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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

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Infant difficult behaviors in the context of perinatal biomedical conditions and early child environment  

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Full Text Available Abstract Background Problems experienced within the first year of an infant's life can be precursors of later mental health conditions. The purpose of this study was to examine the frequency and continuity of difficult behaviors in infants at 3 and 6 months of age and the associations of these difficulties with biomedical and psychosocial factors. Methods This study was a part of an ongoing prospective birth-cohort study. Study participants were 189 uniparous mothers and their full-term newborns. The index of infant difficult behavior was constructed. This index was then associated with the following factors: delivery mode, newborn function after birth, maternal emotional well-being, risk behavior, subjective evaluation of the quality of the relationship of the couple, and attitudes toward infant-rearing. Results Common difficult behaviors, including crying, sleeping and eating problems, were characteristic for 30.2% of 3 month old and for 22.2% of 6 month old full-term infants. The expression of infant difficult behaviors at the age of 3 months increased the likelihood of the expression of these difficulties at 6 months by more than 5 times. Factors including younger maternal age, poor prenatal and postnatal emotional well-being, prenatal alcohol consumption, low satisfaction with the couple's relationship before pregnancy, and deficiency of infant-centered maternal attitudes towards infant-rearing increased the likelihood of difficult behaviors in infants at the age of 3 months. Low maternal satisfaction with the relationship of the couple before pregnancy, negative emotional reactions of both parents toward pregnancy (as reported by the mother and the deficiency of an infant-centered maternal attitude towards infant-rearing increased the likelihood of infant difficult behaviors continuing between the ages of 3 to 6 months. Perinatal biomedical conditions were not related to the difficult behaviors in infants. Conclusions Our study suggests that early onset of difficult behavior highly increases the risk for the continuation of difficult behavior during infancy. In general, the impact of prenatal psychosocial environment on infant behavior decreases from the ages of 3 to 6 months; however, some prenatal and preconceptional psychosocial factors have direct associations with the continuity of difficult behaviors through the first half-year of an infant's life.

Sirvinskiene Giedre

2012-04-01

3

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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Difficult asthma  

Digital Repository Infrastructure Vision for European Research (DRIVER)

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; Tülay Özdemir

1989-01-01

5

Enhanced local texture feature sets for face recognition under difficult lighting conditions.  

Science.gov (United States)

Making recognition more reliable under uncontrolled lighting conditions is one of the most important challenges for practical face recognition systems. We tackle this by combining the strengths of robust illumination normalization, local texture-based face representations, distance transform based matching, kernel-based feature extraction and multiple feature fusion. Specifically, we make three main contributions: 1) we present 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; 2) we introduce 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, and we 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 3) we further improve robustness by adding Kernel principal component analysis (PCA) feature extraction and incorporating rich local appearance cues from two complementary sources--Gabor wavelets and LBP--showing that the combination is considerably more accurate than either feature set alone. The resulting method provides state-of-the-art performance on three data sets that are widely used for testing recognition under difficult illumination conditions: Extended Yale-B, CAS-PEAL-R1, and Face Recognition Grand Challenge version 2 experiment 4 (FRGC-204). For example, on the challenging FRGC-204 data set it halves the error rate relative to previously published methods, achieving a face verification rate of 88.1% at 0.1% false accept rate. Further experiments show that our preprocessing method outperforms several existing preprocessors for a range of feature sets, data sets and lighting conditions. PMID:20172829

Tan, Xiaoyang; Triggs, Bill

2010-06-01

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Effectiveness of qualified riflemen archery in control exercises with difficult conditions performance.  

Directory of Open Access Journals (Sweden)

Full Text Available In the article the study options adversarial exercise of archery with the abnormal conditions of a control to determine the specific training of athletes. It is found no differences between the absolute values of the results of the exercise of options sitting on a chair and standing on the platform and their difference from the values in the exercise with eyes closed. To set available of correlation relationships of varying strength between the results of the exercise of options sitting on a chair, standing on the platform with eyes closed, indicators of tension bow, qualifications and gender athletes.

Antonov Sergej Vasil'evich

2011-09-01

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[Clinical opportunities of 3D-modeling for implant treatment planning for the patients with full or partly adentia in difficult anatomo-topographic conditions].  

Science.gov (United States)

The message is about dental rehabilitation in difficult anatomo-topographic conditions of full adentia and high-grade atrophy of alveolar processes. The more high quality level decision of this problem using the methods of 3D-computer modeling during the diagnostic examination and planning of dental implantation is proposed. PMID:21512463

Kulakov, A A; Gvetadze, R Sh; Butsan, S B; Bra?lovskaia, T V; Khokhlachev, S B; Abramian, S V; Sukharski?, I I; Ivanov, A A; Chernen'ki?, M M

2011-01-01

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Effectiveness of cast iron vermicularization includingconditioning’ of the alloy  

Digital Repository Infrastructure Vision for European Research (DRIVER)

The performed investigations have resulted in conclusion that the vermicularizing treatment of ‘basic’ cast iron, consisting in‘conditioning’ the alloy by means of VLCe(2) master alloy, introducing the DENODUL5 master alloy, and graphitizing with SRF75master alloy, provides for obtaining vermicular graphite precipitates in the structure of material cast within 15 minutes’ period from themodifying treatment. The cast iron has been melted in the induction crucible furnace of medium fr...

Mierzwa, P.; Soin?ski, M. S.

2011-01-01

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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.

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Effectiveness of cast iron vermicularization includingconditioning’ of the alloy  

Directory of Open Access Journals (Sweden)

Full Text Available The performed investigations have resulted in conclusion that the vermicularizing treatment of ‘basic’ cast iron, consisting in‘conditioning’ the alloy by means of VLCe(2 master alloy, introducing the DENODUL5 master alloy, and graphitizing with SRF75master alloy, provides for obtaining vermicular graphite precipitates in the structure of material cast within 15 minutes’ period from themodifying treatment. The cast iron has been melted in the induction crucible furnace of medium frequency under industrial conditions. Thealloy has been subjected to vermicularization in the slender ladle of 1 Mg capacity. Graphitizing has been performed in the course oftransferring the cast iron from the slender ladle to the pouring ladle. A series of test coupons in the form of reversed U-blocks of test part walls 25 mm thick have been cast of the produced cast iron. Then specimens both for metallographic examination and for testing themechanical properties have been taken from the coupons. The analysis of cast iron structure has revealed, among others, that howeverpurely vermicular graphite precipitates occurred in specimens taken out of the lower parts of test coupon walls (which are cooled faster,the nodular graphite precipitates in quantity up to 10% could be observed in specimens from the upper parts of test coupon walls (located close beneath the sinkhead.

P.Mierzwa

2011-04-01

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Combined immunosuppressive therapy including a TNF-alpha blocker induces remission in a difficult to treat patient with Takayasu arteriitis and coronary involvement.  

Science.gov (United States)

A 40 year old woman presented with symptoms of a systemic inflammatory disease and obstruction of the left subclavian artery. Takayasu arteriitis (TA) was clinically diagnosed and confirmed by MR angiography and FDG-PET scan showing inflammation of the aortic arch and the left subclavian artery. Immunosuppression with glucocorticoids and methotrexate resulted in immediate clinical improvement and normalization of systemic markers of inflammation. Despite that the patient developed chest pain on exertion suggesting coronary involvement, which was confirmed by dobutamine stress echocardiography. After adding the TNF-alpha blocker infliximab coronary symptoms gradually improved and a clinically stable situation could be achieved for more than 6 months. Coronary angiography and aortography showed an occluded main stem of the left coronary artery, an occluded left subclavian artery, and stenoses of the brachiocephalic trunk and the left common carotid artery. Revascularization of the coronary artery and the aortic arch and its branches was performed. The patient returned to work two months after the operation. Immunosuppressive therapy with infliximab and methotrexate is continued, glucocorticoids were stopped after one year of treatment. This case shows that vascular progress in TA patients may occur even when systemic inflammation is controlled, therefore patients have to be carefully observed for new vascular manifestations. TNF-alpha blockers may be an additional treatment option in otherwise difficult to treat TA patients allowing to perform revascularization after a stable disease state has been achieved. PMID:23129041

Mahlmann, A; Pfluecke, C; Ouda, A; Simonis, G; Weiss, N; Kappert, U

2012-11-01

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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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Difficult wounds: an update.  

Science.gov (United States)

The purpose of this collective review is to describe revolutionary advances in the treatment of Gardner's syndrome (GS), pseudofolliculitis barbae, nasal septal perforation, factitious wounds, and hidradenitis suppurativa (HS). Gardner's syndrome or familial polyposis has various manifestations that appear to be controlled by a single genetic locus. Apart from the large bowel adenomas, which are always present, a common extracolonic symptom of Gardner's syndrome is the occurrence of epidermal cysts. These cysts can be seen before the intestinal polyps are evident. Because epidermal cysts in patients with Gardner's syndrome are always benign, we excise these cysts using incisions that are commonly used for rhytidectomy. Pseudofolliculitis barbae, a pseudofolliculitis caused by ingrown hairs, effects 85% of blacks who shave their beards. When this disease is allowed to progress to keloid formation, we use a surgical approach that includes excision of the keloidal scar, meticulous debridement of all residual ingrown hairs in the underlying wound, and coverage of the defect with a split-thickness skin graft. More recently, laser therapy has revolutionized the treatment of pseudofolliculitis barbae and has enabled a cure for the first time for those plagued with this disorder and for whom a beardless face is acceptable. Nasal septal perforation is a well recognized complication of septal surgery. Other iatrogenic causes of perforation include cryosurgery, electrocoagulation for epitaxis, nasotracheal intubation, or nose packing. In recent years drugs such as cocaine account for an increasing number of perforations. It has only been with the use of an external approach for the repair of the nasal septal defect that surgical closure has become easier and more reliable. The external approach allows for greater surgical closure and enables the surgeon to use both hands with the aid of binocular vision to mobilize and suture local mucosal advancement flaps and the intraseptal connective tissue grafts. More recently, surgeons have repaired large septal perforations with a radial forearm free flap. Because of its availability and deep emotional significance, the skin is a common site for self-destructive behavior with the development of factitious skin wounds. When suspected, psychiatric care must proceed immediately. Second, the ulcer can then be healed by appropriate techniques and wound repair. It is important to emphasize that the treating physician must first confront the patient, and then a psychiatrist should provide appropriate psychotherapy. Hidradenitis suppurativa is an inflammatory disease of the skin and subcutaneous tissue that occurs in apocrine-gland-bearing areas distributed in the axilla, mammary nipple areola, mons pubis, groin, scrotum, perineum, perianal region, and umbilicus. The condition has an insidious onset. The susceptibility of women's axillary skin to hidradenitis suppurativa may be related, in part, to the practice of axillary removal of hair with a safety razor. Consequently, the use of safety razors must be avoided and replaced with the use of an electric razor. The method of treatment will vary with the stage of the disease. Treatment of the chronic stage of axillary hidradenitis suppurativa is primarily surgical. More recently, carbon dioxide laser treatment, with healing by secondary intention, is proving to be a rapid, efficient, and economic treatment of this difficult wound. PMID:16022640

Edlich, Richard F; Winters, Kathryne L; Britt, L D; Long, William B; Gubler, K Dean; Drake, David B

2005-01-01

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F1 occurrence including L condition in TUCUMAN and BUENOS AIRES  

International Nuclear Information System (INIS)

An analysis of the occurrence of the F1 layer including the L condition has been done, using data from two Argentine stations: TUCUMAN and BUENOS AIRES, at different seasons and solar activity conditions. The comparisons between observations and the F1 occurrence predicted by the IRI-90 model show the need of reviewing the use of the DuCharme et al. (1973) formula adopted by the model to predict the occurrence of the intermediate F1 layer including the L condition. (author). 6 refs, 6 figs, 2 tabs

15

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

16

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

17

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

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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

18

[The difficult venous access].  

Science.gov (United States)

Venipunctures in children are difficult. Some factors can hardly be influenced, for example, a well-developed subcutaneous fat tissue. Technical devices may help to identify invisible veins. With the help of ultrasound deep peripheral veins on the wrists and ankles can be presented and punctured. Stiff resistance of a child thwarts any successful puncture. Children should therefore be adequately sedated, if cannot be induced by mask. Missing practice venipuncture and inadequate knowledge of appropriate puncture sites can be met easily by practicing and reading.The possibility of intraosseous puncture today is standard of anesthesia care for children. Within in a few seconds, a secure access to the vein system can be created. PMID:23633258

Strauß, Jochen M; Denk, Andrea

2013-04-01

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

MANAGEMENT OF DIFFICULT URTICARIA  

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Chronic urticaria, a major health problem causing patient?s distress, induces often physicians? dilemma while dealing with its etiology, investigations and management. Clinical approach of such cases should include apart from clinical history and physical examination laboratory investigations like routine blood test, thyroid profile, etc. as well as sometimes special test like autologous serum skin test. Management includes reassurance, avoidance of precipitating factors, treatm...

Yadav Sudha; Bajaj A

2009-01-01

 
 
 
 
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

22

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

23

Modifying the USDA-NRCS pasture condition score system to include weighted indicators  

Science.gov (United States)

The Pasture Condition Score (PCS) system, developed by the USDA-Natural Resources Conservation Service, is a monitoring and assessment tool for pastureland enrolled in conservation programs. Ten indicators of vegetation and soils status are rated on a 1 to 5 scale and summed to give an aggregate sco...

24

Seismic risk determination including local soil conditions for two possible nuclear power plant sites in Turkey  

International Nuclear Information System (INIS)

This article contains a case study for two potential sites in northwestern Turkey under consideration for the construction of nuclear power plants. A global seismic risk evaluation as well as a geodynamical study were carried out for either site. It was determined that in terms of acceleration on 'firm' soil, site A has greater seismic risk than site B. However when local geological formations were introduced into the study, it was found that site B amplifies oncoming ground motion to a greater degree than site A. In conclusion, the importance of incorporating local soil conditions in seismic risk calculations is indicated

25

Impedance boundary conditions for the pulmonary vasculature including the effects of geometry, compliance, and respiration.  

Science.gov (United States)

With few exceptions, previous models of the pulmonary vascular system have neglected the effects of respiration. This practice is acceptable for normal cardiac function; however, for compromised function, respiration may be critical. Therefore, we have initiated the steps to develop boundary conditions that incorporate the effects of respiration through the use of an impedance boundary condition derived from a bifurcating structured tree geometry. The benefit to using the geometry based method lies in that strategic changes can be made to the geometry to mimic physiologic changes in vascular impedance. In this paper, a scaling factor was used to modify the radius of resistance vessels of the structured tree to capture the maximum change in impedance caused by respiration. A large vessel geometry was established from a lung cast, the structured trees were applied at the outlets, and an experimental flow waveform was applied at the inlet. Finite-element analysis was used to compute the resulting inlet pressure waveform. An optimization minimizing the difference between measured and computed pressure waveforms was performed for two respiratory states, maximal expiration and inspiration, to determine best-fit models for the pulmonary vasculature, resulting in pressure waveforms with an rms error of 0.4224 and 0.7270 mmHg, respectively. PMID:19068419

Clipp, Rachel B; Steele, Brooke N

2009-03-01

26

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

27

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

28

Viability and DNA damage of halobacteria under physical stress conditions, including a simulated Martian atmosphere.  

Science.gov (United States)

Several viable halobacteria were isolated from Alpine rock salt of Permo-Triassic age and described as novel species (1, 2). They have apparently survived in the salt sediments over extremely long periods of time. Halobacteria could therefore be suitable model organisms for exploring the possibility of long-term survival of microorganisms on other planets. In addition, the discovery of extraterrestrial halite makes it plausible to consider a specific search for halophiles, perhaps in the planned sample return missions to Mars. We are developing experimental procedures to test the viability of halobacteria under Martian conditions. Cells of two species of haloarchaea were used: 1. Halobacterium sp. NRC-1, whose whole genome sequence is already known; 2. Halococcus dombrowskii, a novel isolate from Austrian Permo-Triassic rock salt (2). Cells were grown in complex medium, containing up to 4 M NaCl, and were kept at minus 70riptsizeraisebox{1.5ex{o}}C for up to seven days, or freeze-dried in a lyophilizer. In addition, exposure experiments of halobacterial cells in a liquid nitrogen cooled Martian simulation chamber, at the Austrian Academy of Sceinces, were begun, where temperatures from about plus 5 to minus 100riptsizeraisebox{1.5ex{o}}C, pressures of 6-8 mbar, and a carbon dioxide atmosphere (or other gas mixtures) can be produced. Survival of cells was evaluated by determination of colony-forming units, microscopic examination of cellular morphology, and examination of potential strand breaks in DNA using pulsed-field gel electrophoresis (PFGE). Results showed a reduction of viable cells, following deep freezing, or lyophilization, respectively, by a factor of about 10 to 100, depending somewhat on the presence of cations, glycerol and other protective substances. Data will be presented on the DNA from stressed halobacterial cells, following digestion by restriction enzymes and separation by PFGE. 1) Stan-Lotter H, McGenity TJ, Legat A, Denner EBM, Glaser K, Stetter KO, Wanner G (1999) Microbiology 145, 3565-3574. (2) Stan-Lotter H, Pfaffenhuemer M, Legat A, Busse HJ, Radax C, Gruber C (2002) Int. J. System. Evol. Microbiol. 52, 1807-1814.

Weidler, G.; Leuko, S.; Radax, C.; Stan-Lotter, H.

2003-04-01

29

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.

30

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

31

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

32

Healing of the intrabony periodontal lesion following root conditioning with citric acid and wound closure including an expanded PTFE membrane.  

Science.gov (United States)

The effect of citric acid conditioning of the root surface in conjunction with gingival flap surgery including barrier membranes (expanded polytetrafluoroethylene) was clinically evaluated in 26 intrabony periodontal defects in 23 patients. Control treatment included gingival flap surgery with barrier membranes alone. Twelve defects were treated with the experimental and 14 with the control protocol. Healing was evaluated 12 months after surgery. Initial probing depths approximated 6.9 mm and defect depths measured during surgery exceeded 4 mm. The patients exhibited good oral hygiene over the study interval as substantiated by low plaque and bleeding scores. Acid conditioning of the root surface did not enhance periodontal healing in this study, similar amounts of defect resolution were observed following either treatment protocol. Probing depth reduction generally approximated 1.8 mm; gain of clinical attachment, 0.8 mm; and defect bone fill, 1.2 mm. Under the prevailing conditions, the barrier membrane procedure apparently gave a healing result beyond which further improvement could not be achieved by root surface conditioning. PMID:1453303

Kersten, B G; Chamberlain, A D; Khorsandi, S; Wikesjö, U M; Selvig, K A; Nilvéus, R E

1992-11-01

33

HRD in Difficult Times. Symposium.  

Science.gov (United States)

This document contains three papers on challenges facing human resource development today. "In Difficult Times: Influences of Attitudes and Expectations Towards Training and Redeployment Opportunities in a Hospital Retraction Programme" (Sandra Watson, Jeff Hyman) presents reasons behind the low uptake of training and redeployment opportunities in…

2002

34

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

35

[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

36

On one-loop corrections to matching conditions of Lattice HQET including 1/m_b terms  

CERN Document Server

HQET is an effective theory for QCD with N_f light quarks and a massive valence quark if the mass of the latter is much bigger than Lambda_QCD. As any effective theory, HQET is predictive only when a set of parameters has been determined through a process called matching. The non-perturbative matching procedure including 1/m_b terms, developped by the ALPHA collaboration, consists of 19 carefully chosen observables which are precisely computable in lattice QCD as well as in lattice HQET. The matching conditions are then a set of 19 equations which relate the QCD and HQET values of these observables. We present a study of one-loop corrections to two generic matching observables involving correlation function with an insertion of the A_0 operator. Our results enable us to quantify the quality of the relevant observables in view of the envisaged non-perturbative implementation of this matching procedure.

Korcyl, Piotr

2013-01-01

37

On one-loop corrections to matching conditions of lattice HQET including 1/m{sub b} terms  

Energy Technology Data Exchange (ETDEWEB)

HQET is an effective theory for QCD with N{sub f} light quarks and a massive valence quark if the mass of the latter is much bigger than LQCD. As any effective theory, HQET is predictive only when a set of parameters has been determined through a process called matching. The non-perturbative matching procedure including 1/m{sub b} terms, developed by the ALPHA collaboration, consists of 19 carefully chosen observables which are precisely computable in lattice QCD as well as in lattice HQET. The matching conditions are then a set of 19 equations which relate the QCD and HQET values of these observables. We present a study of one-loop corrections to two generic matching observables involving correlation function with an insertion of the A{sub 0} operator. Our results enable us to quantify the quality of the relevant observables in view of the envisaged nonperturbative implementation of this matching procedure.

Korcyl, Piotr [Deutsches Elektronen-Synchrotron (DESY), Zeuthen (Germany). John von Neumann-Inst. fuer Computing NIC

2013-12-15

38

Current Trends in the Management of Difficult Urinary Catheterizations  

Science.gov (United States)

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. PMID:23359117

Willette, Paul A.; Coffield, Scott

2012-01-01

39

Difficult physician-patient relationships.  

Science.gov (United States)

Changes in the delivery of health care services in the United States are proceeding so rapidly that many providers are asking how the working relationships between doctors and patients will be effected. Accelerated by cost containment, quality improvement and the growth of managed care, these changes have caused some critics to feel that shorter visits and gatekeeper systems will promote an adversarial relationship between physicians and patients. However, proponents of the changing system feel that better prevention, follow-up care and the attention to customer service these plans can offer will lead to increased patient satisfaction and improved doctor-patient communication. Dedicated to addressing these concerns, the Bayer Institute for Health Care Communication was established in 1987 as a continuing medical education program (CME) focusing on this topic. A half-day workshop on clinician-patient communication to enhance health outcomes was introduced in 1992 and a second workshop, "Difficult' Clinician-Patient Relationships," was developed two years later. The two courses discussed in this article are offered to all physicians, residents, medical students, mid-level providers and other interested staff within the Carle system. PMID:10186308

Reifsteck, S W

1998-01-01

40

Wear mechanism between alloy 600 and SS-409 by fretting including impact and sliding motion at high temperature conditions  

International Nuclear Information System (INIS)

Fretting wear tests including impact and sliding motion of steam generator tube were performed to investigate wear volume and wear mechanism between alloy-600 tubes and 409 stainless steel (SS-409) tube support plates in the simulated operating conditions, pressure of 15 MPa, high temperature water of 290 C degrees and low dissolved oxygen (<10 ppb). The wear coefficients of alloy-600 and 409-stainless steel were estimated from the work rate. It was found that the wear coefficient for the material of alloy 600 steam generator tube is about half of that of SS-409 tube support plate materials, if the work-rate model is applicable. Hammer imprint, which is known to be an actual damaged wear pattern, has been observed on the worn surface. Wear progression model of impact-fretting wear has been proposed. The abrasive wear mechanism was dominant at the initial test period. In the stable impact-fretting progression, wearing steps are divided into three stages: the layer formation, the energy accumulation and the adhesion removing step. It was also observed that titanium rich phase contributes to the formation of voids and cracks in sub-layer. (authors)

 
 
 
 
41

Working in a difficult regime  

International Nuclear Information System (INIS)

RA and RB, the two research reactors at the Vinca Institute of Nuclear sciences were built in the late 1950s. Both were designed according to the national (former Yugoslavia) plan for developing nuclear energy. Although some modifications have been successfully made, they are now suffering from problems of ageing and funding since the attitude to the country's nuclear program has changed. Some of the equipment is fit for a museum. But the problem of ageing components is only one of the difficulties faced by the operators, they also cope with the political and financial conditions prevailing in the country

42

[Thoracic endometriosis: A difficult diagnosis].  

Science.gov (United States)

Thoracic endometriosis is a rare disease, which presents in women at a mean age of 35 years, later than for pelvic endometriosis. There are no known predisposing factors for the condition and its pathogenesis is not yet clearly established. The symptoms always appear in connection with the periods of the person affected by the condition, occurring within 24-48 h after the start of menstruation. Catamenial pneumothorax is the most common clinical entity. It is associated with pelvic endometriosis in 30-50% of cases. Thoracoscopy, preferably performed during menstruation, allows full inspection of the diaphragm and the pleural cavity for defects in the diaphragm, endometrial nodules and bullae. The level of CA 125 is often elevated but this is not a reliable or specific marker. Medical treatment is aimed at blocking the action of estrogen on the endometrium and ectopic endometrial implants. GnRH analogues or danazol are the preferred treatments. Surgery to repair and strengthen the diaphragm and/or resect nodules or bullae also has a role, supplemented by pleurodesis to prevent further pneumothorax or effusions. The main risk is recurrence, and thus the current usual practice is to combine surgery, immediately followed by hormone therapy focusing on GnRH analogues. PMID:21943537

Hagneré, P; Deswarte, S; Leleu, O

2011-09-01

43

Dealing with the difficult utility  

International Nuclear Information System (INIS)

STS HydroPower, Ltd. (STS) is an independent hydroelectric power developer involved in the full scope of hydroelectric activities. This includes the permitting, design, financing, turbine design and manufacturing, site construction and operation of small to mid-sized hydroelectric sites across the United States. At the present time, STS owns and operates nine sites in four states with a combined capacity of 20 megawatts. In dealing with the implementation of these sites, STS has dealt with five different utilities. In addition, in pursuing additional development opportunities throughout the United States, STS has had contact with numerous other utilities. During this time it would be fair to conclude that each of these utilities has exhibited its own personality with respect to dealing with independent developers. To the credit of the utility industry, the majority of these utilities have been helpful and supportive of independent projects, but a small number of utilities have approached projects from an initial and continuing adversarial position. The purpose of this paper is to examine those options and procedures available to the developer when a utility is encountered with a negative predisposition

44

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

45

Genotype effects on body temperature in dairy cows under grazing conditions in a hot climate including evidence for heterosis  

Science.gov (United States)

We compared diurnal patterns of vaginal temperature in lactating cows under grazing conditions to evaluate genotype effects on body temperature regulation. Genotypes evaluated were Holstein, Jersey, Jersey × Holstein and Swedish Red × Holstein. The comparison of Holstein and Jersey versus Jersey × Holstein provided a test of whether heterosis effects body temperature regulation. Cows were fitted with intravaginal temperature recording devices that measured vaginal temperature every 15 min for 7 days. Vaginal temperature was affected by time of day ( P 0.10]. These genotype × time interactions reflect two effects. First, Swedish Red × Holstein had higher vaginal temperatures than the other genotypes in the late morning and afternoon but not after the evening milking. Secondly, Jersey × Holstein had lower vaginal temperatures than other genotypes in the late morning and afternoon and again in the late night and early morning. Results point out that there are effects of specific genotypes and evidence for heterosis on regulation of body temperature of lactating cows maintained under grazing conditions and suggest that genetic improvement for thermotolerance through breed choice or genetic selection is possible.

Dikmen, S.; Martins, L.; Pontes, E.; Hansen, P. J.

2009-07-01

46

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

47

The 'difficult' polyp: pitfalls for endoscopic removal.  

Science.gov (United States)

Adenomatous polyps are early neoplasias of colorectal cancer (adenoma-carcinoma sequence). The majority of adenomas or early invasive cancers (T1sm1) can be resected by endoscopy. Endoscopic resection techniques include classic loop polypectomy, endoscopic mucosectomy with preceding lifting of the (almost flat) lesion, endoscopic submucosal dissection and transanal microsurgical resection, an alternative to endoscopic submucosal dissection in the rectum. Endoscopic polyp removal should always aim to resect the lesion in 'one piece' and avoid, whenever possible, 'piecemeal resection'. One-piece polypectomy is the basis for a precise histopathological analysis and for proving complete removal of the lesion. Preceding injection of saline solution into the submucosa to lift the targeted polyp is a therapeutic modality to remove even-flat and flat-depressed adenomas. In addition, a positive lifting sign is regarded as a criterion of lower superficial malignancy. Lifting of a polyp can be negatively influenced by an already advanced cancer (T1sm3/T2) in the deep parts of the submucosa as well as by scars and connective tissue in the upper two layers of the colorectal wall. Hence, a negative lifting sign may lead to incorrect macroscopic evaluation of the lesion before removal. Endoscopic submucosal dissection is mostly performed in large laterally spreading tumors in the rectum and in the preanal region. The technique has a relatively long learning curve and is somewhat time consuming. A 'difficult polyp' may be characterized by: (1) the size (>3 cm), pedunculated or sessile (Ip/Is); (2) morphological type (classification of Paris 2003), in particular the flat type II lesions IIa-c flat, flat depressed; laterally spreading tumors and the large sessile-serrated lesions; and (3) the difficult assessment of the grade of malignancy before removal [e.g. dysplasia-associated lesions or masses (DALMs), sporadic adenoma, colitis carcinoma]. Chromoendoscopy (with indigo carmine) represents an adequate method to differentiate advanced flat and depressed type II lesions from those with lower malignancy, and to better identify DALMs and sporadic adenomas in patients with long-lasting ulcerative colitis. To reduce the risk of resection (hemorrhage 0-6%, perforation 0.2%; Munich Polyp Study 2005) the application of hemoclips to visible vessels or injection of adrenaline (1:10,000) in the polyp stalk before removal are methods to prevent bleeding. In case of immediate bleeding, the treatment with hemoclips, injection (adrenaline or fibrin sealant) or endoloops are efficacious to manage this problem. Small perforations can be treated at once by the application of hemoclips, or, in case of larger or difficult leakages by Ovesco clips to avoid surgical interventions. PMID:23207936

Jung, M

2012-01-01

48

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.)

49

Propagation conditions for difficult sites in the Upper Rhine Valley  

Energy Technology Data Exchange (ETDEWEB)

Extensive meteorological measurements have been made in the high and upper Rhine Valley in the context of site protection both for the licencing procedure and the meteorological evidence required for this purpose and also for research purposes into the effects of waste heat discharge into the atmosphere. At the Schwoerstadt, Wyhl, Freistett and Philippsburg sites meteorological measurements have been made on towers of between 120 and 160 metres height. At the Wyhl site 10 automatic ground level measurement stations for the meteorological monitoring of the surrounding vicinity in a narrow circumference of the site and close to the 160 metre high measurement tower are being operated. Information about the meteorological relationships in the propagation zone of chimney and cooling tower plumes has been complemented by a number of radiometeographic measurement programmes.

Schweizer, G.; Schloevogt, T.; Haessler, G.

1983-05-01

50

Propagation conditions for difficult sites in the Upper Rhine Valley  

International Nuclear Information System (INIS)

Extensive meteorological measurements have been made in the high and upper Rhine Valley in the context of site protection both for the licencing procedure and the meteorological evidence required for this purpose and also for research purposes into the effects of waste heat discharge into the atmosphere. At the Schwoerstadt, Wyhl, Freistett and Philippsburg sites meteorological measurements have been made on towers of between 120 and 160 metres height. At the Wyhl site 10 automatic ground level measurement stations for the meteorological monitoring of the surrounding vicinity in a narrow circumference of the site and close to the 160 metre high measurement tower are being operated. Information about the meteorological relationships in the propagation zone of chimney and cooling tower plumes has been complemented by a number of radiometeographic measurement programmes. (orig.)

51

Robust Features for Frontal Face Authentication in Difficult Image Conditions  

Digital Repository Infrastructure Vision for European Research (DRIVER)

In this report we extend the recently proposed {DCT}-mod2 feature extraction technique (which utilizes polynomial coefficients derived from {2D} {DCT} coefficients obtained from horizontally & vertically neighbouring blocks) via the use of various windows and diagonally neighbouring blocks. We also evaluate enhanced {PCA}, where traditional {PCA} feature extraction is combined with {DCT}-mod2. Results using test images corrupted by a linear and a non-linear illumination change, white Gaussian...

Sanderson, Conrad; Bengio, Samy

2003-01-01

52

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

53

Pectoralis major myocutaneous flap: analysis of complications in difficult patients.  

Science.gov (United States)

The purpose of this study was to assess and discuss the effects of old age and systemic diseases on complications related to the use of a pectoralis major myocutaneous flap (PMMF) for reconstruction in head and neck surgery. Eighty-four consecutive patients, operated on between January 1992 and December 1998, were included in the study. Of these patients, 47 were in relatively good condition, while 37were old and frail or affected by systemic diseases. Patients were monitored for complications during a follow-up of 2 years. All patients included in the study had very advanced squamous cell carcinomas (T3-T4) and reconstruction with PMMF was performed after a commando procedure, a total laryngectomy with partial pharyngectomy, or a composite resection. Necrosis of skin island was the most frequently encountered complication, but no surgical intervention was needed. Overall, complications occurred more frequently in patients with underlying pathologies, the risk ratio adjusted for age and sex being 2.94, but 95% confidence intervals were 0.99-8.65 and all complications were minor. In summary, we recommend the use of PMMF for immediate repair in difficult patients who have large oropharyngo-laryngeal excisions and radical neck dissections and who suffer concomitantly with various medical problems known to increase complication rates. PMMF proved to be suitable to give these patients good chances of a quick recovery with satisfactory aesthetic and functional results. PMID:11829193

Castelli, M L; Pecorari, G; Succo, G; Bena, A; Andreis, M; Sartoris, A

2001-12-01

54

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

55

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

56

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

57

Uhl's anomaly: a difficult prenatal diagnosis.  

Science.gov (United States)

Uhl's anomaly is an evolutive disease leading to terminal right ventricular failure. The most difficult differential diagnosis at presentation is the Ebstein disease. We describe the evolution of a foetus with Uhl's anomaly from 21 to 30 weeks of gestation, with progressive reduction in the right ventricular anterior myocardium suggestive of apoptosis, leading to foetal demise. PMID:24784726

Vaujois, Laurence; van Doesburg, Nicolaas; Raboisson, Marie-Josée

2015-03-01

58

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

59

Why mechanical subsystems are difficult to integrate  

Energy Technology Data Exchange (ETDEWEB)

Though the theme of System Engineering is integration, and it is normal to attempt in integration to ignore the lines between disciplines, there are distinct characteristics of the mechanical design portion of any major system design project that make this difficult. How these characteristics compound the difficulty of integration is discussed and means to minimize the associated obstacles are suggested.

Segalman, D.J.; Ortiz, K. [Sandia National Labs., Albuquerque, NM (United States); Wesner, J.J. [Lucent Technologies, Middletown, NJ (United States)

1996-12-31

60

Difficult Physics Topics in Nigerian Secondary Schools.  

Science.gov (United States)

Reports on a study which sought to isolate physics topics perceived to be difficult and examine whether students' interest in mathematics had any significant relationship with the perceived difficulty. Concluded that students perceived more difficulty in mechanics, and a significant relationship existed between active interest in mathematics and…

Okpala, Promise; Onocha, Charles

1988-01-01

 
 
 
 
61

Intraoperative reduction techniques for difficult femoral fractures.  

Science.gov (United States)

Successful intramedullary nailing of difficult femoral fractures is predicated on achieving and maintaining reduction before reaming and implant insertion. Closed and percutaneous strategies are emphasized which preserve fracture biology and encourage primary union. However, open techniques are sometimes necessary to avoid postoperative deformity. PMID:19390376

Pape, Hans-Christoph; Tarkin, Ivan S

2009-01-01

62

The difficult encounter between inspector and farmer  

DEFF Research Database (Denmark)

When the inspector drives into the farmyard and asks to see the animal barns to inspect the welfare of the animals, a tense situation may arise because inspections transcend limits and are complex and difficult for many farmers to relate to. A new research project is examining the interaction between authorities and farmers.

Anneberg, Inger; SØrensen, Jan Tind

2012-01-01

63

Living conditions, including life style, in primary-care patients with nonacute, nonspecific spinal pain compared with a population-based sample: a cross-sectional study  

Directory of Open Access Journals (Sweden)

Full Text Available Odd Lindell, Sven-Erik Johansson, Lars-Erik Strender1Center for Family and Community Medicine, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, SwedenBackground: Nonspecific spinal pain (NSP, comprising back and/or neck pain, is one of the leading disorders behind long-term sick-listing, including disability pensions. Early interventions to prevent long-term sick-listing require the identification of patients at risk. The aim of this study was to compare living conditions associated with long-term sick-listing for NSP in patients with nonacute NSP, with a nonpatient population-based sample. Nonacute NSP is pain that leads to full-time sick-listing>3 weeks.Methods: One hundred and twenty-five patients with nonacute NSP, 2000–2004, were included in a randomized controlled trial in Stockholm County with the objective of comparing cognitive–behavioral rehabilitation with traditional primary care. For these patients, a cross-sectional study was carried out with baseline data. Living conditions were compared between the patients and 338 nonpatients by logistic regression. The conditions from univariate analyses were included in a multivariate analysis. The nonsignificant variables were excluded sequentially to yield a model comprising only the significant factors (P <0.05. The results are shown as odds ratios (OR with 95% confidence intervals.Results: In the univariate analyses, 13 of the 18 living conditions had higher odds for the patients with a dominance of physical work strains and Indication of alcohol over-consumption, odds ratio (OR 14.8 (95% confidence interval [CI] 3.2–67.6. Five conditions qualified for the multivariate model: High physical workload, OR 13.7 (CI 5.9–32.2; Hectic work tempo, OR 8.4 (CI 2.5–28.3; Blue-collar job, OR 4.5 (CI 1.8–11.4; Obesity, OR 3.5 (CI 1.2–10.2; and Low education, OR 2.7 (CI 1.1–6.8.Conclusions: As most of the living conditions have previously been insufficiently studied, our findings might contribute a wider knowledge of risk factors for long-term sick-listing for NSP. As the cross-sectional design makes causal conclusions impossible, our study should be complemented by prospective research.Keywords: nonspecific spinal pain, back pain, neck pain, long-term sick-listing, population-based sample, cross-sectional study

Odd Lindell

2010-11-01

64

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

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Medical Students' Personal Determinants of Overcoming Strategies in Difficult Situations  

Digital Repository Infrastructure Vision for European Research (DRIVER)

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 copi...

Veretelnikova Yu.Ya.; Chernyshkova E.V.; Ye, Belyakov A.

2013-01-01

66

Numerical simulation of CO2 leakage from a geologic disposal reservoir, including transitions from super- to sub-critical conditions, and boiling of liquid of CO2  

International Nuclear Information System (INIS)

The critical point of CO2 is at temperature and pressure conditions of Tcrit = 31.04 C, Pcrit = 73.82 bar. At lower (subcritical) temperatures and/or pressures, CO2 can exist in two different phase states, a liquid and a gaseous state, as well as in two-phase mixtures of these states. Disposal of CO2 into brine formations would be made at supercritical pressures. However, CO2 escaping from the storage reservoir may migrate upwards towards regions with lower temperatures and pressures, where CO2 would be in subcritical conditions. An assessment of the fate of leaking CO2 requires a capability to model not only supercritical but also subcritical CO2, as well as phase changes between liquid and gaseous CO2 in sub-critical conditions. We have developed a methodology for numerically simulating the behavior of water-CO2 mixtures in permeable media under conditions that may include liquid, gaseous, and supercritical CO2. This has been applied to simulations of leakage from a deep storage reservoir in which a rising CO2 plume undergoes transitions from supercritical to subcritical conditions. We find strong cooling effects when liquid CO2 rises to elevations where it begins to boil and evolve a gaseous CO2 phase. A three-phase zone forms (aqueous - liquid - gas), which over time becomes several hundred meters thick as decreasing temperatures permit liquid CO2 to advance to shallower elevations. Fluid mobilities are reduced in the three-phase region from phase interference effects. This impedes CO2 upflow, causes the plume to spread out laterally, and gives rise to dispersed CO2 discharge at the land surface. Our simulation suggests that temperatures along a CO2 leakage path may decline to levels low enough so that solid water ice and CO2 hydrate phases may be formed

67

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

68

Sympathetic responsibility in ethically difficult situations*.  

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Background. Ethical issues arise in many obstetric situations and demand constant consideration by obstetricians. The aim of this study was to highlight the meaning of being in an ethically difficult situation as narrated by obstetricians. Methods. A descriptive design with a qualitative approach using a hermeneutic phenomenological method for analysis. Interviews were performed with 14 obstetricians working in a Swedish hospital setting. Results. The overriding ...

Danerek, Margaretha; Ude?n, Giggi; Dykes, Anna-karin

2005-01-01

69

Difficult male urethral catheterization: a review of different approaches  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: English Abstract in english PURPOSE: To review and compare the different methods for difficult male urethral catheterization described in selected literature. MATERIALS AND METHODS: A PubMed search was done with the terms "difficult", "failed", or "complications" and "urethral catheterization", "transurethral catheterization", [...] "Foley catheter", "urethral catheter" or "filiforms and followers". All articles addressing the issue of difficult adult male urethral catheterization were included. RESULTS: Six main approaches were identified on the 14 articles included for review: 1) Passage of either a Glidewire, guide wire or filiform under direct vision; 2) Blind passage of a filiform, guide wire, Glidewire or hydrophilic catheter; 3) "The Peel-away® sheath placed on a cystoscope/resectoscope technique"; 4) "The rigid ureteroscope placed inside the 22F Foley technique"; 5) Suprapubic catheterization; and 6) "The instillation of 60 cc of saline through the catheter as it is advanced technique". CONCLUSION: There is a paucity of prospective data comparing the benefits, risks, success rates and complications of the different approaches for difficult Foley catheter placement. Our suggested approach starts with the initial attempt at urethral catheterization with an 18F coude and a 12F silicone catheter. If these fail, using a flexible cystoscope or the blind Glidewire technique are reasonable alternatives. If dilatation of a stricture is necessary, ureteric dilatators or a urethral balloon dilatator are recommended.

Carlos, Villanueva; George P., Hemstreet III.

2008-08-01

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Difficult male urethral catheterization: a review of different approaches  

Directory of Open Access Journals (Sweden)

Full Text Available PURPOSE: To review and compare the different methods for difficult male urethral catheterization described in selected literature. MATERIALS AND METHODS: A PubMed search was done with the terms "difficult", "failed", or "complications" and "urethral catheterization", "transurethral catheterization", "Foley catheter", "urethral catheter" or "filiforms and followers". All articles addressing the issue of difficult adult male urethral catheterization were included. RESULTS: Six main approaches were identified on the 14 articles included for review: 1 Passage of either a Glidewire, guide wire or filiform under direct vision; 2 Blind passage of a filiform, guide wire, Glidewire or hydrophilic catheter; 3 "The Peel-away® sheath placed on a cystoscope/resectoscope technique"; 4 "The rigid ureteroscope placed inside the 22F Foley technique"; 5 Suprapubic catheterization; and 6 "The instillation of 60 cc of saline through the catheter as it is advanced technique". CONCLUSION: There is a paucity of prospective data comparing the benefits, risks, success rates and complications of the different approaches for difficult Foley catheter placement. Our suggested approach starts with the initial attempt at urethral catheterization with an 18F coude and a 12F silicone catheter. If these fail, using a flexible cystoscope or the blind Glidewire technique are reasonable alternatives. If dilatation of a stricture is necessary, ureteric dilatators or a urethral balloon dilatator are recommended.

Carlos Villanueva

2008-08-01

71

Genetic and epidemiological studies of Dystocia : Difficult labour  

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Objective: To explore the epidemiological characteristics, the influence on reproductive health and the genetic basis of dystocia prolonged and difficult labour. Material and methods: The thesis has a retrospective design and is mainly based on a material from an entire cohort of women, extracted from the Swedish Medical Birth Register, who had their first delivery during the years 1973 to 1997. This includes totally 2 539 534 deliveries. The number of dystocia diagnos...

Algovik, Michael

2008-01-01

72

Difficult weaning in delayed onset diaphragmatic hernia  

Directory of Open Access Journals (Sweden)

Full Text Available Diaphragmatic injuries are relatively rare and result from either blunt or penetrating trauma. Regardless of the mechanism, diagnosis is often missed and high index of suspicion is vital. The clinical signs associated with a diaphragmatic hernia can range from no outward signs to immediately life-threatening respiratory compromise. Establishing the clinical diagnosis of diaphragmatic injuries (DI can be challenging as it is often clinically occult. Accurate diagnosis is critical since missed DI may result in grave sequelae due to herniation and strangulation of displaced intra-abdominal organs. We present a case of polytrauma with rib fracture and delayed appearance of diaphragmatic hernia manifesting as difficult weaning from ventilatory support.

Ahmed Syed

2009-01-01

73

Rigid fibrescope Bonfils: use in simulated difficult airway by novices  

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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

74

Nonadherence in difficult asthma – facts, myths, and a time to act  

Directory of Open Access Journals (Sweden)

Full Text Available John T Lindsay, Liam G HeaneyCentre for Infection and Immunity, Queens University Belfast, Belfast, UKAbstract: Nonadherence to prescribed treatment is an important cause of difficult asthma. Rates of nonadherence amongst asthmatic patients have been shown to range between 30% and 70%. This is associated with poor health care outcomes and increased health care costs. There is no such thing as a "typical" nonadherent patient. The reasons driving nonadherence are multifactorial. Furthermore, adherence is a variable behavior and not a trait characteristic. Adherence rates can vary between the same individual across treatments for different conditions. There is no consistent link between socioeconomic status and nonadherence, and although some studies have shown that nonadherence is more common amongst females, this is not a universal finding. The commonly held perception that better adherence is driven by greater disease severity has been demonstrated to not be the case, in both pediatric and adult patients. Identification of nonadherence is the first step. If adherence is not checked, it is likely that poor adherence will be labeled as refractory disease. Failure to identify poor adherence may lead to inappropriate escalation of therapy, including the potential introduction of complex biological therapies. Surrogate measures, such as prescription counting, are not infallible. Nonadherence can be difficult to identify in clinical practice, and a systematic approach using a variety of tools is required. Nonadherence can be successfully addressed. Therefore, assessment of adherence is of paramount importance in difficult asthma management, in order to reduce exacerbations and steroid-related side effects as well as hospital and intensive care admissions, health care cost, and inappropriate treatment escalation. In this paper, we present an overview of the literature surrounding nonadherence in difficult asthma. We explore the facts and myths surrounding the factors driving nonadherence as well as how it can be identified and addressed.Keywords: concordance, compliance, inhaled corticosteroids, drug monitoring

Lindsay JT

2013-04-01

75

EMAP/NOAA 2003 SURVEY OF ECOLOGICAL CONDITIONS OF THE WESTERN U.S. CONTINENTAL SHELF, INCLUDING GULF OF FARALLONES NATIONAL MARINE SANCTUARY  

Science.gov (United States)

In June of 2003 a partnership between EPA, NOAA, and the western coastal states conducted a joint survey of ecological condition of aquatic resources along the U.S. western continental shelf (30-120 m), using multiple indicators of ecological condition. The study is an element o...

76

Flavobacterium psychrophilum vaccine development: a difficult task  

Science.gov (United States)

Bacterial cold water disease (BCWD) is a globally distributed freshwater fish disease caused by the Gram-negative bacterium Flavobacterium psychrophilum. It is a particularly devastating infection in fry salmonids and may lead to high levels of mortality. In spite of its economic impact on fish farms, neither the biology of the bacterium nor the bacterium–host interactions are well understood. This review provides a synopsis of the major problems related to critical remaining questions about research into the use of vaccines against F. psychrophilum and the development of a commercial vaccine against this disease. Studies using sera from convalescent rainbow trout have shown the antigenic properties of different proteins such as OmpH, OmpA and FspA, as well as low and high molecular mass lipopolysaccharide of F. psychrophilum, which are potential candidates for subunit vaccines. Inactivated F. psychrophilum bacterins have been successfully tested as vaccines under laboratory conditions by both immersion and intraperitoneal routes. However, the efficacy and the practical usefulness of these preparations still have to be proved. The use of attenuated and wild-type strains to immunize fish showed that these systems offer high levels of protection. Nevertheless, their application clashes with the regulations for environmental protection in many countries. In conclusion, protective vaccines against BCWD are theoretically possible, but substantial efforts still have to be made in order to permit the development of a commercial vaccine. PMID:25056179

Gómez, Esther; Méndez, Jessica; Cascales, Desirée; Guijarro, José A

2014-01-01

77

Thermoelastic stresses in non-uniform geological environments difficult outline  

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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

78

Teaching the difficult-to-teach topics.  

Science.gov (United States)

It is now accepted that teaching in palliative medicine should be integrated throughout the medical undergraduate curriculum. Recommendations suggest the inclusion of knowledge areas such as symptom control, as well as more attitudinal aspects such as teamwork and understanding patient and carer perspectives on illness. These subjects should be taught on a stepwise basis, introducing concepts at an early stage and then be built on throughout training. However, how this is done and how effectively all aspects are taught vary considerably. This article outlines one way of using patient and carer experiences of significant illness, and multi-disciplinary teams, to teach attitudinal concepts behind palliative care to medical students early in their undergraduate careers. Palliative care is considered here in a broad sense, with the relevance to all healthcare professionals emphasised, and specialist palliative care used as an example of holistic care. The sessions consisted of small group discussions with patient and carer representatives as well as discussions with various members of the multi-disciplinary team. These were led by the patient/carer/professionals' experiences and further explored with facilitated questions by the students. The sessions have been evaluated well by all involved, including patients, carers, multi-disciplinary team members and palliative medicine doctors. The learning objectives (to understand patient perspectives, multi-disciplinary working and holistic care) were achieved, along with discussion of professionalism. PMID:24644778

MacPherson, Anna; Lawrie, Iain; Collins, Sarah; Forman, Louise

2014-03-01

79

Processing a difficult urethane elastomer system  

International Nuclear Information System (INIS)

A detailed study of an adiprene/butanediol/trimethylolpropane elastomer system and the associated production process was performed to assess the importance of various processing factors on the physical properties of the system. Results indicated that control of the curing cycle, material ratio, moisture in the curing agent and elastomer, mixing, and vacuum level was necessary. Sufficient control of the manual process could not be obtained to eliminate significant physical property variability. An automatic metering, mixing and dispensing machine was purchased for laboratory evaluation. After modification, including the addition of a high shear vacuum type mixer, and with close vacuum and temperature control, material property variability was still at an unacceptable level. A tracer agent was introduced into the curing agent system to assess the distribution of the curing agent in the elastomer. Machine evaluation using the tracer agent indicated that distribution of the curing agent in the elastomer was very poor is spite of the high shear mixing configuration. The addition of an oscillating motion to the mixing configuration. The addition of an oscillating motion to the mixing system significantly improved curing agent distribution and eliminated material property variability problems. 16 figures, 3 tables

80

Penile Corporeal Reconstruction during Difficult Placement of a Penile Prosthesis  

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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

 
 
 
 
81

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

82

Comparison of strand-specific transcriptomes of enterohemorrhagic Escherichia coli O157:H7 EDL933 (EHEC) under eleven different environmental conditions including radish sprouts and cattle feces  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Background Multiple infection sources for enterohemorrhagic Escherichia coli O157:H7 (EHEC) are known, including animal products, fruit and vegetables. The ecology of this pathogen outside its human host is largely unknown and one third of its annotated genes are still hypothetical. To identify genetic determinants expressed under a variety of environmental factors, we applied strand-specific RNA-sequencing, comparing the SOLiD and Illumina systems. Results ...

Landstorfer, Richard; Simon, Svenja; Schober, Steffen; Keim, Daniel; Scherer, Siegfried; Neuhaus, Klaus

2014-01-01

83

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

84

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

85

Investigation on the behaviour of Fe++ and Cu++ chemical dosimeter under process conditions, including the influence of solute concentration in the system  

International Nuclear Information System (INIS)

The reaction mechanism proposed for the Fe-Cu dosemeter in the literature has failed to explain why the yield of Fe+++ is not a linear function of dose and why there is a difference in the initial yield when the solution is oxygen saturated as opposed to oxygen depleted. In addition, an investigation of the dose-rate effect on G(Fe+++) in oxygenated and oxygen depleted solutions yields results which have not proved amenable to the introduction of new reaction mechanisms. Pulse radiolysis studies have also failed to provide insight into additional reaction mechanisms which would explain the various discrepancies in the radiological behavior of the Fe-Cu system. In the present work, the Fe-Cu system was studied under extreme conditions of solute concentration and dose-rate. The experiments were aimed at determining the influence of concentrations of O2, Fe++, Fe+++ and Cu++ on the yield of Fe+++ in the irradiated Fe++-Cu++ dosemeter solution. Rapid mixing techniques were employed and a model reaction scheme developed for computer calculations to test the understanding of the radiochemical reactions. Methods for suppressing the reactions Cu++O2?Cu+++O2- and HO2+Fe++?HO2-+Fe+++ and thus improving dosemeter performance in a gamma field were determined. However, the investigation demonstrated that the dosemeter cannot be used for high dose-rate dosimetry of pulsed electron beams

86

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

87

Actual Condition of Paddy Field Levee Maintenance by Various Farm Households including Large-scale Farming in the Developed Land Renting Area  

Science.gov (United States)

The survey of interview, resource acquisition, photographic operation, and questionnaire were carried out in the “n” Community in the “y” District in Hakusan City in Ishikawa Prefecture to investigate the actual condition of paddy field levee maintenance in the area where land-renting market was proceeding, large-scale farming was dominant, and the problems of geographically scattered farm-land existed. In the study zone, 1) an agricultural production legal person rent-cultivated some of the paddy fields and maintained the levees, 2) another agricultural production legal person rent-cultivated some of the soy bean fields for crop changeover and land owners maintained the levees. The results indicated that sufficient maintenance was executed on the levees of the paddy fields cultivated by the agricultural production legal person, the soy bean fields for crop changeover, and the paddy fields cultivated by the land owners. Each reason is considered to be the managerial strategy, the economic incentive, the mutual monitoring and cross-regulatory mechanism, etc.

Sakata, Yasuyo

88

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

89

Hypopharyngeal fistula complicating difficult thyroidectomy for invasive papillary cancer.  

Science.gov (United States)

Thyroidectomy is associated with certain known complications, including recurrent laryngeal or superior laryngeal nerve injury and hypocalcaemia due to hypoparathyroidism. Other much rarer complications include oesophageal injury with oesophageal fistula formation. In this report, we describe the clinical course of a patient with an invasive papillary thyroid carcinoma who underwent total thyroidectomy and developed hypopharyngeal fistula in the immediate postoperative period, a complication that has never been reported previously following thyroidectomy. Under conservative treatment, the fistula closed within two weeks and the patient was referred, in good condition, to the oncologist for completion of therapy. PMID:25245720

Rabie, M Ezzedien

2014-10-01

90

Method of working thick gently sloping beds of minerals with roofing rocks difficult to collapse. [Strong roofs, thick seams  

Energy Technology Data Exchange (ETDEWEB)

The invention refers to the mine industry and can be used in working thick gently sloping beds of minerals, primarily coal, with roofing rocks difficult to collapse. There is a known method of making preparatory shafts, cutting slits in the roof and subsequent extraction of coal. However this method is characterized by considerable volume of preparatory operations and great labor intensity. There is also a known method of working thick gently sloping beds of minerals with roofing rocks difficult to collapse by two inclined layers including making of preparatory shafts and subsequent working of the bed. However, this method is insufficiently effective and requires considerable outlays under definite mining-geological conditions. In order to improve the effectiveness of working, using the suggested method, the layers are extracted simultaneously and in ascending order with advance of the face of the upper layer by a face of the lower layer by an amount of the span of collapse of the roofing which is difficult to collapse. The drifts of the lower layer are eliminated after passage of the stoping face of the upper layer. As the stoping face of the lower layer advances, the overlying mass of mineral collapses and the smooth subsidence of the rocks in the roof into the collapsed mineral as a result of formation of fractures in the roofing rock.

Kruglikov, V.P.

1979-05-25

91

Genetic evidence of multiple loci in dystocia - difficult labour  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Background Dystocia, difficult labour, is a common but also complex problem during childbirth. It can be attributed to either weak contractions of the uterus, a large infant, reduced capacity of the pelvis or combinations of these. Previous studies have indicated that there is a genetic component in the susceptibility of experiencing dystocia. The purpose of this study was to identify susceptibility genes in dystocia. Methods A total of 104 women in 47 families were included where at least two sisters had undergone caesarean section at a gestational length of 286 days or more at their first delivery. Study of medical records and a telephone interview was performed to identify subjects with dystocia. Whole-genome scanning using Affymetrix genotyping-arrays and non-parametric linkage (NPL analysis was made in 39 women exhibiting the phenotype of dystocia from 19 families. In 68 women re-sequencing was performed of candidate genes showing suggestive linkage: oxytocin (OXT on chromosome 20 and oxytocin-receptor (OXTR on chromosome 3. Results We found a trend towards linkage with suggestive NPL-score (3.15 on chromosome 12p12. Suggestive linkage peaks were observed on chromosomes 3, 4, 6, 10, 20. Re-sequencing of OXT and OXTR did not reveal any causal variants. Conclusions Dystocia is likely to have a genetic component with variations in multiple genes affecting the patient outcome. We found 6 loci that could be re-evaluated in larger patient cohorts.

Westgren Magnus

2010-06-01

92

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

93

New techniques and devices for difficult airway management.  

Science.gov (United States)

The purpose of this review is to compare old conventional techniques and devices for difficult airway management and new sophisticated techniques and devices. Recent techniques and devices are defined as the American Society of Anesthesiology (ASA) practice guidelines for the management of difficult airway, published in 1992, reviewed in 1993 and updated in 2003. According to ASA, the techniques for difficult airway management are divided into techniques for difficult intubation and techniques for difficult ventilation. Awake fiberoptic intubation is the technique of choice for difficult airway management prescribed by the World Health Organization document for patient safety in the operating theater. Conventional techniques for intubation used direct visualization. The new generation of devices does not require direct visualization of the vocal cords for endotracheal tube placement. They allow better glottis view and successful endotracheal placement of the tube with indirect laryngoscopy. New intubation devices such as video laryngoscopes facilitate endotracheal intubation by indirect visualization of glottis structures without aligning the oral, pharyngeal and laryngeal axes in patients with cervical spine abnormality. Video laryngoscopes such as V-Mac and C-Mac, Glide scope, McGrath, Airway Scope, Airtraq, Bonfils and Bullard laryngoscope are widely available at the market. Airway gadgets are lighted stylets and endotracheal tube guides. The principal conclusion of this review is that utilization of these devices can be easily learned. The technique of indirect laryngoscopy is currently used for managing difficult airway in the operating room as well as for securing the airway in daily anesthesia routine. PMID:23330414

Shirgoska, Biljana; Netkovski, Jane

2012-09-01

94

Effect of CADe on radiologists' performance in detection of "difficult" polyps in CT colonography  

Science.gov (United States)

To investigate the actual usefulness of computer-aided detection (CADe) of polyps as a second reader, we conducted a free-response observer performance study with radiologists in the detection of "difficult" polyps in CT colonography (CTC) from a multicenter clinical trial. The "difficult" polyps were defined as the ones that had been "missed" by radiologists in the clinical trial or rated "difficult" in our retrospective review. Our advanced CADe scheme utilizing massive-training artificial neural networks (MTANNs) technology was sensitive and specific to the "difficult" polyps. Four board-certified abdominal radiologists participated in this observer study. They were instructed, first without and then with our CADe, to indicate the location of polyps and their confidence level regarding the presence of polyps. Our database contains 20 patients with 23 polyps including 14 false-negative (FN) and 7 "difficult" polyps and 10 negative patients. With CADe, the average by-polyp sensitivity of radiologists was improved from 53 to 63% at a statistically significant level (P=0.037). Thus, our CADe scheme utilizing the MTANN technology improved the diagnostic performance of radiologists, including expert readers, in the detection of "difficult" polyps in CTC.

Suzuki, Kenji; Hori, Masatoshi; Iinuma, Gen; Dachman, Abraham H.

2013-03-01

95

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

96

PREDICTORS OF DIFFICULT INTUBATION: STUDY IN KASHMIRI POPULATION  

Directory of Open Access Journals (Sweden)

Full Text Available Airway assessment is the most important aspect of Anaesthesia practice as a difficult intubation may be unanticipated. A prospective study was done to compare the efficacy of airway parameters to predict difficult intubation viz; degree of head extension, thyromental distance, inter incisor gap, grading ofprognathism, obesity and modified mallampati test. Six hundred patients with ASA I& ASA II grade were enrolled in study. All patients were preoperatively assessed for airway parameters. Intra-operatively all patients were classified according to Cormack and Lehane laryngoscopic view. Clinical data of each test was collected, tabulated and analyzed to obtain the sensitivity, specificity, positive predictive value & negative predictive value. Results obtained showed incidence of difficult intubation in 3.3%. Head&neck movements had the highest sensitivity (86.36%; high arched palate had highest specificity (99.38%.Head & neck movements had highest sensitivity; high arched palate had highest specificity, however, head & neck movements strongly correlated for patients with difficult intubation.

Gupta A K

2009-12-01

97

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

98

Complicated Jejunal Diverticulitis: A Challenging Diagnosis and Difficult Therapy  

Science.gov (United States)

Background/Aim: In contrast to diverticulosis of the colon, jejunal diverticulosis is a rare entity that often becomes clinically relevant only after exacerbations occur. The variety of symptoms and low incidence make this disease a difficult differential diagnosis. Patients and Methods: Data from all patients who were treated in our surgical department for complicated jejunal diverticulitis, that is, gastrointestinal hemorrhage or a diverticula perforation were collected prospectively over a 6-year period (January 2004 to January 2010) and analyzed retrospectively. Results: The median age among the 9 patients was 82 years (range: 54–87). Except for 2 cases (elective operation for a status postjejunal peridiverticulitis and a re-perforation of a diverticula in a patient s/p segment resection with free perforation), the diagnosis could only be confirmed with an exploratory laparotomy. Perforation was observed in 5 patients, one of which was a retroperitoneal perforation. The retroperitoneal perforation was associated with transanal hemorrhage. Hemodynamically relevant transanal hemorrhage requiring transfusion were the reason for an exploratory laparotomy in 2 further cases. In one patient, the hemorrhage was the result of a systemic vasculitis with resultant gastrointestinal involvement. A singular jejunal diverticulum caused an adhesive ileus in one patient. The extent of jejunal diverticulosis varied between a singular diverticulum to complete jejunal involvement. A tangential, transverse excision of the diverticulum was carried out in 3 patients. The indication for segment resection was made in the case of a perforation with associated peritonitis (n=4) as well as the presence of 5 or more diverticula (n=2). Histological analysis revealed chronic pandiverticulitis in all patients. Median operating time amounted to 142 minutes (range: 65–210) and the median in-hospital stay was 12 days (range: 5–45). Lethality was 0%. Major complications included secondary wound closure after s/p repeated lavage and bilateral pleural effusions in one case. Signs of malabsorption as the result of a short bowel syndrome were not observed. Minor complications included protracted intestinal atony in 2 cases and pneumonia in one case. Median follow-up was 6 months (range: 1–18). Conclusion: Complicated jejunal diverticulitis often remains elusive preoperatively due to its unspecific clinical presentation. A definitive diagnosis can often only be made intraoperatively. The resection of all diverticula and/or the complete diverticula-laden segment is the goal in chronic cases. The operative approach chosen (tangential, transverse excision vs segment resection) should be based on the extent of the jejunal diverticulosis as well as the intraoperative findings. PMID:22421718

Schloericke, Erik; Zimmermann, Markus S.; Hoffmann, Martin; Kleemann, Markus; Laubert, Tilman; Bruch, Hans-Peter; Hildebrand, Phillip

2012-01-01

99

In difficult economic times, cities ask nonprofits for voluntary contributions  

Science.gov (United States)

City to ask more from nonprofitshttp://www.boston.com/news/local/massachusetts/articles/2010/12/22/city_to_ask_more_from_nonprofits/?rss_id=Boston.com+--+Local+newsPrinceton: University will provide township a $500K gifthttp://www.centraljersey.com/articles/2011/01/03/the_princeton_packet/news/doc4d2270475d056711196808.txtNonprofits shouldn't be a revenue sourcehttp://www.journaltimes.com/news/opinion/editorial/article_b52dc2e6-1793-11e0-859c-001cc4c03286.htmlBalancing Budgetshttp://www.watertowndailytimes.com/article/20101228/OPINION01/312289981Commentary: The Burden of Tax-Exempt Propertyhttp://www.njpp.org/com_dkoped.htmlOver the holidays, cheer and goodwill reigned supreme in most quarters. In the New Year, it is back to business, and for many nonprofit organizations this could mean another difficult challenge. A movement has been afoot to garner property tax payments from a wide range of nonprofits across the United States as of late, and a number of nonprofits have voiced strong concerns about such a trend. Nonprofits, such as universities and churches, are largely exempt from property taxes, and cash-strapped local governments are seeking a wide range of voluntary contributions from these institutions. In Princeton, New Jersey, the well-endowed Princeton University recently made a voluntary payment to the township of Princeton, but such an offering is much more difficult for other organizations. Tim Delaney, the chief executive of the National Council of Nonprofits, recently remarked, "Governments are taking their public burdens and putting them on the backs of nonprofits, at a time when the demand for our services is skyrocketing." Other taxes instituted as of late on nonprofits include drainage feeds, street-light fees, and a catchall type of voluntary offering known as "payment in lieu of taxes", or PILOT.The first link will take visitors to a recent piece from the Wall Street Journal which talks about this recent trend. The second link leads to a piece from the Boston Globe which describes how the city of Boston is revamping its formula for determining how much nonprofits should contribute to the city coffers. Moving along, the third link leads to a piece from this Monday's Princeton Packet about the voluntary payment given by Princeton University to Princeton Township. The fourth piece leads to an editorial from the Racine Journal Times on this controversial issue. The fifth link leads to another editorial, this time from the Watertown Daily Times which remarks, "Rather than reach into the pockets of schools, churches and community groups, municipalities need to bring their costs under control." Finally, the last link leads to a thoughtful piece from Donald A. Krueckeberg of the Bloustein School of Rutgers University-New Brunswick on the potential burden of tax-exempt property.

Grinnell, Max

2010-01-07

100

The Neural Bases of Difficult Speech Comprehension and Speech Production: Two Activation Likelihood Estimation (ALE) Meta-Analyses  

Science.gov (United States)

The role of speech production mechanisms in difficult speech comprehension is the subject of on-going debate in speech science. Two Activation Likelihood Estimation (ALE) analyses were conducted on neuroimaging studies investigating difficult speech comprehension or speech production. Meta-analysis 1 included 10 studies contrasting comprehension…

Adank, Patti

2012-01-01

 
 
 
 
101

Evolving combinatorial problem instances that are difficult to solve.  

Science.gov (United States)

This paper demonstrates how evolutionary computation can be used to acquire difficult to solve combinatorial problem instances. As a result of this technique, the corresponding algorithms used to solve these instances are stress-tested. The technique is applied in three important domains of combinatorial optimisation, binary constraint satisfaction, Boolean satisfiability, and the travelling salesman problem. The problem instances acquired through this technique are more difficult than the ones found in popular benchmarks. In this paper, these evolved instances are analysed with the aim to explain their difficulty in terms of structural properties, thereby exposing the weaknesses of corresponding algorithms. PMID:17109606

van Hemert, Jano I

2006-01-01

102

Treatment of Difficult Asthma: What do you do when asthma doesn't respond to therapy?  

Digital Repository Infrastructure Vision for European Research (DRIVER)

The difficult asthmatic patient should first be managed by confirming the diagnosis and eliminating any aggravating environmental or occupational factors, including medication use. Proper treatment requires rational addition of drugs in a logical sequence. It is most important to ensure proper inhaler technique, patient compliance, effective doctor-patient communication, and proper patient monitoring.

Bowie, Dennis M.

1991-01-01

103

Improving the Quality of Home Visitation: An Exploratory Study of Difficult Situations  

Science.gov (United States)

Objective: The primary purpose of this study was to use an ecological assessment model to obtain a better understanding of difficult situations that home visitors confront when implementing home visitation services. Method: A mixed method study was used which included conducting focus groups to identify specific situations faced by home visitors…

LeCroy, Craig Winston; Whitaker, Kate

2005-01-01

104

Transparent-cap-fitted colonoscopy shows higher performance with cecal intubation time in difficult cases  

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Full Text Available AIM: To investigate the efficacy of cap-fitted colonoscopy (CFC with regard to cecal intubation time. METHODS: Two hundred and ninety-five patients undergoing screening colonoscopy at Gospel Hospital, Kosin University College of Medicine were enrolled in this randomized controlled trial between January and December 2010. Colonoscopies were conducted by a single endoscopist. Patient characteristics including age, sex, body mass index, history of abdominal surgery, quality of preparation, and the presence of diverticulosis were recorded. RESULTS: One hundred and fifty patients were allocated into a CFC group and 145 into a non-CFC (NCF group. Cecal intubations were achieved in all patients. Cecal intubation time in the CFC group was significantly shorter than in the NCF group for specific conditions: age ? 60 years, prior abdominal surgery, and poor bowel preparation. The number of detected adenomas was higher in the CFC group than in the NCF group (P = 0.040. CONCLUSION: CFC facilitated shortening of the cecal intubation time in difficult cases, and was more sensitive for detecting adenomas than was NCF.

Hyung Hun Kim

2012-01-01

105

Recent and historic sediment dynamics along Difficult Run, a suburban Virginia Piedmont stream  

Science.gov (United States)

Suspended sediment is one of the major concerns regarding the quality of water entering the Chesapeake Bay. Some of the highest suspended-sediment concentrations occur on Piedmont streams, including Difficult Run, a tributary of the Potomac River draining urban and suburban parts of northern Virginia. Accurate information on catchment level sediment budgets is rare and difficult to determine. Further, the sediment trapping portion of sediment budget represents an important ecosystem service that profoundly affects downstream water quality. Our objectives, with special reference to human alterations to the landscape, include the documentation and estimation of floodplain sediment trapping (present and historic) and bank erosion along an urbanized Piedmont stream, the construction of a preliminary sediment balance, and the estimation of legacy sediment and recent development impacts. We used white feldspar markers to measure floodplain sedimentation rates and steel pins to measure erosion rates on floodplains and banks, respectively. Additional data were collected for/from legacy sediment thickness and characteristics, mill pond impacts, stream gaging station records, topographic surveying, and sediment density, texture, and organic content. Data were analyzed using GIS and various statistical programs. Results are interpreted relative to stream equilibrium affected by both post-colonial bottomland sedimentation (legacy) and modern watershed hardening associated with urbanization. Six floodplain/channel sites, from high to low in the watershed, were selected for intensive study. Bank erosion ranges from 0 to 470 kg/m/y and floodplain sedimentation ranges from 18 to 1369 kg/m/y (m refers to meters of stream reach). Upstream reaches are net erosional, while downstream reaches have a distinctly net depositional flux providing a watershed sediment balance of 2184 kg/m/y trapped within the system. The amounts of both deposition and erosion are large and suggest nonequilibrium channel conditions. Both peak discharge and number of peaks above base have substantially increased since the mid-1960s when urbanization of the watershed began. Deposition patterns are most closely correlated with channel gradient, sinuosity, and channel width/floodplain width for recent and historic periods. The substantial amounts of fine grained sediment deposited on the floodplain over the past two centuries or so do not appear to be closely related to historic mill pond presence or location. The floodplain continues to provide the critical ecosystem service of sediment trapping in the face of multiple human alterations. Trends in sediment deposition/erosion may react rapidly to land use practices within the watershed and offer a valuable barometer of the effects of management actions.

Hupp, Cliff R.; Noe, Gregory B.; Schenk, Edward R.; Benthem, Adam J.

2013-01-01

106

Wagging the Dog: Managing Museum Priorities in a Difficult Economy  

Science.gov (United States)

In these difficult financial times, it is more important than ever to manage money carefully. Educators who don't do so are vulnerable, for despite a thirty-year history of increasing authority and status within and without the museum, education departments are still more expendable than curatorial or collections departments in some museums. This…

Bradburne, James M.

2010-01-01

107

Privileged Identity Exploration: Examining Counselor Trainees' Reactions to Difficult Dialogues  

Science.gov (United States)

In this qualitative study, the authors examined master's-level counselor trainees' reactions to difficult dialogues in the classroom regarding racism, heterosexism/homophobia, and ableism over a 3-year period. Using the Consensual Qualitative Research method as introduced by C. E. Hill, B. J. Thompson, and E. N. Williams (1997), the data analysis…

Watt, Sherry K.; Curtis, Gregg C.; Drummond, Jerri; Kellogg, Angela H.; Lozano, Adele; Nicoli, Gina Tagliapietra; Rosas, Marisela

2009-01-01

108

Complement Constructions in English: Fairly Difficult for EFL Language Learners  

Science.gov (United States)

Complement constructions vary significantly in English and Persian. There are more complementation structures in English than in Persian and a complement structure in Persian might have more than one equivalent in English. Producing complement structures (CSs) in English is very difficult for native speakers of Persian, especially in an EFL…

Fazeli, Fatemeh; Shokrpour, Nasrin

2012-01-01

109

Difficult-to-Treat-Depression and GPs’ Role: Perceptions of Psychiatry Registrars  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Introduction: For patients, GPs are the most accessible medical resource in the community and are the gatekeepers to other community resources including psychiatrists. Qualifying as a psychiatrist in Australia involves completing a five-year training program that includes rotations in hospitals and community settings. The aims of this research were to 1) explore psychiatry registrars’ perceptions of difficult-to-treat-depression (DTTD) and 2) what they thought about the GP...

Jones, Kay M.; Leon Piterman

2014-01-01

110

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

111

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

112

Precut sphincterotomy: A reliable salvage for difficult biliary cannulation  

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Even experienced endoscopists have 90% success in achieving deep biliary cannulation with standard methods. Biliary cannulation may become difficult in 10%-15% of patients with biliary obstruction and precut (access) sphincterotomy is frequently chosen as a rescue treatment in these cases. Generally, precut sphincterotomy ensures a rate of 90%-100% successful deep biliary cannulation. The precut technique has been performed as either a fistulotomy with a needle knife sphincterotome or as a tr...

Ulku Saritas; Yucel Ustundag; Ferda Harmandar

2013-01-01

113

Rigid fibrescope Bonfils: use in simulated difficult airway by novices  

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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 ...

Piepho Tim; Noppens Rüdiger R; Heid Florian; Werner Christian; Thierbach Andreas R

2009-01-01

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

Experience in perioperative management in difficult laparoscopic cholecystectomy  

Directory of Open Access Journals (Sweden)

Full Text Available ObjectiveTo investigate perioperative management and the prevention of complications in difficult laparoscopic cholecystectomy. MethodsA retrospective analysis was performed on the clinical data of 82 patients, who underwent difficult laparoscopic cholecystectomy due to acute cholecystitis, Mirizzi syndrome, a history of abdominal surgery with severe abdominal adhesion, atrophic cholecystitis, liver cirrhosis with gallstones, and other diseases in our hospital since 1999, to summarize the experiences and lessons. ResultsAmong all patients, 6 (7.31% were converted to open laparotomy, and other patients were successfully treated by laparoscopic cholecystectomy. Postoperative biliary injury and biliary fistula occurred in 2 cases, and they were cured after reoperation. Postoperative bleeding occurred in 4 cases, and they were cured with conservative treatment. Different degrees of biliary leak of unknown causes occurred in 10 cases, and they were cured after drainage. ConclusionFor difficult laparoscopic cholecystectomy, surgical operation is characterized by high difficulty and high risk, but it can still be completed with proper perioperative management.

TANG Shilong

2014-09-01

116

INFORMATION TECHNOLOGY SECURITY AIRCRAFT FLIGHT IN DIFFICULT CONDITIONS BASED MULTIFACTORIAL FUZZY MODELS  

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Full Text Available The proposed method is designed for situations where the original information that characterizes the state of the aircraft, clearly defined and numerical variables and the so-called “linguistic variables” This simple relationship between the variables are described by means of fuzzy statements, and the complex relationship between the concepts with fuzzy algorithms

Nadir Bafadin oqlu Agayev

2013-12-01

117

Emotional distance to so-called difficult patients  

DEFF Research Database (Denmark)

Scand J Caring Sci; 2011 Emotional distance to so-called difficult patients Purpose: To explore nurses' relationships with patients they regard as being difficult. How do nurses feel about such patients and relate to them, and what are the consequences for nurse and patient? Design and methods: A qualitative study inspired by hermeneutic phenomenology was conducted. The data were obtained through participant observation and interviewing in a home nursing unit in a Danish municipality. During an initial 3 month period, eighteen participant observations were conducted with 12 nurses during their visits to 96 patients. During the following 3 months, 12 more participant observations were made with three nurses visiting 50 patients. Four of these patients whom the three nurses found difficult were selected and six interviews conducted with these patients. Eleven interviews were conducted with five nurses. Patients' case records were studied and four meetings with the staff were arranged to discuss the findings. Data collection lasted 18 months in all. Findings: Three strategies were identified: persuasion, avoidance (emotional distance), and compromise. Interestingly, in the relationship with a particular patient, the avoidance strategy did not necessarily represent the terminal stage, since a nurse could revert to the compromise strategy. Some of the nurses experienced painful emotions regarding these interactions. Conclusions: The avoidance strategy (emotional distance) resulted in important social and health problems of some patients not being recognized, and some nurses using it expressed the fear of losing contact with their emotional lives. The compromise strategy gave possibilities for dialogue. Study limitations: The focus was mainly on the nurses and their perspectives. It would be interesting to study in greater detail the perspectives of the patients.

Michaelsen, Jette Joost

2012-01-01

118

An unanticipated difficult airway in Lesch–Nyhan syndrome  

Digital Repository Infrastructure Vision for European Research (DRIVER)

An 11-year-old boy with Lesch–Nyhan syndrome presented to the emergency for fixation of a fractured femur. During induction of general anesthesia, unexpected difficult intubation was encountered with a 6.5-mm ID endotracheal tube and successively smaller tubes, also failing to pass 1 cm beyond the vocal cords. Intubation was finally achieved with a 4.5-mm ID tube. The surgery was completed uneventfully. A tracheal diverticulum was found in the computerized tomography (CT) scan performed pos...

Salhotra, Rashmi; Sharma, Chhavi; Tyagi, Asha; Kumar, Surendra; Sethi, Ak; Bhatt, Shuchi

2012-01-01

119

Hemorrhagic herpes encephalitis: A difficult diagnosis in computed tomography  

International Nuclear Information System (INIS)

Herpes simplex encephalitis (HSE) is the most common sporadically appearing encephalitis in Central Europe. Differential diagnosis to brain tumors or spontaneous intercerebral hemorrhage is difficult. There are CT scan findings which are characteristic of HSE but there are no pathognomonic patterns. These characteristic findings are helpful in differential diagnosis to neoplastic or vascular processes. Thus, other diagnostic procedures (i.e. brain biopsy) to confirm diagnosis of HSE and effective therapy may be carried out in time. The difficulties in differential diagnosis are shown by the presented case. (orig.)

120

A new twist in the pediatric difficult airway.  

Science.gov (United States)

Difficult intubation of a 2.4 kg ex premature, suspected Pierre Robin Sequence with upper airway obstruction causing respiratory failure. Multiple failed intubation attempts by an experienced pediatric anesthetist using described techniques and adjuncts. A description of a simple new maneuvre using a GlideScope and a stylet. By twisting the stylet into a spiral shape, the endotracheal tube was given improved maneuverability that allowed the intubator to place the endotracheal tube tip to the glottis opening. Then by rotating the tube in a clockwise direction it could be manipulated past the vocal cords into the trachea. PMID:25267583

Lillie, Edwardina M M A; Harding, Louise; Thomas, Mark

2014-09-30

 
 
 
 
121

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

Directory of Open Access Journals (Sweden)

Full Text Available Nowadays, simulators facilitate tasks performed daily by the engineers of different branches, including coordinate metrologists. Sometimes it is difficult or almost impossible to program a Coordinate Measuring Machine (CMM using standard methods. This happens, for example, during measurements of nano elements or in cases when measurements are performed on high-precision (accurate measuring machines which work in strictly air-conditioned spaces and the presence of the operator in such room during the programming of CMM could cause an increase in temperature, which in turn could make it necessary to wait some time until conditions stabilize. This article describes functioning of a simulator and its usage during Coordinate Measuring Machine programming in the latter situation. Article also describes a general process of programming CMMs which ensures the correct machine performance after starting the program on a real machine. As an example proving the presented considerations, measurement of exemplary workpiece, which was performed on the machine working in the strictly air-conditioned room, was described

G?ska A.

2014-02-01

122

Experimental validation of a numerical model for predicting the trajectory of blood drops in typical crime scene conditions, including droplet deformation and breakup, with a study of the effect of indoor air currents and wind on typical spatter drop trajectories.  

Science.gov (United States)

Bloodstain Pattern Analysis (BPA) provides information about events during an assault, e.g. location of participants, weapon type and number of blows. To extract the maximum information from spatter stains, the size, velocity and direction of the drop that produces each stain, and forces acting during flight, must be known. A numerical scheme for accurate modeling of blood drop flight, in typical crime scene conditions, including droplet oscillation, deformation and in-flight disintegration, was developed and validated against analytical and experimental data including passive blood drop oscillations, deformation at terminal velocity, cast-off and impact drop deformation and breakup features. 4th order Runge-Kutta timestepping was used with the Taylor Analogy Breakup (TAB) model and Pilch and Erdman's (1987) expression for breakup time. Experimental data for terminal velocities, oscillations, and deformation was obtained via digital high-speed imaging. A single model was found to describe drop behavior accurately in passive, cast off and impact scenarios. Terminal velocities of typical passive drops falling up to 8m, distances and times required to reach them were predicted within 5%. Initial oscillations of passive blood drops with diameters of 1mmdrop aspect ratio were within 1.6% of experiment. Under typical crime scene conditions, the velocity of the drop within the first 1.5m of fall is affected little by drag, oscillation or deformation. Blood drops with diameter 0.4-4mm and velocity 1-15m/s cast-off from a rotating disk showed low deformation levels (Weber numberDrops formed by blunt impact 0.1-2mm in diameter at velocities of 14-25m/s were highly deformed (aspect ratios down to 0.4) and the larger impact blood drops (?1-1.5mm in diameter) broke up at critical Weber numbers of 12-14. Most break-ups occurred within 10-20cm of the impact point. The model predicted deformation levels of cast-off and impact blood drops within 5% of experiment. Under typical crime scene conditions, few cast-off drops will break up in flight. However some impact-generated drops were seen to break up, some by the vibration, others by bag breakup. The validated model can be used to gain deep understanding of the processes leading to spatter stains, and can be used to answer questions about proposed scenarios, e.g. how far blood drops may travel, or how stain patterns are affected by winds and draughts. PMID:25447183

Kabaliuk, N; Jermy, M C; Williams, E; Laber, T L; Taylor, M C

2014-10-18

123

tts: A SAT-Solver for Small, Difficult Instances  

Directory of Open Access Journals (Sweden)

Full Text Available The Ternary Tree Solver (tts is a complete solver for propositional satisfiability which was designed to have good performance on the most difficult small instances. It uses a static ternary tree data structure to represent the simplified proposition under all permissible partial assignments and maintains a database of derived propositions known to be unsatisfiable. In the SAT2007 competition version 4.0 won the silver medal for the category handmade, speciality UNSAT solvers and was the top qualifier for the second stage for handmade benchmarks, solving 11 benchmarks which were not solved by any other entrant. We describe the methods used by the solver and analyse the competition Phase 1 results on small benchmarks. We propose a first version of a comprehensive suite of smalldifficult satisfiability benchmarks (sdsb and compare the worst-case performance of the competition medallists on these benchmarks.

Ivor Spence

2008-06-01

124

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

125

How can schools build learning organisations in difficult education contexts?  

Scientific Electronic Library Online (English)

Full Text Available SciELO South Africa | Language: English Abstract in english 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 G [...] auteng 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.

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

Difficult airway in advanced Bechterew's disease: case report.  

Science.gov (United States)

Advanced Bechterew's disease presents with increasing ossification of spinal column, from lower lumbar segments upwards, first causing impossibility to place spinal block in lumbar region, and later, due to stiffness of cervical spine, difficult intubation because of inability to extend and/or flex the neck during direct laryngoscopy and intubation. Mask ventilation, on the other hand, usually is possible. We report a case of a 77-year-old man scheduled for elective hernioplasty, with recently advanced Bechterew's disease. According to the recently accepted Mainz algorithm, we first intended to perform awake intubation through the nose by fiber bronchoscope. The bronchoscope passed easily down to tracheal bifurcation, but placing the endotracheal tube was unexpectedly impossible due to the consequences of broken nose the patient had suffered at the age of 8. Fiber bronchoscope was therefore retracted, and we used the Bonfils rigid fiberscope after induction of general anesthesia, achieving intubation in first attempt. PMID:23330415

Novotny, Zdenko; Gvozdenovi?, Aleksandra; Maldini, Branka

2012-09-01

128

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

Directory of Open Access Journals (Sweden)

Full Text Available 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 clínica 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.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 technologies, 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

129

Ecological risk assessments of priority substances in Canada: Identification and resolution of difficult issues  

Energy Technology Data Exchange (ETDEWEB)

Environment Canada has revised its guidance manual for ecological risk assessments of priority substances under the Canadian Environmental Protection Act. This paper briefly summarizes the guidance provided on: problem formulation; data collection and generation; analysis of entry, exposure and effects; and risk characterization. The purpose of this paper is to discuss some of the difficult issues common to all programs conducting ecological risk assessments of substances, and to describe the approaches the authors have taken. Example issues include: (1) how should low toxic effects be determined, (2) how should risks be quantified, and (3) how can the ecological consequences of exposures to substances be determined? Finally, comments are provided on the process followed during the preparation of the revised manual. These comments are provided because the authors believe that the open and transparent process followed was beneficial to the identification and resolution of these and other difficult issues.

Moore, D.R.J. [Cadmus Group, Inc., Ottawa, Ontario (Canada); Breton, R.L.; Doyle, P.; Elliott, B.J.; Taylor, K.; Windle, W.M. [Environment Canada, Hull, Quebec (Canada). Commercial Chemicals Evaluation Branch

1997-09-01

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.

Zilli, Romano; Dalton, Luke

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

SIMULTANEOUS OPTIMIZATION OF TALLIES; IN DIFFICULT SHIELDING PROBLEMS  

Energy Technology Data Exchange (ETDEWEB)

Monte Carlo is quite useful for calculating specific quantities in complex transport problems. Many variance reduction strategies have been developed that accelerate Monte Carlo calculations for specific tallies. However, when trying to calculate multiple tallies or a mesh tally, users have had to accept different levels of relative uncertainty among the tallies or run separate calculations optimized for each individual tally. To address this limitation, an extension of the CADIS (Consistent Adjoint Driven Importance Sampling) method, which is used for difficult source/detector problems, has been developed to optimize several tallies or the cells of a mesh tally simultaneously. The basis for this method is the development of an importance function that represents the importance of particles to the objective of uniform Monte Carlo particle density in the desired tally regions. This method utilizes the results of a forward discrete ordinates solution, which may be based on a quick, coarse-mesh calculation, to develop a forward-weighted source for the adjoint calculation. The importance map and the biased source computed from the adjoint flux are then used in the forward Monte Carlo calculation to obtain approximately uniform relative uncertainties for the desired tallies. This extension is called forward-weighted CADIS, or FW-CADIS.

Peplow, Douglas E. [ORNL; Evans, Thomas M [ORNL; Wagner, John C [ORNL

2009-01-01

133

Simultaneous Optimization of Tallies in Difficult Shielding Problems  

International Nuclear Information System (INIS)

Monte Carlo is quite useful for calculating specific quantities in complex transport problems. Many variance reduction strategies have been developed that accelerate Monte Carlo calculations for specific tallies. However, when trying to calculate multiple tallies or a mesh tally, users have had to accept different levels of relative uncertainty among the tallies or run separate calculations optimized for each individual tally. To address this limitation, an extension of the CADIS (Consistent Adjoint Driven Importance Sampling) method, which is used for difficult source/detector problems, has been developed to optimize several tallies or the cells of a mesh tally simultaneously. The basis for this method is the development of an importance function that represents the importance of particles to the objective of uniform Monte Carlo particle density in the desired tally regions. This method utilizes the results of a forward discrete ordinates solution, which may be based on a quick, coarse-mesh calculation, to develop a forward-weighted source for the adjoint calculation. The importance map and the biased source computed from the adjoint flux are then used in the forward Monte Carlo calculation to obtain approximately uniform relative uncertainties for the desired tallies. This extension is called forward-weighted CADIS, or FW-CADIS

134

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

135

The Difficult-to-Control Asthmatic: A Systematic Approach  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract With the judicious use of inhaled corticosteroids, ?2 agonists, and leukotriene modifiers, most patients with asthma are easily controlled and managed. However, approximately 5% of asthmatics do not respond to standard therapy and are classified as "difficult to control." 1 Typically, these are patients who complain of symptoms interfering with daily living despite long-term treatment with inhaled corticosteroids in doses up to 2,000 ?g daily. Many factors can contribute to poor response to conventional therapy, and especially for these patients, a systematic approach is needed to identify the underlying causes. First, the diagnosis of asthma and adherence to the medication regimen should be confirmed. Next, potential persisting exacerbating triggers need to be identified and addressed. Concomitant disorders should be discovered and treated. Lastly, the impact and implications of socioeconomic and psychological factors on disease control can be significant and should be acknowledged and discussed with the individual patient. Less conventional and novel strategies for treating corticosteroid-resistant asthma do exist. However, their use is based on small studies that do not meet evidence-based criteria; therefore, it is essential to sort through and address the above issues before reverting to other therapy.

Le Annie V

2006-09-01

136

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)

137

Precut sphincterotomy: A reliable salvage for difficult biliary cannulation  

Directory of Open Access Journals (Sweden)

Full Text Available Even experienced endoscopists have 90% success in achieving deep biliary cannulation with standard methods. Biliary cannulation may become difficult in 10%-15% of patients with biliary obstruction and precut (access sphincterotomy is frequently chosen as a rescue treatment in these cases. Generally, precut sphincterotomy ensures a rate of 90%-100% successful deep biliary cannulation. The precut technique has been performed as either a fistulotomy with a needle knife sphincterotome or as a transpapillary septotomy with a standard sphincterotome. Both methods have similar efficacy and complication rates when administered to the proper patient. Although precut sphincterotomy ensures over 90% success of biliary cannulation, it has been characterized as an independent risk factor for pancreatitis. The complications of the precut technique are not limited to pancreatitis. Two more important ones, bleeding and perforation, are also reported in some publications as being observed more commonly than during standard sphincterotomy. It is also reported that precut sphincterotomy increases morbidity when performed in patients without dilatation of their biliary tract. Nevertheless, precut sphincterotomy is a good alternative as a rescue method in the setting of a failed standard cannulation method. This paper discusses the technical details, timing, efficacy and potential complications of precut sphincterotomy.

Ulku Saritas

2013-01-01

138

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

139

[Difficult respiratory management in a patient with bilateral giant bullae].  

Science.gov (United States)

We report a case of bilateral giant bullae in a patient with multiple traumas. He had his arm amputated at the shoulder because of a machine accident and admitted to our hospital. Chest X-ray showed right-sided pneumothorax with bilateral giant bullae. Trimming of the stump was performed immediately after the placement of a right chest tube. He gradually developed hypoxia and hypercapnia with acidemia during the operation because of atelectasis due to sputum. Postoperatively, enlargement of right giant bulla led to frequent respiratory failure and he received a bilateral bullectomy through a median sternotomy 3 weeks after the accident. It was difficult to ventilate him due to air leak from the bilateral bulla and SpO2 dropped to below 70% with 100% oxygen. We continued the operation with standby extracorporeal membrane oxygenator (ECMO). Although the operation was finished without ECMO finally, ECMO had better been kept ready during anethesia with giant bullae when life threatening complication may occur at any point. PMID:19860232

Fujita, Ayaka; Hashiba, Eiji; Takahira, Yoko; Kitayama, Masatou; Tubo, Toshihito; Hirota, Kazuyoshi

2009-10-01

140

In tight : defining tight gas as difficult as producing it  

Energy Technology Data Exchange (ETDEWEB)

Tight gas is considered to be natural gas contained in difficult to produce rock formations that require special completion, stimulation, and production techniques to achieve economic production. Tight gas reservoirs are low-permeability sands or carbonate reservoirs that typically occur in basin-centred or deep-basin settings. For Canadian producers, tight gas plays have grown increasingly more attractive in recent years because of the price environment as well as improved exploration and exploitation technologies. There has been a direct relationship between gas prices and the development of unconventional resources in Canada. The differences between Canadian basins and basins in the United States were discussed in relation to various drilling strategies. In Canada, the strategy has been to map and drill stratigraphic sweet spots, relatively small bodies of rock with conventional reservoir quality within larger tight-gas trends or fairways. It was suggested that 3 major technological advances have stimulated tight gas production in Western Canada: directional and horizontal drilling; under-balanced drilling and advanced fracture stimulation. In tight gas reservoirs, the key to production is to intersect the natural fracture system present within the rock to provide more pathways in which the hydrocarbons can flow to the wellbore. Details of EnCana Corporation's drilling strategies and activities was presented, with specific reference to their recent focus on tight gas opportunities. It was suggested that the key component of any large-scale resource play is to have a sufficient land base so the ongoing development of the resource will encounter enough prolific wells to offset under-producing wells. It was concluded that tight gas production is becoming increasingly important in Canada. 2 figs.

Ball, C.

2005-08-01

 
 
 
 
141

Prediction of difficult laryngoscopy: Extended mallampati score versus the MMT, ULBT and RHTMD  

Science.gov (United States)

Background: Preoperative using of anatomical landmarks detects potentially difficult laryngoscopies. The main object of the present study was to evaluate the predictive power of Extended Mallampati Score (EMS) in comparison with modified Mallampati test (MMT), the ratio of height to thyromental distance (RHTMD) and the Upper-Lip-Bite test (ULBT) in isolation and combination. Materials and Methods: Four hundred seventy sixadult patients who candidate for elective surgery under general anesthesia requiring endotracheal intubation were included in this study and evaluated based of all four factors before surgery. This study was randomized prospective double - blind. After that, laryngoscopy was performed by an anesthesiologist who didn’t involve in preoperative airway assessment and graded based on Cormack and Lehane's classification. We calculated sensitivity, specificity, and area under receiver-operating characteristic (ROC) (AUC) for each score. Results: The AUCof the ROC was significantly more for the ULBT (AUC = 0.820, P = 0.049) and RHTMD score (AUC = 0.845, P = 0.033) than the EMS (AUC = 0.703). This variable was significantly higher for the EMS compared with MMT (0.703 vs. 0.569, P = 0.046 respectively). There was no significant difference between the AUC of the ROC for the ULBT and the RHTMD score (P = 0.685). The optimalcut-off point for the RHTMD for predicting difficult laryngoscopy was 29.3. Conclusion: EMS predicted difficult laryngoscopy better than MMT while both ULBT and RHTMD had more power than EMS and MMT in this regard. ULBT and RHTMD had similar predictive value for prediction of difficult laryngoscopy in general population. PMID:24949304

Safavi, Mohammadreza; Honarmand, Azim; Amoushahi, Mahsa

2014-01-01

142

Coarse abstractions make Zeno behaviours difficult to detect  

CERN Document Server

An infinite run of a timed automaton is Zeno if it spans only a finite amount of time. Such runs are considered unfeasible and hence it is important to detect them, or dually, find runs that are non-Zeno. Over the years important improvements have been obtained in checking reachability properties for timed automata. We show that some of these very efficient optimizations make testing for Zeno runs costly. In particular we show NP-completeness for the LU-extrapolation of Behrmann et al. We analyze the source of this complexity in detail and give general conditions on extrapolation operators that guarantee a (low) polynomial complexity of Zenoness checking. We propose a slight weakening of the LU-extrapolation that satisfies these conditions.

Herbreteau, Frédéric

2011-01-01

143

Psycho-educational interventions for adults with severe or difficult asthma: a systematic review.  

Science.gov (United States)

Research highlights psychosocial factors associated with adverse asthma events. This systematic review therefore examined whether psycho-educational interventions improve health and self-management outcomes in adults with severe or difficult asthma. Seventeen controlled studies were included. Characteristics and content of interventions varied even within broad types. Study quality was generally poor and several studies were small. Any positive effects observed from qualitative and quantitative syntheses were mainly short term and, in planned subgroup analyses (involving < 5 trials), effects on hospitalizations, quality of life, and psychological morbidity in patients with severe asthma did not extend to those in whom multiple factors complicate management. PMID:17454342

Smith, Jane R; Mugford, Miranda; Holland, Richard; Noble, Michael J; Harrison, Brian D W

2007-04-01

144

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

145

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

146

Surgery for ovarian remnant syndrome. Lessons learned from difficult cases.  

Science.gov (United States)

Ten cases of ovarian remnant syndrome jointly managed by gynecology and urology departments are presented. Complications of the surgery included a high incidence of ureteral and bowel injury. Preoperative, intraoperative and postoperative considerations may reduce the complications or minimize their significance. One case of ovarian cancer developed among the instances of ovarian remnant syndrome in this series. Preoperative, intraoperative and postoperative considerations can reduce the complications of surgery for ovarian remnant syndrome. PMID:7932397

Elkins, T E; Stocker, R J; Key, D; McGuire, E J; Roberts, J A

1994-06-01

147

High-precision Penning trap mass measurements of `difficult' elements produced via projectile fragmentation with LEBIT  

Science.gov (United States)

Rare isotope beams of many elements can be difficult or impossible to obtain at ISOL facilities due to their high melting points or chemical reactivity, but they are easily produced by projectile fragmentation and in-flight separation, a technique that rapidly produces fragments lighter than the projectile in a chemistry-free manner. Until recently, such high-energy projectile fragments could not be reduced to the thermal energies necessary for precision mass measurements in Penning traps. The Low Energy Beam and Ion Trap (LEBIT) facility at the National Superconducting Cyclotron Laboratory (NSCL) has demonstrated that projectile fragment beams can be thermalized and measured in a high-precision Penning trap. Since 2005, over 30 isotopes have been measured with LEBIT, including several isotopes of elements which are difficult for ISOL facilities to produce, such as Fe, Co, Si, Br, and S. These measurements have contributed to our understanding of nuclear structure, nuclear astrophysics, and fundamental symmetries. Some recent highlights include the discovery of an isomeric state in 65Fe, testing the Isobaric Mass Multiplet Equation (IMME) with the A = 32, T = 2 quintet with a measurement of 32Si, probing out to the proton dripline with 70 m Br, and studying the N = 28 shell closure with measurements of 40 - 44S. Results of these measurements will be discussed, along with the technical developments which made them possible.

Ringle, R.; Bachelet, C.; Barquest, B. R.; Block, M.; Bollen, G.; Campbell, C. M.; Facina, M.; Ferrer, R.; , C. M. Folden, III; Guénaut, C.; Kwan, E.; Kwiatkowski, A. A.; Lincoln, D. L.; Morrissey, D. J.; Pang, G. K.; Prinke, A. M.; Savory, J.; Schury, P.; Schwarz, S.; Sumithrarachchi, C. S.

2011-07-01

148

Creative Group Problem Solving: An Innovative Computer Application to Facilitate Learning and Retention of Difficult Scientific Principles.  

Science.gov (United States)

Describes a program developed at City University of New York (CUNY) Medical School that was designed to facilitate learning and retention of difficult concepts and principles in first-year biology and chemistry courses. Topics addressed include small group interaction, cooperative learning, mastery learning, interactive technology, and information…

Beckwith, Don

1993-01-01

149

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

150

Hybrid methodology for the detection, tracking, and classification of humans in difficult infrared video  

Science.gov (United States)

The detection, tracking, and classification of humans in video imagery is of obvious military and civilian importance. The problem is difficult under the best of circumstances. In infrared (IR) imagery, or any grayscale imagery, the problem is compounded by the lack of color cues. Sometimes, human detection in IR imagery can take advantage of the thermal difference between humans and background-but this difference is not robust. Varying environmental conditions regularly degrade the thermal contrast between humans and background. In difficult data, humans can be effectively camouflaged by their environment and standard feature detectors are unreliable. The research described here uses a hybrid approach toward human detection, tracking, and classification. The first is a feature-based correlated body parts detector. The second is a pseudo-Hough transform applied to the edge images of the video sequence. The third relies on an optical flow-based vector field transformation of the video sequence. This vector field permits a multidimensional application of the feature detectors initiated in the previous two methods. Then a multi-dimensional oriented Haar transform is applied to the vector field to further characterize potential detections. This transform also shows potential for distinguishing human behavior.

Bonick, James R.

2012-05-01

151

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

152

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

153

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)

154

Difficult encounters with a hemophilic patient: The inner perspective of physicians.  

Science.gov (United States)

This study aimed at exploring the hematologists' internal representation of a difficult encounter with a hemophilic patient, using a written open format. Narrations were analyzed with Interpretative Phenomenological Analysis. Three main issues were identified, each with sub-issues: (1) Inside the relationship: to tell or not to tell, the balance between a normal life and a deviant medical condition, the guilt; (2) The borders of the professional role: professional values, the "do-it-all" doctor; and (3) The existential confrontation. This study reveals the deep involvement of physicians with their patients, at a professional level and, strongly, at a personal level. The experience of being so deeply involved should be considered in the continuing medical programs for physicians dealing with hemophilia. PMID:23864073

Vegni, Elena; Leone, Daniela; Biasoli, Chiara; Moja, Egidio A

2014-12-01

155

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

156

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

157

[Rehabilitation of burn victims. A difficult path back to normality].  

Science.gov (United States)

The most important aims of rehabilitation in burn victims is the restitution and improvement of joint mobility, mimicry and pulmonary function, as well as of muscular endurance and strength. In addition to the management of scars, therefore, patient instruction in unsupervised training and scar care, as well as promotion of re-integration into day-to-day life are essential. Depending on the parts of the body affected, measures may include manual therapy, active exercise, treatment with ultrasound, proprioceptive neuromuscular facilitation in the case of facial burns, respiratory therapy and ergotherapy and, finally coordination training. Treatment of the scars themselves requires a combination of a number of measures, all of which should be of an "active" nature. Of proven value are manual massage of scar tissue, stretching exercises, the use of silicone, special splints and compression clothing, as well as laser therapy. Rehabilitation measures should be applied for not less than 4 weeks. Where indicated, further surgical measures should be discussed with the patient. PMID:12134722

Butz, M; Conrady, D; Baumgärtler, H; Mentzel, H E

2002-06-13

158

Difficult OptEase Filter Retrievals After Prolonged Indwelling Times  

Energy Technology Data Exchange (ETDEWEB)

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.

Van Ha, Thuong G., E-mail: tgvanha@radiology.bsd.uchicago.edu; Kang, Lisa; Lorenz, Jonathan; Zangan, Steven; Navuluri, Rakesh; Straus, Christopher; Funaki, Brian [University of Chicago, Section of Interventional Radiology, Department of Radiology (United States)

2013-08-01

159

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

160

Visual Impairment, Including Blindness  

Science.gov (United States)

... 3rd birthday) and their families. Special education and related services | Services available through the public school system for school-aged children, including preschoolers (ages 3-21). Visual impairment, including blindness, is one of the disabilities specifically ...

 
 
 
 
161

Drugs that modulate aging: the promising yet difficult path ahead.  

Science.gov (United States)

Once a backwater in medical sciences, aging research has emerged and now threatens to take the forefront. This dramatic change of stature is driven from 3 major events. First and foremost, the world is rapidly getting old. Never before have we lived in a demographic environment like today, and the trends will continue such that 20% percent of the global population of 9 billion will be over the age of 60 by 2050. Given current trends of sharply increasing chronic disease incidence, economic disaster from the impending silver tsunami may be ahead. A second major driver on the rise is the dramatic progress that aging research has made using invertebrate models such as worms, flies, and yeast. Genetic approaches using these organisms have led to hundreds of aging genes and, perhaps surprisingly, strong evidence of evolutionary conservation among longevity pathways between disparate species, including mammals. Current studies suggest that this conservation may extend to humans. Finally, small molecules such as rapamycin and resveratrol have been identified that slow aging in model organisms, although only rapamycin to date impacts longevity in mice. The potential now exists to delay human aging, whether it is through known classes of small molecules or a plethora of emerging ones. But how can a drug that slows aging become approved and make it to market when aging is not defined as a disease. Here, we discuss the strategies to translate discoveries from aging research into drugs. Will aging research lead to novel therapies toward chronic disease, prevention of disease or be targeted directly at extending lifespan? PMID:24316383

Kennedy, Brian K; Pennypacker, Juniper K

2014-05-01

162

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

163

Including All the Lines  

Digital Repository Infrastructure Vision for European Research (DRIVER)

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

164

[Infliximab is effective in difficult-to-control peripheral ulcerative keratitis. A report of three cases.  

Science.gov (United States)

Peripheral ulcerative keratitis is caused by an inflammatory and destructive process of the perilimbal peripheral cornea. This inflammation is due to immune complex deposition in this region of the cornea and in adjacent vessels. It can be idiopathic, or a manifestation of systemic disease such as rheumatoid arthritis, vasculitis of small vessels associated with ANCA, relapsing polychondritis, systemic lupus erythematosus and Crohn's disease. Its treatment includes the use of high-dose corticosteroids and, in some cases, the concomitant use of immunosuppressants such as methotrexate, azathioprine, mycophenolate mofetil, cyclophosphamide or cyclosporine. The use of immunobiological agents can be a strategy in cases of difficult control. The authors describe the treatment of three patients who, after failure with the use of corticosteroids or immunosuppressants, showed good response after the use of infliximab. PMID:25440698

Zandavalli, Flávia Maria; de Castro, Glaucio Ricardo Werner; Mazzucco, Maiara; Stöfler, Maria Eduarda Carvalho Wagnes; Pereira, Ivânio Alves

2014-10-24

165

Pump apparatus including deconsolidator  

Science.gov (United States)

A pump apparatus includes a particulate pump that defines a passage that extends from an inlet to an outlet. A duct is in flow communication with the outlet. The duct includes a deconsolidator configured to fragment particle agglomerates received from the passage.

Sonwane, Chandrashekhar; Saunders, Timothy; Fitzsimmons, Mark Andrew

2014-10-07

166

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

167

Fast Global Illumination Including Specular Effects  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Rapidly simulating global illumination, including diffuse and glossy light trans-port is a very difficult problem. Finite element or radiosity approaches can achieve interactive simulations for some classes of diffuse-only scenes, but more general methods are currently too slow and too noisy for interactive use. We present a new method which seamlessly integrates particle tracing (for non-diffuse transport) into the gather step of hierarchical radiosity (for diffuse trans-port) to efficiently...

Granier, Xavier; Drettakis, George; Walter, Bruce

2000-01-01

168

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

169

The Temporal Stability and Predictive Validity of Pupils' Causal Attributions for Difficult Classroom Behaviour  

Science.gov (United States)

Background: Recent studies have investigated the causal attributions for difficult pupil behaviour made by teachers, pupils, and parents but none have investigated the temporal stability or predictive validity of these attributions. Aims: This study examines the causal attributions made for difficult classroom behaviour by students on two…

Lambert, Nathan; Miller, Andy

2010-01-01

170

Two cases of tracheal disease misdiagnosed as difficult-to-treat asthma.  

Science.gov (United States)

Initial management of patients with difficult-to-treat asthma must begin with confirmation of the diagnosis. We present 2 cases of tracheal disease misdiagnosed as difficult-to-treat asthma. After systemic evaluation, tracheomalacia and tracheobronchial narrowing due to diffuse calcification of the cartilaginous rings were found as mimicking asthma. PMID:23431310

Alici, Ibrahim Onur; Kar Kurt, Ozlem; Dursun, Adile Berna; Yilmaz, Aydin; Erkekol, Ferda Oner

2013-11-01

171

Cognitive flexibility in internet addicts: fMRI evidence from difficult-to-easy and easy-to-difficult switching situations.  

Science.gov (United States)

Internet addiction disorder (IAD) has raised widespread public health concerns. In this study, we explored the cognitive flexibility in IAD subjects using a color-word Stroop task. Behavioral and imaging data were collected from 15 IAD subjects (21.2±3.2years) and 15 healthy controls (HC, 22.1±3.6years). Group comparisons found that IAD subjects show higher superior temporal gyrus activations than healthy controls in switching (easy to difficult; difficult to easy) than in repeating trials. In addition, in difficult-to-easy situation, IAD subjects show higher brain activation in bilateral insula than healthy controls; in easy-to-difficult situation, IAD subjects show higher brain activation in bilateral precuneus than healthy controls. Correlations were also performed between behavioral performances and brain activities in relevant brain regions. Taken together, we concluded that IAD subjects engaged more endeavors in executive control and attention in the switching task. From another perspective, IAD subjects show impaired cognitive flexibilities. PMID:24368005

Dong, Guangheng; Lin, Xiao; Zhou, Hongli; Lu, Qilin

2014-03-01

172

Nutritional therapies (including fosteum).  

Science.gov (United States)

Nutrition is important in promoting bone health and in managing an individual with low bone mass or osteoporosis. In adult women and men, known losses of bone mass and microarchitecture occur, and nutrition can help minimize these losses. In every patient, a healthy diet with adequate protein, fruits, vegetables, calcium, and vitamin D is required to maintain bone health. Recent reports on nutritional remedies for osteoporosis have highlighted the importance of calcium in youth and continued importance in conjunction with vitamin D as the population ages. It is likely that a calcium intake of 1200 mg/d is ideal, and there are some concerns about excessive calcium intakes. However, vitamin D intake needs to be increased in most populations. The ability of soy products, particularly genistein aglycone, to provide skeletal benefit has been recently studied, including some data that support a new medical food marketed as Fosteum (Primus Pharmaceuticals, Scottsdale, AZ). PMID:19239823

Nieves, Jeri W

2009-03-01

173

Three-phase current transformer rectifier sets. High-voltage power supplies for difficult conditions in electrostatic precipitators  

Energy Technology Data Exchange (ETDEWEB)

The precipitation rate of electrostatic precipitators (ESP) highly depends on the consistency of waste gas. Among other things, electrical conductivity plays an important role as well as the ability of particles to be electrically charged or ionised. Within certain limits, common ESPs are able to clean waste gas satisfactorily. If the dust attributes exceed these limits, more sophisticated technical solutions are required in the ESP to meet the demands for the gas cleaning equipment. In these cases, a three phase transformer rectifier system offers an alternative to the conventional single phase system, as it delivers a smooth direct current voltage over a wide voltage range. (orig.)

Stackelberg, Josef von [Rico-Werk Eiserlo und Emmrich GmbH, Toenisvorst (Germany)

2013-04-01

174

Herpes simplex virus-associated acute liver failure: a difficult diagnosis with a poor prognosis.  

Science.gov (United States)

We report 5 cases of acute liver failure related to herpes simplex (HSV) infection in 1 immunocompetent and 4 immunosuppressed patients. One patient was too ill for liver transplantation indication. Three patients, among the 4 listed, underwent liver transplantation. Three patients died 11 days to 1 year after transplantation and 2 patients died 2 to 3 days after admission. All presented with fever and none with skin lesions. The diagnosis of HSV-related hepatitis was made antemortem in only 2 patients on the basis of positive blood cultures and/or immunohistochemic findings. In the remaining patients, HSV diagnosis was made retrospectively on further histologic and virologic investigations. Primary HSV infection was certain or likely in all cases, including an HSV2 superinfection of an anti-HSV1-positive patient and two HSV superinfections of hepatitis B virus (HBV)-related chronic liver disease. In these latter patients, HSV diagnosis was totally unsuspected, despite fever. HSV superinfection has significantly contributed to liver dysfunction aggravation and death. In conclusion, the diagnosis of HSV hepatitis is difficult to establish in the absence of specific clinical signs. This may suggest the need for early administration of acyclovir in patients with suspected HSV hepatitis, without waiting for virologic confirmation. Diagnosis methods providing fast results (real-time polymerase chain reaction [PCR]) should be implemented. PMID:16315311

Ichai, Philippe; Roque Afonso, Anne Marie; Sebagh, Mylène; Gonzalez, Maria Eugenia; Codés, Liana; Azoulay, Daniel; Saliba, Faouzi; Karam, Vincent; Dussaix, Elisabeth; Guettier, Catherine; Castaing, Denis; Samuel, Didier

2005-12-01

175

Refraction, including prisms.  

Science.gov (United States)

The literature in the past year on refraction is replete with several isolated but very important topics that have been of interest to strabismologists and refractionists for many decades. The refractive changes in scleral buckling procedures include an increase in axial length as well as an increase in myopia, as would be expected. Tinted lenses in dyslexia show little positive effect in the nonasthmatic patients in one study. The use of spectacles or bifocals as a way to control increase in myopia is refuted in another report. It has been shown that in accommodative esotropia not all patients will be able to escape the use of bifocals in the teenage years, even though surgery might be performed. The hope that disposable contact lenses would cut down on the instance of giant papillary conjunctivitis and keratitis has been given some credence, and the conventional theory that sclerosis alone is the cause of presbyopia is attacked. Also, gas permeable bifocal contact lenses are reviewed and the difficulties of correcting presbyopia by this method outlined. The practice of giving an aphakic less bifocal addition instead of a nonaphakic, based on the presumption of increased effective power, is challenged. In the review of prisms, the majority of articles concern prism adaption. The most significant report is that of the Prism Adaptation Study Research Group (Arch Ophthalmol 1990, 108:1248-1256), showing that acquired esotropia in particular has an increased incidence of stable and full corrections surgically in the prism adaptation group versus the control group.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:10149291

Hiatt, R L

1991-02-01

176

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 LOD milestone to achieve the lowest LOD to date using GC-MS, but more importantly, we attained LOD of 2 fg for diazinon, a common pesticide analyte. In another example, we achieved an LOD of 10 fg for underivatized testosterone, which is not amenable in traditional GC-MS analysis, and conducted many analyses of naturally incurred testosterone in alligator blood extracts. In comparison with standard GC-MS, we measured detectability enhancement factors of 24 for dimethoate, 30 for methylstearate, 50 for cholesterol, 50 for permethrin, >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

177

Observational Study of Topical Imiquimod Immunotherapy in the Treatment of Difficult Lentigo Maligna  

Directory of Open Access Journals (Sweden)

Full Text Available Lentigo Maligna (LM typically presents at sun-exposed sites in elderly patients as an asymmetric, slow-growing, irregularly pigmented macule with an irregular indented border. With changes in sun exposure behaviour LM is becoming more prevalent in middle-aged and younger adults.1The risk of melanoma developing in LM increases with duration of the disease and therefore age,2 and is difficult to quantify, estimates range from 2.2%2 to 50%3 over a lifetime, once invasive disease is established, the tumour carries the same prognosis as other types of cutaneous malignant melanoma as defined by Breslow thickness and presence of ulceration.LM presents a difficult clinical problem and generally there is little consensus on the optimum form of management. The recommended guidelines for treatment of LM are surgical excision with excision margins into clinically normal skin of 2–5 mm.4,5 Others have suggested that up to 20% of cases of LM would require margins greater than this.6 However, lesions are commonly large and located on cosmetically important head and neck sites. Excision may result in a poor cosmetic outcome and it is dif? cult to justify this approach when the risk of malignant transformation may well be low. Amelanotic lentigo maligna also remains a signi? cant problem and inevitably results in incomplete excision since clinical identi? cation of disease extent is impossible.7Non-surgical treatment options are used in 50% of U.K. patients over the age of 70, these include radiotherapy, retinoids,8 5-FU and azelaic acid. Cryotherapy, once popular, has fallen from favour because of reports of invasive melanoma occurring after cryotherapy ablation.9 Commonly a “watch and wait” policy is adopted.Imiquimod (Aldara, Meda Pharmaceuticals Ltd is a topical immune response modifier. The drug causes an increase in interferon locally and therefore may have a place in the management of superficial interferon sensitive malignancy. There are several reports of its use to treat lentigo maligna.10-12 We describe our experience with the use of imiquimod in a group of patients with LM on the head and neck where surgery was not an option.

E.E. Craythorne

2008-01-01

178

The Stanford Prison Experiment: Implications for the Care of the "Difficult" Patient.  

Science.gov (United States)

Approximately 15% of patients are perceived by clinicians as "difficult." Early theories about difficult patients focused on patients' and clinicians' characteristics, often underemphasizing the influence of the environment on patients' behavior. The Stanford Prison Experiment, a classic experiment in the psychology of human behavior, provides a broader systems approach for understanding the environmental influences on patient behavior. A systems approach to the care of the difficult patient takes into consideration not only the patient's characteristics but also the health care environment and the more distal environments (ie, familial, societal, and cultural). Clinicians who are aware of the multilevel impact of these various environments on the behavior of patients are better equipped to understand, address, and hopefully even prevent difficult patient encounters. PMID:25248307

Onishi, So L; Hebert, Randy S

2014-09-23

179

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...

180

Supraglottic airways in difficult airway management: successes, failures, use and misuse.  

Science.gov (United States)

Supraglottic airway devices (SAD) play an important role in the management of patients with difficult airways. Unlike other alternatives to standard tracheal intubation, e.g. videolaryngoscopy or intubation stylets, they enable ventilation even in patients with difficult facemask ventilation and simultaneous use as a conduit for tracheal intubation. Insertion is usually atraumatic, their use is familiar from elective anaesthesia, and compared with tracheal intubation is easier to learn for users with limited experienced in airway management. Use of SADs during difficult airway management is widely recommended in many guidelines for the operating room and in the pre-hospital setting. Despite numerous studies comparing different SADs in manikins, there are few randomised controlled trials comparing different SADs in patients with difficult airways. Therefore, most safety data come from extended use rather than high quality evidence and claims of efficacy and particularly safety must be interpreted cautiously. PMID:22074079

Timmermann, A

2011-12-01

 
 
 
 
181

Potassium permanganate toxicity: A rare case with difficult airway management and hepatic damage  

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Potassium permanganate (KMnO4) is rarely used for suicidal attempt. Its ingestion can lead to local as well as systemic toxicities due to coagulation necrosis and damage, caused by free radicals of permanganate. We recently managed a case of suicidal ingestion of KMnO4 in a lethal dose. She had significant narrowing of upper airway leading to difficult intubation as well as hepatic dysfunction and coagulopathy as systemic manifestation. We suggest to keep ourselves ready to handle difficult a...

Agrawal, Vijay Kumar; Bansal, Abhishek; Kumar, Ranjeet; Kumawat, Bhanwar Lal; Mahajan, Parul

2014-01-01

182

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

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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 psych...

Benedittis, G.

2005-01-01

183

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.

184

Conditions Affecting Treatment of Pertrochanteric Osteomyelitis  

Directory of Open Access Journals (Sweden)

Full Text Available Background: Although osteomyelitis following treatment of pertrochanteric fractures israre, management can be difficult and often results in several physical andeconomic difficulties. Data regarding treatment of patients withpertrochanteric osteomyelitis is currently limited. This retrospective studyevaluates the management of pertrochanteric osteomyelitis and presents ourexperience using a two-stage treatment protocol.Methods: From 1984 to 1998, twenty-three pertrochanteric osteomyelitis cases weretreated with a two-stage protocol comprising of an external skeletal fixator orBuck traction after radical debridement in the first stage and reconstructionin the second stage. The study included sixteen males and seven femaleswith a mean age of 48.3 years (range 16-82 years. Patients were categorizedas “successful” or “difficult” according to the number of operations they hadundergone. Conditions including patient age, compromised host, intervalbefore treatment, fracture severity, nonunion, hip joint involvement, multipleorganisms and the presence of oxacillin-resistant Staphylococcus aureuswere recorded for analysis.Results: Only twelve of the twenty-three (52% cases were successfully managed andinfection recurred in four (17.4% cases at final follow-up. Difficult casesmanaged by the two-stage protocol were more likely to be characterized byyounger age (p = 0.03, unstable fractures (p = 0.003 and nonunions (p =0.027.Conclusion: The use of external skeletal fixation is not recommended for managingpertrochanteric osteomyelitis. Success using a two-stage protocol was difficultto achieve. Initial fracture severity should be carefully assessed whendevising a treatment protocol for pertrochanteric osteomyelitis.

Steven Wen-Neng Ueng

2007-10-01

185

Selective inhibition of anandamide cellular uptake versus enzymatic hydrolysis--a difficult issue to handle.  

Science.gov (United States)

There is considerable debate at present as to whether the uptake of anandamide (AEA) into cells is by a facilitated transport process or by passive diffusion driven by fatty acid amide hydrolase (FAAH). The possibility that both processes occur, but to different extents depending upon the cell type used, has been difficult to investigate pharmacologically since available compounds show little selectivity between inhibition of AEA uptake and inhibition of FAAH. Recently, three compounds, UCM707 [N-(Fur-3-ylmethyl)arachidonamide], OMDM-1 and OMDM-2 [the 1'-(S)- and 1'-(R)-enantiomers of the 1'-4-hydroxybenzoyl analogue of oleoylethanolamide], selective for the uptake process, have been described and we have used these compounds, together with AM404 [(N-(4-hydroxyphenyl) arachidonoyl amide)] and VDM11 [(5Z,8Z,11Z,14Z)-N-(4-Hydroxy-2-methylphenyl)-5,8,11,14-eicosatetraenamide]), with the initial aim of determining which mechanism of uptake predominates in C6 glioma and RBL-2H3 cells. AM404 and VDM11 were both found to decrease the uptake of 2 microM AEA into cells (IC50 values 6-11 microM), but they also inhibited rat brain FAAH (IC50 values 1-6 microM). However, when using a different FAAH assay protocol, VDM11 was a much less potent FAAH inhibitor (IC50>50 microM) regardless of the cell type and animal species used. In contrast, we confirmed that UCM707, OMDM-1 and OMDM-2 were weak inhibitors of FAAH (IC50 values >50 microM) under all conditions used. However, their potency as inhibitors of AEA cellular accumulation appears to be largely dependent on the cell type and assay conditions used. In particular, the potency of UCM707 (IC50 value > or =25 microM) was considerably lower than the submicromolar potency previously reported for U937 cells. It is concluded that the cause/effect relationship between AEA uptake and hydrolysis cannot be investigated uniquely by using supposedly selective inhibitors of each process. PMID:15145699

Fowler, Christopher J; Tiger, Gunnar; Ligresti, Alessia; López-Rodríguez, María L; Di Marzo, Vincenzo

2004-05-10

186

A modified technique for Gore Excluder limb deployment in difficult iliac anatomy during endovascular abdominal aortic aneurysm repair.  

Science.gov (United States)

Complex iliac anatomy including extreme tortuosity constitutes a relative contraindication for endovascular abdominal aortic aneurysm repair with additional risk of limb-graft occlusion. The Gore Excluder limb-graft is a flexible stent-graft, which adapts easily to iliac tortuosity. Nevertheless, the presence of the stiff guide wire does not always allow for an ideal apposition of the stent graft to the angulated common iliac artery vessel wall. We describe herein a modified technique for Gore Excluder limb-graft deployment with partial removal of the stiff wire in cases with difficult tortuous or narrow iliac arteries during endovascular abdominal aortic aneurysm repair. PMID:24668057

Vourliotakis, George; Katsargyris, ?thanasios; Tielliu, Ignace Fj; Zeebregts, Clark J; Verhoeven, Eric Lg

2015-02-01

187

Nonlinear equilibrium in Tokamaks including convective terms and viscosity  

International Nuclear Information System (INIS)

MHD equilibrium in tokamaks becomes very complex, when the non-linear convective term and viscosity are included in the momentum equation. In order to simplify the analysis, each new term has been separated in type gradient terms and vorticity depending terms. For the special case in which the vorticity vanishes, an extended Grad-Shafranov type equation can be obtained. However now the magnetic surface is not isobars or current surfaces as in the usual Grad-Shafranov treatment. The non-linear convective terms introduces gradient of Bernoulli type kinetic terms . Montgomery and other authors have shown the importance of the viscosity terms in tokamaks [1,2], here the treatment is carried out for the equilibrium condition, including generalized tokamaks coordinates recently described [3], which simplify the equilibrium analysis. Calculation of the new isobar surfaces is difficult and some computation have been carried out elsewhere for some particular cases [3]. Here, our analysis is extended discussing how the toroidal current density, plasma pressure and toroidal field are modified across the midplane because of the new terms (convective and viscous). New calculations and computations are also presented. (Author)

188

Do lean methodologies include ergonomic tools?  

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This paper presents some methodologies for Lean implementation, highlighting which ergonomic tools are included in these methodologies. In order to achieve this, a review on ergonomic tools used to diagnostic work conditions was necessary. Being Lean Production, a well known work organizational model, widely implemented in all sort of industries and services companies in nowadays, it is important to include ergonomic tools for diagnose, evaluate and measure the workers conditions ...

Maia, Laura Costa; Alves, Anabela Carvalho; Lea?o, Celina Pinto

2012-01-01

189

Radiofrequency ablation of hepatocellular carcinoma in difficult locations: Strategies and long-term outcomes  

Science.gov (United States)

AIM: To investigate the treatment strategies and long-term outcomes of radiofrequency ablation (RFA) of hepatocellular carcinoma (HCC) in difficult locations and to compare the results with non-difficult HCC. METHODS: From 2004 to 2012, a total of 470 HCC patients underwent ultrasound-guided percutaneous RFA. Among these HCC patients, 382 with tumors located ? 5 mm from a major vessel/bile duct (n = 87), from peripheral important structures (n = 232) or from the liver capsule (n = 63) were regarded as difficult cases. There were 331 male patients and 51 female patients, with an average age of 55.3 ± 10.1 years old. A total of 235 and 147 patients had Child-Pugh class A and class B liver function, respectively. The average tumor size was 3.4 ± 1.2 cm. Individual treatment strategies were developed to treat these difficult cases. During the same period, 88 HCC patients with tumors that were not in difficult locations served as the control group. In the control group, 74 patients were male, and 14 patients were female, with an average age of 57.4 ± 11.8 years old. Of these, 62 patients and 26 patients had Child-Pugh class A and class B liver function, respectively. Regular follow-up after RFA was performed to assess treatment efficacy. Survival results were generated from Kaplan-Meier estimates, and multivariate analysis was performed using the Cox regression model. RESULTS: Early tumor necrosis rate in the difficult group was similar to that in the control group (97.6% vs 94.3%, P = 0.080). The complication rate in the difficult group was significantly higher than that in the control group (4.9% vs 0.8%, P = 0.041). The follow-up period ranged from 6 to 116 mo, with an average of 28 ± 22.4 mo. Local progression rate in the difficult group was significantly higher than that in the control group (12.7% vs 7.1%, P = 0.046). However, the 1-, 3-, 5-, and 7-year overall survival rates in the difficult group were not significantly different from those in the control group (84.3%, 54.4%, 41.2%, and 29.9% vs 92.5%, 60.3%, 43.2%, and 32.8%, respectively, P = 0.371). Additionally, a multivariate analysis revealed that tumor location was not a significant risk factor for survival. CONCLUSION: There was no significant difference in long-term overall survival between the two groups even though the local progression rate was higher in the difficult group. PMID:25663774

Yang, Wei; Yan, Kun; Wu, Gong-Xiong; Wu, Wei; Fu, Ying; Lee, Jung-Chieh; Zhang, Zhong-Yi; Wang, Song; Chen, Min-Hua

2015-01-01

190

[A miliary tuberculosis case without lung involvement difficult to distinguish from autoimmune hepatitis exacerbation].  

Science.gov (United States)

A 48-year-old female with a past history of systemic lupus erythematosus had developed autoimmune hepatitis (AIH) at the age of 45 years, and administration of PSL 30 mg/day was initiated. However, AIH exacerbation was suspected based on elevation of hepatic and biliary tract enzymes such as ALP (1207U/L) with a fever of 38 degrees C after tapering off the steroids to PSL 7.5 mg daily, and she was thus hospitalized. A liver biopsy was recommended, but she refused. Thus, we suspected concomitant AIH and autoimmune cholangitis (AIC). Although high-dose steroid treatment including steroid pulse therapy was administered, there was no improvement. We performed a liver biopsy on the 66th hospital day, after obtaining the patient's consent. Epithelioid granuloma was detected in the liver leaflet as the background of the AIH and AIC findings. In addition, acid fast bacteria were detected with auramine and Ziehl-Neelsen staining, raising the possibility of tuberculosis. Additionally, granuloma was also seen in her bone marrow, and miliary tuberculosis was suspected. Anti-tuberculous therapy with isoniazid, rifampicin, ethambutol and pyrazinamide was initially administered, but the regimen was changed to levofloxacin, ethambutol, and streptomycin due to the side effects of the earlier medications. Liver functions improved and the inflammatory reaction became negative. The patient was discharged on the 138th hospital day. Ultimately, no acid fast bacteria were detected with culture, PCR of her bone marrow, or liver biopsy. However, miliary tuberculosis was definitively diagnosed from the pathological findings and her clinical course. AIH was an underlying disease, and the discrimination from AIH exacerbation was difficult. Consequently, the diagnosis was miliary tuberculosis without the lung involvement and the main lesion was in the liver. It is important to take account of miliary tuberculosis in the differential diagnosis of fevers of unknown origin with elevation of hepatic and biliary tract enzymes, and to make a definitive diagnosis with a liver biopsy. PMID:25199380

Yamashita, Hiroyuki; Ueda, Yo; Takahashi, Yuko; Mimori, Akio

2014-07-01

191

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

192

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

193

Difficult mask ventilation in general surgical population: observation of risk factors and predictors  

Science.gov (United States)

Background: There are few predictors of difficult mask ventilation and a simple, objective, predictive system to identify patients at risk of difficult mask ventilation does not currently exist. We present a retrospective - subgroup analysis aimed at identifying predictive factors for difficult mask ventilation (DMV) in patients undergoing pre-operative airway assessment before elective surgery at a major teaching hospital. Methods: Data for this retrospective analysis were derived from a database of airway assessments, management plans, and outcomes that were collected prospectively from August 2008 to May 2010 at a Level 1 academic trauma center. Patients were stratified into two groups based on the difficulty of mask ventilation and the cohorts were analyzed using univariate analysis and stepwise selection method. Results: A total of 1399 pre-operative assessments were completed with documentation stating that mask ventilation was attempted. Of those 1399, 124 (8.9%) patients were found to be difficult to mask ventilate. A comparison of patients with and without difficult mask ventilation identified seven risk factors for DMV: age, body mass index (BMI), neck circumference, history of difficult intubation, presence of facial hair, perceived short neck and obstructive sleep apnea. Although seven risk factors were identified, no individual subject had more than four risk factors. Conclusion: The results of this study confirm that in a real world clinical setting, the incidence of DMV is not negligible and suggest the use of a simple bedside predictive score to improve the accuracy of DMV prediction, thereby improving patient safety. Further prospective studies to validate this score would be useful. PMID:25485097

Cattano, Davide; Killoran, Peter V.; Cai, Chunyan; Katsiampoura, Anastasia D.; Corso, Ruggero M.; Hagberg, Carin A.

2014-01-01

194

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

195

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

196

Why Do Disadvantaged Filipino Children Find Word Problems in English Difficult?  

Science.gov (United States)

Young Filipino students are expected to solve mathematical word problems in English, a language that many encounter only in schools. Using individual interviews of 17 Filipino children, we investigated why word problems in English are difficult and the extent to which the language interferes with performance. Results indicate that children could…

Bautista, Debbie; Mulligan, Joanne

2010-01-01

197

Difficult?to?control asthma management through the use of a specific protocol  

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The present study is a critical review of difficult-to-control asthma, highlighting the characteristics and severity of the disease. It also presents a protocol for the management of patients with this asthma phenotype. The protocol, which was based on relevant studies in the literature, is described and analyzed.

Pedro Giavina-Bianchi; Marcelo Vivolo Aun; Carla Bisaccioni; Rosana Agondi; Jorge Kalil

2010-01-01

198

Why is it so difficult? Misconceptions about Eastern European education in transition  

Science.gov (United States)

Eastern European educational systems today face many problems, frequently described in recent publications. This paper discusses several misconceptions both in Western and in Eastern countries, which render more difficult the change process. These concern the inherited situation, reforms underway, power relationships, decentralisation, the roles of tradition and Western assistance, curriculum, financial and statistical data and the relationship between education and society.

Sandi, Ana Maria

1992-11-01

199

2010 ASCO Annual Meeting: progress in difficult-to-treat cancers  

Directory of Open Access Journals (Sweden)

Full Text Available The 46th Annual Meeting of the American Society of Clinical Oncology took place in June 2010 in Chicago, USA. More than 30,000 specialists discussed the latest innovations in research, quality, practice and technology in cancer. Here we highlight the most significant advances in difficult-to-treat cancers [2].

Günther J Wiedemann

2010-01-01

200

"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

 
 
 
 
201

A Research Methodology for Studying What Makes Some Problems Difficult to Solve  

Science.gov (United States)

We present a quantitative model for predicting the level of difficulty subjects will experience with specific problems. The model explicitly accounts for the number of subproblems a problem can be broken into and the difficultly of each subproblem. Although the model builds on previously published models, it is uniquely suited for blending with…

Gulacar, Ozcan; Fynewever, Herb

2010-01-01

202

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

203

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

204

LAPAROSCOPIC CHOLECYSTECTOMY AT THE PATIENTS WITH THE ASSOCIATE PATHOLOGY AND DIFFICULT SURGICAL TECHNIQUES  

Directory of Open Access Journals (Sweden)

Full Text Available This paper present an analysis made on 1210 cases of laparoscopic cholecystectomies (LC. From these, 88 patients had associated pathology. The age of the patients was 11 – 82 yo. The indication for LC was large. In the study group (88 cases, the Acid-Base Balance (ABB, blood gasses, blood pressure, the central venous pressure (CVP, intra-cranial pressure (ICP, inspiratory resistance, temperature changes and also peritoneal biopsy were analysed. Methods: The multilateral study clinic-instrumental examinations of associate pathology in preoperative period were determined. Determination of the risk group and patients for LC has been allowed. Results: The CO2 pneumoperitoneum (PP (7-12 mmHg determines changes of the: 1 ABB (intra operator blood pH was 7.37 before and 7.25 after the procedure; 2 partial carbon dioxide (before 40, after 47; 3 blood pressure; 4 mean CVP (before operation - 6.67±0.17 and 10.73±0.29 after procedure (p<0.01; 5 ICP (8.65±0.19 mm, p<0.01; 6 inspiratory resistance; 7 temperature changes (due to the CO2 temperature. The conversion rate was (0,41%: complicated acute cholecystites (1, dense multiple adhesions (1, the incidence of significant hemorrhage (2, bile duct injury (1. The postoperative mortality were 0,33% (4 cases due to pulmonary artery tromboemboly. Billiary lesions during LC occur with a frequency of 0,41% (5 patients: four bile duct injuries and leaks and one case – right billiary accessory duct, were solved following another operation three days after the initial procedure. Wound infection was more frequently, occurring in 21 cases (1,74%. The other complications (14 cases include: subcutaneous emphysema and insufflations of the pro-peritoneal space, omentum, or mesentery. Conclusions: LC is a safety technique even in the patients with associated pathology, but the morbidity and mortality are high. No presumed ductal or vascular structure should be divided until its anatomical features have been completely demonstrated. If the ductal and vascular structures are so obscured by dense inflammation then the procedure should be converted to an open laparotomy. Intra-operative cholangiography will supply the surgeon with accurate details concerning the juncture of the cystic and common bile ducts. To avoid intra-operative bleeding during emergency cholecystectomy it is important to carefully dissect and identify both branches of the cystic artery as well as the main trunk before any suspected vascular structures are divided. Often the most difficult sources of bleeding to avoid in patients with acute cholecystitis is bleeding from the gallbladder fossa.

A. Lesco

2006-01-01

205

Attributions of blame to battered women when they are perceived as feminists or as "difficult to deal with".  

Science.gov (United States)

This study aimed to analyze the influence of victim-related and observer-related factors in victim blaming of battered women. Two hundred and forty six college students participated. They were asked to read a scenario describing a hypothetical case of physical violence perpetrated by a man against his partner. Depending on the experimental condition, the victim was described either as a feminist and/or as exhibiting difficulties in her relationship with others or not. A hierarchical regression analysis was performed with victim blaming as dependent variable. Participants' hostile sexism positively predicted victim blaming when the victim was described as a feminist and as a "difficult to deal with" woman (p blame on the victim when she was presented as a feminist woman (p victim-related and observer-related factors, and of their interaction, in blaming the victim of gender-based violence. PMID:25011491

Vidal-Fernández, Ana; Megías, Jesús L

2014-01-01

206

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

207

Assessment of difficult laryngoscopy by electronically measured maxillo-pharyngeal angle on lateral cervical radiograph: A prospective study  

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Background: Difficult airway continued to be a major cause of anesthesia-related morbidity and mortality. Successful airway management depends on direct laryngoscopy and tracheal intubation. Difficult laryngoscopy is a resultant of incomplete structural arrangements during the process of head positioning. Through clinical history,examination of the patients along with craniofacial indices alerts the anesthetist for difficult laryngoscopy. But it does not predict all causes of difficult...

Gupta Kumkum; Gupta Prashant

2010-01-01

208

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

209

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.

210

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

211

Neuromuscular Diseases and Conditions (and Oral Health)  

Science.gov (United States)

... be identified. Causes can include herpes simplex virus, Lyme disease, herpes zoster and certain tumors in the ear. ... barriers to dental care, including transportation problems and chronic diseases. If you have dentures, they may become difficult ...

212

Endoscopic papillary balloon dilation after sphincterotomy for difficult choledocholithiasis: A case-controlled study  

Directory of Open Access Journals (Sweden)

Full Text Available AIM: To evaluate the efficacy and safety of endoscopic sphincterotomy (EST + endoscopic papillary large balloon dilation (EPLBD vs isolated EST. METHODS: We conducted a retrospective single center study over two years, from February 2010 to January 2012. Patients with large (? 10 mm, single or multiple bile duct stones (BDS, submitted to endoscopic retrograde cholangio-pancreatography (ERCP were included. Patients in Group A underwent papillary large balloon dilation after limited sphincterotomy (EST+EPLBD, using a through-the-scope balloon catheter gradually inflated to 12-18 mm according to the size of the largest stone and the maximal diameter of the distal bile duct on the cholangiogram. Patients in Group B (control group underwent isolated sphincterotomy. Stones were removed using a retrieval balloon catheter and/or a dormia basket. When necessary, mechanical lithotripsy was performed. Complete clearance of the bile duct was documented with a balloon catheter cholangiogram at the end of the procedure. In case of residual lithiasis, a double pigtail plastic stent was placed and a second ERCP was planned within 4-6 wk. Some patients were sent for extracorporeal lithotripsy prior to subsequent ERCP. Outcomes of EST+EPLBD (Group A vs isolated EST (Group B were compared regarding efficacy (complete stone clearance, number of therapeutic sessions, mechanical and/or extracorporeal lithotripsy, biliary stent placement and safety (frequency, type and grade of complications. Statistical analysis was performed using ?2 or Fisher’s exact tests for the analysis of categorical parameters and Student’s t test for continuous variables. A P-value of less than 0.05 was considered statistically significant. RESULTS: One hundred and eleven patients were included, 68 (61.3% in Group A and 43 (38.7% in Group B. The mean diameter of the stones was similar in the two groups (16.8 ± 4.4 and 16.0 ± 6.7 in Groups A and B, respectively. Forty-eight (70.6% patients in Group A and 21 (48.8% in Group B had multiple BDS (P = 0.005. Overall, balloon dilation was performed up to 12 mm in 10 (14.7% patients, 13.5 mm in 17 (25.0%, 15 mm in 33 (48.6%, 16.5 mm in 2 (2.9% and 18 mm in 6 (8.8% patients, taking into account the diameter of the largest stone and that of the bile duct. Complete stone clearance was achieved in sixty-five (95.6% patients in Group A vs 30 (69.8% patients in Group B, and was attained within the first therapeutic session in 82.4% of patients in Group A vs 44.2% in Group B (P < 0.001. Patients submitted to EST+EPLBD underwent fewer therapeutic sessions (1.1 ± 0.3 vs 1.8 ± 1.1, P < 0.001, and fewer required mechanical (14.7% vs 37.2%, P = 0.007 or extracorporeal (0 vs 18.6%, P < 0.001 lithotripsy, as well as biliary stenting (17.6% vs 60.5%, P < 0.001. The rate of complications was not significantly different between the two groups. CONCLUSION: EST+EPLBD is a safe and effective technique for treatment of difficult BDS, leading to high rates of complete stone clearance and reducing the need for lithotripsy and biliary stenting.

Bruno Rosa

2013-01-01

213

Hip Conditioning Program  

Science.gov (United States)

... or her orthopaedic surgeon. Purpose of Program _________________________________________________________________ Hip Conditioning Program After an injury or surgery, an exercise ... Target Muscles: The muscle groups targeted in this conditioning program include: • Gluteus maximus (buttocks) • Gluteus medius (buttocks) • ...

214

Risk Factors Assessment of the Difficult Intubation using Intubation Difficulty Scale (IDS)  

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Background: The major responsibility of anaesthesiologist is to maintain adequate gas exchange in his patients in all circumstances and this require that patency of upper airway is constantly maintained. Problems with upper airway management are among the most frequent causes of anaesthetic mishaps. Using intubation difficulty scale (IDS) we made an attempt to objectively assess the predictors of difficult intubation. We assessed classical bedside tests such as modified Mallampati test, Thyro...

K Nasa, Vaibhav; S Kamath, Shaila

2014-01-01

215

Neural Processing of Respiratory Sensations when Breathing Becomes More Difficult and Unpleasant  

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The accurate perception of respiratory sensations is important for the successful management and treatment of respiratory diseases. Previous studies demonstrated that external stimuli such as affective pictures and distracting films can impact the perception and neural processing of respiratory sensations. This study examined the neural processing of respiratory sensations when breathing as an internal stimulus is manipulated and becomes more difficult and unpleasant. Sustained breathing thro...

AndreasVon Leupoldt

2010-01-01

216

Evaluation of three commercial detection systems for Mycobacterium tuberculosis where clinical diagnosis is difficult.  

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AIMS: To assess the performance of three commercially available Mycobacterium tuberculosis detection systems employing nucleic acid amplification, when applied directly to respiratory and non-respiratory specimens from patients where the diagnosis of tuberculosis is difficult using clinical and traditional bacteriological methods. METHODS: 42 respiratory and 21 non-respiratory specimens were concentrated, examined with auramine staining, and cultured on Lowenstein-Jensen slopes. These specime...

Brown, T. J.; Power, E. G.; French, G. L.

1999-01-01

217

On the Use of the Multiple Scale Method in Solving 'Difficult' Bifurcation Problems  

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Several algorithms consisting in 'non-standard' versions of the Multiple Scale Method are illustrated for 'difficult' bifurcation problems. Preliminary, the 'easy' case of bifurcation from a cluster of distinct eigenvalues is addressed, which requires using integer power expansions, and it leads to bifurcation equations all of the same order. Then, more complex problems are studied. The first class concerns bifurcation from a defective eigenvalue, which calls for using fractional power expans...

Luongo, Angelo

2013-01-01

218

Bonfils assisted double lumen endobronchial tube placement in an anticipated difficult airway  

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The role of various airway adjuncts in the management of difficult airway has been described in the literature. Bonfils rigid fiberscope is one of the airway assist devices widely used for endotracheal intubation in the individuals with cervical instability warranting limited neck movements. With our experience in the utilization of Bonfils for single lumen endotracheal tube placement, we are increasingly using for double lumen endobronchial (DLT) intubation as well. We would like to describe...

Subramani, Sudhakar; Poopalalingam, Ruban

2014-01-01

219

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

220

Flood-plain delineation for Difficult Run Basin, Fairfax County, Virginia  

Science.gov (United States)

Water-surface profiles of the 25-year and 100-year floods and maps on which the 25-, 50-, and 100-year flood boundaries are delineated for streams in the Difficult Run basin in Fairfax County, Virginia. The techniques used in the computation of the flood profiles and delineation of flood boundaries are presented. Difficult Run heads at about 500 ft. elevation near the city of Fairfax and discharges into the Potomac River at about 70 feet above mean sea level. Stream channel slopes are fairly steep, the main channel of Difficult Run has an average fall of about 25 feet per mile. Stream channels are well defined with established flood plains covered in most cases with trees and dense brush. Development within the basin has been gradual and mostly residential. In 1965 most of the development was in the area of Fairfax City and the town of Vienna and imperviousness for the basin at that time was computed to be less than 1 percent. Since 1965 considerable additional residential development has taken place within the basin in the Vienna and Reston areas and ultimate development with an overall imperviousness of 30 percent is anticipated with higher percentages of imperviousness near centers of anticipated development. (Woodard-USGS)

Soule, P.L.

1976-01-01

 
 
 
 
221

Treatment resistant depression in primary care: co-constructing difficult encounters.  

Science.gov (United States)

Many patients with depression do not recover despite medication or therapy. Individuals with treatment resistant depression often have co-morbid anxiety, personality difficulties and drug or alcohol misuse and have been characterised as difficult, heartsink or problem personalities by general practitioners. Yet critical studies of interaction in medical settings suggest that the context may have a role in constructing the patient. A total of 12 audio-recorded routine consultations were analysed following guidelines for qualitative analysis of medical discourse. The interpretation focused on ways in which the context and structure of primary care consultations in a UK setting construct difficult encounters, which may lead to patients with treatment resistant depression being seen as difficult to manage in various ways. Three overarching observations were that presentation of multiple problems in multiple domains clash with the consultation format; that patients' atypically high level of activity in a time-limited setting prevents patient-centred work; that the question and answer format restricts multifaceted discussions of social and emotional problems, preventing shared understandings emerging. However, although interactions appear uneasy, they are repaired and may be moderately palliative. Suggestions are made for re-orienting general practitioner work with treatment resistant depression towards long-term goal setting outside of the traditional consultation structure in order to develop shared understandings. PMID:23994794

McPherson, Susan; Byng, Richard; Oxley, Donna

2014-05-01

222

The intubation scoop (i-scoop) - a new type of laryngoscope for difficult and normal airways.  

Science.gov (United States)

The i-scoop is an intubation device with a curved guiding bar with laterally located lenses at its tip, rather than a blade. Twenty-five anaesthesiologists intubated a manikin that simulated first a normal and then a difficult airway. All participants were able to intubate the difficult airway with a good view of the glottis using the i-scoop. None was able to intubate using seven other laryngoscopes (Macintosh laryngoscope, GlideScope(®) GVL and AVL, McGrath(®) (Series 5/MAC), C-MAC(®) , A.P. Advance(™) ). Intubation was successful only with the Airtraq(®) (n = 10), the Airway Scope (n = 5), the C-MAC D-Blade (n = 2), the A.P. Advance DAB (n = 1) and the GlideScope DL Trainer (n = 1) (p < 0.001, success rate of i-scoop vs all 12 laryngoscopes combined). In contrast to all other videolaryngoscopes, intubation of the normal airway with the i-scoop was achieved even faster than with the Macintosh laryngoscope (p < 0.02). The i-scoop outperformed all other laryngoscopes in both difficult and normal airways, and therefore has potential as an easier and safer alternative to present devices. PMID:24894025

Raymondos, K; Seidel, T; Sander, B; Gerdes, A; Goetz, F; Helmstädter, V; Panning, B; Dieck, T

2014-09-01

223

Nurse leaders' responsibilities in supporting nurses experiencing difficult situations in clinical nursing.  

Science.gov (United States)

AIM: To make nurse leaders aware of different kinds of difficult situations in clinical nursing that may cause suffering to nurses and to discuss how nurse leaders can approach and alleviate this suffering. BACKGROUND: Difficult situations are a part of clinical nursing. Nurses are repeatedly exposed to situations that may cause them suffering and reduce their ability to serve the patients. METHOD: Data collection was based on a sample of semi-structured face-to-face deep interviews with eight nurses who were encouraged to narrate their lived experiences of difficult situations in clinical nursing. RESULTS: Nurses want to discuss issues connected to nursing and caring science that emerge in clinical nursing with their nurse leaders. Painful memories and thoughts are often related to patients struggling between life and death, the despair of families and friends, and their hovering between hope and hopelessness. The results do not support the notion that nurses would request other kinds of support or debriefing. CONCLUSIONS: The mission of nursing is to serve, console and alleviate human suffering. Nurse leaders carry a responsibility to create such evidence-based caring cultures that support the mission of nursing. Nurse leaders' understanding, sympathetic attitude, ethical value basis, personality and ability to discuss are important aspects for nurses. Through the support from nurse leaders, it seems possible to alleviate the nurse's suffering in clinical nursing. Implications for Nursing Management Nurse leaders' support creates a foundation for the nurses' professional development. PMID:23409869

Honkavuo, Leena; Lindström, Unni Å

2012-11-01

224

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.)

225

Endotracheal intubation in a medical transport helicopter - comparing direct laryngoscopy with the prototype Storz CMAC videolaryngoscope in a simulated difficult intubating position.  

Science.gov (United States)

This pilot study examined backward intubation of the Laerdal Difficult Airway Manikin in a medical transport helicopter using the prototype (a new more compact) Storz CMAC videolaryngoscope. The standard manikin airway Cormack Lehane (CL) view scores were 2.00 +/- 1.00 for direct view and 1.375 +/- 0.517 for the indirect view (CMAC). Success rates for backward intubation in the standard airway were 100% (CMAC) and 87.5% (DV). Average CL grades in the difficult airway were 3.63 +/- 0.74 (DV) and 2.00 +/- 0.926 (CMAC)(p = 0.002). The success rates for backward intubation of the difficult airway were 12.5% (DV) and 63% (CMAC). Our results show that in backward intubation of the difficult airway in a helicopter setting, the prototype CMAC videolaryngoscope significantly improved the airway score by 1-2 grades and improved intubation success 5-fold. Studies using the portable CMAC videolaryngoscope under challenging rescue conditions and positions should be considered. PMID:19377110

Boedeker, Ben H; Berg, Benjamin W; Bernhagen, Mary; Murray, W Bosseau

2009-01-01

226

Citric acid and quinine share perceived chemosensory features making oral discrimination difficult in C57BL/6J mice.  

Science.gov (United States)

Evidence in the literature shows that in rodents, some taste-responsive neurons respond to both quinine and acid stimuli. Also, under certain circumstances, rodents display some degree of difficulty in discriminating quinine and acid stimuli. Here, C57BL/6J mice were trained and tested in a 2-response operant discrimination task. Mice had severe difficulty discriminating citric acid from quinine and 6-n-propylthiouracil (PROP) with performance slightly, but significantly, above chance. In contrast, mice were able to competently discriminate sucrose from citric acid, NaCl, quinine, and PROP. In another experiment, mice that were conditioned to avoid quinine by pairings with LiCl injections subsequently suppressed licking responses to quinine and citric acid but not to NaCl or sucrose in a brief-access test, relative to NaCl-injected control animals. However, mice that were conditioned to avoid citric acid did not display cross-generalization to quinine. These mice significantly suppressed licking only to citric acid, and to a much lesser extent NaCl, compared with controls. Collectively, the findings from these experiments suggest that in mice, citric acid and quinine share chemosensory features making discrimination difficult but are not perceptually identical. PMID:21421543

Treesukosol, Yada; Mathes, Clare M; Spector, Alan C

2011-06-01

227

Haematological control under normal conditions  

International Nuclear Information System (INIS)

Below a dose of 25 rem it is impossible to discover any significant variation in the haemogram. Therefore, as the maximum permissible one-exposure dose under normal conditions is 3 rem for a person directly engaged in work with radiation, routine controls cannot be based on haematological examinations alone. In fact, the search for new methods of investigation (Whitfield et al., 1965), especially those relating to karyotype anomalies, is due to this inadequacy of the usual haematological examinations for low doses. Unfortunately, appropriate techniques are very difficult to apply on a routine basis. The use of special examinations (whole-body counters, radiotoxicology, etc.) to control and assess the doses of persons exposed to radiation also illustrates the very relative interest now shown in haematology examinations alone. This trend is the outcome of experience acquired from wide use of such examinations for large groups of persons exposed to radiological hazards. However, haematological examinations are still valuable for high exposures and, in the field of radiological hazard, most occupational disorders are haematological ones (Delpla et al., 1967; EURATOM, 1963; Vereinigung deutscher Strahlenschutzaerzte, 1964). Haematological control under normal conditions should include: an examination prior to assignment to work within a 'controlled area' - this should be applied even to persons already working in the establishment; and an examination at intervals which wil and an examination at intervals which will be left to the judgement of the medical officer but which must not be longer than six months for the general medical examination and the haematological examination

228

Classical Conditioning  

Science.gov (United States)

!!Classical Conditioning!! Classical conditioning is the use of Pavlovian conditioning procedures where a neutral stimulus becomes capable of evoking a response through pairing with an unconditioned stimulus. Click the link below to get an introduction into classical conditioning. Introduction to Classical Conditioning Now that you\\'ve been introduced to classical conditioning, view the clip at the link below, ...

Mrs. Palacios, Miss Miller, Mr. Rowser

2008-04-01

229

Fistulas of the lower urinary tract: percutaneous approaches for the management of a difficult clinical entity.  

Science.gov (United States)

Fistulas of the lower urinary tract are uncommon conditions that may occur spontaneously or after therapy in patients with various pelvic abnormalities. When present, these fistulas are associated with urine leakage, which is often socially distressing and disabling. Unfortunately, factors that lead to the formation of genitourinary fistulas often increase their complexity or preclude surgical repair. A high failure rate is associated with surgical repair, and many patients are not optimal surgical candidates. For such patients, a percutaneous treatment approach is highly desirable. Percutaneous ureteral occlusion combined with insertion of a functioning nephrostomy tube allows complete diversion of urine in those patients in whom nephrostomy alone does not provide adequate relief. Many approaches to percutaneous ureteral occlusion have been used with variable success, including coils and gelatin sponge, isobutyl-2-cyanoacrylate, detachable balloons, radiofrequency electrocautery, ureteral clipping, and solid and soft polymer agents. Furthermore, percutaneous or retrograde ureteral stents may be used to preserve antegrade urine flow, and surgical options are also available. It is essential that the interventional radiologist involved in the care of these patients be familiar with these different techniques as well as with the limitations, pitfalls, and possible complications of their use. PMID:15486242

Avritscher, Rony; Madoff, David C; Ramirez, Pedro T; Wallace, Michael J; Ahrar, Kamran; Morello, Frank A; Gupta, Sanjay; Murthy, Ravi; Wright, Kenneth C; Hicks, Marshall E

2004-10-01

230

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

231

Participatory research with youth: idealising safe social spaces or building transformative links in difficult environments?  

Science.gov (United States)

Freire's theory of social change informs analysis of youth-focused participatory research, with researchers describing links between participation and young people's critical thinking. There is less analysis of how youth move from the safe social space of a participatory research project to take health-promoting action in difficult real-world contexts. This article analyses a project conducted with Papua New Guinean youth, disrupting assumptions that critical thinking inevitably leads to critical action on health. Findings suggest the need to shift the focus of participatory research from supporting 'safe social spaces' to supporting 'transformative action in context' to concretely contribute to improving youth health. PMID:24058110

Vaughan, Cathy

2014-01-01

232

Prevention and control of serious trauma and accidental injury in China: Timely but difficult  

Directory of Open Access Journals (Sweden)

Full Text Available Serious trauma and accidental injury are the leading causes of death among people younger than 45 years old in China. Thus, the prevention and control of serious trauma and accidental injury are important for reducing these deaths. The concept is timely but difficult. Here, we review the current state of serious trauma and accidents in China and other countries, focusing on road accidents, and provide our personal perspectives and suggestions on how to prevent and control these serious injuries in China.

Xiaobing Fu

2013-07-01

233

Multipurpose alloys with controlled set of difficult-to-combine mechanical and physico-chemical properties  

International Nuclear Information System (INIS)

The principles and the methods of production are reported which relate to metallic materials possessing a combination of many (five, six and more) properties corresponding to the level close to limit values of one-purpose materials for each individual property. The investigation results on thin atomic, crystalline and magnetic structures of Fe-Ni and Fe-Ni-C base alloys are presented. Interrelationships are established of the variations in atomic-crystalline structure, martensitic transformations to physicomechanical and thermal properties of the alloys. The composition and the methods of production are determined for multi-purpose multiple-parameter alloys with a number of difficult-to-combine high level properties

234

Observational Study of Topical Imiquimod Immunotherapy in the Treatment of Difficult Lentigo Maligna  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Lentigo Maligna (LM) typically presents at sun-exposed sites in elderly patients as an asymmetric, slow-growing, irregularly pigmented macule with an irregular indented border. With changes in sun exposure behaviour LM is becoming more prevalent in middle-aged and younger adults.1The risk of melanoma developing in LM increases with duration of the disease and therefore age,2 and is difficult to quantify, estimates range from 2.2%2 to 50%3 over a lifetime, once invasive disease is established,...

Craythorne, E. E.; Lawrence, C. M.

2008-01-01

235

Treatment of difficult fractures and nonunions of the humerus and elbow with a modified Küntscher nail.  

Digital Repository Infrastructure Vision for European Research (DRIVER)

A series of fourteen difficult fractures and nonunions of the humerus and elbow have been treated over a period of twenty-eight years with a modified Kuntscher Nail. A total of twenty-six operative attempts had been previously made in this group of fourteen patients. One patient had eight failed surgeries prior to treatment. Slots were placed along the spine of the nail for transfixion with screws. In two instances additional modification of the Kuntscher nail was made by attaching a plate to...

Burdeaux, B. D.; York, B. P.

1993-01-01

236

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)

237

Primary sclerosing cholangitis in which differential diagnosis from gallbladder carcinoma was difficult.  

Science.gov (United States)

We report a case of localized primary sclerosing cholangitis (PSC) which was difficult to distinguish from gallbladder carcinoma. A 75-year-old woman with elevated serum bilirubin was hospitalized and underwent endoscopic nasobiliary drainage (ENBD). There was no history of diseases such as gallbladder stone, pancreatitis, or ulcerative colitis. Cholangiography through the ENBD tube showed localized stenosis of the common bile duct; the gallbladder could not be seen. Angiography showed no encasement of the hepatic artery. Ultrasonography showed a tumor in the cystic duct, and the tumor had invaded the gallbladder and common bile duct. We diagnosed gallbladder carcinoma on radioimaging, and performed an S4aS5 subsegmentectomy of the liver and resection of the extrahepatic biliary tree. Pathologically, no malignant cells were detected, and fibrosis around bile ducts and infiltration of inflammatory cells into hepatic tissue were found. It is well known that PSC is sometimes difficult to differentially diagnose from cholangiocarcinoma. Our case is of high interest because ultrasonography showed findings suggestive of gallbladder carcinoma. It is therefore necessary to keep the possibility of PSC in mind for the diagnosis and treatment of such localized biliary stenosis. PMID:15868081

Kobayashi, Hiroyuki; Hosotani, Ryo; Imai, Yukihiro; Wada, Kaori; Kajiwara, Tatehiro

2005-01-01

238

Neural processing of respiratory sensations when breathing becomes more difficult and unpleasant  

Directory of Open Access Journals (Sweden)

Full Text Available The accurate perception of respiratory sensations is important for the successful management and treatment of respiratory diseases. Previous studies demonstrated that external stimuli such as affective pictures and distracting films can impact the perception and neural processing of respiratory sensations. This study examined the neural processing of respiratory sensations when breathing as an internal stimulus is manipulated and becomes more difficult and unpleasant. Sustained breathing through an inspiratory resistive load was used to increase perceived breathing difficulty in 12 female individuals without respiratory disease. Using high-density EEG, respiratory-related evoked potentials (RREP to short inspiratory occlusions were recorded at early versus late time points of sustained loaded breathing. Ratings of perceived intensity and unpleasantness of breathing difficulty showed an increase from early to late time points of loaded breathing (p < 0.01 and p < 0.05, respectively. This was paralleled by significant increases in the magnitudes of RREP components N1, P2 and P3 (p < 0.01, p < 0.05 and p < 0.05, respectively. The present results demonstrate increases in the neural processing of respiratory sensations when breathing becomes more difficult and unpleasant. This might reflect a protective neural mechanism allowing effective response behavior when air supply is at risk.

AndreasVon Leupoldt

2010-11-01

239

Evaluation of the Airtraq and Macintosh laryngoscopes in patients at increased risk for difficult tracheal intubation.  

LENUS (Irish Health Repository)

The Airtraq, a novel single use indirect laryngoscope, has demonstrated promise in the normal and simulated difficult airway. We compared the ease of intubation using the Airtraq with the Macintosh laryngoscope, in patients at increased risk for difficult tracheal intubation, in a randomised, controlled clinical trial. Forty consenting patients presenting for surgery requiring tracheal intubation, who were deemed to possess at least three characteristics indicating an increased risk for difficulty in tracheal intubation, were randomly assigned to undergo tracheal intubation using a Macintosh (n = 20) or Airtraq (n = 20) laryngoscope. All patients were intubated by one of three anaesthetists experienced in the use of both laryngoscopes. Four patients were not successfully intubated with the Macintosh laryngoscope, but were intubated successfully with the Airtraq. The Airtraq reduced the duration of intubation attempts (mean (SD); 13.4 (6.3) vs 47.7 (8.5) s), the need for additional manoeuvres, and the intubation difficulty score (0.4 (0.8) vs 7.7 (3.0)). Tracheal intubation with the Airtraq also reduced the degree of haemodynamic stimulation and minor trauma compared to the Macintosh laryngoscope.

Maharaj, C H

2008-02-01

240

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

 
 
 
 
241

Towards a unified model of pavlovian conditioning: short review of trace conditioning models  

Digital Repository Infrastructure Vision for European Research (DRIVER)

There are three basic paradigms of classical conditioning: delay, trace and context conditioning where presentation of a conditioned stimulus (CS) or a context typically predicts an unconditioned stimulus (US). In delay conditioning CS and US normally coterminate, whereas in trace conditioning an interval of time exists between CS termination and US onset. The modeling of trace conditioning is a rather difficult computational problem and is a challenge to the behavior and connectionist approa...

Kryukov, V. I.

2012-01-01

242

Chitin Hydrolysis by Listeria spp., Including L. monocytogenes?  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Listeria spp., including the food-borne pathogen Listeria monocytogenes, are ubiquitous microorganisms in the environment and thus are difficult to exclude from food processing plants. The factors that contribute to their multiplication and survival in nature are not well understood, but the ability to catabolize various carbohydrates is likely to be very important. One major source of carbon and nitrogen in nature is chitin, an insoluble linear ?-1,4-linked polymer of N-acetylglucosamine (G...

Leisner, J. J.; Larsen, M. H.; Jørgensen, R. L.; Brøndsted, L.; Thomsen, L. E.; Ingmer, H.

2008-01-01

243

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

244

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

245

Neutralino relic density including coannihilations  

Digital Repository Infrastructure Vision for European Research (DRIVER)

We evaluate the relic density of the lightest neutralino, the lightest supersymmetric particle, in the Minimal Supersymmetric extension of the Standard Model (MSSM). For the first time, we include all coannihilation processes between neutralinos and charginos for any neutralino mass and composition. We use the most sophisticated routines for integrating the cross sections and the Boltzmann equation. We properly treat (sub)threshold and resonant annihilations. We also include...

Gondolo, Paolo; Edsjo, Joakim

1997-01-01

246

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

247

Case report of clival tuberculoma. Difficult to diagnose by means of a CT scan  

Energy Technology Data Exchange (ETDEWEB)

A patient with tuberculoma at the skull base was reported. Twenty-two years old, she had complained for ten years of amenorrhea, headache, and visual disturbance. On neurological examination, bitemporal hemianopsia, bilateral sixth nerve palsy, and recent right-side facial palsy were demonstrated. On radiological examination, a destructive lesion was found at the clivus. CT and MRI demonstrated, a space-taking lesion expanding to the floor of the third ventricle anteriorly, to the cerebello-pontine angle superiorly, and to the epipharynx inferiorly, and a marked swelling of the cerebellum, though no confirmative diagnosis could be obtained without a biopsy of the epipharyngeal tumor. The histological examination revealed that the tumor was tuberculoma. Medical treatment with INH, RFP, and steroids was effective. Although tuberculoma involving the skull base is very rare and rather difficult to diagnose, the authors would like to stress that early accurate diagnosis is very important because the lesion is curable with appropriate medical treatment.

Ichikawa, F.; Tachibana, S.; Miyasaka, Y.; Suwa, T.; Iida, H.; Kan, S.; Matsuda, Y.

1987-02-01

248

Giant cell aortitis: a difficult diagnosis assessing risk for the development of aneurysms and dissections.  

Science.gov (United States)

A significant location affected by giant cell (GC) arteritis is the ascending aorta, where aneurysms may develop and catastrophic ruptures and acute dissections can occur. Herein, we discuss three cases of GC aortitis discovered at pathological examination of surgically excised aortic aneurysmal tissue. There was no clinical suspicion of any underlying inflammatory process. We describe the main clinical features of the patients in conjunction with a review of the literature to identify any common clinical presentations that manifest in these patients. Giant cell aortitis in the absence of previously established GC arteritis is difficult to identify, and a careful analysis of the history and presentation along with appropriate investigations (e.g., erythrocyte sedimentation rate) may prompt the clinician to consider GC aortitis and suggest immunosuppressant therapy. PMID:21288742

Lee, Andrew; Luk, Adriana; Phillips, Katharine R B; Lim, Ki Dong; David, Tirone E; Butany, Jagdish

2011-01-01

249

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

2014-01-01

250

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

251

Bonfils assisted double lumen endobronchial tube placement in an anticipated difficult airway.  

Science.gov (United States)

The role of various airway adjuncts in the management of difficult airway has been described in the literature. Bonfils rigid fiberscope is one of the airway assist devices widely used for endotracheal intubation in the individuals with cervical instability warranting limited neck movements. With our experience in the utilization of Bonfils for single lumen endotracheal tube placement, we are increasingly using for double lumen endobronchial (DLT) intubation as well. We would like to describe our experience in the use of Bonfils for DLT placement and outline the merits and limitations of the other suitable airway assist devices in this report. The double lumen tube has to be modified by decreasing the length of DLT to accommodate the Bonfils fiberscope and this is applicable only in certain type of double lumen tubes for e.g. Bronchocath. PMID:25425788

Subramani, Sudhakar; Poopalalingam, Ruban

2014-10-01

252

Difficult airway management with bonfils fiberscope in case of emergency: acute abdomen with ileus.  

Science.gov (United States)

This clinical report describes an emergency case of a 49-year-old man, ASA E III status, with clinical symptoms of acute abdomen and ileus, who was scheduled for urgent surgery. Predictors of difficult intubation (Mallampati test Class III, short thyro-mental (Bonfils fiberoptic intubation as primary intervention and urgent tracheotomy, if needed, as secondary intervention. Immediately after assuming supine position on the operating table, the patient lost consciousness and cardiac arrest developed. Successful intubation with oxygenation was followed by cardiopulmonary resuscitation. Upon stabilization of the patient's vital functions, urgent surgery was performed. In the emergency case presented, we succeeded quickly to secure the airway with Bonfils fiberoptic intubation, which allowed for appropriate oxygenation and starting resuscitation. The high risk of the possible aspiration was avoided by timely provision of airway in the experienced anesthetist's hands. PMID:23330419

Maldini, Branka; Novotny, Zdenko; Letica-Brnadi?, Renata; Brkljaci?, Ana; Bartolek, Dubravka

2012-09-01

253

China in the Copenhagen process: the difficult inclusion of an emerging power  

International Nuclear Information System (INIS)

The authors propose an analysis of the Chinese assets and posture before the Copenhagen Conference. They evoke the environmental consequences of the rapid development of the Chinese economy and demography: urban pollution, acid rains, and desertification. They note that the Chinese government had to acknowledge these environmental concerns by specifying energetic performance objectives in its economic planning, by publishing a National Climate Change Programme and a middle and long term development plan for renewable energies. They outline that the different objectives related to energy performance, renewable energy production or greenhouse gas emissions are still difficult to implement at the local level as Chinese provinces are wishing to preserve their competitiveness. The authors comment China's posture in international negotiations as an emerging country or developing country which sets it free of any constraining objective. They examine the possibilities for changing this situation and involve China in reduction obligations. Then they try to foresee China's attitude in Copenhagen and to identify the possible scenarios

254

Full siblings impersonating parent/child prove most difficult to discredit with DNA profiling alone.  

Science.gov (United States)

DNA profiling is currently the most widely used method for parentage verification, although many forms of it have limitations of some sort. In this paper, a general formula is derived to depict a simple relationship between the probability that a random man and the probably that a male relative of the child, other than the child's father, is excluded from paternity, when the phenotype of the child's mother is unavailable. With this, the possible limitations of a finite set of STR loci in excluding close relatives of the child from paternity are illustrated. Genetically, among the commonly encountered biologic relationships, to exclude a full sibling of the child from paternity if they pose themselves as father and child remains the most difficult. PMID:15383026

Fung, Wing K; Wong, Dart-Man; Hu, Yue-Qing

2004-10-01

255

A case of hepatic angiomyolipoma difficult to distinguish from hepatocellular carcinoma  

Directory of Open Access Journals (Sweden)

Full Text Available We report a case of hepatic angiomyolipoma with uncommon clinical features. A 56-year-old man presented with a hepatic tumor in the caudate lobe. The tumor was hypoechoic on ultrasonography, showed early-phase hyperattenuation on enhanced computed tomography and did not absorb iron on superparamagnetic iron oxide-enhanced magnetic resonance imaging. Hepatocellular carcinoma was highly suspected, and the patient underwent hepatic resection. Histologically, the tumor was mainly composed of smooth muscle cells and contained small amounts of adipose cells and blood vessels. On immunohistochemical staining, the smooth muscle cells were positive for a melanocytic cell-specific monoclonal antibody. In cases with uncommon features of angiomyolipoma, it is quite difficult to distinguish angiomyolipoma from hepatocellular carcinoma.

Masahiro Takahara, Yasuhiro Miyake, Kazuyuki Matsumoto, Daisuke Kawai, Eisuke Kaji, Tatsuya Toyokawa, Morihito Nakatsu, Masaharu Ando, Mamoru Hirohata

2009-06-01

256

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

257

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

Directory of Open Access Journals (Sweden)

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

258

Fracture nonunion: CT assessment with multiplanar reconstruction and role of CT in suspected and difficult cases  

International Nuclear Information System (INIS)

The author evaluated ten patients with suspected fracture nonunion using CT with multiplanar reconstruction. Each case represented a difficult problem in fracture management. Disparities in clinical and radiographic findings led orthopedists to request multiplanar CT to confirm or further evaluate possible nonunion. CT with multiplanar reconstruction delineated lack of bony bridging across the fracture site in multiple planes, clarifying the diagnosis of nonunion in eight of ten cases. Evaluation of nonunion in bone subjected to multiple prior operations or with remaining hardware in place was possible (six cases). Multiplanar reconstruction aided assessment of malalignment and angular deformities in multiple views and provided additional information regarding the nonviability of the femoral head in two proximal femur fractures

259

Double needle technique: an alternative method for performing difficult sacroiliac joint injections.  

Science.gov (United States)

The sacroiliac joint (SIJ) is a common source of low back pain. The most appropriate method of confirming SIJ pain is to inject local anesthesia into the joint to find out if the pain decreases. Unfortunately, although the SIJ is a large joint, it can be difficult to enter due to the complex nature of the joint and variations in anatomy. In my experience a double needle technique for sacroiliac joint injection can increase the chances of accurate injection into the SIJ in difficult cases. After obtaining appropriate fluoroscopic images, the tip of the needle is advanced into the SIJ. Once the tip of the needle is correctly placed, its position is checked under continuous fluoroscopy while moving the C-arm in the right and left oblique directions (dynamic fluoroscopy). On dynamic fluoroscopy the tip of the needle should remain within the joint line and not appear to be on the bone. If the tip of the needle appears to be on the bone a new joint line will need to be identified (the most translucent area through the joint) by dynamic fluoroscopy and another needle advanced into the newly identified joint line. Dynamic fluoroscopy is repeated again to confirm that the tip of the second needle remains within the joint line. Once both needles are in place contrast dye is injected through the needle that is most likely to be in the SIJ. If the contrast dye spread is not satisfactory then it is injected through the other needle. I have used this technique in 10 patients and found it very helpful in accurately performing SIJ injection which can at times be challenging. PMID:21587331

Gupta, Sanjeeva

2011-01-01

260

Categories children find easy and difficult to process in figural analogies  

Directory of Open Access Journals (Sweden)

Full Text Available Analogical reasoning, the ability to learn about novel phenomena by relating it to structurally similar knowledge, develops with great variability in children. Furthermore, the development of analogical reasoning coincides with greater working memory efficiency and increasing knowledge of the objects and rules present in analogy problems. In figural matrices, a classical form of analogical reasoning assessment, some categories, such as color, appear easier for children to encode and infer than others, such as orientation. Yet, few studies have structurally examined differences in the difficulty of rule-types across different age-groups. This cross-sectional study of figural analogical reasoning examined which underlying rules in figural analogies were easier or more difficult for children to correctly process. School children (N=1422, M=7.0 years, SD=21 months, range 4.5-12.5 years were assessed in analogical reasoning using classical figural matrices and memory measures. The transformations the children had to induce and apply concerned the categories: animal, color, orientation, position, quantity and size. The role of age and memory span on the children’s ability to correctly process each type of transformation was examined using explanatory item response theory models. The results showed that with increasing age and/or greater memory span all transformations were processed more accurately. The “what” transformations animal, color, quantity and size were easiest, whereas the “where” transformations orientation and position were most difficult. However, animal, orientation and position became relatively easier with age and increased memory efficiency. The implications are discussed in terms of the development of visual processing in object recognition versus position and motion encoding, the ventral (“what” and dorsal (“where” pathways respectively.

ClaireEStevenson

2014-08-01

 
 
 
 
261

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

262

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.

263

[Effectiveness of the GlideScope(®) video laryngoscope in a case of unexpected difficult airway due to lingual tonsil hypertrophy.  

Science.gov (United States)

Lingual tonsil hypertrophy can cause varying degrees of airway obstruction and is considered a risk factor for difficult mask ventilation and tracheal intubation. We report a case of unexpected difficult airway in a patient with unknown lingual tonsil hypertrophy that was solved with the use of the GlideScope(®) video laryngoscope. PMID:25487764

Cruz, P; Alarcón, L; Del Castillo, T; Cabrerizo, P; Díaz, S

2014-12-01

264

Comparison of the glidescope, CMAC, storz DCI with the Macintosh laryngoscope during simulated difficult laryngoscopy: a manikin study  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Abstract Background Videolaryngoscopy presents a new approach for the management of the difficult and rescue airway. There is little available evidence to compare the performance features of these devices in true difficult laryngoscopy. Methods A prospective randomized crossover study was performed comparing the performance features of the Macintosh Laryngoscope, Glidescope, Storz CMAC and Storz DCI videolaryngoscope. Thirty anesthesia providers attempted intuba...

Healy David W; Picton Paul; Morris Michelle; Turner Christopher

2012-01-01

265

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.

266

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

267

Vía aérea difícil: interacciones entre ortodoncia y anestesiología / Difficult airway: relationship between orthodontics and anaesthesiology  

Scientific Electronic Library Online (English)

Full Text Available SciELO Spain | Language: Spanish Abstract in spanish Introducción: La intubación endotraqueal es una técnica bien estandarizada pero sin embargo, dependiendo de la experiencia del operador, alteraciones anatómicas o impuestas por la patología, pueden existir situaciones en las que no se puede ventilar al paciente. Objetivo: Pretendemos identificar la [...] implicación de nuestra disciplina en el control de la via aérea de pacientes que requieren anestesia o reanimación respiratoria o hemodinámica. Metodos: Se han estudiado los hallazgos clínicos denominados «poco tranquilizadores» publicados en la guía clínica de la Sociedad Americana de Anestesiología (ASA) para establecer una via aérea difícil a la intubación. Hemos tratado de ver y traducir estas situaciones clínicas desde el punto de vista ortodóncico-odontológico. Resultados: De los once criterios de riesgo de la ASA, podemos modificar favorablemente, con tratamientos ortodóncicos y ortopédicos convencionales, seis de ellos y parte de las situaciones adscritas al apartado cinco (grados III y IV de la clasificación de Mallampati-Samsoon). Conclusión: Parece adecuado considerar las posibilidades del tratamiento ortodóncico y la ortopedia dentofacial, no sólo como instrumento de tratamiento de maloclusiones habituales, sino como profilaxis de algunas situaciones que pueden desencadenar problemas ante situaciones de urgencia, como es la dificultad de intubación previa a una intervención quirúrgica. Abstract in english Introduction: Endotracheal intubation is a well standardised technique although depending on the experience of the operator, anatomical or pathology-related alterations, there may exist situations in which the patient cannot receive ventilation. Objective: We aim to identify the implication of our s [...] peciality in the control of the airway of patients requiring anaesthesia or respiratory or hemodynamic resuscitation. Methods: We have studied the clinical findings termed «non-reassuring» published in the PRACTICE GUIDELINES FOR MANAGEMENT OF THE DIFFICULT AIRWAY of the American Society of Anaesthesiology (ASA) in order to establish an airway difficult for intubation. We have attempted to view and translate these clinical situations from the orthodontic-odontologic perspective. Results: Of the eleven ASA risk criteria, we can favourably modify, with conventional orthodontic and orthopaedic treatments, six of these and part of the situations ascribed to Section five (degrees III and IV of the Mallampati-Samsoon classification). Conclusion: It seems fitting to consider the possibilities of orthodontic treatment and dentofacial orthopaedics, not only as an instrument for treating habitual malocclusions, but rather as a prophylaxis for some situations that can trigger off problems in emergency situations, such as the difficulty of intubation before a surgical operation.

Félix de, Carlos-Villafranca; Juan, Cobo-Plana; Emilio, Macías-Escalada; Juliana, Martínez.

2005-04-01

268

Dexmedetomidine for awake intubation and an opioid-free general anesthesia in a superobese patient with suspected difficult intubation  

Directory of Open Access Journals (Sweden)

Full Text Available Tomasz Gaszynski,1 Ewelina Gaszynska,2 Tomasz Szewczyk31Department of Anesthesiology and Intensive Therapy, 2Department of Hygiene and Health Promotion, 3Department of Gastroenterology, Oncology, and General Surgery, Barlicki University Hospital, Medical University of Lodz, PolandAbstract: Super-obese patients (body mass index [BMI] >50 kg/m2 are at a particularly high risk of anesthesia-related complications during postoperative period, eg, critical respiratory events including respiratory arrest, and over-sedation leading to problems with maintaining airway open, hypoxia and hypercapnia. In this paper authors present a case of a 39-year-old super-obese (BMI 62.3 kg/m2 female patient who was admitted for surgical treatment of obesity. Preanesthesia evaluation revealed hypertension and type 2 diabetes mellitus (DM as comorbidities as well as potential for a difficult intubation– neck circumference of 46 cm, reduced neck mobility and DM type 2. Patient was intubated using "awake intubation" method using topical anesthesia and dexmedetomidine infusion. General anesthesia was maintained with sevoflurane and dexmedetomidine infusion instead of opioid administration in "opioid-free anesthesia method".Keywords: morbid obesity, non-opioid anesthesia, dexmedetomidine

Gaszynski T

2014-07-01

269

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

270

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

271

Forty month follow-up of persistent and difficultly controlled acromegalic patients treated with depot long acting somatostatin analog octreotide  

International Nuclear Information System (INIS)

The objective of the present study was to investigate the effects of octreotide long acting release (S-LAR) preparation on growth hormone (GH) and insulin-like growth factor (IGF)-1 serum concentrations and pituitary tumor size in patients with persistent and difficultly controlled acromegaly even after adjuvant irradiation and/or dopamine agonists. Thirty-three patients with active acromegaly (26 female and 7 male, mean age; 43.94±14.01 standard deviation (SD) years) were included in this study. Patients were evaluated at baseline and at 6, 12, 30 and 40 months for GH, IGF-1, and GH response to oral glucose tolerance test (OGTT) and biliary ultrasonography. Sella MRI was performed at initial and at 40 months. All patients received 20 mg S-LAR. Afterwards, the dosage was titrated to improve individual GH response and reduction of IGF-1 into normal ranges. Basal serum IGF-1 levels decreased from median: 530 ?g/l [IQR: 420-600] to 340 ?g/l [IQR: 230-460] at 6 months (p=0.01), to 400 ?g/l [IQR: 222.4-600] at 12 months (p=0.48), to 396 ?g/l [IQR: 318-468] at 30 months (p=0.49), to 482 ?g/l [308-580] at 40 months (p=0.47). Nadir GH levels in OGTT fell from 2.70 ng/ml [IQR: 1.35-6.90] to 1.60 ng/ml [IQR: 0.36-4.10] at 6 months (p=0.03), to 0.31 ng/ml [IQR: 0.18-0.65] at 12 months (p<0.0001), to 1.50 ng/ml [IQR: 0.83-4.00] at 30 months (p=0.398) and to 0.89 ng/ml [IQR: 0.58-1.35] at 40 months (p<0.0001). Initially, pituitary adenoma volume was median: 1.18 ml [IQR: 0.0volume was median: 1.18 ml [IQR: 0.08-3.50] and it shrank to 0.21 ml [IQR: 0-2.1] at 40 months (p=0.08). Gallstones were detected in 12 patients and six of them underwent cholecystectomy. S-LAR is an effective treatment regimen in reducing GH and IGF-1 concentrations and as well as in shrinking tumor volume in persistent and difficultly controlled acromegalic patients. (author)

272

Perinatal risk factors including malformation  

International Nuclear Information System (INIS)

The study gives a survey of the factors most frequently mentioned in the literature as factors likely to adversely affect a pregnancy. One essential aspect is the discussion of those factors that can be counted among the causes of malformations, as among others, prenatal radiation exposure. The study prepared within the framework of the research project 'Radiobiological environmental monitoring in Bavaria' is intended to serve as a basis for a retrospective and prospective evaluation of infant mortality, perinatal conditions and occurrence of malformations in Bavaria, with the principal idea of drawing up an environment - related health survey. The study therefore, in addition to ionizing radiation also takes into account other detectable risks within the ecologic context, as e.g. industrial installations, refuse incineration plants or waste dumps, or urbanity. (orig./MG)

273

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)

274

Pseudomixoma peritonei, a rare entity difficult to diagnose and treat - case report.  

Science.gov (United States)

The authors present the case of a 56 year-old patient diagnosed with pseudomyxoma peritonei, 4 years after being subjected to a left adnexectomy for ovarian cystadenoma. The intra-parietal insemination of the mucinous cells enabled the development,at this level, of a gelatinous mass that raised problems of differential diagnosis with irreducible incisional hernia. In what regards the preoperative signs of clinical and paraclinical diagnosis we consider them obscure and nonspecific. The abdominal computed tomography revealed the presence of a massive intraperitoneal collection, but given the rarity of this pathology the initial diagnosis was made in the course of the exploratory laparotomy. Intraoperatively it became necessary to perform the omentectomy and total hysterectomy with contralateral adnexectomy and appendectomy. The histopathological examination confirmed the diagnosis. Using cisplatin associated with aggressive surgical cytoreduction this case of pseudomixoma had a good long-term evolution. The diagnosis was a challenge, and the nonspecific slow evolution of the disease led to difficult differential diagnostic. PMID:25560512

Mavrodin, Ci; Pariza, G; Iordache, V; Iorga, P; Sajin, M

2014-01-01

275

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

Directory of Open Access Journals (Sweden)

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

2007-06-01

276

A Cascade Optimization Strategy for Solution of Difficult Multidisciplinary Design Problems  

Science.gov (United States)

A research project to comparatively evaluate 10 nonlinear optimization algorithms was recently completed. A conclusion was that no single optimizer could successfully solve all 40 problems in the test bed, even though most optimizers successfully solved at least one-third of the problems. We realized that improved search directions and step lengths, available in the 10 optimizers compared, were not likely to alleviate the convergence difficulties. For the solution of those difficult problems we have devised an alternative approach called cascade optimization strategy. The cascade strategy uses several optimizers, one followed by another in a specified sequence, to solve a problem. A pseudorandom scheme perturbs design variables between the optimizers. The cascade strategy has been tested successfully in the design of supersonic and subsonic aircraft configurations and air-breathing engines for high-speed civil transport applications. These problems could not be successfully solved by an individual optimizer. The cascade optimization strategy, however, generated feasible optimum solutions for both aircraft and engine problems. This paper presents the cascade strategy and solutions to a number of these problems.

Patnaik, Surya N.; Coroneos, Rula M.; Hopkins, Dale A.; Berke, Laszlo

1996-01-01

277

Parent perspectives on biomarkers for OCD: Talking of difficult presents, desired pasts, and imagined futures  

DEFF Research Database (Denmark)

This paper investigates parent perspectives on potential future applications of neuroimaging and genetic research in the obsessive-compulsive disorder (OCD) clinic: for prediction, diagnosis, and treatment choice. It does so with a reflective eye on parental motivations for discussing near but still uncertain technological futures, and with attention to the conceptual and normative difficulties that such time-travelling talk presents. Grounded in qualitative interviews with parents whose children had participated in an OCD neuroimaging and genetic research study in the United States, we situate parent discussions of imagined futures in their projections from difficult presents and into desired pasts. Parents reported apparently high receptivity to potential future technological scenarios, connected to central challenges they faced in relation to OCD. Yet when parents responded to questions about biomarker tests with the reply, 'yes, anything that helps', uncertainty, caution, and resistance were expressed in implicit negotiations over what it means to 'help'. This paper further considers what the analysis of parent perspectives can contribute to ongoing attempts to situate questions about biological selfhood and the ontological status of the brain and genes in the concrete specificities of individual lived experience; where knowledge is defined in relation to both the actions and rhetorics it facilitates.

Whiteley, Louise Emma; Borgelt, Emily L

2014-01-01

278

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

Directory of Open Access Journals (Sweden)

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

279

Spectral synthesis including massive binaries  

Digital Repository Infrastructure Vision for European Research (DRIVER)

We have constructed a new code to produce synthetic spectra of stellar populations that includes massive binaries. We have tested this code against the broadband colours of unresolved young massive stellar clusters in nearby galaxies, the equivalent widths of the Red and Blue Wolf-Rayet bumps in star-forming SDSS galaxies and the UV and optical spectra of the star forming regions Tol-A and B in NGC5398. In each case we find a good agreement between our models and observation...

Eldridge, John J.; Stanway, Elizabeth R.

2009-01-01

280

Cognitive processing load across a wide range of listening conditions: insights from pupillometry.  

Science.gov (United States)

The pupil response to speech masked by interfering speech was assessed across an intelligibility range from 0% to 99% correct. In total, 37 participants aged between 18 and 36 years and with normal hearing were included. Pupil dilation was largest at intermediate intelligibility levels, smaller at high intelligibility, and slightly smaller at very difficult levels. Participants who reported that they often gave up listening at low intelligibility levels had smaller pupil dilations in these conditions. Participants who were good at reading masked text had relatively large pupil dilation when intelligibility was low. We conclude that the pupil response is sensitive to processing load, and possibly reflects cognitive overload in difficult conditions. It seems affected by methodological aspects and individual abilities, but does not reflect subjective ratings. PMID:24506437

Zekveld, Adriana A; Kramer, Sophia E

2014-03-01

 
 
 
 
281

Boltzmann equations including quantum coherence  

Energy Technology Data Exchange (ETDEWEB)

Based on the Schwinger-Keldysh formalism, we develop a novel approximation scheme (cQPA) to study the nonequilibrium dynamics of fermionic quantum fields in the limit of weak interactions and slowly varying background. Compared to standard kinetic approach with Boltzmann equations, we are able to include the effects of quantum coherence in the presence of decohering collisions. The key element in our formalism is the finding of new singular shell solutions for 2-point Wightman functions in noninteracting theory, which are located in the phase space at k{sub 0}=0 in single flavor case and at k{sub 0}=({+-}{omega}{sub i}{+-}{omega}{sub j})/2 in the mass basis of multiple flavor mixing fields. These new shell solutions are shown to encode the information on quantum coherence between particles and antiparticles of possibly different flavor states. Imposing this phase space structure as an ansatz to the interacting theory leads to a closed set of equations of motion (extended Boltzmann equations) for the corresponding on-shell distribution functions, with a well defined collision integral. This formalism has potentially a variety of applications in particle physics of the early universe, including baryogenesis, leptogenesis and neutrino flavor oscillations.

Fidler, Christian; Herranen, Matti [Institut fuer Theoretische Physik E, RWTH Aachen University, D - 52056 Aachen (Germany); Kainulainen, Kimmo; Rahkila, Pyry M. [Department of Physics, P.O. Box 35 (YFL), University of Jyvaskyla (Finland); Helsinki Institute of Physics, P.O. Box 64, University of Helsinki (Finland)

2010-07-01

282

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

Directory of Open Access Journals (Sweden)

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

283

AUTOMATIC MESH ADAPTIVITY FOR CADIS AND FW-CADIS NEUTRONICS MODELING OF DIFFICULT SHIELDING PROBLEMS  

Energy Technology Data Exchange (ETDEWEB)

The hybrid Monte Carlo/deterministic techniques CADIS and FW-CADIS 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 restricted by the availability of computing resources for their preliminary deterministic calculations and the large computer memory requirements of their final Monte Carlo calculations. Three automatic mesh adaptivity algorithms were developed to reduce the memory requirements of CADIS and FW-CADIS without sacrificing their efficiency improvement. First, a macromaterial 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 some maximum number of mesh elements. Finally, a weight window coarsening algorithm decouples the weight window mesh from the mesh of the deterministic calculations to remove the memory constraint of the weight window map from the deterministic mesh resolution. The three algorithms were used to calculate the prompt dose rate throughout the entire ITER experimental facility. Compared to a FW-CADIS calculation with the same weight window map memory requirement, using the three algorithms resulted in a 23.3% increase in the regions where 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 the accurate performance of this difficult global Monte Carlo calculation, which traditionally needed high performance computing, using a FW-CADIS simulation on a regular computer cluster.

Ibrahim, Ahmad M [ORNL; Wilson, P. [University of Wisconsin; Peplow, Douglas E. [ORNL; Mosher, Scott W [ORNL; Sawan, M. [University of Wisconsin; Wagner, John C [ORNL; Evans, Thomas M [ORNL

2013-01-01

284

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

Energy Technology Data Exchange (ETDEWEB)

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)

Ibrahim, A. M.; Peplow, D. E.; Mosher, S. W.; Wagner, J. C.; Evans, T. M. [Oak Ridge National Laboratory, P.O. Box 2008, Oak Ridge, TN 37831 (United States); Wilson, P. P.; Sawan, M. E. [University of Wisconsin-Madison, 1500 Engineering Dr., Madison, WI 53706 (United States)

2013-07-01

285

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

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: Portuguese Abstract in portuguese 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 suspeit [...] a 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. Abstract in english OBJECTIVE: The aim of this study is to analize the efficacy of laparoscopy in cases of acute inflamatory abdomen of difficult diagnosis, according to accuracy, sensitivity, specificity and negative and positive predictive values. METHODS: The authors studied, prospectively, 29 patients with clinical [...] suspicion of inflamatory acute abdomen, that, after inconclusive clinical and complemental investigations were submitted to diagnostic and / or therapeutic laparoscopy. RESULTS: In 96,5 % of the patients the procedure confirmed the diagnosis; 58,6 % of the patients were treated by laparoscopy, 6,8% by laparotomy and 34,4% received clinical treatment. The complication rate was 10,3 %, with no mortality in this study. Patients treated by laparoscopy were discharged from hospital in 36 hours after the procedure. CONCLUSIONS: Laparoscopy proved to be a good diagnostic and therapeutic method in acute inflamatory diseases of the abdomen and is associated with lower hospitalization time and lower rate of complications.

Antonio Carlos, Valezi; Jorge, Mali Junior; Rodrigo Gomes de, Oliveira; Mario, Liberatti; Antonio César, Marson; Edivaldo Macedo de, Brito.

2003-08-01

286

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)

287

Can HRCT be used as a marker of airway remodelling in children with difficult asthma?  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Background Whole airway wall thickening on high resolution computed tomography (HRCT is reported to parallel thickening of the bronchial epithelial reticular basement membrane (RBM in adult asthmatics. A similar relationship in children with difficult asthma (DA, in whom RBM thickening is a known feature, may allow the use of HRCT as a non-invasive marker of airway remodelling. We evaluated this relationship in children with DA. Methods 27 children (median age 10.5 [range 4.1–16.7] years with DA, underwent endobronchial biopsy from the right lower lobe and HRCT less than 4 months apart. HRCTs were assessed for bronchial wall thickening (BWT of the right lower lobe using semi-quantitative and quantitative scoring techniques. The semi-quantitative score (grade 0–4 was an overall assessment of BWT of all clearly identifiable airways in HRCT scans. The quantitative score (BWT %; defined as [airway outer diameter – airway lumen diameter]/airway outer diameter ×100 was the average score of all airways visible and calculated using electronic endpoint callipers. RBM thickness in endobronchial biopsies was measured using image analysis. 23/27 subjects performed spirometry and the relationships between RBM thickness and BWT with airflow obstruction evaluated. Results Median RBM thickness in endobronchial biopsies was 6.7(range 4.6 – 10.0 ?m. Median qualitative score for BWT of the right lower lobe was 1(range 0 – 1.5 and quantitative score was 54.3 (range 48.2 – 65.6%. There was no relationship between RBM thickness and BWT in the right lower lobe using either scoring technique. No relationship was found between FEV1 and BWT or RBM thickness. Conclusion Although a relationship between RBM thickness and BWT on HRCT has been found in adults with asthma, this relationship does not appear to hold true in children with DA.

Jeffery PK

2006-03-01

288

Advertising and the internet: the difficult convergence Publicidade e internet: a difícil convergência  

Directory of Open Access Journals (Sweden)

Full Text Available Advertising and the internet: the difficult convergence — Ever since the crisis of Fordism, competition between companies has led to an increasingly fierce quest to draw the consumer's attention to advertisements, engendering what we call audience saturation resulting from the ubiquitousness of advertising. This saturation is aggravated as the rising costs of broadcasting in the mass media continually drive advertisers to seek new forms of addressing the consumer. In this context, it would be reasonable to expect the Internet to become a privileged route of access to the consumer. However, the Internet's relevance in traditional advertising is still negligible, at least in Brazil. This article strives to demonstrate this phenomenon, analyzing some recurring opinions in the advertising sector and explaining it in the light of an understanding of a broader advertising dynamics, thus contributing to the debate on the consequences of the advent of the Internet for the communication system and for culture. Desde a crise do fordismo, a concorrência entre as empresas tem se traduzido em uma busca ainda mais frenética pela atenção do consumidor às mensagens publicitárias, o que levou ao que chamamos aqui de saturação da audiência, isto é, a banalização dos anúncios diante da sua multiplicação. Essa saturação é agravada quando o aumento dos custos de veiculação nos meios de comunicação de massa estimula os publicitários a buscarem novas formas de interpelação do consumidor. Nesse cenário, não seria de esperar que a internet despontasse como uma rota privilegiada de acesso ao consumidor? No entanto, a sua relevância para a publicidade tradicional é pequena no Brasil. Pretendemos então demonstrar esse fato, analisar algumas opiniões recorrentes a esse respeito, dentro do campo publicitário, e explicá-lo à luz de uma compreensão da dinâmica publicitária mais abrangente. Nesse percurso, poderemos dar alguma contribuição ao debate sobre as consequências do advento da internet para o sistema de comunicação e a cultura.

Maria Eduarda da Mota Rocha

2009-09-01

289

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

290

Dealing with difficult deformations: Construction of a knowledge-based deformation atlas  

DEFF Research Database (Denmark)

Twenty-three Taiwanese infants with unilateral cleft lip and palate (UCLP) were CT-scanned before lip repair at the age of 3 months, and again after lip repair at the age of 12 months. In order to evaluate the surgical result, detailed point correspondence between pre- and post-surgical images was needed. We have previously demonstrated that non-rigid registration using B-splines is able to provide automated determination of point correspondences in populations of infants without cleft lip. However, this type of registration fails when applied to the task of determining the complex deformation from before to after lip closure in infants with UCLP. The purpose of the present work was to show that use of prior information about typical deformations due to lip closure, through the construction of a knowledge-based atlas of deformations, could overcome the problem. Initially, mean volumes (atlases) for the pre- and post-surgical populations, respectively, were automatically constructed by non-rigid registration. An expert placed corresponding landmarks in the cleft area in the two atlases; this provided prior information used to build a knowledge-based deformation atlas. We model the change from pre- to post-surgery using thin-plate spline warping. The registration results are convincing and represent a first move towards an automatic registration method for dealing with difficult deformations due to this type of surgery. New or breakthrough work to be presented: The method provides a simple way of dealing with complex morphological changes using knowledge of typical deformations.

Thorup, Signe Strann; Darvann, T.A.

2010-01-01

291

Risk Factors and Complications Associated with Difficult Retrieval of Embolic Protection Devices in Carotid Artery Stenting  

International Nuclear Information System (INIS)

Purpose: This study was designed to investigate the risk factors and complications of difficult retrieval (DR) of embolic protection devices (EPDs) in carotid artery stenting (CAS). Methods: A total of 195 consecutive patients who underwent CAS between December 2007 and March 2010 in a general hospital were enrolled and divided into two groups: with DR and without DR. The risk factors of DR were analyzed with univariate and multivariate analyses. The complications of DR were recorded and analyzed. Results: A total of 30 (15.4%) patients with DR of EPDs were observed, of whom EPDs were successfully retrieved in 29, and in 1 was it taken out by surgical treatment. The retrieval time was significantly longer in patients with DR (490.5 ± 143.9 s) than in patients without DR (157.2 ± 15.7 s, p = 0.000). Vasospasm was observed more frequently in patients with DR than in patients without DR (55.2% vs. 14.5%, p = 0.000). Intracranial compilations were more frequent in patients with DR than in those without DR (17.2% vs. 0.6%, p = 0.000). Calcified plaques, degree of residual stenosis, types of the stents, and tortuosity index (TI > 80°) were all associated with DR. A logistic regression analysis indicated that calcified plaques (odds ratio (OR) = 6.5; p = 0.000) and TI > 80° (OR = 18.8; p = 0.000) were independent predictors of DR. Conclusions: Calcified plaques and TI > 80° may be related to DR in patients with CAS. DR may lengthen the retrieving time and increase the che retrieving time and increase the complications of the procedure.

292

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

Directory of Open Access Journals (Sweden)

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

293

Predictive factors for difficult mask ventilation in the obese surgical population  

Science.gov (United States)

Background Difficult Mask Ventilation (DMV), is a situation in which it is impossible for an unassisted anesthesiologist to maintain oxygen saturation >90% using 100% oxygen and positive pressure ventilation to prevent or reverse signs of inadequate ventilation during mask ventilation.  The incidence varies from 0.08 – 15%. Patient-related anatomical features are by far the most significant cause.  We analyzed data from an obese surgical population (BMI> 30 kg/m 2) to identify specific risk and predictive factors for DMV. Methods Five hundred and fifty seven obese patients were identified from a database of 1399 cases associated with preoperative airway examinations where mask ventilation was attempted. Assessment of mask ventilation in this group was stratified by a severity score (0-3), and a step-wise selection method was used to identify independent predictors.  The area under the curve of the receiver-operating-characteristic was then used to evaluate the model’s predictive value. Adjusted odds ratios and their 95% confidence intervals were also calculated. Results DMV was observed in 80/557 (14%) patients. Three independent predictive factors for DMV in obese patients were identified: age 49 years, short neck, and neck circumference  43 cm. In the current study th sensitivity for one factor is 0.90 with a specificity 0.35. However, the specificity increased to 0.80 with inclusion of more than one factor. Conclusion According to the current investigation, the three predictive factors are strongly associated with DMV in obese patients. Each independent risk factor alone provides a good screening for DMV and two factors substantially improve specificity. Based on our analysis, we speculate that the absence of at least 2 of the factors we identified might have a significant negative predictive value and can reasonably exclude DMV, with a negative likelihood ratio 0.81. PMID:25485099

Cattano, Davide; Katsiampoura, Anastasia; Corso, Ruggero M.; Killoran, Peter V.; Cai, Chunyan; Hagberg, Carin A.

2014-01-01

294

Difficult Decisions: Animal Rights--Do We Have the Right to Do Research on Animals?  

Science.gov (United States)

Discusses who has the right to determine the use of animals in scientific research which includes medical experimentation and the toxicity testing of compounds, ranging from pesticides to cosmetics. Provides a list of questions for consideration and discussion. (RT)

Parakh, Jal S.; Slesnick, Irwin L.

1989-01-01

295

Device including a contact detector  

DEFF Research Database (Denmark)

The present invention relates to a probe for determining an electrical property of an area of a surface of a test sample, the probe is intended to be in a specific orientation relative to the test sample. The probe may comprise a supporting body defining a first surface. A plurality of cantilever arms (12) may extend from the supporting body in co-planar relationship with the first surface. The plurality of cantilever arms (12) may extend substantially parallel to each other and each of the plurality of cantilever arms (12) may include an electrical conductive tip for contacting the area of the test sample by movement of the probe relative to the surface of the test sample into the specific orientation.; The probe may further comprise a contact detector (14) extending from the supporting body arranged so as to contact the surface of the test sample prior to any one of the plurality of cantilever arms (12) contacting the surface of the test sample when performing the movement.

Petersen, Dirch Hjorth Technical University of Denmark,

296

Classifying Conditionals  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Classifying Conditionals Mathieu Vidal Abstract: In natural language there exists a type of sentence called conditionals. They are characterized in English by the use of connectors. These connectors can be different but fulfil, in most cases, at least two conditions: they link two sentences and they contain the word 'if'. The semantic developed to treat this type of sentences is generally a non-classical one and its most famous representative is intensional logi...

Vidal, Mathieu

2002-01-01

297

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

298

Addicts with chronic hepatitis C: Difficult to reach, manage or treat?  

Science.gov (United States)

AIM: To assess the acceptance, safety and efficacy of care and treatment for chronic hepatitis C (CHC) in drug addicts. METHODS: We designed a multidisciplinary, phase IV prospective cohort study. All illicit drug users (IDUs) visited a Territorial Addiction Service (SerT) in the District of Brescia, and hepatitis C antibody (HCVAb) testing positive were offered as part of a standardised hepatologic visit in our Gastroenterology Unit. Patients with confirmed CHC and without medical contraindications were administered peginterferon alfa-2b 1.5 ?g/kg per week plus ribavirin (800-1400 mg/d) for 16-48 wk. All IDUs were unselected because of ongoing addiction and read and signed an informed consent form. Virologic responses at weeks 4 and 12 of therapy, at the end of treatment and 24 wk after the end of treatment were the main measures of efficacy. Adherence was estimated according to the 80/80/80 criteria. RESULTS: From November 2007 to December 2009, 162 HCVAb+ IDUs were identified. Sixty-seven patients (41% of the initial cohort) completed the diagnostic procedure, and CHC was diagnosed in 54 (33% of the total). Forty-nine patients were offered therapy, and 39 agreed (80% of acceptance rate). The prevalent HCV genotype was type 1, and the HCV RNA baseline level was over 5.6 log/mL in 61% of cases. Five patients dropped out, two because of severe adverse events (SAEs) and three without medical need. Twenty-three and 14 patients achieved end of treatment responses (ETRs; 59%) and sustained virologic responses (SVRs; 36%), respectively. Thirty-one patients were fully compliant with the study protocol (80% adherence). The prevalence of host and viral characteristics negatively affecting the treatment response was high: age over 40 years (54%), male gender (85%), overweight body type (36%), previous unsuccessful antiviral therapy (21%), HCV genotype and viral load (60% and 62%, respectively), earlier contact with HBV (40%) and steatosis and fibrosis (44% and 17%, respectively). In a univariate analysis, alcohol intake was associated with a non-response (P = 0.0018, 95%CI: 0.0058-0.4565). CONCLUSION: Drug addicts with CHC can be successfully treated in a multidisciplinary setting using standard antiviral combination therapy, despite several “difficult to reach, manage and treat” characteristics. PMID:24307794

Zanini, Barbara; Benini, Federica; Pigozzi, Marie Graciella; Furba, Patrizia; Giacò, Ernesto; Cinquegrana, Antonia; Fasoli, Mariagrazia; Lanzini, Alberto

2013-01-01

299

Addicts with chronic hepatitis C: Difficult to reach, manage or treat?  

Directory of Open Access Journals (Sweden)

Full Text Available AIM: To assess the acceptance, safety and efficacy of care and treatment for chronic hepatitis C (CHC in drug addicts. METHODS: We designed a multidisciplinary, phase IV prospective cohort study. All illicit drug users (IDUs visited a Territorial Addiction Service (SerT in the District of Brescia, and hepatitis C antibody (HCVAb testing positive were offered as part of a standardised hepatologic visit in our Gastroenterology Unit. Patients with confirmed CHC and without medical contraindications were administered peginterferon alfa-2b 1.5 ?g/kg per week plus ribavirin (800-1400 mg/d for 16-48 wk. All IDUs were unselected because of ongoing addiction and read and signed an informed consent form. Virologic responses at weeks 4 and 12 of therapy, at the end of treatment and 24 wk after the end of treatment were the main measures of efficacy. Adherence was estimated according to the 80/80/80 criteria. RESULTS: From November 2007 to December 2009, 162 HCVAb+ IDUs were identified. Sixty-seven patients (41% of the initial cohort completed the diagnostic procedure, and CHC was diagnosed in 54 (33% of the total. Forty-nine patients were offered therapy, and 39 agreed (80% of acceptance rate. The prevalent HCV genotype was type 1, and the HCV RNA baseline level was over 5.6 log/mL in 61% of cases. Five patients dropped out, two because of severe adverse events (SAEs and three without medical need. Twenty-three and 14 patients achieved end of treatment responses (ETRs; 59% and sustained virologic responses (SVRs; 36%, respectively. Thirty-one patients were fully compliant with the study protocol (80% adherence. The prevalence of host and viral characteristics negatively affecting the treatment response was high: age over 40 years (54%, male gender (85%, overweight body type (36%, previous unsuccessful antiviral therapy (21%, HCV genotype and viral load (60% and 62%, respectively, earlier contact with HBV (40% and steatosis and fibrosis (44% and 17%, respectively. In a univariate analysis, alcohol intake was associated with a non-response (P = 0.0018, 95%CI: 0.0058-0.4565. CONCLUSION: Drug addicts with CHC can be successfully treated in a multidisciplinary setting using standard antiviral combination therapy, despite several “difficult to reach, manage and treat” characteristics.

Barbara Zanini

2013-01-01

300

The Soviet doctor and the treatment of drug addiction: "A difficult and most ungracious task"  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract This paper reviews the development of early Soviet drug treatment approaches by focusing on the struggle for disciplinary power between leading social and mental hygienists and clinical psychiatrists as a defining moment for Soviet drug treatment speciality that became known as "narcology." From this vantage point, I engage in the examination of the rise and fall of various treatment methods and conceptualizations of addiction in Russian metropolitan centres and look at how they were imported (or not to other Soviet republics. As clinical psychiatrists appeared as undisputed victors from the battle with social and mental hygienists, the entire narcological arsenal was subdued in order to serve the needs of mainstream psychiatry. However, what that 'mainstream' would be, was not entirely clear. When, in 1934, Aleksandr Rapoport insisted on the need for re-working narcological knowledge in line with the Marxist approach, he could only raise questions and recognise that there were almost no "dialectically illuminated scientific data" to address these questions. The maintenance treatment of opiate users, which emerged as the most effective one based on the results of a six-year study published in 1936, was definitely not attuned to the political and ideological environment of the late 1930s. Maintenance was rather considered as a temporary solution, in the absence of radical therapeutic measures to free Soviet society from "narkomania." As the Great Terror swept across the Soviet Union, Stalin's regime achieved its objective of eliminating drug addiction from the surface of public life by driving opiate users deep underground and incarcerating many of them in prisons and the Gulag camps. In the final section, I briefly discuss the changing perceptions of drug use during the World War II and outline subsequent transformations in Soviet responses to the post-war opiate addiction [Additional file 1]. Additional file 1 Abstract. The Soviet doctor and the treatment of drug addiction: "A difficult and most ungracious task". A Russian translation of an abstract of this article. Click here for file

Latypov Alisher B

2011-12-01

 
 
 
 
301

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

302

The probability that a small perturbation of a numerical analysis problem is difficult  

CERN Document Server

We prove a general theorem providing smoothed analysis estimates for conic condition numbers of problems of numerical analysis. Our probability estimates depend only on geometric invariants of the corresponding sets of ill-posed inputs. Several applications to linear and polynomial equation solving show that the estimates obtained in this way are easy to derive and quite accurate. The main theorem is based on a volume estimate of \\epsilon-tubular neighborhoods around a real algebraic subvariety of a sphere, intersected with a disk of radius \\sigma. Besides \\epsilon and \\sigma, this bound depends only the dimension of the sphere and on the degree of the defining equations.

Buergisser, P; Lotz, M; Buergisser, Peter; Cucker, Felipe; Lotz, Martin

2006-01-01

303

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

304

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

305

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

306

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.

2008-06-01

307

A novel modified method of using Trachway intubating stylet for awake tracheal intubation in patients with anticipated difficult airway.  

Science.gov (United States)

The Trachway intubating stylet is designed to facilitate tracheal intubation in anesthetized patients with a normal or difficult airway anatomy. The shortcoming of this device is the lack of a working channel to provide topicalization of the airway. We describe a novel modified method of using Trachway intubating stylet to provide airway topicalization and perform awake orotracheal intubation in two cases with an anticipated difficult airway. The first case was a superobese patient with a cervical spine disorder, whereas the second case was a patient with an enlarged thyroid gland. Transtracheal lidocaine injection was technically difficult in these patients because of neck obesity and thyroid enlargement, respectively. We believe that this modified method can be used to provide effective airway topicalization when Trachway intubating stylet is used for awake orotracheal intubation. PMID:23968661

Hung, Kuo-Chuan

2013-06-01

308

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

309

25 CFR 20.403 - What do protective services include?  

Science.gov (United States)

...provided to a child, family or elderly person will...children, elderly, and families, including referrals...social conditions that affect community well-being...problems of individuals, families, and children. ...remove individuals in life threatening...

2010-04-01

310

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

311

Congenital talipes equinovarus in Papua New Guinea: a difficult yet potentially manageable situation  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Reports in the literature have suggested a high incidence of congenital deformities, including congenital talipes equinovarus (CTEV), in many Pacific Islands. This study performed a retrospective analysis of cases of CTEV in an isolated region of Papua New Guinea over a 2-year period. Data was collected on the incidence of CTEV, together with an analysis of initial treatment and outcome. The incidence of CTEV was 2.7 per 1,000 live births per year. A peak incidence of CTEV births in September...

Culverwell, A. D.; Tapping, C. R.

2009-01-01

312

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

313

Recurrent inverted nipple: a reliable technique for the most difficult cases.  

Science.gov (United States)

The inverted nipple is a frequent pathologic condition, involving up to 10% of women. This deformity results in a negative self-image for the affected patient. Recurrence after corrective surgery is possible and may represent extreme frustration for the patient and the surgeon. The aim of our study is to propose a useful and reliable technique to employ in case of recurrence or severe inverted nipple. During 2000 and 2010, the study was conducted on 19 patients treated with this procedure: 10 patients (20 nipples) having severe inverted nipple (grade III according to Han and Hong classification) and 9 patients (15 nipples) presenting with relapses. One nipple could not be corrected. One patient developed a temporary loss of sensibility. No major complications (necrosis, infection, hematoma, and permanent numbness), no recurrences, and no noticeable scars have been reported at follow-up. In our series, the shape and the projection after the procedure were evaluated as satisfactory by the patients, remained consistent over time, and no protective devices were required. In conclusion, although our technique is not the best in terms of invasiveness, it is one of the few truly effective ones in treating relapses. For patients who have already undergone surgery, the priority is certainly to solve this clinical anomaly and the psychological sequelae; a "microincision" or a scar-free technique is the secondary aspect to be taken into account. PMID:21659844

Bracaglia, Roberto; Tambasco, Damiano; Gentileschi, Stefano; D'Ettorre, Marco

2012-07-01

314

[A case of primary unknown cancer difficult to distinguish from lung cancer].  

Science.gov (United States)

A 26-year-old man was admitted to our hospital with dyspnea, fever, and weight loss. A chest X-ray showed multiple tumor shadows, and a computed tomography (CT) scan showed swelling of the mediastinal and hilar lymph nodes, a mass in the retroperitoneum, and an embolus in the inferior vena cava. A biopsy from the left cervical lymph node revealeda poorly differentiated adenocarcinoma. Metastatic lung cancer was suspected, but in spite of the examinations, its primary site was unknown. Serum alfa-fetoprotein(AFP)was slightly elevated, but an AFP stain of the tumor was negative. The patient's respiratory failure rapidly worsened, and therefore, additional examinations could not be performed. The patient received chemotherapy with carboplatin and paclitaxel. His condition improved, but the tumor increased in size after 5 courses of chemotherapy. He received chemotherapy with docetaxel as second-line treatment, but it was not effective. The third-line chemotherapy regimen with carboplatin and gemcitabine was effective. In total, he received 7 lines of chemotherapy, and he lived for approximately 12 months since receiving the first chemotherapy regimen. After he died, we were able to perform OCT-4 immunohistochemistry on a tumor biopsy specimen from the lymph node, which came back positive for OCT-4. Therefore, we made a final diagnosis of extragonadal germ cell cancer syndrome. PMID:24917010

Tanaka, Yoko; Tago, Kentaro; Narabayashi, Tomoko; Sasaki, Yoshiaki; Iwahashi, Eriko; Hibino, Chihiro; Iwasaki, Teruo; Watanabe, Takahiro; Kasugai, Tsutomu; Kohama, Joji; Ohno, Kiyoshi

2014-05-01

315

Pioderma Gangrenoso: apresentação clínica de difícil diagnóstico Pyoderma gangrenosum: a clinical manifestation of difficult diagnosis  

Directory of Open Access Journals (Sweden)

Full Text Available Pioderma gangrenoso é uma dermatose cutânea ulcerativa incomum, associada a uma variedade de doenças sistêmicas, incluindo doença inflamatória intestinal, artrites, neoplasias hematológicas, hepatites e aids. A sua patogênese é desconhecida. O diagnóstico geralmente é baseado em evidências clínicas e confirmado com a exclusão das outras etiologias de lesões ulceradas cutâneas. Relatamos um caso de PG com ulcerações extensas com boa resposta ao tratamento.Pyoderma gangrenosum is an uncommon ulcerative cutaneous dermatosis associated with a variety of systemic diseases including inflammatory bowel disease, arthritis, hematological malignancies, hepatitis and acquired immunodeficiency syndrome (AIDS. The pathogenesis of pyoderma gangrenosum remains unknown. Its diagnosis is usually based on clinical evidence and confirmed through a process of elimination of the other possible causes of cutaneous ulcers. This report describes a case of pyoderma gangrenosum with extensive ulceration that responded well to treatment.

Mônica Santos

2011-02-01

316

Pioderma Gangrenoso: apresentação clínica de difícil diagnóstico / Pyoderma gangrenosum: a clinical manifestation of difficult diagnosis  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: Portuguese Abstract in portuguese Pioderma gangrenoso é uma dermatose cutânea ulcerativa incomum, associada a uma variedade de doenças sistêmicas, incluindo doença inflamatória intestinal, artrites, neoplasias hematológicas, hepatites e aids. A sua patogênese é desconhecida. O diagnóstico geralmente é baseado em evidências clínicas [...] e confirmado com a exclusão das outras etiologias de lesões ulceradas cutâneas. Relatamos um caso de PG com ulcerações extensas com boa resposta ao tratamento. Abstract in english Pyoderma gangrenosum is an uncommon ulcerative cutaneous dermatosis associated with a variety of systemic diseases including inflammatory bowel disease, arthritis, hematological malignancies, hepatitis and acquired immunodeficiency syndrome (AIDS). The pathogenesis of pyoderma gangrenosum remains un [...] known. Its diagnosis is usually based on clinical evidence and confirmed through a process of elimination of the other possible causes of cutaneous ulcers. This report describes a case of pyoderma gangrenosum with extensive ulceration that responded well to treatment.

Mônica, Santos; Carolina, Talhari; Renata Fernandes, Rabelo; Antonio Pedro Mendes, Schettini; Carlos Alberto, Chirano; Sinésio, Talhari.

2011-02-01

317

Why is co-infection with influenza virus and bacteria so difficult to control?  

Science.gov (United States)

Influenza viruses are genetically labile pathogens which avoid immune detection by constantly changing their coat proteins. Most human infections are caused by mildly pathogenic viruses which rarely cause life-threatening disease in healthy people, but some individuals with a weakened immune system can experience severe complications. Widespread infections with highly pathogenic strains of influenza virus are less common, but have the potential to cause enormous death tolls among healthy adults if infection rates reach pandemic proportions. Increased virulence has been attributed to a variety of factors, including enhanced susceptibility to co-infection with common strains of bacteria. The mechanisms that facilitate dual infection are a major focus of current research, as preventative measures are needed to avert future pandemics PMID:25636959

Cauley, Linda S.; Vella, Anthony T.

2015-01-01

318

[Two cases of lymphoma in an implant capsule: A difficult diagnosis, an unknown pathology].  

Science.gov (United States)

The anaplastic large cell lymphoma (ALCL) is a rare disease, its incidence in the United States is one case per 500,000 women and three for 100 million patients for breast single location. Forty-six cases have been reported in the literature. They can grow on any type of implant: expander prosthesis silicone and saline, smooth or textured envelope. Currently, the consensus process includes capsulectomy, removal of the implant, chemotherapy and radiotherapy. However, some authors classify under indolent disease, but we believe that some cases may escape any therapeutic and become very aggressive forms. It is therefore important to make an early diagnosis and start treatment urgently. Severity and suspicion of iatrogenic nature of ALCL have an obligation to inform future with implants. PMID:23707084

Ivaldi, C; Perchenet, A S; Jallut, Y; Casanova, D

2013-12-01

319

Congenital talipes equinovarus in Papua New Guinea: a difficult yet potentially manageable situation.  

Science.gov (United States)

Reports in the literature have suggested a high incidence of congenital deformities, including congenital talipes equinovarus (CTEV), in many Pacific Islands. This study performed a retrospective analysis of cases of CTEV in an isolated region of Papua New Guinea over a 2-year period. Data was collected on the incidence of CTEV, together with an analysis of initial treatment and outcome. The incidence of CTEV was 2.7 per 1,000 live births per year. A peak incidence of CTEV births in September suggested that maternal anaemia secondary to malaria was a significant risk factor. Good functional outcome was confirmed in only 20% of cases following initial treatment. The authors suggest the Ponseti method as a realistic option for treating CTEV in this region and that it could be instigated with minimal resources and training. PMID:18196240

Culverwell, A D; Tapping, C R

2009-04-01

320

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

International Nuclear Information System (INIS)

Current radiation protection is a very sophisticated and elaborate domain where, once the information about the exposure of persons is known in terms of the quantity of the effective dose, we can predict resulting radiological consequences related to the stochastic risk to the health of the exposed persons without a need for other details. In fact, the effective dose contains all pertinent information including the average organ dose distribution and relevant radiation and tissue weighting factors which take into account the specific effects of different types of radiation and selected tissue radiosensitivity. Since the effective dose cannot be measured directly, one has to rely on the monitoring of other appropriate measurable quantities and then do some conversions. The current structure of radiation protection quantities includes too many quantities, the definitions of some of which are not easy to understand and interpret. Moreover, there are numerous quantities based on the dose equivalent, such as the equivalent dose, effective dose, committed equivalent dose, committed effective dose, collective equivalent dose, collective effective dose, personal dose equivalent, ambient dose equivalent and directional dose equivalent, where the only unit of Sv is used.. There are a number of cases in open literature reflecting the difficulties and mistakes in the use of radiation protection quantities. Even more complicated situations are encountered in the field, where the staff responsible for personal and workplace monitoring is confused because of so many different quantities and where the staff may not be qualified and experienced enough to be able to make the relevant conversions and interpretations. The paper summarizes our experience in teaching students and lecturing in various training courses addressing radiation protection where the primary task was to ensure that all radiation protection personnel understood the quantities and units used in radiation protection in the correct way consistent with their latest definitions and ICRP recommendations. (author)

 
 
 
 
321

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

322

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

323

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

324

Preparing mine rescue teams for deployment under tough climatic conditions  

Energy Technology Data Exchange (ETDEWEB)

A large number of all mine rescue team operations for fighting open or concealed mine fires and many interventions to open and check old, sealed off mine workings have to be undertaken under tough climatic conditions. Rescue beam members have not only to be up to heavy physical workloads and be trained for endurance, but also acclimatised to difficult climatic conditions or introduced to them. Exercises will prepare the men to their difficult work. In 1983 the Central Mine Rescue Station of Bergbau-Forschung set up a climate test facility in which team members undergo exercises at dry-bulb temperatures of up to 50/sup 0/C and relative humidities of up to 70%. In addition to a 100 min standard exercise with a 10 min climatic part (tsub(t)=40/sup 0/C; tsub(f)=31/sup 0/C) other exercises from 15 to 75 min duration were organised with different clothing, including cooling clothing. Cooling vests can keep the physiological indicators (heart rate and rectal temperature) lower with the same workload and at high climatic values, thereby extending deployment time. Climatic exercises show mine rescue team members their performance limits and high climatic values. This makes them respect the set deployment times without further ado. This makes underground operations safer. (orig.).

Funkemeyer, M.; Stoklossa, J.

1985-09-26

325

The palm print as a sensitive predictor of difficult laryngoscopy in diabetics: a comparison with other airway evaluation indices.  

Directory of Open Access Journals (Sweden)

Full Text Available AIMS: To evaluate the ink impression made by the palm of the dominant hand as a screening tool for difficult laryngoscopy in diabetic patients. SUBJECTS AND METHODS: In this prospective study, airway of 50 adult diabetic patients, undergoing elective surgery under general anaesthesia, was assessed preoperatively using the common clinical indices such as Modified Mallampati test, thyromental distance, degree of head extension and a specific index- the palm print test. Following induction of anaesthesia and neuromuscular relaxation, laryngoscopy was performed and the laryngoscopic view scored. The sensitivity, specificity and positive predictive value of each airway evaluation index were calculated. RESULTS: The incidence of difficult laryngoscopy was 16%. The palm print test had the highest sensitivity (75% of all the indices. The thyromental distance less than six cm had the highest specificity (95.2% but was least sensitive (25%. 87% of patients with difficult laryngoscopy had two or more indices abnormal. CONCLUSION: Though the palm print test was the most sensitive index of the four indices studied, a better prediction of difficult laryngoscopy can be achieved by evaluating all the four airway indices preoperatively.

Vani V

2000-04-01

326

Use of GlideScope for double lumen endotracheal tube insertion in an awake patient with difficult airway.  

Science.gov (United States)

There is scientific evidence that an anticipated difficult airway must be managed with the patient being awake. The GlideScope has been proven to be a useful device to intubate the trachea in some instances when difficult airway is present, and particularly in the awake patient. It has also been used for double lumen tube (DLT) in the anaesthetized patient, but its use with DLT in both circumstances, awake patients with difficult airway has not been described. GlideScope enabled us to achieve accurate local anesthetic spraying and a successful endotracheal intubation with a double lumen tube (DLT) in an awake patient with predicted difficult airway and bronchoaspiration risk. Different ways to resolve cases like this can be found in the anesthetic literature, but we think this could be another option to bear in mind. We also describe a new variation in the maneuver of introducing a DLT into the trachea under GlideScope view as DLT presents with some difficulties when introduced under normal circumstances. This option could add some risk for the patients when used in inexperienced hands and there is not sufficient scientific evidence in the literature to recommend it for all cases. PMID:23849718

Onrubia, X; Lluch-Oltra, A; Armero, R; Baldó, J

2014-01-01

327

Changes in Interest and Affect during a Difficult Reading Task: Relationships with Perceived Difficulty and Reading Fluency  

Science.gov (United States)

This study investigated changes in middle school students' interest and affect during a moderately difficult reading task. The aim was to explore how changes in interest (topic and situational) and affect were related to students' reading fluency throughout the task and perceived difficulty. Interest and affect were recorded at four time points:…

Fulmer, Sara M.; Tulis, Maria

2013-01-01

328

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

329

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

Science.gov (United States)

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 20×20 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. PMID:24765479

Abid, Sandreddine Ben; Hefaiedh, Rania; Zghab, Sameh; Miloudi, Nizar; Gharbi, Lassad; Khalfallah, Mohamed Taher

2012-01-01

330

Making a task difficult: evidence that device-oriented steps are effortful and error-prone.  

Science.gov (United States)

Errors in the execution of procedural tasks can have severe consequences. Attempts to ameliorate these slip errors through increased training and motivation have been shown to be ineffective. Instead, we identified the steps in a task procedure on which errors are most likely to occur, so that these might be designed out of the task procedure in the first place. Specifically, we considered whether device-oriented steps (i.e., steps in the task procedure that do not directly contribute to the achievement of the task goal) are more error-prone than task-oriented steps (i.e., steps that do directly contribute to the task goal). Two experiments are reported in which participants were trained to perform a novel procedural task. Across conditions, we manipulated the extent to which each step in the task procedure appeared to contribute to the achievement of the task goal (i.e., alternating the assignment of a task step between device- and task-oriented), while keeping the interface and underlying task procedure the same. Results show that participants made more errors and took longer to complete a task step when it played a device-oriented role rather than a task-orientated role. These effects were exacerbated by the introduction of a secondary task designed to increase working memory load, suggesting that when a task step plays a device-oriented role it is more weakly represented in memory. We conclude that device-oriented task steps are inherently problematic and should be avoided where possible in the design of task procedures. PMID:24059822

Ament, Maartje G A; Cox, Anna L; Blandford, Ann; Brumby, Duncan P

2013-09-01

331

Extubation of the perioperative patient with a difficult airway / Extubación del paciente perioperatorio con una vía aérea difícil  

Scientific Electronic Library Online (English)

Full Text Available SciELO Colombia | Language: Spanish Abstract in spanish Existe un volumen importante de literatura dedicada al tema del manejo de la vía aérea difícil, y se han desarrollado una serie de algoritmos y recomendaciones para el manejo seguro de pacientes en riesgo de una intubación difícil. Sin embargo, solo recientemente se ha despertado una mayor concienci [...] a acerca de la extubación de la vía aérea difícil, pues aun cuando sea un procedimiento programado, suele estar plagado de complicaciones. La importancia de desarrollar estrategias pre-programadas para la extubación de la vía aérea difícil a fin de aumentar la seguridad del paciente y sus desenlaces se hace evidente a partir de los datos del ASA Closed Claims Analysis y del reciente Cuarto Proyecto Nacional de Auditoría del Reino Unido sobre complicaciones mayores en el manejo de la vía aérea. La clave para un manejo exitoso de los pacientes en riesgo de extubación difícil es efectuar una evaluación precisa de riesgo, aplicar estrategias apropiadas y la preparación tanto del médico como de la institución. Abstract in english A considerable amount of literature has been dedicated to the topic of difficult airway management and a number of algorithms and recommendations have been established to safely manage patients at risk for difficult intubation. Only recently, however, has extubation of the difficult airway gained mo [...] re awareness since this procedure, although elective, is often fraught with complications. The importance of developing pre-planned strategies for extubation of the difficult airway to improve patient safety and outcomes is apparent from data from both the ASA Closed Claims Analysis and the UK's recent Fourth National Audit Project of major complications of airway management. The key to successful management of patients at risk for difficult extubation is accurate risk assessment, application of appropriate strategies, and preparedness by both the individual practitioner and the institution.

Carin A., Hagberg; Carlos A., Artime.

2014-10-01

332

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

333

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

334

Inclusion-body myositis: a difficult diagnosis? / Miosite por corpos de inclusão: um diagnóstico difícil?  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: English Abstract in portuguese A miosite por corpos de inclusão (MCI) esporádica é a miopatia mais comum acima dos 55 anos de idade. No entanto, em muitos casos, o diagnóstico é negligenciado. Os principais achados incluem fraqueza muscular progressiva, níveis séricos normais ou levemente elevados de creatinoquinase (CK) e ausênc [...] ia de resposta à imunossupressão. A biópsia muscular evidencia reação inflamatória associada com alterações degenerativas das fibras musculares. Apresentamos um caso típico de MCI cujo diagnóstico foi obtido após a realização de uma terceira biopsia muscular. Discutimos os desafios para a confirmação do diagnóstico histológico e os cuidados que podem evitar repetições do exame. Abstract in english Sporadic inclusion-body myositis (IBM) is the most common myopathy in individuals over 55 years of age. However, in many cases, the diagnosis is neglected. Its main findings include progressive muscle weakness, normal or low levels of serum creatine kinase, and the absence of a response to immunosup [...] pression. Muscle biopsy shows inflammatory reaction in association with degenerative changes of the muscle fibers. We report a typical case of IBM, in which diagnosis was possible only after three muscle biopsies. The challenges to confirm histological diagnosis and the caution to avoid repeating tests are discussed.

Carolina da Cunha, Correia; Maria Clara de Oliveira, Magalhães; Pedro Lucas de Mendonça, Barbosa; Eliene Dutra, Campos; Edmar, Zanoteli.

2014-10-01

335

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

336

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

337

Determination of chlorothalonil in difficult-to-analyse vegetable matrices using various multiresidue methods.  

Science.gov (United States)

The molecular characteristics of chlorothalonil can cause particular determination difficulties in some vegetable commodities such as leek or garlic. These difficulties are mainly related to the low recoveries obtained using common multi-residue methods (MRMs)--a consequence of the very high interaction level with natural components in the matrix. These shortcomings were pointed out in the last European Proficiency Test for Pesticide Residues on Fruits and Vegetables, where false negatives for chlorothalonil in leek were observed at around 50%. In this study we have evaluated the ethyl acetate, the Dutch mini-Luke and the QuEChERS MRMs to compare their capabilities for chlorothalonil determination using GC-MS/MS in both the electron impact ionization (EI) and negative chemical ionization (NCI) modes. Best recoveries (in the range of 100-120%, with an RSD below 20%) were obtained using the Dutch mini-Luke method. Lower values (52-70%) were obtained for ethyl acetate whereas no recovery was obtained when the QuEChERS method was applied. Furthermore, tomato matrix was also included in the experiments in order to facilitate the comparability of results. Two ionization modes, electron impact ionization (EI) and negative chemical ionization (NCI) in GC-MS/MS, were applied to evaluate their respective advantages and disadvantages for quantification and identification. As expected, NCI showed limits of detection (LODs) 5 to 10 times lower than EI. However, in both cases, the LODs were still below 10 ?g kg(-1). The proposed optimal method was applied for chlorothalonil determination in leek and garlic with good results--in accordance with the European Union (EU) Analytical Quality Control (AQC) Guidelines for pesticides analysis. PMID:22500289

Belmonte Valles, N; Retamal, M; Martínez-Uroz, M A; Mezcua, M; Fernández-Alba, A R; de Kok, A

2012-05-21

338

Systematizing semishortening conditions  

Science.gov (United States)

We rederive semishortening conditions for four-dimensional superconformal field theory with a different approach. These conditions have similar patterns that can be generalized to weaker constraints, including all those of Dolan and Osborn [Ann. Phys. (Amsterdam) 307, 41 (2003)]. In particular, for the case of N =4 super-Yang-Mills theory formulated in projective superspace, we find constraints for all Bogomol'nyi-Prasad-Sommerfield operators. We also give an example how constraints can be found from known ones. These constraints are a subset of our maximal set of semishortening conditions.

Ju, C.-Y.; Siegel, W.

2014-12-01

339

Automatic Mesh Adaptivity for Hybrid Monte Carlo/Deterministic Neutronics Modeling of Difficult Shielding Problems  

Science.gov (United States)

Over the last decade, the role of neutronics modeling has been shifting from analysis of each component separately to high fidelity, full-scale analysis of the nuclear systems' entire domains. The high accuracy, associated with minimizing modeling approximations and including more physical and geometric details, is now feasible because of advancements in computing hardware and development of efficient modeling methods. The hybrid Monte Carlo/deterministic techniques, CADIS and FW-CADIS, dramatically increase the efficiency of neutronics modeling, but their use in the design of very large and geometrically complex nuclear systems can be restricted by the availability of computing resources for their preliminary deterministic calculations and the large computer memory requirements of their final Monte Carlo calculations. To reduce the computational time and memory requirements of the CADIS and FW-CADIS methods, while maintaining their efficiency improvements, three automatic mesh adaptivity algorithms were developed and added to the AutomateD VAriaNce reducTion Generator (ADVANTG) code. First, a macromaterial approach, which mixes the materials for the deterministic calculations, enhances the fidelity of the deterministic models without changing the mesh. Second, a deterministic mesh refinement algorithm improves the accuracy of structured mesh deterministic calculations by developing meshes that capture as much geometric detail as possible without exceeding some maximum number of mesh elements, usually determined by the availability of computing resources. Finally, a weight window coarsening algorithm decouples the weight window mesh from the mesh of the deterministic calculations to remove the memory constraint of the weight window map from the deterministic mesh resolution. The three algorithms were used to increase the efficiency of a FW-CADIS calculation of the prompt dose rate throughout the entire ITER experimental facility. This calculation represents a very challenging shielding problem because of the immense size and complexity of the ITER structure. Compared to a FW-CADIS calculation with the same storage size of the variance reduction parameters, the use of the three algorithms resulted in a 23.3% increase in the regions where the dose rate results are achieved in a 10 day Monte Carlo calculation and increased the efficiency of the Monte Carlo simulation by a factor of 3.4.

Ibrahim, Ahmad

340

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

 
 
 
 
341

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

342

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  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: English Abstract in portuguese 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. Abstract in english 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 complianc [...] e 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.

Laura S., Ward.

343

Difficult diagnoses of two cases of double cancer involving malignant lymphoma with peritoneal localization and malignant abdominal tumor.  

Science.gov (United States)

We encountered two cases of malignant lymphoma with peritoneal localization complicated by sigmoid colon cancer and hepatocellular carcinoma. Multiple primary cancers were suspected on the basis of differences in absorption values on computed tomography (CT) and differences in the degree of accumulation on positron emission tomography CT; however, a definitive diagnosis based on these findings alone was difficult. Endoscopic ultrasound-guided fine-needle aspiration was useful for determining the diagnosis and treatment strategy. In cases of double cancers involving malignant lymphoma with peritoneal localization and malignant abdominal tumor, differentiation and staging are often difficult, which increases the risk of selecting the wrong treatment strategy. Therefore, care must be taken when diagnosing these diseases. PMID:25482905

Inoue, Tadahisa; Okumura, Fumihiro; Mizushima, Takashi; Nishie, Hirotada; Iwasaki, Hiroyasu; Anbe, Kaiki; Ozeki, Takanori; Kachi, Kenta; Fukusada, Shigeki; Sano, Hitoshi

2014-12-01

344

Clinical management and outcome of refractory asthma in the UK from the British Thoracic Society Difficult Asthma Registry  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Refractory asthma represents a significant unmet clinical need. Data from a national online registry audited clinical outcome in 349 adults with refractory asthma from four UK specialist centres in the British Thoracic Society Difficult Asthma Network. At follow-up, lung function improved, with a reduction in important healthcare outcomes, specifically hospital admission, unscheduled healthcare visits and rescue courses of oral steroids. The most frequent therapeutic intervention was maintena...

Sweeney, Joan; Brightling, Chris E.; Menzies-gow, Andrew; Niven, Robert; Patterson, Chris C.; Heaney, Liam G.

2012-01-01

345

Radiofrequency Ablation with the Real-Time Virtual Sonography System for Treating Hepatocellular Carcinoma Difficult to Detect by Ultrasonography  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Radiofrequency ablation has been applied to treat hepatocellular carcinoma, with favorable therapeutic outcomes. Nevertheless, practitioners have approached radiofrequency ablation with some reluctance due to the difficulty of identifying isoechoic tumors and recurrent tumors. The aim of the present study is to investigate the efficacy of Real-time Virtual Sonography to treat hepatocellular carcinoma difficult to detect by conventional ultrasonography. Real-time Virtual Sonography is a system...

Kawasoe, Hiroaki; Eguchi, Yuichiro; Mizuta, Toshihiko; Yasutake, Tsutomu; Ozaki, Iwata; Shimonishi, Tomonori; Miyazaki, Kohji; Tamai, Tsutomu; Kato, Akira; Kudo, Sho; Fujimoto, Kazuma

2007-01-01

346

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)

347

3D seismic experiment in difficult area in Japan; Kokunai nanchiiki ni okeru sanjigen jishin tansa jikken  

Energy Technology Data Exchange (ETDEWEB)

Difficult area in this context means an exploration-difficult area supposed to store oil/gas but retarded in exploration for the lack of knowledge about the geological structure due to poor quality of available seismic survey records. Discussed in this paper is a survey conducted into an area covering the southern part of Noshiro-shi, Akita-ken, and Yamamoto-cho, Yamamoto-gun, Akita-ken. An area size suitable for data collection at a target depth of 2500m is determined using an interpretation structure compiled on the basis of available well data and 2D seismic survey data. The plan for siting shock points and receiving points is modified case by case as restrictive factors come to the surface (resulting from the complicated hilly terrain, presence of pipes for agricultural water, etc.). The peculiarities of seismic waves in the terrain are studied through the interpretation of the available well data and 2D seismic survey data for the construction of a 3D velocity model for the confirmation of the appropriateness of the plan for siting shock points and receiving points. Efforts are exerted through enhanced coordination with the contractor to acquire data so that a technologically best design may be won within the limits of the budget. The quality of the data obtained from this experiment is in general better than those obtained from previous experiments, yet many problems remain to be settled in future studies about exploration-difficult areas. 4 refs., 4 figs., 1 tab.

Minegishi, M.; Nakagami, K.; Tanaka, H. [Japan National Oil Corp., Tokyo (Japan). Technology Research Center

1997-05-27

348

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

349

Extending Newtonian Dynamics to Include Stochastic Processes  

Science.gov (United States)

A paper presents further results of continuing research reported in several previous NASA Tech Briefs articles, the two most recent being Stochastic Representations of Chaos Using Terminal Attractors (NPO-41519), [Vol. 30, No. 5 (May 2006), page 57] and Physical Principle for Generation of Randomness (NPO-43822) [Vol. 33, No. 5 (May 2009), page 56]. This research focuses upon a mathematical formalism for describing post-instability motions of a dynamical system characterized by exponential divergences of trajectories leading to chaos (including turbulence as a form of chaos). The formalism involves fictitious control forces that couple the equations of motion of the system with a Liouville equation that describes the evolution of the probability density of errors in initial conditions. These stabilizing forces create a powerful terminal attractor in probability space that corresponds to occurrence of a target trajectory with probability one. The effect in configuration space (ordinary three-dimensional space as commonly perceived) is to suppress exponential divergences of neighboring trajectories without affecting the target trajectory. As a result, the post-instability motion is represented by a set of functions describing the evolution of such statistical quantities as expectations and higher moments, and this representation is stable.

Zak, Michail

2009-01-01

350

Diagnostic accuracy of anaesthesiologists' prediction of difficult airway management in daily clinical practice: a cohort study of 188 064 patients registered in the Danish Anaesthesia Database.  

Science.gov (United States)

Both the American Society of Anesthesiologists and the UK NAP4 project recommend that an unspecified pre-operative airway assessment be made. However, the choice of assessment is ultimately at the discretion of the individual anaesthesiologist. We retrieved a cohort of 188 064 cases from the Danish Anaesthesia Database, and investigated the diagnostic accuracy of the anaesthesiologists' predictions of difficult tracheal intubation and difficult mask ventilation. Of 3391 difficult intubations, 3154 (93%) were unanticipated. When difficult intubation was anticipated, 229 of 929 (25%) had an actual difficult intubation. Likewise, difficult mask ventilation was unanticipated in 808 of 857 (94%) cases, and when anticipated (218 cases), difficult mask ventilation actually occurred in 49 (22%) cases. We present a previously unpublished estimate of the accuracy of anaesthesiologists' prediction of airway management difficulties in daily routine practice. Prediction of airway difficulties remains a challenging task, and our results underline the importance of being constantly prepared for unexpected difficulties. PMID:25511370

Nørskov, A K; Rosenstock, C V; Wetterslev, J; Astrup, G; Afshari, A; Lundstrøm, L H

2015-03-01

351

Difficult comparison; Schwieriger Vergleich  

Energy Technology Data Exchange (ETDEWEB)

c-Si technology as well as thin-film technology could live in coexistence in the future instead of fighting for market shares. The technology is not crucial for the company's success. The success of a company is based on its strategy.

Colville, Finlay [NPD Solarbuzz, Port Washington, NY (United States)

2013-05-01

352

COMMUNICATING WITH DIFFICULT CUSTOMERS  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Ob?inska uprava opravlja pomembno vlogo pri neposrednem stiku z uporabniki njenih storitev. Kakovost njenih storitev se v veliki meri odraža pri zadovoljstvu strank. Namen in cilj diplomske naloge je, da z raziskavo na Mestni ob?ini Kranj ugotovimo, kako bi lahko izboljšali odnose med javnimi uslužbenci in strankami. Vse to z namenom, da bi zmanjšali število težavnih strank, prepre?ili nepotrebne konflikte ter omogo?ili javnim uslužbencem nemoteno delovanje. Problem, ki s...

Pritekelj, Teja

2009-01-01

353

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

354

Terrestrial photovoltaic performance reference conditions  

Science.gov (United States)

The rationale behind the selection of key photovoltaic performance reference (reporting) conditions, including the standard Air Mass 1.5 solar spectrum and reference irradiance and cell temperature levels, is investigated. Besides providing a repeatable reference for performance comparisons, it is shown that the choice of reference conditions directly controls the accuracy of array energy output prediction calculations. Conclusions are drawn on the accuracy associated with present reference conditions, and recommendations are made concerning alternative reference conditions with improved accuracy.

Ross, R. G., Jr.

1981-01-01

355

Transnasal Humidified Rapid-Insufflation Ventilatory Exchange (THRIVE): a physiological method of increasing apnoea time in patients with difficult airways.  

Science.gov (United States)

Emergency and difficult tracheal intubations are hazardous undertakings where successive laryngoscopy-hypoxaemia-re-oxygenation cycles can escalate to airway loss and the 'can't intubate, can't ventilate' scenario. Between 2013 and 2014, we extended the apnoea times of 25 patients with difficult airways who were undergoing general anaesthesia for hypopharyngeal or laryngotracheal surgery. This was achieved through continuous delivery of transnasal high-flow humidified oxygen, initially to provide pre-oxygenation, and continuing as post-oxygenation during intravenous induction of anaesthesia and neuromuscular blockade until a definitive airway was secured. Apnoea time commenced at administration of neuromuscular blockade and ended with commencement of jet ventilation, positive-pressure ventilation or recommencement of spontaneous ventilation. During this time, upper airway patency was maintained with jaw-thrust. Transnasal Humidified Rapid-Insufflation Ventilatory Exchange (THRIVE) was used in 15 males and 10 females. Mean (SD [range]) age at treatment was 49 (15 [25-81]) years. The median (IQR [range]) Mallampati grade was 3 (2-3 [2-4]) and direct laryngoscopy grade was 3 (3-3 [2-4]). There were 12 obese patients and nine patients were stridulous. The median (IQR [range]) apnoea time was 14 (9-19 [5-65]) min. No patient experienced arterial desaturation rate of increase in end-tidal carbon dioxide was 0.15 kPa.min(-1) . We conclude that THRIVE combines the benefits of 'classical' apnoeic oxygenation with continuous positive airway pressure and gaseous exchange through flow-dependent deadspace flushing. It has the potential to transform the practice of anaesthesia by changing the nature of securing a definitive airway in emergency and difficult intubations from a pressured stop-start process to a smooth and unhurried undertaking. PMID:25388828

Patel, A; Nouraei, S A R

2015-03-01

356

A simple method for the preparation of difficult 99mTc complexes using surface adsorbed stannous ions  

International Nuclear Information System (INIS)

A simple new technique where stannous tin is adsorbed on the inner surface of plastic tubing and used to reduce (99mTc) pertechnetate prior to labelling radiopharmaceuticals, has been evaluated, using some lipophillic and metal containing ligands. Complexes formed using the technique had good labelling efficiency and behaved the same in rat biodistribution studies as those prepared using conventional labelling methods. The labelling efficiency of the ligands was not related to their lipophillicity suggesting that this technique may be useful for labelling lipophillic and other difficult ligands such as those containing metals, which are incompatible with free stannous ions in solution. (M.E.L.)

357

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.

2011-08-01

358

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

359

Italmontaggi builds expertise Conquering monsoons, adverse conditions Bangladesh pipelines  

Energy Technology Data Exchange (ETDEWEB)

Bangladesh natural gas pipeline projects have become a specialty for Italmontaggi Pte Ltd., Singapore-based gas pipeline contractor and engineering organization. The firm's latest project is a 35-mile, 24-in. gas pipeline, branching from the Bakhrabad-Chittagong main gas pipeline to the city gate station at Demra, near the capital city of Dacca. Gas is delivered to the Titas gas distribution system. The 35-mile turnkey project, valued at $25 million, included design, procurement, construction, and commissioning. A small pipeline was in existence from the Titas gas field to Dacca, but increased demand caused acute power shortages in the capital city's industrial areas. The new gas line will alleviate that problem. That project is a followup to Italmontaggi's successful completion of the major 108-mile, 24-in. main gas pipeline between the Bakhrabad gas fields, outside Dhaha, to the country's principal port and industrial center at Chittagong. Italmontaggi also installed 22 miles of ring main for the Chittagong gas distribution system. That included 12 miles of 24-in. and 10 miles of 16- and 20-in. to provide connections to industrial customers. Bangladesh lines difficult. The $45million contract for the Bakhrabad-toChittagong pipeline to Italmlontaggi, an autonomous offshoot of the Italian firm, resulted in a constant battle against hostile ground conditions, difficult access, and rapidly changing weather conditions. October-to- April is the dry season and Mayto-September is the wet season in this region. To keep the project moving, Italmontaggi developed two independent techniques for ground preparation during the wet season, and a pipelaying technique for the dry season. The new gas pipeline provides a major saving to the Bangladesh national economy as industries convert from oil to gas. Predicted savings are for more than $100 million in energy costs.

1984-10-01

360

Syngas Conditioning  

Energy Technology Data Exchange (ETDEWEB)

A brief review of water gas shift (WGS) catalysis is provided. An overview of the four general classes of WGS catalysts is presented, which include: 1) high temperature shift (HTS), 2) low temperature shift (LTS), 3) sulfur-tolerant shift catalysts, and 4) precious metal-based shift catalysts. A review of WGS utilizing monoliths or other reactor technologies that pertain to fuel cell applications, an area of increasing interest over the past several years, is also presented. Ratnasamy and Wagner have recently provided an outstanding and comprehensive review of WGS catalysis. A particular emphasis of that work is “catalyst surface structures, active sites, reaction intermediates, and mechanisms”, particularly for noble metal-based catalysts1. The summary provided here is a succinct review of water gas shift catalysis and reactors, with an emphasis on fuel processing applications for fuel cells, and is not intended to provide a comprehensive review of WGS technology.

Dagle, Robert A.; Karim, Ayman M.; Li, Guosheng; Su, Yu; King, David L.

2011-04-29

 
 
 
 
361

Difficult mask ventilation in general surgical population: observation of risk factors and predictors [v1; ref status: indexed, http://f1000r.es/47z  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Background: There are few predictors of difficult mask ventilation and a simple, objective, predictive system to identify patients at risk of difficult mask ventilation does not currently exist. We present a retrospective - subgroup analysis aimed at identifying predictive factors for difficult mask ventilation (DMV) in patients undergoing pre-operative airway assessment before elective surgery at a major teaching hospital. Methods: Data for this retrospective analysis were derived from a dat...

Davide Cattano; Killoran, Peter V.; Chunyan Cai; Katsiampoura, Anastasia D.; Corso, Ruggero M.; Hagberg, Carin A.

2014-01-01

362

Minimal deviation mucinous adenocarcinoma of the uterine cervix that proved difficult to differentiate from endometrial cancer: A case report.  

Science.gov (United States)

Minimal deviation adenocarcinoma (MDA), also known as adenoma malignum of the uterine cervix, accounts for only ~1% of uterine cervical adenocarcinomas. Adenoma malignum of the uterine cervix was initially described by Gusserow in 1870. Using magnetic resonance imaging (MRI), MDA appears as multilocular lesions with solid components that extend from the endocervical glands to the deep cervical stroma. Cytological evaluation and biopsies have low detection rates, therefore, it is difficult to diagnose MDA accurately prior to treatment. The current study describes a rare case of MDA that was difficult to differentiate from endometrial adenocarcinoma of the corpus uteri preoperatively, as the endometrial biopsy results suggested a well-differentiated endometrioid adenocarcinoma and MRI did not show typical images for MDA. A total abdominal hysterectomy with bilateral salpingo-oophorectomy was performed under the diagnosis of endometrial cancer, and the mass was subsequently diagnosed as MDA of the uterine cervix by pathological examination of the hysterectomy specimen. Postoperatively, although two types of adjuvant chemotherapy were performed, the remaining tumor continued to grow, causing obstruction of the bilateral ureters and leading to bilateral hydronephrosis. The patient is currently alive with the disease 10 months following the surgery. PMID:25364411

Nishii, Yuko; Fukuda, Takeshi; Imai, Kenji; Yamauchi, Makoto; Hashiguchi, Yasunori; Ichimura, Tomoyuki; Yasui, Tomoyo; Sumi, Toshiyuki

2014-12-01

363

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

364

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

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: Portuguese Abstract in portuguese 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 gr [...] ave 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. Abstract in english OBJECTIVE: To determine the prevalence of factors associated with difficult-to-control asthma. METHODS: Patients with severe asthma were selected from the outpatient asthma clinic of the Ribeirão Preto School of Medicine Hospital das Clínicas. The patients were divided into two groups: controlled se [...] vere asthma and difficult-to-control severe asthma. After new attempts to optimize the severe asthma treatment, a questionnaire was applied, and additional tests for factors associated with difficult-to-control asthma, such as environmental and occupational exposure, smoking history, social factors, rhinitis/sinusitis, gastroesophageal reflux disease (GERD), obstructive sleep apnea, congestive heart failure (CHF), pulmonary embolism, cystic fibrosis, vocal cord dysfunction, alpha-1 antitrypsin deficiency, and Churg-Strauss syndrome, were performed. RESULTS: 77 patients with severe asthma were selected, of which 47 suffered from hard-to-control asthma, being 68.1% female, with mean age of 44.4 years (±14.4), and forced expiratory volume in one second of 54.7% (±18.3). The most factors most often associated with difficult-to-control asthma were noncompliance with treatment (68%), rhinitis/sinusitis (57%), GERD (49%), environmental exposure (34%), occupational exposure (17%), smoking history (10%), obstructive sleep apnea (2%), and CHF (2%). At least one of these factors was identified in every case. CONCLUSIONS: Noncompliance with treatment was the factor most often associated with difficult-to-control asthma, underscoring the need to investigate comorbidities in the evaluation of patients with this form of the disease.

Ana Carla Sousa de, Araujo; Érica, Ferraz; Marcos de Carvalho, Borges; João, Terra Filho; Elcio Oliveira, Vianna.

2007-10-01

365

76 FR 35026 - Hutchinson Technology, Inc., Including On-Site Workers Leased From Doherty, Including Workers...  

Science.gov (United States)

...Including On-Site Workers Leased From Doherty, Including Workers Whose Unemployment...Including On-Site Workers Leased From Doherty, Including Workers Whose Unemployment...including on-site leased workers from Doherty, Hutchinson, Minnesota and...

2011-06-15

366

Diagnostics in low-temperature plasmas by laser spectroscopy: Expensive and difficult but worth all the trouble  

International Nuclear Information System (INIS)

In recent times, novel techniques and innovations of equipment have lead to a substantial improvement of laser spectroscopic diagnostics on low-temperature plasmas. This applies especially to the detection of charged species (electrons, positive and negative ions) and neutral radicals (atoms and molecules) as well as the measurement of electric fields. Spatially and temporally resolved measurements with high spectral resolution allow the non-invasive determination of a whole list of important parameters, e.g. temperature, density, velocity distribution, degree of dissociation, diffusion and reaction rates, sticking coefficients, voltages, currents etc. Available techniques are based generally either on scattering, absorption or fluorescence. Within this general frame a large variety of alternative schemes has been developed, especially in the case of multi-photon interaction. This sometimes confusing multitude of alternatives is necessary since as a matter of fact all schemes and techniques are limited to a certain parameter range and their applicability is determined strongly by the experimental conditions. The talk intends to give an overview on recent developments by introducing selected examples. This will include basic technical aspects as well as opportunities and limits of the interpretation of raw data for understanding the physics or chemistry of the discharge under investigation. An example is given below. The discharge presented was pulsed and for each pressure the decay of the relative density in the afterglow was traced by LIF. From the exponential part of the decay curve the decay time was determined by a least mean square fit. The non-linear behavior of the pressure scaling allows the determination of the chemical reaction rate for destruction of the radical in the discharge volume. Similar measurements on CF2 in the same discharge show that quite in contrast this radical is lost only by reaction at the reactor walls. (author)

367

42 CFR 409.10 - Included services.  

Science.gov (United States)

...2010-10-01 2010-10-01 false Included services. 409.10 Section 409.10 Public Health CENTERS FOR MEDICARE & MEDICAID...Services and Inpatient Critical Access Hospital Services § 409.10 Included services. (a) Subject to...

2010-10-01

368

Sommerfeld radiation condition at threshold  

DEFF Research Database (Denmark)

We prove Besov space bounds of the resolvent at low energies in any dimension for a class of potentials that are negative and obey a virial condition with these conditions imposed at infinity only. We do not require spherical symmetry. The class of potentials includes in dimension ? 3 the attractive Coulomb potential. There are two boundary values of the resolvent at zero energy which we characterize by radiation conditions. These radiation conditions are zero energy versions of the well-known Sommerfeld radiation condition.

Skibsted, Erik

2011-01-01

369

Fuel gas conditioning process  

Science.gov (United States)

A process for conditioning natural gas containing C.sub.3+ hydrocarbons and/or acid gas, so that it can be used as combustion fuel to run gas-powered equipment, including compressors, in the gas field or the gas processing plant. Compared with prior art processes, the invention creates lesser quantities of low-pressure gas per unit volume of fuel gas produced. Optionally, the process can also produce an NGL product.

Lokhandwala, Kaaeid A. (Union City, CA)

2000-01-01

370

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

371

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

Science.gov (United States)

...Catheter-Associated Infection. Surgical Site Infection Following: + Coronary Artery...Medicare's HACs, like Surgical Site Infection following CABG or Bariatric...research determined that Surgical Site Infection following CABG,...

2011-06-06

372

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

373

How to treat a difficult-to-anesthetize patient. Twelve alternatives to the traditional inferior alveolar nerve block.  

Science.gov (United States)

In the case of the difficult-to-anesthetize patient, the inferior alveolar nerve can be particularly challenging In those patients, other approaches may be necessary to achieve profound anesthesia. This article presents techniques that may be used in those efforts. The clinician can change his target slightly, or increase the dosage of anesthetic. Accessory innervation by lingual and mylohyoid nerves sometimes needs to be addressed. Some standard alternative approaches are Gow-Gates and Varizani-Akinosi injections. Intraosseous and intraligamentary injections should be considered. For lower anteriors, infiltration and incisive nerve blocks can be effective. Slight changes in armamentarium, such as increasing the needle gauge, can be helpful. Twelve approaches that can be used instead of or as an adjunct to, the traditional Halstead injection are described. PMID:20583494

Forbes, William C

2010-01-01

374

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

375

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

376

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

377

German is not Necessarily more Difficult than English: Evidence from a comparison among English, German and Hanyu Pinyin  

Directory of Open Access Journals (Sweden)

Full Text Available
In the area of foreign language learning in China, it is a widely-received view that German is more difficult to learn than English. Few people have realized that the factors that make German difficult to learn can in fact make it easier to learn. This article argues that it is not necessarily the case. Through comparing three pairs of relations in German, English and Hanyu-Pinyin, the author shows that there is a similarity between German and Hanyu-Pinyin in terms of pronunciation and spelling. The relations set up and observed in this article are those between vowel letters and their names, between the names of vowel letter and their sounds in words, between the sounds of vowel letters and their written forms in words. The conclusion at the end may to a certain extent change the generally received claim.
Key words: phoneme, grapheme, orthography
Résumé: En Chine, dans le milieu de l’enseignement des langues étrangères, nombreux sont les chercheurs qui disent que l’allemand est plus difficile à apprendre que l’anglais, mais peu d’entre eux essaient de trouver les choses « faciles » dans cette langue « difficile ». Nous essayerons dans le présent article de trouver des choses plus faciles à maîtriser en allemand qu’en anglais, en faisant des comparaisons entre le Pinyin et ces deux langues. Ces comparaisons portent principalement sur trois relations : relation entre les voyelles et leur nom; relation entre le nom des voyelles et leur prononciation dans un mot ; relation entre la prononciation des voyelles dans un mot et l’épellation de ce mot. Le but de cette recherche est de changer en quelques sortes le préjugé qui dit que « l’allemand est plus difficile que l’anglais de tous les points de vue».
Mots-Clés: phonème, graphème, orthographe

Jian-xiong WU layout editor

2007-06-01

378

Nasotracheal intubation in a difficult airway using the Storz C-MAC Videolaryngoscope, the Boedeker Bougie endotracheal introducer, and the Boedeker curved forceps.  

Science.gov (United States)

Airway management has multiple indications for nasotracheal intubation. In this study, we focus on its indication in difficult airways. This work describes a modified procedure of nasotracheal intubation using the new Storz CMAC® Videolaryngoscope, the malleable Boedeker Bougie and the curved Boedeker Forceps in the intubation of a difficult airway manikin. PMID:22357008

Nicholas, Thomas A; Bernhagen, Mary A; Boedeker, Ben H

2012-01-01

379

Strong nucleosomes of mouse genome including recovered centromeric sequences.  

Science.gov (United States)

Recently discovered strong nucleosomes (SNs) characterized by visibly periodical DNA sequences have been found to concentrate in centromeres of Arabidopsis thaliana and in transient meiotic centromeres of Caenorhabditis elegans. To find out whether such affiliation of SNs to centromeres is a more general phenomenon, we studied SNs of the Mus musculus. The publicly available genome sequences of mouse, as well as of practically all other eukaryotes do not include the centromere regions which are difficult to assemble because of a large amount of repeat sequences in the centromeres and pericentromeric regions. We recovered those missing sequences using the data from MNase-seq experiments in mouse embryonic stem cells, where the sequence of DNA inside nucleosomes, including missing regions, was determined by 100-bp paired-end sequencing. Those nucleosome sequences, which are not matching to the published genome sequence, would largely belong to the centromeres. By evaluating SN densities in centromeres and in non-centromeric regions, we conclude that mouse SNs concentrate in the centromeres of telocentric mouse chromosomes, with ~3.9 times excess compared to their density in the rest of the genome. The remaining non-centromeric SNs are harbored mainly by introns and intergenic regions, by retro-transposons, in particular. The centromeric involvement of the SNs opens new horizons for the chromosome and centromere structure studies. PMID:24998943

Salih, Bilal F; Teif, Vladimir B; Tripathi, Vijay; Trifonov, Edward N

2014-07-28

380

Positive Coping with Health Conditions  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Positive Coping with Health Conditions, A Self-Care Workbook (Dan Bilsker, PhD, RPsych, Joti Samra, PhD, RPsych, Elliot Goldner, MD, FRC(P), MHSc) is a self-care manual authored by scientist-practitioners with expertise in issues relating to coping with health conditions.  This manual is designed for individuals who deal with health conditions, including patients, physicians, psychologists, nurses, rehabilitation professionals and researchers.

Bilsker, Dan; Samra, Joti; Goldner, Elliot

2009-01-01

 
 
 
 
381

Relación entre electroencefalograma y neuroimagen en niños con epilepsia focal de difícil control / Relation between electroencephalogram and neuroimaging present in children with epilepsy of difficult control  

Scientific Electronic Library Online (English)

Full Text Available SciELO Cuba | Language: Spanish Abstract in spanish INTRODUCCIÓN. Las epilepsias focales son las más frecuentes en los niños, y la resistencia al tratamiento farmacológico puede estar presente hasta en el 30 % de los pacientes. Se realizó este estudio con el objetivo de dirigir la atención hacia la coincidencia topográfica de los paroxismos electroen [...] cefalográficos, con lesiones estructurales demostrables por neuroimagen, para facilitar el diseño de estrategias terapéuticas futuras. MÉTODOS. Se realizó un estudio descriptivo, longitudinal prospectivo, con 44 niños con diagnóstico de epilepsia focal de difícil control, ingresados en el Servicio de Neuropediatría del Hospital Pediátrico Docente «Juan M. Márquez», entre enero de 2003 y junio de 2007. Se realizaron estudios por electroencefalograma (EEG) al ingreso y videoelectroencefalograma, además de estudios de neuroimagen por tomografía axial o resonancia magnética nuclear. RESULTADOS. Los paroxismos en EEG involucraron el lóbulo frontal hasta en el 68 % de los pacientes. En el 48 % de los pacientes, los paroxismos electroencefalográficos coinciden con zonas de alteración estructural según neuroimagen, más frecuentes en el lóbulo frontal. En el 25 % no hay coincidencia topográfica y en el 27 % no se precisan alteraciones estructurales. CONCLUSIONES. En las epilepsias focales de difícil control se debe prestar especial atención a las zonas elocuentes con coincidencia entre el EEG y la neuroimagen, para evaluar de forma temprana las alternativas quirúrgicas de tratamiento. Abstract in english INTRODUCTION: Focal epilepsies are the more frequent conditions in children and a pharmacologic treatment resistance could be present up to 30% of patients. Aim of present paper was to direct the attention to topographic coincidence of electroencephalographic paroxysms with structural lesions by neu [...] roimaging facilitating the future therapeutical strategies design. METHODS: A descriptive, longitudinal, prospective study was conducted in 44 children diagnosed with epilepsy of difficult control admitted in Neuropediatrics Service of "Juán Manuel Márquez" Teaching Children Hospital from January, 2003 to June, 2007. At admission, we made electroencephalogram (EEG) and videoelectroencephalogram (VEEG) studies as well as neuroimaging studies by axial tomography (AT) or nuclear magnetic resonance (NMR). RESULTS: Paroxysms in EEG involved frontal lobule up to the 68% of patients. In 48%, electroencephalographic paroxysms coincide with structural alteration zones according neuroimaging, more frequent in frontal lobule. In 25% there is not topographic coincidence, and in 27% there are not specified structural alterations. CONCLUSIONS: In focal epilepsies of difficult control, we must to take care of eloquent zones with coincident between EEG and neuroimaging to assess in time the surgical treatment options.

Ileana, Valdivia Álvarez; Liane, Aguilar Fabré; Alicia, Francisco Pérez.

2009-09-01

382

Relación entre electroencefalograma y neuroimagen en niños con epilepsia focal de difícil control Relation between electroencephalogram and neuroimaging present in children with epilepsy of difficult control  

Directory of Open Access Journals (Sweden)

Full Text Available INTRODUCCIÓN. Las epilepsias focales son las más frecuentes en los niños, y la resistencia al tratamiento farmacológico puede estar presente hasta en el 30 % de los pacientes. Se realizó este estudio con el objetivo de dirigir la atención hacia la coincidencia topográfica de los paroxismos electroencefalográficos, con lesiones estructurales demostrables por neuroimagen, para facilitar el diseño de estrategias terapéuticas futuras. MÉTODOS. Se realizó un estudio descriptivo, longitudinal prospectivo, con 44 niños con diagnóstico de epilepsia focal de difícil control, ingresados en el Servicio de Neuropediatría del Hospital Pediátrico Docente «Juan M. Márquez», entre enero de 2003 y junio de 2007. Se realizaron estudios por electroencefalograma (EEG al ingreso y videoelectroencefalograma, además de estudios de neuroimagen por tomografía axial o resonancia magnética nuclear. RESULTADOS. Los paroxismos en EEG involucraron el lóbulo frontal hasta en el 68 % de los pacientes. En el 48 % de los pacientes, los paroxismos electroencefalográficos coinciden con zonas de alteración estructural según neuroimagen, más frecuentes en el lóbulo frontal. En el 25 % no hay coincidencia topográfica y en el 27 % no se precisan alteraciones estructurales. CONCLUSIONES. En las epilepsias focales de difícil control se debe prestar especial atención a las zonas elocuentes con coincidencia entre el EEG y la neuroimagen, para evaluar de forma temprana las alternativas quirúrgicas de tratamiento.INTRODUCTION: Focal epilepsies are the more frequent conditions in children and a pharmacologic treatment resistance could be present up to 30% of patients. Aim of present paper was to direct the attention to topographic coincidence of electroencephalographic paroxysms with structural lesions by neuroimaging facilitating the future therapeutical strategies design. METHODS: A descriptive, longitudinal, prospective study was conducted in 44 children diagnosed with epilepsy of difficult control admitted in Neuropediatrics Service of "Juán Manuel Márquez" Teaching Children Hospital from January, 2003 to June, 2007. At admission, we made electroencephalogram (EEG and videoelectroencephalogram (VEEG studies as well as neuroimaging studies by axial tomography (AT or nuclear magnetic resonance (NMR. RESULTS: Paroxysms in EEG involved frontal lobule up to the 68% of patients. In 48%, electroencephalographic paroxysms coincide with structural alteration zones according neuroimaging, more frequent in frontal lobule. In 25% there is not topographic coincidence, and in 27% there are not specified structural alterations. CONCLUSIONS: In focal epilepsies of difficult control, we must to take care of eloquent zones with coincident between EEG and neuroimaging to assess in time the surgical treatment options.

Ileana Valdivia Álvarez

2009-09-01

383

Initial wall conditioning for the TMX-U fusion experiment  

International Nuclear Information System (INIS)

The introduction of impurities and hydrogen from the walls and liners of the TMX-U device can have a deleterious effect on the plasma. The area of these surfaces is large (approx.107 cm2) and has a complicated shape, so cleaning is difficult. Techniques that have been used to condition these walls include (1) initial solvent cleaning; (2) baking; (3) glow discharge cleaning; (4) gettering; and (5) plasma clean up. Several diagnostic techniques, including UV and visible spectroscopy and residual gas analysis, have been used to evaluate the effectiveness of the conditioning procedures. A series of experiments was performed to optimize the glow discharge in the TMX-U geometry; during approximately 80 h of glow discharge cleaning, low-Z impurities were removed. Gettering along with pumping with liquid-nitrogen-cooled liners and cryopumps resulted in base pressures approx.10-8 Torr. This paper describes these procedures and their importance in the formation of initial plasmas in TMX-U

384

Laser surgery for selected small animal soft-tissue conditions  

Science.gov (United States)

With the acquisition of a Nd:YAG and a CO2 laser in the College of Veterinary Medicine at Oklahoma State University in 1989, over 100 small animal clinical cases have been managed with these modern modalities for surgical excision and tissue vaporization. Most procedures have been for oncologic problems, but inflammatory, infectious, or congenital conditions including vaporization of acral lick 'granulomas,' excision/vaporization of foreign body induced, infected draining tracts, and resection of elongated soft palates have been successfully accomplished. Laser excision or vaporization of both benign and malignant neoplasms have effectively been performed and include feline nasal squamous cell carcinoma, mast cell tumors, and rectal/anal neoplasms. Results to date have been excellent with animals exhibiting little postoperative pain, swelling, and inflammation. Investigations involving application of laser energy for tissue welding of esophageal lacerations and hepatitic interstitial hyperthermia for metastatic colorectal cancer have also shown potential. A review of cases with an emphasis on survival time and postoperative morbidity suggests that carefully planned laser surgical procedures in clinical veterinary practice done with standardized protocols and techniques offer an acceptable means of treating conditions that were previously considered extremely difficult or virtually impossible to perform.

Bartels, Kenneth E.

1991-05-01

385

Generalized quantization condition in topological insulator  

Digital Repository Infrastructure Vision for European Research (DRIVER)

The topological magnetoelectric effect (TME) is the fundamental quantization effect for topological insulators in units of the fine structure constant $\\alpha$. In [Phys. Rev. Lett. 105, 166803(2010)], a topological quantization condition of the TME is given under orthogonal incidence of the optical beam, in which the wave length of the light or the thickness of the TI film must be tuned to some commensurate values. This fine tuning is difficult to realize experimentally. In...

Lan, Yuanpei; Wan, Shaolong; Zhang, Shou-cheng

2010-01-01

386

42 CFR 410.100 - Included services.  

Science.gov (United States)

...difficulties in communication. (e) Respiratory therapy services . (1) Respiratory therapy services are for the assessment, treatment...of cardiopulmonary function. (2) Respiratory therapy services include the following:...

2010-10-01

387

Server-Side Includes Made Simple.  

Science.gov (United States)

Describes server-side include (SSI) codes which allow Webmasters to insert content into Web pages without programming knowledge. Explains how to enable the codes on a Web server, provides a step-by-step process for implementing them, discusses tags and syntax errors, and includes examples of their use on the Web site for Southern Illinois…

Fagan, Jody Condit

2002-01-01

388

US for diagnosis of musculoskeletal conditions in the young athlete: emphasis on dynamic assessment.  

Science.gov (United States)

Ultrasonography (US) is increasingly recognized as an important tool for diagnosis and therapeutic management of a variety of musculoskeletal conditions. Advantages of US use in the young athlete include the ability to diagnose dynamic conditions that are occult with other modalities, provide additional diagnostic information, and aid in treatment. Uses of US in young patients include evaluation of acquired musculoskeletal conditions that manifest with symptoms and assessment of congenital variants that may manifest with pain or limitations in activity. Acquired conditions in the young athlete include tendon disorders, such as proximal tendinosis, and ligament disorders, such as anterior talofibular ligament or ulnar collateral ligament tears. While static images are frequently able to depict these disorders without difficulty, a dynamic examination that provides stress to the joint of interest may be able to uncover a ligament tear or insufficiency and concurrently provide the clinician with information regarding joint stability. Numerous congenital variants that occur throughout the musculoskeletal system can be associated with awkward sensations such as snapping, popping, and clunking and occasionally with pain. Pathologic processes associated with congenital variants in the upper extremities include slipping rib syndrome, atraumatic anterior subluxation of the sternoclavicular joint, and snapping triceps syndrome. Conditions that affect the lower extremities include internal and external snapping hip syndrome, snapping knee syndrome, and medial plica syndrome. The dynamic capability of US is ideal for diagnosis of many conditions that affect the musculoskeletal system of the young athlete, many of which would be difficult or impossible to identify with use of other imaging modalities. PMID:25208273

Zbojniewicz, Andrew M

2014-01-01

389

Conditional path sampling of stochastic differential equations by drift relaxation  

Digital Repository Infrastructure Vision for European Research (DRIVER)

We present an algorithm for the efficient sampling of conditional paths of stochastic differential equations (SDEs). While unconditional path sampling of SDEs is straightforward, albeit expensive for high dimensional systems of SDEs, conditional path sampling can be difficult even for low dimensional systems. This is because we need to produce sample paths of the SDE which respect both the dynamics of the SDE and the initial and endpoint conditions. The dynamics of a SDE are...

Stinis, Panagiotis

2010-01-01

390

Switchgear condition monitoring  

Energy Technology Data Exchange (ETDEWEB)

Electric utilities strive to keep switchgear in proper condition over their long life. Medium voltage switchgear are one of the key components in electrical power systems used to distribute electrical power, selectively isolate electrical loads and protect loads from cascading failure. They generally include a combination of electrical elements such as disconnectors, fuses, circuit breakers and distribution bus bars arranged in a lineup of frames. Since switchgear distributes electrical current, heat buildup becomes an important characteristic to monitor. The most significant amount of heat dissipation is on distribution elements like bus bars. Unexpected temperature rise at a particular location may indicate corrosion or a defect. If left uncorrected, this defect could result in catastrophic failure resulting in deactivated loads and potentially hazardous conditions to personnel. Currently, switchgear bus temperature monitoring is done periodically by manual inspections using IR cameras or by fibre-optic systems. Both methods have limitations, such as inaccurate and infrequent readouts, high implementation cost and limited monitoring area. This paper presented a modern approach for condition monitoring based on passive, SAW-based, wireless sensors, reducing installation costs and enhancing monitoring by allowing measurements in previously unreachable locations. A practical implementation of the wireless condition monitoring system was illustrated as a part of a general, built-in, switchgear diagnostics and maintenance system. The use of miniature SAW sensors proved effective in monitoring breaker connectors and non-invasive installation inside the switchgear. 8 refs., 5 figs.

Budyn, M. [ABB Corporate Research, Krakow (Poland); Karandikar, H.M.; Urmson, M.G. [ABB Inc., Lake Mary, FL (United States)

2010-07-01

391

Difficult cannulation: what should I do before EUS guided access? / Canulación difícil: ¿qué hacer antes de acceso guiado por EUS?  

Scientific Electronic Library Online (English)

Full Text Available SciELO Peru | Language: Spanish Abstract in spanish La canulación selectiva del conducto biliar común puede ser difícil por eso se han desarrollado diferentes estrategias para disminuir esta dificultad. La presente revisión analiza el uso de papilótomos diferentes en lugar del catéter estándar, la papilotomía con pre corte usando cuchillos o papilóto [...] mos, la septotomía papilar transpancreática y el uso de stents. La canulación biliar sigue siendo el factor más importante para considerar una ERCP como exitosa. Las indicaciones de accesos biliares alternativos y su uso es muy importante si esta falla. La punción suprapapilar es una técnica promisoria. Es importante tener en cuenta que la meta de todas las técnicas es disminuir la ocurrencia de pancreatitis aguda Abstract in english Selective cannulation of the common bile duct can be difficult, so multiple strategies have been developed to overcome the situation. In this review we analize the different strategies that can be used like different papillotome instead of the standard catheter, precut papillotomy using precut needl [...] e knives or precut papillotome, transpancreatic papillary septotomy, and stenting of the pancreatic duct. Bile duct cannulation remains an important benchmark of successful ERCP. Alternative biliary access indication and its use is very important If biliary cannulation remains unsuccessful.The suprapapillary puncture is a promissory technique. It´s important to have in mind that the goal of all techniques is to provide acute pancreatitis decrease

Everson L.A, Artifon; Renata N, Moura; Jose P, Otoch.

2014-01-01

392

Soft X-ray XANES of N in ZnO:N - Why is doping so difficult?  

International Nuclear Information System (INIS)

Soft X-ray absorption near-edge experiments (XANES) were carried out at the N K-edge for both as-grown and rapid thermal annealed epitaxial N-doped ZnO samples grown on both {112-bar 0} sapphire substrates and the (0001) face of ZnO single crystal substrates. Samples were grown by plasma-assisted MBE at a growth temperature of 450 deg. C using a solid Zn source and high-purity O2 and N2 RF radical sources. Calibrated secondary ion microscopy measurements demonstrated an as-grown N chemical concentration of approximately 1020 cm-3. The location in the ZnO lattice of N was determined in concert with first-principles real-space multiple scattering simulations. For as-grown samples, it was determined that N incorporates substitutionally on oxygen sites. It was found that a short 3min rapid thermal anneal to 800 deg. C resulted in the unambiguous formation of molecular nitrogen underscoring the metastable nature of substitutional nitrogen. High resolution XANES scans clearly matched those of a N2 gas standard. These results strongly suggest that while nitrogen can be incorporated in ZnO using metastable growth processes, the small activation barrier to the formation of molecular nitrogen will make it very difficult for nitrogen to be a dopant in actual device fabrication

393

The antibacterial activity of geranium oil against Gram-negative bacteria isolated from difficult-to-heal wounds.  

Science.gov (United States)

Hard-to-heal wounds represent a significant problem to patients, health care professionals, and health care system. They can be formed as a result of mechanical injuries and burns, and any co-existing chronic disease increases the risk of their emergence. Diabetics are at a greater risk of developing chronic wounds because of poor circulation, slow healing times, vascular disease and neuropathy. The aim of this study was to determine the antimicrobial activity of geranium oil against Gram-negative bacterial clinical strains. Clinical strains were isolated from patients with difficult-to-treat wounds and a comprehensive evaluation of their sensitivity to antibiotics was carried out. The constituents of geranium oil were specified by GC-FID-MS analysis. The micro-dilution broth method was used to check the inhibition of microbial growth at various concentrations of geranium oil. The tested geranium oil was efficacious against Gram-negative pathogens responsible for problems with wound treatment. The results suggest that geranium oil may be considered an effective component of therapy in the case of frequent recurrences of infections caused by resistant pathogens. PMID:24290961

Sienkiewicz, Monika; Pozna?ska-Kurowska, Katarzyna; Kaszuba, Andrzej; Kowalczyk, Edward

2014-08-01

394

Leiomioma renal sintomático: una masa renal de difícil diagnóstico / Symptomatic leiomyoma of the kidney: renal mass with difficult preoperative diagnosis  

Scientific Electronic Library Online (English)

Full Text Available SciELO Spain | Language: Spanish Abstract in spanish El leiomioma renal es un tumor mesenquimatoso benigno poco frecuente que, no obstante, se debe tener en cuenta ante el diagnóstico de una masa renal. Esta neoplasia puede originarse en cualquier órgano del aparato genitourinario que contenga músculo liso, siendo la cápsula renal la localización más [...] frecuente. Dado el comportamiento benigno de la lesión, es subsidiario de la realización de una cirugía renal conservadora. No obstante, ante la dificultad para distinguirlo del adenocarcinoma, no será infrecuente que el diagnóstico se produzca tras el análisis histológico de una pieza de nefrectomía radical. Abstract in english Renal leiomyoma is a benign mesenchymal tumour that, albeit very rare, has to be ruled out when a renal mass has been diagnosed. This tumour can arise from any organ of the genitourinary tract with smooth muscle cells, being the renal capsule the most frequent origin. As its behaviour is not aggress [...] ive, nephron-sparing surgery is indicated. However, as it is difficult to preoperatively differentiate the leiomyoma from the adenocarcinoma, the former is commonly diagnosed after examination of the entire organ surgically removed.

L.M., Clemente Ramos; A., Candia Fernández; A., Allona Almagro.

2003-08-01

395

Finite Element Error Estimates for Critical Exponent Semilinear Problems without Angle Conditions  

CERN Document Server

In this article we consider a priori error estimates for semilinear problems with critical and subcritical polynomial nonlinearity in d space dimensions. When d=2 and d=3, it is well-understood how mesh geometry impacts finite element interpolant quality. However, much more restrictive conditions on angles are needed to derive basic a priori quasi-optimal error estimates as well as a priori pointwise estimates for Galerkin approximations. In this article, we show how to derive these types of a priori estimates without requiring the discrete maximum principle, hence eliminating the need for restrictive angle conditions that are difficult to satisfy in three dimensions or adaptive settings. We first describe a class of semilinear problems with critical exponents. The solution theory for this class of problems is then reviewed, including generalized maximum principles and the construction of a priori L-infinity bounds using cutoff functions and the De Giorgi iterative method (or Stampacchia truncation method). W...

Bank, Randolph E; Szypowski, Ryan; Zhu, Yunrong

2011-01-01

396

Maximum-entropy closure of hydrodynamic moment hierarchies including correlations.  

Science.gov (United States)

Generalized hydrodynamic moment hierarchies are derived which explicitly include nonequilibrium two-particle and higher-order correlations. The approach is adapted to strongly correlated media and nonequilibrium processes on short time scales which necessitate an explicit treatment of time-evolving correlations. Closure conditions for the extended moment hierarchies are formulated by a maximum-entropy approach, generalizing related closure procedures for kinetic equations. A self-consistent set of nonperturbative dynamical equations are thus obtained for a chosen set of single-particle and two-particle (and possibly higher-order) moments. Analytical results are derived for generalized Gaussian closures including the dynamic pair distribution function and a two-particle correction to the current density. The maximum-entropy closure conditions are found to involve the Kirkwood superposition approximation. PMID:22697532

Hughes, Keith H; Burghardt, Irene

2012-06-01

397

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

398

Dementia (Including Alzheimer Disease) (Beyond the Basics)  

Science.gov (United States)

... Patient information Vascular dementia Patient information: Dementia (including Alzheimer disease) (Beyond the Basics) Authors Michael Alexander, MD ... affect the brain. The most common cause is Alzheimer disease. Alzheimer disease accounts for 60 to 80 ...

399

42 CFR 410.100 - Included services.  

Science.gov (United States)

...materials and components, measure, fit, and align the device, and instruct the patient in its use. (g) Orthotic device services. These services include— (1) Orthopedic devices that support or align movable parts of the body,...

2010-10-01

400

A deformed medium including a defect field and differential forms  

International Nuclear Information System (INIS)

We consider basic equations for a deformed medium including a defect field on the basis of differential forms. To make our analysis, we extend three basic equations: (I) an incompatibility equation; (II) the Peach-Koehler equation; (III) the Navier equation based on the Hodge duality of the deformed medium. By combining two exterior differential operators, we derive (I) an incompatibility equation that extends the compatibility equation to include a defect field. The Hodge dual of the incompatibility equation becomes a generalized stress function, which includes previously derived stress functions such as Beltrami's, Morera's, Maxwell's and Airy's stress functions. By applying homotopy operators, we extend (II) the Peach-Koehler equation to include disclinations. In this case, we can define the basic quantities of stress space by analogy with the monopole theory. By combining exterior differential operators and star operators, we extend (III) the Navier equation to include a defect field. In this analysis, we define a Navier operator that is related to the Laplace operator through Hodge duality. We consider gauge conditions for a defect field based on the differential geometry of a deformed medium. This suggests a duality between yielding and fatigue fractures. The gauge condition in strain space-time is interpreted as basic relations in polycrystalline plastic deformation. (author)