

2014-09-01

375

Searching for a needle in the haystack: comparing six methods to evaluate heteroplasmy in difficult sequence context.  

Science.gov (United States)

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

Kurelac, Ivana; Lang, Martin; Zuntini, Roberta; Calabrese, Claudia; Simone, Domenico; Vicario, Saverio; Santamaria, Monica; Attimonelli, Marcella; Romeo, Giovanni; Gasparre, Giuseppe

2012-01-01

376

Behaviour of actinides and other radionuclides that are difficult to measure in the melting of contaminated steel  

International Nuclear Information System (INIS)

The research work carried out confirmed the expected homogeneous distribution of the radionuclides selected for the experiments (Fe 55 and Ni 63) in the metal ingot, as was already known from the behaviour of Co 60. The latter radionuclide may be used as an indicator nuclide for Fe 55 and Ni 63 which are both difficult to measure. C 14 also showed homogeneous distribution in the ingot (carbon steel). As expected for the melt technique strontium is released to the slag. In principle this is valid for actinides too, but depends to some extent on their chemical form (elemental uranium, UO2), the added tracer quantity and the quantity of slag forming material. A direct alpha-measurement technique has been developed for steel samples and may be suitable for free release measurements of alpha-emitting steel waste decontaminated by the melt technique

377

Tracheal agenesis as a rare cause of difficult intubation in a newborn with respiratory distress: a case report  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Introduction Tracheal agenesis is a very rare congenital airway anomaly. It may pose a great challenge to the first attending physician both in diagnosis and in establishing the airway during the first day of life. Case presentation We report a newborn Malay baby boy with trachea agenesis (type III by Floyd's classification who presented with severe respiratory distress immediately after birth. Clinical diagnosis in this case was not straightforward, as it started with difficulty in intubation followed by an unsuccessful emergency tracheostomy in the neonatal intensive care unit. Urgent surgical neck exploration with endoscopic examination in the general operating theatre revealed the final diagnosis. The authors present a short description of the embryopathology and diagnostic criteria of the abnormality. Conclusion We hope this case presentation will be valuable in increasing the awareness of physicians about this rare cause of tracheal obstruction or difficult intubation.

Ahmad Raja

2009-11-01

378

42 CFR 410.100 - Included services.  

Science.gov (United States)

...services. These are services for the diagnosis and treatment of speech and language disorders...respiratory therapy services. (i) Nursing care services . Nursing care services include nursing services provided by a registered...

2010-10-01

379

42 CFR 410.100 - Included services.  

Science.gov (United States)

...2010-10-01 2010-10-01 false Included services. 410.100 Section 410.100 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM SUPPLEMENTARY...

2010-10-01

380

Gas storage materials, including hydrogen storage materials  

Science.gov (United States)

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.

Mohtadi, Rana F; Wicks, George G; Heung, Leung K; Nakamura, Kenji

2013-02-19

 
 
 
 
381

Genotype 4 HCV infection is difficult to cure with pegylated interferon and ribavirin. Results from a Greek Nationwide Cohort Study  

Science.gov (United States)

Background and aim: Patients with genotype 4 (G4) chronic hepatitis C (CHC) are considered a difficult to treat population, although current data on G4 treatment responsiveness and duration are controversial. Greece represents a country with an intermediate prevalence of G4 infections, offering an opportunity to compare treatment outcomes by genotype and to identify potential prognostic factors for sustained virologic response (SVR). Methods: All CHC patients from the HepNet.Greece, an ongoing nationwide cohort study on viral hepatitis, with known hepatitis C virus (HCV) genotype who received treatment with Peg-IFNa and ribavirin were analyzed. Results: From 4443 patients, 951 (61.7% males, 78.4% Greeks, median age 40.6 years, 10% cirrhosis) fulfilled the inclusion criteria. G4 was found in 125 (13.1%) patients. Genotype distribution was not significantly different between Greeks and immigrants. Patients with G4 had similar odds of SVR compared to G1 but significantly lower compared to G2/G3. Age, treatment discontinuation, presence of cirrhosis and previous history of HCV-treatment were associated with lower probabilities of SVR. Ethnicity did not affect SVR for all genotypes while response to treatment was similar between Greek and Egyptian patients groups (35.7% vs 40.9%, p=0.660%) with G4 infection. The relation between SVR and genotype did not substantially change after adjustment for age, gender, cirrhosis, treatment interruption and history of HCV-treatment. Conclusions: The findings of this large cohort of CHC patients with a well balanced genotype distribution further supports the idea of considering G4 as a difficult to treat genotype. Further investigation is needed to identify genotype specific prognostic factors. PMID:25125954

Anagnostou, O; Manolakopoulos, S; Bakoyannis, G; Papatheodoridis, G; Zisouli, A; Raptopoulou-Gigi, M; Manesis, E; Ketikoglou, I; Dalekos, G; Gogos, C; Vassiliadis, T; Tzourmakliotis, D; Karatapanis, S; Kanatakis, S; Zoumpoulis, -; Hounta, A; Koutsounas, S; Giannoulis, G; Tassopoulos, N; Touloumi, G

2014-01-01

382

Leaching studies on waste included in concrete  

International Nuclear Information System (INIS)

The purpose of this paper is the testing and evaluation of the resistance of solid matrix materials in which radioactive wastes were incorporated in conditions similar to those used by the Baita National Radioactive Waste Repository at Baita, Romania. Decaying activity levels of a set of radionuclide standards (Te-123, Cr-51, Cs-134, Cs-137 and Co-60) were measured as well as of the leachate (immersion solution) under testing. As matrix materials, used to incorporate radioactive wastes, cement, sand and water in the ratio 1: 2: 0.4 were investigated. The test samples are of cubic form, with a 2 cm side and 2.2 g/cm3 density. The leachate used in this study was distilled water while the testing conditions were: room temperature, atmospheric pressure, measuring time intervals, 1, 3, 7, 10, 14, 21, 28 days, and the total test duration, 6 months. The gamma ray spectrometric measurements were carried out with a GeHP detector connected to a Canberra multichannel analyzer under a PC-486. The efficiency calibration has been done with a set of calibration standards identical, as geometrical and physical characteristics, with the measuring samples. Also a calibration of the spectrometric chain has been carried out with standards of 1 g / c3 density (for the immersion solution). The tests have proved the high sensitivity of the testing procedures and showed that the solid matrices used are adequate for incorporating radioactive wastes since the diffusion rates in the given storage conditions are extremely low. These tests offered a basis for further investigation of the behaviour of radioactive wastes incorporated in solid matrices and maintained in normal conditions. (authors)

383

33 CFR 175.23 - Serviceable condition.  

Science.gov (United States)

...175.23 Serviceable condition. A PFD is considered to be in serviceable condition...following conditions are met: (a) No PFD may exhibit deterioration that could diminish the performance of the PFD, including— (1) Metal or plastic...

2010-07-01

384

The Comparison of Mallampati Test in Supine and Sitting Position in Traditional Approach and During Phonation for Predicting of Difficult Laryngoscopy and Intubation  

Directory of Open Access Journals (Sweden)

Full Text Available Background: Inadequate ventilation, esophageal intubation and difficult intubation are the most common adverse respiratory outcomes in patient undergoing anesthesia .The aim of this study was to compare Mallampati test in supine and sitting positions in traditional approach and during phonation for predicting difficult laryngoscopy and intubation. Methods: In this study performed in Imam Khomeini Hospital in Tehran, Iran, Mallampati test was performed on 661 patients who met the inclusion criteria for the study. The test was done in supine and sitting positions with and without phonation by a rater who was blind to Mallampati test. Subsequently, laryngoscopy view and difficult intubation were evaluated in the four aforesaid positions by Mallampati test for predicting difficult laryngoscopy and intubation. For each situations, sensitivity, specificity, positive and negative predictive values and accuracy were calculated.Results: Overall, 28 (4.2% patients had difficult laryngoscopy and 9 (1.4% patients had difficult intubation. The highest sensitivity for Mallampati test in predicting difficult laryngoscopy and intubation was in supine and sitting positions without phonation, and the highest specificity was seen in sitting position with phonation. Negative predictive values were more than 95% in all different positions for Mallampati tests and the highest positive predictive value was seen in supine position with phonation.Conclusion: According to our findings, the highest correlation between Mallampati test and different positions in predicting difficult laryngoscopy and intubation was seen in supine position with phonation. Phonation improved Mallampati score in supine rather than sitting position.

A Meysamie

2012-09-01

385

High voltage power condition systems powered by flux compression generators  

Science.gov (United States)

Compact, high-gain magnetic flux compressors (FCGs) are convenient sources of substantial energy for plasma-physics and electron-beam-physics experiments, but the need for high-voltage, fast-rising pulses is difficult to meet directly with conventional generators. While a variety of novel concepts employing simultaneous, axially-detonated explosive systems are under development, power-conditioning systems based on fuse opening switches and high-voltage transformers constitute another approach that complements the fundamental size, weight, and configuration of the small helical flux compressor. In this paper, we consider first a basic inductive store/opening switch circuit and the implications associated with, specifically, a fuse opening switch and an FCG energy source. We develop a general solution to a transformer/opening switch circuit---which also includes (as a special case) the direct inductive store/opening switch circuit (without transformer) and we report results of one elementary experiment demonstrating the feasibility of the approach.

Reinovsky, R. E.; Lindemuth, I. R.; Vorthman, J. E.

386

Electric Power Monthly, August 1990. [Glossary included  

Energy Technology Data Exchange (ETDEWEB)

The Electric Power Monthly (EPM) presents monthly summaries of electric utility statistics at the national, Census division, and State level. The purpose of this publication is to provide energy decisionmakers with accurate and timely information that may be used in forming various perspectives on electric issues that lie ahead. Data includes generation by energy source (coal, oil, gas, hydroelectric, and nuclear); generation by region; consumption of fossil fuels for power generation; sales of electric power, cost data; and unusual occurrences. A glossary is included.

1990-11-29

387

Including Students with Visual Impairments: Softball  

Science.gov (United States)

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…

Brian, Ali; Haegele, Justin A.

2014-01-01

388

TMD gluon density determination including uncertainties  

Digital Repository Infrastructure Vision for European Research (DRIVER)

We discuss fits to the combined HERA structure function measurements based on transverse momentum dependent (TMD) QCD factorization and CCFM evolution, and present determinations of the TMD gluon density including experimental and theoretical uncertainties. © Copyright owned by the author(s).

Hautmann, F.; Jung, H.

2013-01-01

389

Evaluation method to floodwater amount of difficult control and utilization in flood season for hyperconcentration rivers and its application  

Science.gov (United States)

The severe soil erosion in the Chinese Loess Plateau has resulted in high sediment concentration in runoff, which can cause tremendous pressure to the development and utilization of regional floodwater resources as well as the regional flood control and disaster mitigation. The floodwater amount of difficult control and utilization in flood season (FADCUFS) is an important part of the available amount of surface water resources. It also has a critical role in the sustainable development of water resources, especially for those hyperconcentration rivers (HRs) in the Loess Plateau. The evaluation of FADCUFS for HRs is an important issue in the field of hydrology and water resources. However, the understandings of its connotation, evaluation method, and nature are limited. Combined engineering measures with non-engineering ones, the evaluation method of FADCUFS for HRs was presented based on the angles of water quantity and quality. The method divides the FADCUFS into two parts in terms of the flood control operation characteristics of reservoir in HR and the relationship between water resources utilization and sediment in runoff, respectively. One is the amount of difficult regulation-control floodwater (DRCF), and the other is the volume of difficult utilization floodwater (DUF). A case study of the Bajiazui Reservoir, located in the typical Jinghe River (the second tributary of the Chinese Yellow River with high sediment concentration) was performed. Three typical years, wet year (1988), average year (1986), and dry years (1995 and 2000), were employed. According to the