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1

Anxiety Differences in Difficult and Easy Test Conditions.  

Science.gov (United States)

Test anxiety is of particular significance in education in light of its debilitative effect on test scores and the implications and longranged effects of test results on the individual lives of the school children. This research is concerned with test anxiety of children under different test conditions. Subjects were 4th and 6th grade students who…

Forhetz, John E.

2

TAKRAF bucket wheel excavators for difficult operating conditions  

Energy Technology Data Exchange (ETDEWEB)

Design, performance and technical specifications are explained for bucket wheel excavators, built by TAKRAF Lauchhammerwerk, GDR. The SRs (K) 2000 excavator (capacity 3000 m/sup 3//h, digging height 28 m) has been built since 1972 and operates in Ehkibastuz black coal surface mines at a temperature range of +/- 40 C. A total of nine such excavators are in operation, two more are being built. The SRs 2000 excavator (42 are in operation, 5 more are being built) operates in the Greek Ptolemais brown coal mine with 4000 m/sup 3//h capacity and at 30 m bench height. The SRs 4000 excavator (7600 m/sup 3//h capacity, 36 m digging height) is new and being assembled at Ptolemais and at Kansk-Achinsk. The largest excavation type is the SRs 6300 for 13,000 m/sup 3//h overburden removal. Smaller equipment includes the SRs 400 operating in the Austrian Oberdorf brown coal mine and also in Yugoslavia, among other places, the SRs 700 and the SRs 1500, the latter two being developed for hard, cohesive overburden, 17 to 22 m digging height and with 2400 to 3000 m/sup 3//h capacity. Photographs of excavators operating in various surface mines are provided. 3 refs.

Harta, H.; Jurisch, H.

1987-04-01

3

Effectiveness of frequency shifted feedback at reducing disfluency for linguistically easy, and difficult, sections of speech (original audio recordings included)  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Frequency shifted feedback (FSF) induces fluency when presented to speakers who stutter. This study examined whether FSF was more effective at removing disfluencies on easy or on difficult stretches of speech (where difficulty was defined with respect to utterance and word length). There were more disfluencies on the difficult stretches than on the easy stretches. There were significantly fewer disfluencies under FSF than in normal listening conditions (indicating that FSF improved fluency). ...

Howell, Peter; Davis, Stephen; Bartrip, Jon; Wormald, Laura

2004-01-01

4

Morbidly obese parturient: Challenges for the anaesthesiologist, including managing the difficult airway in obstetrics. What is new?  

Directory of Open Access Journals (Sweden)

Full Text Available The purpose of this article is to review the fundamental aspects of obesity, pregnancy and a combination of both. The scientific aim is to understand the physiological changes, pathological clinical presentations and application of technical skills and pharmacological knowledge on this unique clinical condition. The goal of this presentation is to define the difficult airway, highlight the main reasons for difficult or failed intubation and propose a practical approach to management Throughout the review, an important component is the necessity for team work between the anaesthesiologist and the obstetrician. Certain protocols are recommended to meet the anaesthetic challenges and finally concluding with "what is new?" in obstetric anaesthesia.

Rao Durga

2010-01-01

5

Effectiveness of frequency shifted feedback at reducing disfluency for linguistically easy, and difficult, sections of speech (original audio recordings included).  

Science.gov (United States)

Frequency shifted feedback (FSF) induces fluency when presented to speakers who stutter. This study examined whether FSF was more effective at removing disfluencies on easy or on difficult stretches of speech (where difficulty was defined with respect to utterance and word length). There were more disfluencies on the difficult stretches than on the easy stretches. There were significantly fewer disfluencies under FSF than in normal listening conditions (indicating that FSF improved fluency). There was no interaction between difficulty of material and type of feedback when disfluency rate was used as the dependent variable, suggesting that targeting FSF on easy stretches of speech is as effective as targeting it on difficult stretches. The original audio data are provided in this report and can be used by readers to check for themselves the characteristics of voice control that alter when FSF is delivered. PMID:18418474

Howell, Peter; Davis, Stephen; Bartrip, Jon; Wormald, Laura

2004-09-01

6

Optimizing Electroporation Conditions in Primary and Other Difficult-to-Transfect Cells  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Electroporation is a valuable tool for nucleic acid delivery because it can be used for a wide variety of cell types. Many scientists are shifting toward the use of cell types that are more relevant to in vivo applications, including primary cells, which are considered difficult to transfect. The ability to electroporate these cell types with nucleic acid molecules of interest at a relatively high efficiency while maintaining cell viability is essential for elucidating the pathway(s) in which...

Jordan, Elizabeth T.; Collins, Michelle; Terefe, Joseph; Ugozzoli, Luis; Rubio, Teresa

2008-01-01

7

Difficult sinking cut in severe winter conditions improves productivity at Lac des Iles Mines  

Energy Technology Data Exchange (ETDEWEB)

The Lac des Iles Mine, in an isolated area of Northwestern Ontario is a relatively new open pit mine. They encountered problems with the equipment and production scheduling when ramping down to begin production on the subsequent benches. A co-operative effort between Lac des Iles Mine operations, ICI Explosives, and the mines drilling and blasting contractor, Consbec Inc., resulted in a decision being made to use full depth sinking cuts to provide access to the next bench. The sinking cut was carried out under a combination of extremely difficult conditions--shattered rock, collapsing holes, flowing water and frozen explosives{hor_ellipsis}--in severe Canadian winter and under a tight schedule. This paper will outline the problems associated with the changes in the blast design, drilling, loading and blasting of the sinking cut. Details will be provided that outline the procedures that were developed, and the types of explosives that were used in order to overcome the problems and achieve significant operational cost savings in the process.

Moffat, C.; Kita, J.; Walker, R.

1996-12-01

8

Flue gas conditioning for enhanced precipitation of difficult ashes. Final report  

Energy Technology Data Exchange (ETDEWEB)

A review of the available prior investigations indicates that the effectiveness of ammonia and triethylamine as conditioning agents used to improve the performance of electrostatic precipitators has been inconclusive. When successful conditioning has occurred, it sometimes has ben impossible to determine the process by which the conditioning agent affected the performance. The objective of this research was to examine the ability of these two conditioning agents with respect to the attenuation of resistivity and the suppression of back corona. Conventional resistivity determinations were made using simulated flue gas environments containing the subject agents. A second approach utilized a wire-guarded plate apparatus for the determination of voltage-current relationships. With regard to the effect these conditioning agents have on the electrical characteristics of a precipitator, the laboratory data suggest only an attenuation of resistivity. A mechanism by which these agents enhance conduction is hypothesized. The usefulness of triethylamine and particularly ammonia is severely limited by temperature and ash composition. The effectiveness of both agents is also influenced by the sulfur oxides present. The voltage-current data suffered from several experimental difficulties. In general the data support the observation that these agents are capable of reducing resistivity under certain limiting conditions. Experimental problems prevented the observation of space charge effects related to ammonia injection that have been identified during field testing performed by one of the authors and reported elsewhere.

Bickelhaupt, R.E.; Dismukes, E.B.; Spafford, R.B.

1978-10-01

9

Haze, clouds and limited sky visibility: polarotactic orientation of crickets under difficult stimulus conditions.  

Science.gov (United States)

Field crickets (Gryllus campestris L.) are able to detect the orientation of the electric vector (e-vector) of linearly polarized light. They presumably use this sense to exploit the celestial polarization pattern for course control or navigation. Polarization vision in crickets can be tested by eliciting a spontaneous polarotactic response. Previously, wide and 100% polarized stimuli were employed to induce this behavior. However, field crickets live on meadows where the observation of the sky is strongly limited by surrounding vegetation. Moreover, degrees of polarization (d) in the natural sky are much lower than 100%. We have therefore investigated thresholds for the behavioral response to polarized light under conditions mimicking those experienced by the insects in the field. We show that crickets are able to rely on polarized stimuli of just 1 degrees diameter. We also provide evidence that they exploit polarization down to an (average) polarization level of less than 7%, irrespective of whether the stimulus is homogeneous, such as under haze, or patched, such as a sky spotted by clouds. Our data demonstrate that crickets can rely on skylight polarization even under unfavorable celestial conditions, emphasizing the significance of polarized skylight orientation for insects. PMID:17766304

Henze, Miriam J; Labhart, Thomas

2007-09-01

10

Construction of a high voltage aerial power line over difficult terrain and with adverse foundation conditions in Nigeria  

Energy Technology Data Exchange (ETDEWEB)

The authors report on the foundation plans including the earth survey methods, the assembly procedure used and on the special transport problems which characterised the recent construction of a 330 kv high voltage aerial power line in Nigeria. The methods applied contributed significantly to the fact that BBC (Brown Boveri) was able to successfully complete the construction of this power line in an extremely short time under the adverse terrain conditions offered by the swamps and jungle of the Niger delta, and to hand over the line to the customer for punctual switch in.

Kaeufl, O.; Kummermehr, R.

1983-09-12

11

78 FR 68907 - Agency Information Collection (Foot (Including Flatfeet (pes planus)) Conditions Disability...  

Science.gov (United States)

...Collection (Foot (Including Flatfeet (pes planus)) Conditions Disability Benefits...2900- NEW (Foot (including flatfeet (pes planus)) Conditions Disability Benefits...2900-NEW (Foot (including flatfeet (pes planus)) Conditions Disability...

2013-11-15

12

78 FR 34708 - Proposed Information Collection (Foot (Including Flatfeet (pes planus)) Conditions Disability...  

Science.gov (United States)

...Collection (Foot (Including Flatfeet (pes planus)) Conditions Disability Benefits...2900--NEW (Foot (including flatfeet (pes planus)) Conditions Disability Benefits...Title: (Foot (including flatfeet (pes planus)) Conditions Disability...

2013-06-10

13

Effectiveness of cast iron vermicularization including ‘conditioning’ 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...

2011-01-01

14

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.

2010-03-01

15

Effectiveness of cast iron vermicularization including ‘conditioning’ 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

16

Conflict management: difficult conversations with difficult people.  

Science.gov (United States)

Conflict occurs frequently in any workplace; health care is not an exception. The negative consequences include dysfunctional team work, decreased patient satisfaction, and increased employee turnover. Research demonstrates that training in conflict resolution skills can result in improved teamwork, productivity, and patient and employee satisfaction. Strategies to address a disruptive physician, a particularly difficult conflict situation in healthcare, are addressed. PMID:24436688

Overton, Amy R; Lowry, Ann C

2013-12-01

17

Difficult framework conditions hinder free competition. On the current situtation of medium-sized petroleum companies; Schwierige Rahmenbedingungen behindern den Wettbewerb. Zur aktuellen Situation der mittelstaendischen Mineraloelunternehmen  

Energy Technology Data Exchange (ETDEWEB)

The UNITI, German association of medium-sized petroleum companies, held its annual meeting 1998 on May 26 in Berlin, with prominent representatives from industry and politics attending the meeting. The article here presents a shortened version of the welcome address of the president of the UNITI association, which deals in particular with the difficult framework conditions challenging the medium-sized petroleum industry in a shrinking market characterized by correspondingly fierce competition. (orig./CB) [Deutsch] Der Vorsitzende des UNITI Bundesverbandes mittelstaendischer Mineraloelunternehmen e.V. konnte anlaesslich der diesjaehrigen Mitgliederversammlung am 26. Mai im Berliner Hilton Hotel wieder prominente Vertreter aus Politik und Wirtschaft begruessen. Der Beitrag gibt eine leicht gekuerzte Fassung der einleitenden Ausfuehrungen des UNITI-Vorsitzenden wieder, in denen er inbesondere auf die schwierigen Rahmenbedingungen einging, mit denen sich die mittelstaendischen Mineraloelunternehmen in einem schrumpfenden Markt bei dementsprechend hartem Wettbewerb auseinandersetzen muessen. (orig./RHM)

Anon.

1998-06-01

18

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

1997-05-01

19

Tackling difficult estates  

Digital Repository Infrastructure Vision for European Research (DRIVER)

There are up to 2,000 difficult social housing estates across the UK. Residents, landlords, local authorities, government and other agencies face a challenging set of problems in trying to make these ‘difficult to live in’ areas work. In some of these estates there are individuals and organisations who are successfully rebuilding communities - tackling unemployment, crime, health, family and youth problems and co-ordinating service delivery. This report summarises the presentations and di...

Richardson, Liz

1998-01-01

20

Difficult to control atopic dermatitis  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Difficult to control atopic dermatitis (AD) presents a therapeutic challenge and often requires combinations of topical and systemic treatment. Anti-inflammatory treatment of severe AD most commonly includes topical glucocorticosteroids and topical calcineurin antagonists used for exacerbation management and more recently for proactive therapy in selected cases. Topical corticosteroids remain the mainstay of therapy, the topical calcineurin inhibitors tacrolimus and pimecrolimus are preferred...

Darsow, Ulf; Wollenberg, Andreas; Simon, Dagmar; Tai?eb, Alain; Werfel, Thomas; Oranje, Arnold; Gelmetti, Carlo; Svensson, Ake; Deleuran, Mette; Calza, Anne-marie; Giusti, Francesca; Lu?bbe, Jann; Seidenari, Stefania; Ring, Johannes

2013-01-01

 
 
 
 
21

An unexpected difficult laryngoscopy.  

Science.gov (United States)

A case of unexpected difficult laryngoscopy in a patient with gross hydrocephalus and generalized hypertonus is described. The 30-month-old girl had no antecedent history of such difficulty, having had two recent uneventful anaesthetics. We suggest that the reason for our inability to open the patient's mouth was a result of contracture of the temporalis muscle. The patient was managed using a laryngeal mask airway with controlled ventilation. PMID:12358665

De Beer, D A H; Williams, D G; Mackersie, A

2002-09-01

22

Proceedings of the 3. Canada-US rock mechanics symposium and 20. Canadian rock mechanics symposium : rock engineering 2009 : rock engineering in difficult conditions  

Energy Technology Data Exchange (ETDEWEB)

This conference provided a forum for geologists, mining operators and engineers to discuss the application of rock mechanics in engineering designs. Members of the scientific and engineering communities discussed challenges and interdisciplinary elements involved in rock engineering. New geological models and methods of characterizing rock masses and ground conditions in underground engineering projects were discussed along with excavation and mining methods. Papers presented at the conference discussed the role of rock mechanics in forensic engineering. Geophysics, geomechanics, and risk-based approaches to rock engineering designs were reviewed. Issues related to high pressure and high flow water conditions were discussed, and new rock physics models designed to enhance hydrocarbon recovery were presented. The conference featured 84 presentations, of which 9 have been catalogued separately for inclusion in this database. tabs., figs.

NONE

2009-07-01

23

Neutron multiple scattering corrections including extensive realistic simulations of inherent experimental conditions  

International Nuclear Information System (INIS)

An improved and more realistic method for the correction of neutron time-of-flight measurements for the effects of multiple scattering and finite geometry has been developed. Several important inherent experimental conditions, which are often neglected or treated very approximately in previous techniques, are more rigorously included in the present calculation. In particular, in the study of elastic and inelastic scattering of neutrons from samples of light nuclei in the form of chemical compounds, the energy spectrum of the neutron source, the time spreads of the source and detector and finite sizes of the source and detector often lead to sizeable corrections. For each detector position, the computer program calculates time-of-flight spectra which agree well with those measured during the experiment. The calculated 'measured' differential cross sections are also compared to the actual measured ones in a straightforward manner. Several examples demonstrating the importance of the above effects on the calculated time-of-flight spectra and differential cross sections are given. The proper simulation of all the important experimental parameters makes possible the confident measurement of new differential cross sections for cases such as deep inelastic scattering, where the cross sections are usually small and the multiple scattering corrections related to the above effects are relatively large. Without such a method, certain important measurements might well not be performed, because of the uncertainty regarding proper corrections caused by these added effects. (orig.)

1984-07-15

24

Amino acid composition, including key derivatives of eccrine sweat: potential biomarkers of certain atopic skin conditions.  

Science.gov (United States)

The free amino acid (AA) composition of eccrine sweat is different from other biological fluids, for reasons which are not properly understood. We undertook the detailed analysis of the AA composition of freshly isolated pure human eccrine sweat, including some of the key derivatives of AA metabolism, to better understand the key biological mechanisms governing its composition. Eccrine sweat was collected from the axillae of 12 healthy subjects immediately upon formation. Free AA analysis was performed using an automatic AA analyser after ninhydrin derivatization. Pyrrolidine-5-carboxylic acid (PCA) and urocanic acid (UCA) levels were determined using GC/MS. The free AA composition of sweat was dominated by the presence of serine accounting for just over one-fifth of the total free AA composition. Glycine was the next most abundant followed by PCA, alanine, citrulline and threonine, respectively. The data obtained indicate that the AA content of sweat bears a remarkable similarity to the AA composition of the epidermal protein profilaggrin. This protein is the key source of free AAs and their derivatives that form a major part of the natural moisturizing factor (NMF) within the stratum corneum (SC) and plays a major role in maintaining the barrier integrity of human skin. As perturbations in the production of NMF can lead to abnormal barrier function and can arise as a consequence of filaggrin genotype, we propose the quantification of AAs in sweat may serve as a non-invasive diagnostic biomarker for certain atopic skin conditions, that is, atopic dermatitis (AD). PMID:23075272

Mark, Harker; Harding, Clive R

2013-04-01

25

Management of difficult urticaria  

Digital Repository Infrastructure Vision for European Research (DRIVER)

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

26

MANAGEMENT OF DIFFICULT URTICARIA  

Digital Repository Infrastructure Vision for European Research (DRIVER)

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 underly...

2009-01-01

27

Management of difficult urticaria.  

Science.gov (United States)

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. PMID:20161863

Yadav, Sudha; Bajaj, A K

2009-07-01

28

ATV rollover prevention system including varying grip conditions and bank angle  

Digital Repository Infrastructure Vision for European Research (DRIVER)

In this paper, an algorithm dedicated to light ATVs, which estimates and anticipates the rollover, is proposed. It is based on the on-line estimation of the Lateral Load Transfer (LLT), allowing the valuation of dynamic instabilities. The LLT is computed thanks to a dynamical model split into two 2D projections. Relying on this representation and a low cost perception system, an observer is proposed to estimate on-line the terrain properties (grip conditions and slope), then allowing to deduc...

Richier, M.; Lenain, R.; Thuilot, B.; Berducat, M.

2012-01-01

29

Assisting Difficult Subsea Operations  

Energy Technology Data Exchange (ETDEWEB)

The requirements placed on remotely operated vehicles (ROV) in offshore oil drilling are becoming severe both as these operations extend to deeper waters and in the abandonment of old wells. Oceaneering have developed an integrated ROV system called Minimum to support the company's deep-water Magnum and Millennium ROV systems. Minimum is integrated into the Magnum or Millennium systems and is an inspection ROV designed to operate at a depth of 10 000 feet, operating from a self-contained module beneath the primary ROV cage. The Minimum has been very successfully used in severe deepwater conditions west of Shetland. The article also describes a new dredging tool for use during well abandonment as a contingency when divers encounter sediments inside a well. It was developed by Andrews Genflo.

NONE

2000-07-01

30

Susceptibility of Legionella pneumophila to eight antimicrobial agents including four macrolides under different assay conditions.  

Science.gov (United States)

A comparison of agar dilution and microdilution susceptibility testing for eight antimicrobial agents, including roxithromycin, was performed against 48 isolates of Legionella pneumophila. For agar dilution tests, charcoal free agar (BSYE) and charcoal supplemented agar (BCYE) were used. In general, BSYE agar produced lower MICs than BCYE agar, except for imipenem. Microdilution testing data fell between the data obtained for the two agar media. The MBCs were two to sixteen fold higher than the MICs. Prolongation of the incubation time from 48 h to 72 h or growth in 5% CO2 did not influence the results. As tested by the microdilution method, an increase in the inoculum from 10(5) to 10(7) was associated with a two-fold increase in the MIC. Roxithromycin and two other investigational macrolides (A-56268 and rosaramicin) demonstrated better in-vitro activity than erythromycin. PMID:2526110

Liebers, D M; Baltch, A L; Smith, R P; Hammer, M C; Conroy, J V

1989-01-01

31

Difficult to control atopic dermatitis  

DEFF Research Database (Denmark)

Difficult to control atopic dermatitis (AD) presents a therapeutic challenge and often requires combinations of topical and systemic treatment. Anti-inflammatory treatment of severe AD most commonly includes topical glucocorticosteroids and topical calcineurin antagonists used for exacerbation management and more recently for proactive therapy in selected cases. Topical corticosteroids remain the mainstay of therapy, the topical calcineurin inhibitors tacrolimus and pimecrolimus are preferred in certain locations. Systemic anti-inflammatory treatment is an option for severe refractory cases. Microbial colonization and superinfection contribute to disease exacerbation and thus justify additional antimicrobial / antiseptic treatment. Systemic antihistamines (H1) may relieve pruritus but do not have sufficient effect on eczema. Adjuvant therapy includes UV irradiation preferably of UVA1 wavelength. "Eczema school" educational programs have been proven to be helpful.

Darsow, Ulf; Wollenberg, Andreas

2013-01-01

32

Difficult to control atopic dermatitis.  

Science.gov (United States)

Difficult to control atopic dermatitis (AD) presents a therapeutic challenge and often requires combinations of topical and systemic treatment. Anti-inflammatory treatment of severe AD most commonly includes topical glucocorticosteroids and topical calcineurin antagonists used for exacerbation management and more recently for proactive therapy in selected cases. Topical corticosteroids remain the mainstay of therapy, the topical calcineurin inhibitors tacrolimus and pimecrolimus are preferred in certain locations. Systemic anti-inflammatory treatment is an option for severe refractory cases. Microbial colonization and superinfection contribute to disease exacerbation and thus justify additional antimicrobial / antiseptic treatment. Systemic antihistamines (H1) may relieve pruritus but do not have sufficient effect on eczema. Adjuvant therapy includes UV irradiation preferably of UVA1 wavelength. "Eczema school" educational programs have been proven to be helpful. PMID:23663504

Darsow, Ulf; Wollenberg, Andreas; Simon, Dagmar; Taïeb, Alain; Werfel, Thomas; Oranje, Arnold; Gelmetti, Carlo; Svensson, Ake; Deleuran, Mette; Calza, Anne-Marie; Giusti, Francesca; Lübbe, Jann; Seidenari, Stefania; Ring, Johannes

2013-01-01

33

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

1993-01-01

34

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

Energy Technology Data Exchange (ETDEWEB)

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

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

2011-10-15

35

Unexpected difficult airway with hypogonadotropic hypogonadism  

Directory of Open Access Journals (Sweden)

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

Yaman F

2014-04-01

36

Unexpected difficult airway with hypogonadotropic hypogonadism  

Science.gov (United States)

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

Yaman, Ferda; Arslan, Bengi; Yuvanc, Ercan; Buyukkocak, Unase

2014-01-01

37

Difficult diagnoses in the skeletal radiology  

International Nuclear Information System (INIS)

The book on difficult diagnoses in the skeletal radiology discusses the path from symptom to diagnoses including image interpretation. Specific case studies concern the skull, the spinal cord, pelvis, shoulder and chest, upper and lower extremities. The used radiological techniques include projecting radiography, computerized tomography, scintiscanning, PET/CT, NNR imaging and ultrasonography.

2013-01-01

38

Surgical technique for closure of difficult abdomen.  

Science.gov (United States)

Abdominal dehiscence reported to occur with a frequency of one per cent even under the best circumstances, is a dreaded complication. Closure of the dehisced abdominal wall under adverse conditions like local infection and wound edge retraction may be difficult. We describe a new technique which is a modification of classical retention sutures for the abdominal wall closure. PMID:12914378

Abbasoglu, O; Nursal, T

2003-06-01

39

Adenomyosis: Difficult to Diagnose, and Difficult to Treat  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Drug therapy may be effective in controlling symptoms but the frequent coexistence of endometriosis and the lack of controlled studies make their efficacy difficult to quantify. Danazol IUD has been shown to reduce symptoms. Conservative surgery involving endomyometrial ablation, laparoscopic myometrial electrocoagulation or excision has proven to be effective in more than 50% of patients, although follow up has been restricted to three years. Arterial uterine artery embo...

Wood, C.

2001-01-01

40

Teaching Difficult Topics with Primary Sources  

Science.gov (United States)

"Difficult" or "challenging" topics to teach include racism, violence, genocide, bullying, gangs, abuse (physical, emotional, and substance), slavery, suffering, hatred, terrorism, war, disease, loss, addiction, and more. But by confronting them with students, in the safety of a classroom through thoughtfully constructed lessons (ones that take…

Potter, Lee Ann

2011-01-01

 
 
 
 
41

German equipment majors prosper in difficult markets  

Energy Technology Data Exchange (ETDEWEB)

The quality reputation of German materials handling equipment continues to play a major role in contract success at home and abroad. In spite of tough market conditions and strong competition, most companies have either agents or representative offices in key sales markets (local offices being generally limited to those companies multi-national in structure or ownership). Some, however, express no difficulty in covering distant markets from Germany with a combination of energetic marketing efforts and good knowledge of the local region and its businesses. The evidence of strong repeat orders as well as breakthrough contracts is that the size and strangeness of the burgeoning Asia-Pacific market present challenges no more difficult than that already encountered in many years of business experience. This article reviews activities in a year which saw a series of changes and realignments in the German materials handling industry. Equipment type includes: grabs for the coal trade: storage and reclaim equipment; unloaders and loaders; power station coaling plant; and FGD gypsum handling. 2 figs.

NONE

1997-01-01

42

Multiphase Binary Mixture Flows in Porous Media in a Wide Pressure and Temperature Range Including Critical Conditions  

Science.gov (United States)

Multiphase flows in porous media with a transition between sub- and supercritical thermodynamic conditions occur in many natural and technological processes (e.g. in deep regions of geothermal reservoirs where temperature reaches critical point of water or in gas-condensate fields where subject to critical conditions retrograde condensation occurs and even in underground carbon dioxide sequestration processes at high formation pressure). Simulation of these processes is complicated due to degeneration of conservation laws under critical conditions and requires non-classical mathematical models and methods. A new mathematical model is proposed for efficient simulation of binary mixture flows in a wide range of pressures and temperatures that includes critical conditions. The distinctive feature of the model lies in the methodology for mixture properties determination. Transport equations and Darcy law are solved together with calculation of the entropy maximum that is reached in thermodynamic equilibrium and determines mixture composition. To define and solve the problem only one function - mixture thermodynamic potential - is required. Such approach allows determination not only single-phase states and two-phase states of liquid-gas type as in classical models but also two-phase states of liquid-liquid type and three-phase states. The proposed mixture model was implemented in MUFITS (Multiphase Filtration Transport Simulator) code for hydrodynamic simulations. As opposed to classical approaches pressure, enthalpy and composition variables together with fully implicit method and cascade procedure are used. The code is capable of unstructured grids, heterogeneous porous media, relative permeability and capillary pressure dependence on temperature and pressure, multiphase diffusion, optional number of sink and sources, etc. There is an additional module for mixture properties specification. The starting point for the simulation is a cubic equation of state that is used for mixture thermodynamic potential - entropy - calculation in pressure, enthalpy and composition variables. A polynomial spline is implemented to save the potential for subsequent hydrodynamic simulations. At this stage the majority of complicated thermodynamic procedures are performed prior to hydrodynamic that results in sufficient acceleration of calculations. The code was used for analysis of multiphase water-carbon dioxide mixture flows in porous media. Using the developed methodology the mixture phase diagram was calculated both below and above critical point of water. A zone of three-phase state conditions was detected where the mixture splits in three phases: liquid water and liquefied and gaseous carbon dioxide. The mixture flows subjected to formation of the three-phase flow region were investigated. The work is supported by Grant of the President of the Russian Federation (575.2010.1, 4810.2010.1).

Afanasyev, A.

2011-12-01

43

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

44

Difficult defecation: difficult problem assessment and management; what really helps?  

Science.gov (United States)

Difficult defecation is a common and perhaps underrecognized cause of chronic constipation. While the history and a careful digital rectal examination are very useful for diagnosing defecatory disorders, the diagnosis needs to be confirmed by anorectal tests. Anorectal manometry and a rectal balloon expulsion test generally suffice to diagnose defecatory disorders; barium or MR defecography may necessary in selected cases. Colonic transit is normal or slow in patients with defecatory disorders. Pelvic floor retraining by biofeedback therapy is superior to laxatives for managing defecatory disorders. PMID:22100121

Bharucha, Adil E

2011-12-01

45

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

Science.gov (United States)

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

Barkeshli, Kasra; Volakis, John L.

1991-01-01

46

The early warning system of landslides and sediment runoffs using meteorological condition including rainfall-soil moisture index (Invited)  

Science.gov (United States)

The research including observation of rain, soil moisture content and sediment discharge is conducted on a torrent in northern Kyushu whose geology consists of Paleozoic metamorphic rocks (mainly schist) and whose vegetation consists of mainly Japanese cypress and cedar. Soil depth is approximately 50cm in average and permeability k is 0.1~0.01 order. With data obtained by the observation for more than 4 years, standard rainfalls of warning and evacuation against the sudden sediment runoffs are analyzed. Then, the result was compared with the ones in Nuevo Leon Mexico (geology of schist, slate, k=0.01~0.001 order) and in southern Sulawesi Island Indonesia (volcanic geology, k=0.001~0.0001 order). Hitherto, various methods were proposed to analyze the warning critical standard for landslide disaster or large sediment discharge. In this study, we employed Hirano's element slope runoff theory, the Self Organized Criticality Assumption (SOC), and the Elementary Catastrophe Theory (ETC) to analyze the data, although the soil moisture fluctuation, meteorological condition such as upper air wind and dew point depression, the rainfall-soil moisture index provided by Japan Meteorological Agency was considered. The last one is a cutting edge technology based on the tank model calculation of soil moisture content combined with short term rainfall prediction which is a product of numerical simulation using radar image advection analysis compensated with surface rain data and with orographic rain effect. In Hirano's theory, we can describe the critical rain Rc and rain intensity Ric as following equation. Q/A/M/ cos? = Ri ?(r*cos?)dt = Ri*R (1) ? Ric*Rc = C (2) Here, Q: sediment runoff or debris flow discharge, A: watershed area, M: function concerning with sediment deposit features on the upstream torrents or slopes (porosity, torrent bed slope gradient, sediment accumulation length and depth, cohesion), t: time, ?: torrent bed or hillside slope gradient, r: instant precipitation. C: constant, given as 8000 in Fukuoka (Kyushu, Japan), as 3750 in Sierra Madere Oriental (Nuevo Leon, Mexico), as 9000 in southern Sulawesi(Indonesia). Consequently, the forecast-warning system which has enough accuracy of 80% against sediment runoffs or debris flows for both wide range region with meteorological conditions and narrow region with the critical rain standard are established. However, in the region with lower soil permeability we may revise the standard rain by the compensation with the soil moisture content response such as increasing rate.

Kubota, T.; Silva, I. C.; Hasnawir, H.

2009-12-01

47

Difficult Bond. Derrida and Jewishness  

DEFF Research Database (Denmark)

Watchful insomnia can be a nerve-wracking business especially if there is a question to be, if not resolved, then at least confronted; or a decision called for, not despite the famous undecidablity hypothesis, but precisely because of it. Thus it is that finally, casting off the shadows of the night, Jacques Derrida steps into the daylight, in Paris in December 2000, to address directly the question of his Jewishness. Even if his presentation remains marked by the reservations shown in the past, and in particular the casting of affiliation in the self-cancelling terms of its annulment, Derrida nevertheless here lets down his guard in a way he had not done before. And the outcome is remarkable: for the first time he ascribes the aporetic structure of his thinking to a particular propensity for indeterminacy, which he aligns â??not with Judaism in any of its doctrinal formsâ?? but with the haunting event of â??circumcisionâ?? and with his own, somewhat idiosyncratic, experience of being Jewish. As both theme and strategy, â??circumcisionâ?? has indeed become a trope of tremendous significance in Derridaâ??s writing as it articulates itself inside the aporia where affiliation is inevitably determined by its own effacement. It epitomizes a difficult double bond which may well have a direct bearing on Derridaâ??s construal of what it means to think deconstructively.

Siegumfeldt, Inge Birgitte

2013-01-01

48

Working with Difficult Group Members.  

Science.gov (United States)

Describes types of group members who are challenging in group settings including entitled, manipulative, and character-disordered clients. Provides suggestions for working with these group members, either as isolated cases or as homogenous populations, emphasizing the protection of other clients' rights. Includes 31 references. (Author/CRR)

Kottler, Jeffrey A.

1994-01-01

49

Working in a difficult regime  

Energy Technology Data Exchange (ETDEWEB)

Some of the equipment in the two research reactors at the Vinca Institute in Belgrade, Serbia is fit for a museum. But the problem of ageing components is only one of the difficulties faced by the operators - they also have to cope with the political and financial conditions prevailing in their country. (author).

Pesic, M.; Cupac, S. [Vinca Institute of Nuclear Sciences, Belgrade (Yugoslavia). Nuclear Engineering Laboratory

1996-01-01

50

Electric scroll compressor for mobile air conditioning including heat pump; Elektrischer Scrollverdichter in PKW Klimaanlage mit Waermepumpe  

Energy Technology Data Exchange (ETDEWEB)

In a two-zone climatic chamber a refrigeration cycle for mobile air conditioning of an electric vehicle was designed by switching with multi way valves between cooling and heating cycle. As a refrigerant compressor, an electric scroll compressor is used. In experimental studies, the COPs and compressor ratios of the two modes are shown. (orig.)

Mardorf, Lutz; Menger, Peter; Heiker, Mathias [Hochschule Osnabrueck (Germany). Labor fuer Angewandte Thermodynamik

2011-04-15

51

Current Trends in the Management of Difficult Urinary Catheterizations  

Directory of Open Access Journals (Sweden)

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

Paul A Willette

2012-12-01

52

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

1996-01-01

53

Factors Making Expository Reading Difficult.  

Science.gov (United States)

This paper discusses the difficulty students often face when many new words are simultaneously introduced in a text. It suggests teachers may address this difficulty in a number of ways, including the following: writing to a publisher to suggest improvements; providing lists of new words to students before reading selections; and focusing on…

Ediger, Marlow

54

Tough Choices in Difficult Times.  

Science.gov (United States)

Key areas school districts have used in making the decision to purchase technology applications include: what the district hopes to achieve by purchasing the system; how the proposed system will support the district's vision and help achieve the strategic plan; what the effect of the proposed solution will be on staffing; and what type of timeline…

Scheer, Sage Ann

2002-01-01

55

Difficult airway and difficult intubation in postintubation tracheal stenosis: a case report and literature review  

Directory of Open Access Journals (Sweden)

Full Text Available Paul Zarogoulidis,1 Theodoros Kontakiotis,1 Kosmas Tsakiridis,2 Michael Karanikas,3 Christos Simoglou,4 Konstantinos Porpodis,1 Alexandros Mitrakas,3 Agisilaos Esebidis, 3 Maria Konoglou,5 Nikolaos Katsikogiannis,6 Vasilis Zervas,1 Christina Aggelopoulou,7 Dimitrios Mikroulis,4 Konstantinos Zarogoulidis11Pulmonary Department, "G Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece; 2Cardiothoracic Department, Saint Luke Private Hospital, Thessaloniki, Greece; 31st University Surgery Department, 4Cardiothoracic Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece; 51st Pulmonary Department, "G Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece; 6Surgery Department (NHS, 7Neurology Department (NHS, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, GreeceAbstract: Management of a "difficult airway" remains one of the most relevant and challenging tasks for anesthesiologists and pulmonary physicians. Several conditions, such as inflammation, trauma, tumor, and immunologic and metabolic diseases, are considered responsible for the difficult intubation of a critically ill patient. In this case report we present the case of a 46-year-old male with postintubation tracheal stenosis. We will focus on the method of intubation used, since the patient had a "difficult airway" and had to be intubated immediately because he was in a life-threatening situation. Although technology is of utter importance, clinical examination and history-taking remain invaluable for the appropriate evaluation of the critically ill patient in everyday medical life. Every physician who will be required to perform intubation has to be familiar with the evaluation of the difficult airway and, in the event of the unanticipated difficult airway, to be able to use a wide variety of tools and techniques to avoid complications and fatality.Keywords: difficult airway, bronchoscopic intubation, predictive factors, predictive scales

Zarogoulidis P

2012-06-01

56

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

57

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

1993-01-01

58

Effects of Cd & Ni toxicity to Ceratophyllum demersum under environmentally relevant conditions in soft & hard water including a German lake.  

Science.gov (United States)

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. PMID:24096235

Andresen, Elisa; Opitz, Judith; Thomas, George; Stärk, Hans-Joachim; Dienemann, Holger; Jenemann, Kerstin; Dickinson, Bryan C; Küpper, Hendrik

2013-10-15

59

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

Science.gov (United States)

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

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

2012-01-01

60

Clostridium difficile phages: still difficult?  

Science.gov (United States)

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 summarize 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. PMID:24808893

Hargreaves, Katherine R; Clokie, Martha R J

2014-01-01

 
 
 
 
61

A practical approach to difficult urinary catheterizations.  

Science.gov (United States)

Routine placement of transurethral catheters can be challenging in some situations, such as urethral strictures, severe phimosis and false passages. Intravaginal retraction of the urethral meatus can complicate Foley placement in postmenopausal females. In men, blind urethral procedures with mechanical or metal sounds without visual guidance or guidewire assistance are now discouraged due to the increased risk of urethral trauma and false passages. Newer techniques of urethral catheterization including guidewires, directed hydrophilic mechanical dilators, urethral balloon dilation, and direct vision endoscopic catheter systems are discussed, along with the new standardized protocol for difficult transurethral catheter insertions. Suprapubic catheter placement techniques, including percutaneous trocars and the use of the curved Lowsley tractor for initial suprapubic catheter insertion, are reviewed. Prevention and management of common catheter-related problems such as encrustation, leakage, Foley malposition, balloon cuffing and frequent blockages are discussed. PMID:23959835

Ghaffary, Cameron; Yohannes, Amanuel; Villanueva, Carlos; Leslie, Stephen W

2013-12-01

62

Solving difficult hepatobiliary problems in children  

Scientific Electronic Library Online (English)

Full Text Available SciELO South Africa | Language: English Abstract in english Most difficult hepatobiliary (HPB) problems in infancy and childhood result from pathological anatomical/mechanical derangements; therefore, surgery on the liver and bile ducts depends on a detailed understanding of liver structure, function and repair response to injury or disease. The surgeon must [...] be aware of the very diverse range of anatomical variations. Perhaps key to improving the outcome of paediatric HPB surgery is centralised management and associating this with a paediatric liver transplant programme, which adds expertise and, frequently, the added benefit of adult HPB surgical input to paediatric surgical care. In the United Kingdom, this has resulted in excellent measurable benefit, particularly in the management of biliary atresia, but also of choledochal cysts, portal hypertension and liver tumours. These conditions are briefly discussed here, with focus on the technical aspects of operative management.

Millar, A J W.

63

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...

2003-01-01

64

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.)

1983-05-01

65

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.)

1980-01-01

66

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

67

Sympathetic responsibility in ethically difficult situations*.  

Digital Repository Infrastructure Vision for European Research (DRIVER)

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.

2005-01-01

68

Difficult Channel Generation Using Genetic Algorithm  

Directory of Open Access Journals (Sweden)

Full Text Available For channel routing problems, Deutsch's channel examples were used extensively asbenchmarks for testing new algorithms. However, it is also important to test the performanceof channel routing algorithms on a wider variety of difficult examples. In this paper, wepresent a random channel routing generator which can generate difficult channel routinginstances of arbitrary size. In this paper our goal is to generate those channels using GeneticAlgorithm, which have maximum constraints (both vertical and horizontal constraint.

Siddhartha Banerjee

2010-10-01

69

Discharge and charge characteristics of amorphous FeOOH including aniline (a{sub an}-FeOOH). Influence of preparation conditions on discharge and charge characteristics  

Energy Technology Data Exchange (ETDEWEB)

The effect of the preparation conditions for amorphous FEOOH including aniline (a{sub an}-FeOOH) on its discharge and charge characteristics as a cathode material for a rechargeable lithium battery was investigated to improve the discharge and charge characteristics. The a{sub an}-FeOOH was prepared in solutions containing different Concentrations of aniline, or in solutions with different pH. From the discharge and charge characteristics of these products, it can be seen that the discharge capacity depends on the pH of the reaction solution rather than the concentration of aniline.

Sakaebe, Hikari; Higuchi, Shunichi [Osaka National Research Inst. (Japan). Dept. for Energy Conversion; Kanamura, Kiyoshi; Fujimoto, Hiroyuki; Takehara, Zenichiro [Kyoto Univ. (Japan)

1995-02-01

70

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

2003-01-01

71

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

72

Crisis management during anaesthesia: difficult intubation  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Background: Anaesthetists may experience difficulty with intubation unexpectedly which may be associated with difficulty in ventilating the patient. If not well managed, there may be serious consequences for the patient. A simple structured approach to this problem was developed to assist the anaesthetist in this difficult situation.

Paix, A.; Williamson, J.; Runciman, W.

2005-01-01

73

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

74

PRAISE: Christians Educators and the Difficult Student  

Directory of Open Access Journals (Sweden)

Full Text Available This article defends the role of the Christian educator in reaching the difficult student. It further offers tips for handling the challenging student from a Christian perspective, coupled with tried-and-true research using the acronym PRAISE: being proactive, using reinforcements, assessing and analyzing the intent of misbehavior, being sincere, and empowering students and the Holy Spirit in them.

Beth E. Ackerman

2008-05-01

75

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

76

The Art of Diplomacy: Winning the Support of Difficult Parents.  

Science.gov (United States)

Provides guidelines for educators to prepare for potentially difficult parent conferences and to conduct them to a successful conclusion. Suggestions include anticipating concerns, accentuating the positive, listening to parents, being truthful, being firm, being polite, offering solutions and assistance, asking for suggestions, admitting…

Smith, Cecilia Joyce

1997-01-01

77

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

78

Characterizing mine detector performance over difficult soils  

Science.gov (United States)

A variety of metal detectors are available for the detection of buried metallic targets in general and for humanitarian demining in particular. No one detector is optimal in all environments: variations in soil conductivity, and more importantly, frequency dependent soil magnetic susceptibility can favor one design over another. The use of computer modeling for assessing different designs is straightforward in principle, at least to first order, but still difficult in practice. The Geophysics Lab of the University of Toronto is attempting to address this problem in two ways. The first is by assembling the required computational algorithms to do this into a single simulation code with a straightforward GUI, intended to be public domain as a MATLAB code. The second, the subject of a companion paper in this conference, is by making measurements of the electromagnetic properties of difficult soils, and finding semi-analytic representations of these responses suitable for modeling purposes. The final version of the code, when completed, is to handle single or multiple transmitter and receiver coils of circular or polygonal shape, general transmitter current waveforms, arbitrary transmitter orientations and survey paths, small targets with frequency-dependent anisotropic responses (permitting both magnetic and inductive responses to be calculated), embedded in multi-layered half spaces with both conductivity and frequency-dependent susceptibility (so-called "difficult soils"). The current state of the simulation code and examples of its use will be described in this paper.

Bailey, R. C.; West, G. F.

2006-06-01

79

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

80

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.

Villanueva, Carlos; Hemstreet III, George P..

 
 
 
 
81

Honey bees selectively avoid difficult choices.  

Science.gov (United States)

Human decision-making strategies are strongly influenced by an awareness of certainty or uncertainty (a form of metacognition) to increase the chances of making a right choice. Humans seek more information and defer choosing when they realize they have insufficient information to make an accurate decision, but whether animals are aware of uncertainty is currently highly contentious. To explore this issue, we examined how honey bees (Apis mellifera) responded to a visual discrimination task that varied in difficulty between trials. Free-flying bees were rewarded for a correct choice, punished for an incorrect choice, or could avoid choosing by exiting the trial (opting out). Bees opted out more often on difficult trials, and opting out improved their proportion of successful trials. Bees could also transfer the concept of opting out to a novel task. Our data show that bees selectively avoid difficult tasks they lack the information to solve. This finding has been considered as evidence that nonhuman animals can assess the certainty of a predicted outcome, and bees' performance was comparable to that of primates in a similar paradigm. We discuss whether these behavioral results prove bees react to uncertainty or whether associative mechanisms can explain such findings. To better frame metacognition as an issue for neurobiological investigation, we propose a neurobiological hypothesis of uncertainty monitoring based on the known circuitry of the honey bee brain. PMID:24191024

Perry, Clint J; Barron, Andrew B

2013-11-19

82

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...

83

A comprehensive predictive scoring method for difficult laparoscopic cholecystectomy  

Science.gov (United States)

CONTEXT: Laparoscopic cholecystectomy (LC) is the gold standard cholecystectomy. LC is the most common difficult laparoscopic surgery performed by surgeons today. The factors leading to difficult laparoscopic cholecystectomy can be predicted. AIMS: To develop a scoring method that predicts difficult laparoscopic cholecystectomy. SETTINGS AND DESIGN: Bidirectional prospective study in a medical college setup. MATERIALS AND METHODS: Following approval from the institutional ethical committee, cases from the three associated hospitals in a medical college setup, were collected using a detailed proforma stating the parameters of difficulty in laparoscopic cholecystectomy. Study period was between May 10 and June 12. Preoperative, sonographic and intraoperative criteria were considered. STATISTICAL ANALYSIS USED: Chi Square test and Receiver Operater Curve (ROC) analysis. RESULTS: Total 323 patients were included. On analysis, elderly patients, males, recurrent cholecystitis, obese patients, previous surgery, patients who needed preoperative Endoscopic retrograde cholangiopancreatography (ERCP), abnormal serum hepatic and pancreatic enzyme profiles, distended or contracted gall bladder, intra-peritoneal adhesions, structural anomalies or distortions and the presence of a cirrhotic liver on ultrasonography (USG) were identified as predictors of difficult LC. A scoring system tested against the same sample proved to be effective. A ROC analysis was done with area under receiver operator curve of 0.956. A score above 9 was considered difficult with sensitivity of 85% and specificity of 97.8%. CONCLUSIONS: This study demonstrates that a scoring system predicting the difficulty in LC is feasible. There is scope for further refinement to make the same less cumbersome and easier to handle. Further studies are warranted in this direction.

Vivek, Mittalgodu Anantha Krishna Murthy; Augustine, Alfred Joseph; Rao, Ranjith

2014-01-01

84

A guide for easy- and difficult-to-treat hypertension.  

Science.gov (United States)

Although the blood pressure (BP) of many patients can be controlled using standard combinations, treatment of hypertension frequently represents a clinical challenge to the primary care physician. This article will review best practices for managing patients with easy- and difficult-to-treat hypertension, including preferred antihypertensive combinations, optimizing adherence and persistence, recognizing white-coat hypertension, and intensifying therapy for treatment-resistant patients. Each physician must decide based on his or her own level of experience at what point a patient becomes too challenging and would benefit from referral to a hypertension specialist for more intensive management and to complete the exclusion of secondary forms of arterial hypertension. With intensive pharmacotherapy, many patients with difficult-to-treat hypertension can achieve BP control. If it fails, interventional strategies (e.g., renal denervation) are a valid option to get BP controlled. PMID:24456885

Schmieder, Roland E; Volpe, Massimo; Waeber, Bernard; Ruilope, Luis M

2014-03-01

85

[Anesthesia in spontaneous ventilation for difficult intubation].  

Science.gov (United States)

Difficult intubation in children is rare and often predictable during anesthesia consultation. This allows to establish a strategy to provide fiberoptic guided tracheal intubation with spontaneous ventilation in function of age and children pathology. A good knowledge of physiologic and anatomic children particularities, of fiberoptic technique and the respect for some principles lead to ensure the security of this procedure. First principle is to use only one anesthetic inhaled or intravenous agent in order to limit an important decrease of ventilation. The anesthetic technique recommended for pediatric fiberoptic guided intubation is inhaled anesthesia with sevoflurane. But it is possible to use an intravenous agent, like propofol, with a continuous infusion (bolus of 0.1 to 0.3 mg/kg then 0.1-0.3mg/kg per hour for maintenance) or with target controlled infusion (Schnider model, initial concentration 2.5 ?g/mL, then increase by 0.5 ?g/mL steps) particularly in children older than 5 years with an anesthetic depth control. Whatever the agent, the dose must to be titrated to maintain spontaneous ventilation. Second principle is to combine an airway local anesthesia with general anesthesia to limit airway reactivity. First, a nose topical anesthesia is administered with lidocaine plus naphazoline in children older than 2 years. Then, a laryngeal topical anesthesia is realized with lidocaine 1% (1-2 mL, 2mg/kg) through operating channel of fiberoptic bronchoscope. Finally, third principle is to ensure patient oxygenation with several techniques like use of endoscopic facial mask or nasopharyngeal tube. The use of laryngeal mask is a rescue technique in case of spontaneous ventilation lost. In conclusion, each institution has to establish an algorithm with his own knowledge, constantly feasible and regularly taught. PMID:24209989

Salvi, N; Orliaguet, G

2013-12-01

86

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

Science.gov (United States)

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

Scott, Hazel J.; Gale, Alastair G.

2005-04-01

87

THE GENERALIZATION OF A CIRCULAR BOUNDARY CONDITION IN THE PROGRAM POISSON TO INCLUDE NO SYMMETRY AND AXIS-SYMMETRY OF REVOLUTION  

Energy Technology Data Exchange (ETDEWEB)

We have previously reported on the incorporation of a circular boundary condition into the program POISSON for two-dimensional problems (Incorporation of a Circular Boundary Condition into the Program POISSON, S. Caspi, M. Helm, and L.J. Laslett, LBID-887, SSC MAG Note-S, February 13, 1984). The least square method has now been generalized to accept any suitable set of orthogonal functions which can describe the vector potential function outside a circular boundary so located that no external sources are present. We have proceeded to incorporate the boundary condition into cartesian problems which involve no symmetry, and into axis-symmetry cylindrical problems that may have left-right symmetry, antisymmetry or no symmetry.

Caspi, S.; Helm, M.; Laslett, L.J.

1984-07-01

88

Reaching Consensus Is a Difficult Task.  

Science.gov (United States)

Critiques the consensus statement of an international conference on child abuse. Criticism includes lack of true interdisciplinary representation at the conference, lack of acknowledgement of the possible trauma of multiple interviews for children, and lack of a more comprehensive statement on medical examinations. (JPS)

Lyle, Carolyn

1994-01-01

89

Invited Speech- PACS & US: A Difficult Integration  

Digital Repository Infrastructure Vision for European Research (DRIVER)

PACS is in daily use in many hospitals and shows a reasonably good degreeof functionality when dealing with radiological images.However, there are still some unresolved problems when PACS is asked tomanage ultrasonographic images. These images are markedly different withrespect to the other diagnostic images. They are dynamic, and multiframehas to be supported. They may include colour areas, and special LUT andwindow/level have to be foreseen. They display on the same screendifferent dimensio...

Davide Caramella

2007-01-01

90

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

91

Invited Speech- PACS & US: A Difficult Integration  

Directory of Open Access Journals (Sweden)

Full Text Available PACS is in daily use in many hospitals and shows a reasonably good degreeof functionality when dealing with radiological images.However, there are still some unresolved problems when PACS is asked tomanage ultrasonographic images. These images are markedly different withrespect to the other diagnostic images. They are dynamic, and multiframehas to be supported. They may include colour areas, and special LUT andwindow/level have to be foreseen. They display on the same screendifferent dimensions of data (e.g. a space - measured in cm - and avelocity - measured in cm/sec.Most PACS workstations are unable to cope with the specific requirementsfor optimally displaying ultrasonographic images.In this talk the specific issues of ultrasonography that are relevant forPACS will be discussed.

Davide Caramella

2007-08-01

92

Effects of Cd and Ni toxicity to Ceratophyllum demersum under environmentally relevant conditions in soft and hard water including a German lake  

International Nuclear Information System (INIS)

Highlights: •Hardly any macrophytic growth occurred in an oligotrophic hard water lake in Germany. •All parameters were optimal, besides elevated, nanomolar concentrations of Ni and Cd. •We cultivated submerged macrophytes in real and simulated hard and soft lake water. •Nanomolar Cd and Ni inhibited the plants’ photosynthetic light reactions in soft water. •The inhibition was synergistic, i.e. stronger than the addition of Cd and Ni effects. -- Abstract: Even essential trace elements are phytotoxic over a certain threshold. In this study, we investigated whether heavy metal concentrations were responsible for the nearly complete lack of submerged macrophytes in an oligotrophic lake in Germany. We cultivated the rootless aquatic model plant Ceratophyllum demersum under environmentally relevant conditions like sinusoidal light and temperature cycles and a low plant biomass to water volume ratio. Experiments lasted for six weeks and were analysed by detailed measurements of photosynthetic biophysics, pigment content and hydrogen peroxide production. We established that individually non-toxic cadmium (3 nM) and slightly toxic nickel (300 nM) concentrations became highly toxic when applied together in soft water, severely inhibiting photosynthetic light reactions. Toxicity was further enhanced by phosphate limitation (75 nM) in soft water as present in many freshwater habitats. In the investigated lake, however, high water hardness limited the toxicity of these metal concentrations, thus the inhibition of macrophytic growth in the lake must have additional reasons. The results showed that synergistic heavy metal toxicity may change ecosystems in many more cases than estimated so far

2013-10-15

93

Effects of Cd and Ni toxicity to Ceratophyllum demersum under environmentally relevant conditions in soft and hard water including a German lake  

Energy Technology Data Exchange (ETDEWEB)

Highlights: •Hardly any macrophytic growth occurred in an oligotrophic hard water lake in Germany. •All parameters were optimal, besides elevated, nanomolar concentrations of Ni and Cd. •We cultivated submerged macrophytes in real and simulated hard and soft lake water. •Nanomolar Cd and Ni inhibited the plants’ photosynthetic light reactions in soft water. •The inhibition was synergistic, i.e. stronger than the addition of Cd and Ni effects. -- Abstract: Even essential trace elements are phytotoxic over a certain threshold. In this study, we investigated whether heavy metal concentrations were responsible for the nearly complete lack of submerged macrophytes in an oligotrophic lake in Germany. We cultivated the rootless aquatic model plant Ceratophyllum demersum under environmentally relevant conditions like sinusoidal light and temperature cycles and a low plant biomass to water volume ratio. Experiments lasted for six weeks and were analysed by detailed measurements of photosynthetic biophysics, pigment content and hydrogen peroxide production. We established that individually non-toxic cadmium (3 nM) and slightly toxic nickel (300 nM) concentrations became highly toxic when applied together in soft water, severely inhibiting photosynthetic light reactions. Toxicity was further enhanced by phosphate limitation (75 nM) in soft water as present in many freshwater habitats. In the investigated lake, however, high water hardness limited the toxicity of these metal concentrations, thus the inhibition of macrophytic growth in the lake must have additional reasons. The results showed that synergistic heavy metal toxicity may change ecosystems in many more cases than estimated so far.

Andresen, Elisa, E-mail: Elisa.Andresen@uni-konstanz.de [University of Konstanz, Department of Biology, D-78457 Konstanz (Germany); Opitz, Judith, E-mail: Daniela.Opitz@uni-konstanz.de [University of Konstanz, Department of Biology, D-78457 Konstanz (Germany); Thomas, George, E-mail: George.Thomas@uni-konstanz.de [University of Konstanz, Department of Biology, D-78457 Konstanz (Germany); Stärk, Hans-Joachim, E-mail: Ha-Jo.Staerk@ufz.de [UFZ – Helmholtz Centre for Environmental Research, Department of Analytical Chemistry, Permoserstr. 15, D-04318 Leipzig (Germany); Dienemann, Holger, E-mail: Holger.Dienemann@smul.sachsen.de [Saxon State Company for Environment and Agriculture, Business Domain 5 (Laboratory), Department 53, Bitterfelder Str. 25, D-04849 Bad Düben (Germany); Jenemann, Kerstin, E-mail: Kerstin.Jenemann@smul.sachsen.de [Sächsisches Landesamt für Umwelt, Landwirtschaft und Geologie, Abteilung Wasser, Boden, Wertstoffe, Zur Wetterwarte 11, D-01109 Dresden (Germany); Dickinson, Bryan C., E-mail: Bryan.Dickinson@gmail.com [Harvard University, Department of Chemistry and Chemical Biology, 12 Oxford Street, Cambridge, MA 02138 (United States); Küpper, Hendrik, E-mail: Hendrik.Kuepper@uni-konstanz.de [University of Konstanz, Department of Biology, D-78457 Konstanz (Germany); University of South Bohemia, Faculty of Biological Sciences and Institute of Physical Biology, Branišovská 31, CZ-370 05 ?eské Budejovice (Czech Republic)

2013-10-15

94

Maxillofacial trauma patient: coping with the difficult airway  

Directory of Open Access Journals (Sweden)

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

Barak Michal

2009-05-01

95

Laser-assisted machining of difficult-to-machine materials  

Energy Technology Data Exchange (ETDEWEB)

Laser-assisted machining (LAM) is a hybrid process for which a difficult-to-machine material, such as a ceramic or super alloy, is irradiated by a laser source prior to material removal by a cutting tool. The process has the potential to significantly increase material removal rates, as well as to improve the geometry and properties of the finished work piece. Features and limitations of theoretical and experimental procedures for determining the transient thermal response of a work piece during LAM are described, and representative results are presented for laser-assisted turning of sintered silicon nitride. Significant physical trends are revealed by the calculations, as are guidelines for the selection of appropriate operating conditions.

Incropera, F.P.; Rozzi, J.C.; Pfefferkorn, F.E.; Lei, S.; Shin, Y.C.

1999-07-01

96

Difficult-to-wean: High index of suspicion  

Science.gov (United States)

Patient: Female, 57 Final Diagnosis: Syryngomyelia • cervical Symptoms: Acute respiratory insufficiency Medication: — Clinical Procedure: — Specialty: Pulmonology Objective: Rare disease Background: Failed planned extubation occurs in a minority of patients with acute respiratory failure requiring invasive mechanical ventilation. In patients presenting with acute respiratory failure with no identifiable cardiopulmonary causes, uncommon conditions, such as cervical spondylotic myelopathy, should be considered. In very rare instances, when cervical spondylotic myelopathy and syringomyelia present concomitantly, they can be devastating. Case Report: A 57-year-old woman visited the emergency room (ER) after feeling unwell for several days. She was brought to the ER with acute respiratory distress and obtunded state with GCS of 6/15. She was hypotensive and agonally breathing. Her initial neurologic evaluation was unrevealing. Based on these findings, she was intubated. Over the next several days, she was difficult to wean from the ventilator and had persistent respiratory acidosis. After a short-lived extubation, the patient was again re-intubated. This time the neurologic evaluation showed decreased movements of all muscle groups against gravity and forces, with generalized weakness. An MRI of the brain and cervical spine demonstrated moderate degenerative disc disease and syringomyelia extending from C2 to C7 level. The patient underwent de-compression laminectomy. After failing several weaning trials, she underwent bronchoscopically-assisted tracheotomy. Conclusions: Acute cardiopulmonary and intensive care unit-acquired neuromuscular conditions have been attributed as a major cause of difficult weaning and extubation. Failure to identify and correct other rare combinations (such as cervical degenerative disc disease and syringomyelia) may cause acute respiratory failure and subsequent failure to wean and extubation, resulting in high rates of mortality and morbidity.

Gelaye, Alehegn; Patel, Brijesh; Farra, Wassim; Kole, Bruce

2014-01-01

97

Improved techniques to successfully access the difficult reserves of the WCSB  

Energy Technology Data Exchange (ETDEWEB)

This paper described what constitutes a difficult reserve, and where they can be found in the Western Canada Sedimentary Basin (WCSB). Difficult reserves are sensitive to conventional drilling fluids, they are deep with extended reach and have restricted surface locations. They are difficult to reach because they are in faulted foothills such as the Front Foothills, Alberta Foothills, BC Foothills, and Northern Sections of the WCSB. The specific applications of new technologies to improve the economic viability of the basin were described. The latest instruments, motors and hardware that have been developed to improve the access and production potential of the reserves in the WCSB include wireline retrievable electronic drift tools, electromagnetic measurement while drilling (MWD) directional tools, and rotary steerable tools. These instruments can be applied under deep vertical, tight boundary conditions or to liquid sensitive formations such as coal beds, shales, anhydrates, salts, unconsolidated sections, and chalks. They can also be applied to most underbalanced drilling applications and other unconventional drilling fluid applications. Other available technologies include auto-drift correction motors, at-bit technology, mechanical thrusters, and high performance water based drilling fluids. The paper also discussed the use of acoustic telemetry as a method to transmit data from downhole systems to the surface. The paper examined whether these new developments will improve or weaken the economic viability of the WCSB. The economic break-even points to utilize these new technologies in the WCSB were established along with time horizons needed to improve drilling proficiency. The paper also examined how successful directional drilling is in terms of an exploration tool for the WCSB. 7 refs., 4 tabs., 6 figs.

Peters, A. [Newsco Directional and Horizontal Drilling Services Inc., Calgary, AB (Canada)

2003-07-01

98

Difficult male urethral catheterization: a review of different approaches  

Digital Repository Infrastructure Vision for European Research (DRIVER)

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 urethr...

Carlos Villanueva; Hemstreet Iii, George P.

2008-01-01

99

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

100

Pipeline developments 1998 and beyond : more choices, more difficult decisions  

Energy Technology Data Exchange (ETDEWEB)

Some of the basic economic principles that drive gas prices and gas flows across North America, and the pressures these have placed on the pipeline sector, are reviewed. Of pressing importance to the natural gas industry in Western Canada is the prospect that in the near future industrial gas users in eastern Canada will have a wider array of pipeline choices available to them than ever before. This will mean that the users will face more offerings from more pipeline providers, forcing pipeline owners to make more difficult decisions regarding new pipeline capacity. Variables such as price, terms and conditions will become increasingly negotiable. Market power concerns also remain an important issue. As a result, there is increasing call for market-based financial regulation of pipelines. `Market gaming` a condition where a firm manipulates the market to its own market advantage is also receiving considerable attention. The latter is of particular concern in the United States. Against this background, the nature of competition (or the lack of it) in natural gas transport, the influence of short-term service revenues for pipelines, pipeline commitments through subsidiaries, and concerns over short term pipeline valuations skewing investment decisions, are issues that will continue to invite much attention. Regarding market outlook, it was noted that significantly increased export capacity from Alberta could raise the costs of Alberta supplies to eastern Canadian end-users relative to other supply/transport options which may now be viable economic alternatives. figs.

VanderSchee, K. [EnergyERA (Canada)

1998-12-31

 
 
 
 
101

Pipeline developments 1998 and beyond : more choices, more difficult decisions  

International Nuclear Information System (INIS)

Some of the basic economic principles that drive gas prices and gas flows across North America, and the pressures these have placed on the pipeline sector, are reviewed. Of pressing importance to the natural gas industry in Western Canada is the prospect that in the near future industrial gas users in eastern Canada will have a wider array of pipeline choices available to them than ever before. This will mean that the users will face more offerings from more pipeline providers, forcing pipeline owners to make more difficult decisions regarding new pipeline capacity. Variables such as price, terms and conditions will become increasingly negotiable. Market power concerns also remain an important issue. As a result, there is increasing call for market-based financial regulation of pipelines. 'Market gaming' a condition where a firm manipulates the market to its own market advantage is also receiving considerable attention. The latter is of particular concern in the United States. Against this background, the nature of competition (or the lack of it) in natural gas transport, the influence of short-term service revenues for pipelines, pipeline commitments through subsidiaries, and concerns over short term pipeline valuations skewing investment decisions, are issues that will continue to invite much attention. Regarding market outlook, it was noted that significantly increased export capacity from Alberta could raise the costs of Alberta supplies to eastern Canadian end-users relative to other supply/transport options which may now be viable economic alternatives. figs

1998-11-03

102

Racial microaggressions and difficult dialogues on race in the classroom.  

Science.gov (United States)

A qualitative study supports the observation that difficult dialogues on race and racism are often triggered by racial microaggressions that make their appearance in classroom encounters or educational activities and materials. Difficult dialogues are filled with strong powerful emotions that may prove problematic to both students and teachers. When poorly handled by teachers, difficult dialogues can assail the personal integrity of students of color while reinforcing biased worldviews of White students. The success or failure of facilitating difficult dialogues on race is intimately linked to the characteristics and actions of instructors and their ability to recognize racial microaggressions. Implications regarding specific education and training recommendations are presented. PMID:19364205

Sue, Derald Wing; Lin, Annie I; Torino, Gina C; Capodilupo, Christina M; Rivera, David P

2009-04-01

103

Uncomfortable Positions: How Policy Practitioners Negotiate Difficult Subjects  

Digital Repository Infrastructure Vision for European Research (DRIVER)

This thesis examines how policy practitioners negotiate difficult subjects, specifically the difficult subjects entailed in negotiations around community cohesion policy. The research applies a governmentality perspective to consider how people working within government (using techniques of governmentality to govern populations) are subject to regimes of governmentality themselves. A substantial body of the research is based on detailed ethnographic work (both participant observation and exte...

2011-01-01

104

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

105

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

106

Difficult medical problems: on explanatory models and a pragmatic alternative.  

Science.gov (United States)

Despite the significant improvements in the treatment of many pathologic processes witnessed over the past century, some particularly difficult medical problems persist. Some of these problems, perhaps best exemplified by chronic low back pain/degenerative disc disease, are characterized by unclear underlying etiologies and less than desirable outcomes of treatment in spite of considerable intellectual and financial investment. Faced with these disorders, many physicians rely on 'explanatory models', such as the traditional Biomedical model or the Biopsychosocial model, to provide a perspective from which to aim research, diagnosis, and treatment programs. The strength of the Biomedical model is its proven success as a roadmap for diagnosis and treatment of a multitude of diseases over the past two centuries. Its weakness lies in its failure to fully include psychosocial factors which have proven to be powerful co-factors of disease in modern society. The Biopsychosocial model has filled this void, but carries with it the potential to blur more straightforward biomedical models of causation (and their straight-forward treatments), questions about whether it is a falsifiable scientific theory, and whether it further 'medicalizes' those being treated. In this paper, we expand and detail the strengths and weaknesses of using these explanatory models and conclude by presenting a 'pragmatic alternative' hypothesis. PMID:17055182

Weiner, Bradley K

2007-01-01

107

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

108

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

109

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

110

Easy computation of difficult to measure activation radionuclides  

International Nuclear Information System (INIS)

Electricite de France (EDF), radioactive waste producer, is responsible for managing waste from dismantling of its permanently shut-down nuclear power plants. The process has been opened for a few years for 9 units. The main constraint of dismantling is the waste disposal and EDF is required to obtain a certification (or acceptance certification) form French governmental disposal agency (ANDRA) before any waste container production. Such a certification which is a detailed technical file, is the proof that the container, the waste conditioning method and the waste composition itself, especially the activity of each radionuclide (RN), comply with all the requirements of the disposal safety studies. Taking into account that EDF has already prepared numerous files describing a container and the means to fill it, the main problem to cope with now is the assessment of each RN present in each container ready to be shipped to the disposal. The general case of difficult-to-measure (DTM) RN management and specially the high difference between waste from plants in operation and waste from dismantling plants, are pointed out. Starting from a global neutron flux cartography at 100% power, a specific global strategy of DTM activation RN assessment for each type of waste is developed. As Co-60 is the only tracer, which is almost always the case in EDF dismantling, a simple way to compute the global scaling factors of mix of different waste initial composition is presented for that purpose. A new concept is introduced, the 'pseudo-scaling factor' which interesting geometric property allows a very simple industrial application container by container. If the neutron flux cartography is too detailed, a method of merging cells is introduced to decrease the number and the time of computation without any impact on the result quality. A method is also proposed to balance the fact that exact localization of each waste of each composition cannot be given very precisely in the neutron flux cartography. Then, we see that the knowledge of global mass of each composition allows us to limit this over assessment. An example of application of the global methodology is shortly presented about Creys-Malville French fast-breeder. (authors)

2007-03-01

111

Dissolution method for difficult-to-dissolve nuclear fuel  

International Nuclear Information System (INIS)

Difficult-to-dissolve nuclear fuels like e.g. ThO_2, PuO_2 are brought into a metallic dissolution vessel together with a nitric solven initially containing only small amounts of fissionable material. To the solvent an equimolar amount of fluoride ions is added that will form a complex compound with the fissionable material, thus only traces of the fluoride ions can be catalytically effective. In this way the difficult-to-dissolve fuels will be dissolved within a few hours. (orig.)

1981-07-02

112

This is the tricky part: When directions become difficult  

Directory of Open Access Journals (Sweden)

Full Text Available Automated route guidance systems, both web-based systems and en-route systems, have become commonplace in recent years. These systems often replace human-generated directions, which are often incomplete, vague, or in error. However, human-generated directions have the ability to differentiate between easy and complex steps through language in a way that is more difficult in automated systems. This article examines a set of human-generated verbal directions to better understand why some parts of directions are perceived as being more difficult than the remaining steps. Insights from this analysis will lead to recommendations to improve the next generation of automated route guidance systems.

Kai-Florian Richter

2010-07-01

113

Difficult Endoscopic Retrieval of a Migrated Stent inside a Pseudocyst  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Endoscopic ultrasound (EUS) guided pseudocyst drainage can have complications such as bleeding, perforation, infection, and stent migration. We report a case of iatrogenic migration of stent inside a large dumbbell-shaped pseudocyst managed successfully with a difficult endoscopic retrieval procedure.

2008-01-01

114

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

115

Management of difficult airway in intratracheal tumor surgery  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Abstract Background Tracheal malignancies are usual victim of delay in diagnosis by virtue of their symptoms resembling asthma. Sometimes delayed diagnosis may lead to almost total airway obstruction. For difficult airways, not leaving any possibility of manipulation into neck region or endoscopic intervention, femorofemoral cardiopulmonary bypass can be a promising approach. Case Presentation We are presenting a case of tracheal adenoid cystic carcinoma (cylind...

2005-01-01

116

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

Science.gov (United States)

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

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

2002-01-01

117

Councils face a difficult task to replace council tax benefit  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Stuart Adam and James Browne argue that the advantages of localising council tax rebate schemes seem to be strongly outweighed by the disadvantages; for instance, it will be difficult to design replacement schemes that protect the vulnerable while maintaining work incentives in the context of reduced funding.

Adam, Stuart; Browne, James

2012-01-01

118

Endoscopic management of difficult common bile duct stones  

Directory of Open Access Journals (Sweden)

Full Text Available Endoscopy is widely accepted as the first treatment option in the management of bile duct stones. In this review we focus on the alternative endoscopic modalities for the management of difficult common bile duct stones. Most biliary stones can be removed with an extraction balloon, extraction basket or mechanical lithotripsy after endoscopic sphincterotomy. Endoscopic papillary balloon dilation with or without endoscopic sphincterotomy or mechanical lithotripsy has been shown to be effective for management of difficult to remove bile duct stones in selected patients. Ductal clearance can be safely achieved with peroral cholangioscopy guided laser or electrohydraulic lithotripsy in most cases where other endoscopic treatment modalities have failed. Biliary stenting may be an alternative treatment option for frail and elderly patients or those with serious co morbidities.

Guru Trikudanathan

2013-01-01

119

Endoscopic management of difficult common bile duct stones.  

Science.gov (United States)

Endoscopy is widely accepted as the first treatment option in the management of bile duct stones. In this review we focus on the alternative endoscopic modalities for the management of difficult common bile duct stones. Most biliary stones can be removed with an extraction balloon, extraction basket or mechanical lithotripsy after endoscopic sphincterotomy. Endoscopic papillary balloon dilation with or without endoscopic sphincterotomy or mechanical lithotripsy has been shown to be effective for management of difficult to remove bile duct stones in selected patients. Ductal clearance can be safely achieved with peroral cholangioscopy guided laser or electrohydraulic lithotripsy in most cases where other endoscopic treatment modalities have failed. Biliary stenting may be an alternative treatment option for frail and elderly patients or those with serious co morbidities. PMID:23345939

Trikudanathan, Guru; Navaneethan, Udayakumar; Parsi, Mansour A

2013-01-14

120

How difficult is it to make a micro refrigerator?  

Energy Technology Data Exchange (ETDEWEB)

This paper describes how the entropy generation rate changes at each component in a vapor compression refrigerator as the system scale is decreased. A so-called micro refrigerator composed of all components in micro scale is inherently difficult to work according to the second law of thermodynamics. Although the quantitative evaluation of the entropy generation is not made here, it is clearly revealed that the mechanical compressor is the most difficult component to be miniaturized in a micro refrigerator. If a micro vapor compression refrigerator is to be successfully operated, a great deal of efforts must be made to develop a workable micro compressor and to minimize internal heat leak to the evaporator of the refrigerator. (author)

Sangkwon Jeong [Korea Advanced Institute of Science and Technology, Taejon (Korea). Department of Mechanical Engineering

2004-05-01

 
 
 
 
121

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

2005-03-01

122

Bronchogenic Cyst in a Patient with Difficult Asthma  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Difficult to treat asthma is an asthma syndrome that brings in our mind other differentials. Mediastinal masses are not common findings, but are important variables. Bronchogenic cyst is a congenital anomaly of the foregut that is typically found in the mediastinum and diagnosed accidentally. We present a 4-year-old girl with allergic asthma that began at 8-months of age and finally a bronchogenic cyst was detected in this patient. The patient had history of asthma since she was eight months ...

2010-01-01

123

Endoscopic management of difficult common bile duct stones  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Endoscopy is widely accepted as the first treatment option in the management of bile duct stones. In this review we focus on the alternative endoscopic modalities for the management of difficult common bile duct stones. Most biliary stones can be removed with an extraction balloon, extraction basket or mechanical lithotripsy after endoscopic sphincterotomy. Endoscopic papillary balloon dilation with or without endoscopic sphincterotomy or mechanical lithotripsy has been shown to be effective ...

2013-01-01

124

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

125

Support and roadway dimensioning under difficult technological conditions in coal mines  

Energy Technology Data Exchange (ETDEWEB)

Formulae are proposed for calculating rock pressure and roadway convergence in underground mines. Rock deformations measured in a roadway with arch supports are analyzed; bending moments on steel arch supports were calculated. Application of formulae is demonstrated with the example of a type 7 (Polish standard) three-part, flexible steel arch support. Calculations show that arch supports should be placed at 0.5 m intervals to withstand rock pressure in this particular mine section. (3 refs.)

Galczynski, S.; Dudek, J.

1983-01-01

126

Pneumatic conveyance of stowing material under difficult conditions in the Asse research mine  

International Nuclear Information System (INIS)

The Asse mine as a former potash and rock salt mine has been used for research work in the field of final storage of radioactive waste since 1965. Because of the prevailing rock pressure the pillars between the individual chambers were loaded to such an extent that extensive spalling and increased caving of pillars occurred over the years. As the chambers could no longer be entered without risk, the BGR considered that the backfilling of the southern flank to improve the stability of the mine with a view to continued use was urgently required. The paper deals with selection of the conveying method and stowing material and also provides information on the operating experience already acquired. (orig.)

2000-04-13

127

Enhanced Local Texture Feature Sets for Face Recognition under Difficult Lighting Conditions  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Recognition in uncontrolled situations is one of the most important bottlenecks for practical face recognition systems. We address this by combining the strengths of robust illumination normalization, local texture based face representations and distance transform based matching metrics. Specifically, we make three main contributions: (i) we present a simple and efficient preprocessing chain that eliminates most of the effects of changing illumination while still preserving the essential appe...

Tan, Xiaoyang; Triggs, Bill

2007-01-01

128

Cirugía maxilofacial ambulatoria: una estrategia en difíciles condiciones Ambulatory maxillofacial surgery: a strategy under difficult conditions  

Directory of Open Access Journals (Sweden)

Full Text Available Se exponen los resultados alcanzados en la cirugía mayor ambulatoria del Servicio de Cirugía Maxilofacial del Hospital Universitario "Dr. Miguel Enríquez" en el año 2003, con el objetivo de evaluar el comportamiento de esta actividad y su repercusión institucional y económica. Se realizó un análisis prospectivo de observación considerando las variables edad, sexo, tipo de anestesia, intervención quirúrgica realizada y complicaciones, las cuales fueron organizadas, analizadas y tabuladas por el método simple de los palotes. El 61 % de los pacientes fue operado por este proceder, todos con anestesia local. Los indicadores hospitalarios mejoraron al reportarse por esta vía el 58,32 % del total de intervenciones quirúrgicas. El sexo femenino (63,38 % y los grupos de edades de 15-24 y 35-44 años, fueron predominantes en nuestra serie. Las extracciones múltiples con alveoloplastias y la exéresis de los dientes retenidos, fueron las intervenciones quirúrgicas de mayor frecuencia, con el 48,02 y 38,60 %, respectivamente. No hubo complicaciones significativas. Se comparan los resultados con el de otros autores, que son muy similares en el orden cuantitativo. Se evalúa el impacto económico-social por el importante ahorro de recursos que representa este método, fundamentalmente al no haber gastos por hospitalización, y en la familia, que solo deja de trabajar el día de la operación, además de preferir este método por tener mayor acercamiento con el paciente.The results attained in the ambulatory major surgery of the Maxillofacial Surgery Service of “Dr. Miguel Enríquez” Teaching Hospital in 2003 are exposed aimed at evaluating the behavior of this activity and its institutional and economic impact. The method consisted in an observational prospective analysis, considering variables such as age, sex, type of anesthesia, surgery performed and complications, which were organized, analyzed and tabulated by the downstroke method. It was observed that 61 % underwent this surgical procedure with local anesthesia. The hospital indicators improved on being reported by this way 58.32 % of the total of operations. Females (63.38 % and the age groups 15-24 and 35-44 predominated in our series. Multiple extractions with alveoloplasties and the exeresis of the retained tooth were the most frequent operations, with 48.02 and 38.60 %, respectively. There were no significant complications. The results are compared with those obtained by other authors that were very similar in the quantitative sense. The economic-social impact is evaluated due to the significant saving of resources this method represents., since there are no hospitalization costs and the relatives only have to be absent from work the day of the operation. They also prefer this method because they are closer to the patient.

Luis Hernández Pedroso

2006-04-01

129

Cirugía maxilofacial ambulatoria: una estrategia en difíciles condiciones / Ambulatory maxillofacial surgery: a strategy under difficult conditions  

Scientific Electronic Library Online (English)

Full Text Available SciELO Cuba | Language: Spanish Abstract in spanish Se exponen los resultados alcanzados en la cirugía mayor ambulatoria del Servicio de Cirugía Maxilofacial del Hospital Universitario "Dr. Miguel Enríquez" en el año 2003, con el objetivo de evaluar el comportamiento de esta actividad y su repercusión institucional y económica. Se realizó un análisis [...] prospectivo de observación considerando las variables edad, sexo, tipo de anestesia, intervención quirúrgica realizada y complicaciones, las cuales fueron organizadas, analizadas y tabuladas por el método simple de los palotes. El 61 % de los pacientes fue operado por este proceder, todos con anestesia local. Los indicadores hospitalarios mejoraron al reportarse por esta vía el 58,32 % del total de intervenciones quirúrgicas. El sexo femenino (63,38 %) y los grupos de edades de 15-24 y 35-44 años, fueron predominantes en nuestra serie. Las extracciones múltiples con alveoloplastias y la exéresis de los dientes retenidos, fueron las intervenciones quirúrgicas de mayor frecuencia, con el 48,02 y 38,60 %, respectivamente. No hubo complicaciones significativas. Se comparan los resultados con el de otros autores, que son muy similares en el orden cuantitativo. Se evalúa el impacto económico-social por el importante ahorro de recursos que representa este método, fundamentalmente al no haber gastos por hospitalización, y en la familia, que solo deja de trabajar el día de la operación, además de preferir este método por tener mayor acercamiento con el paciente. Abstract in english The results attained in the ambulatory major surgery of the Maxillofacial Surgery Service of “Dr. Miguel Enríquez” Teaching Hospital in 2003 are exposed aimed at evaluating the behavior of this activity and its institutional and economic impact. The method consisted in an observational prospective a [...] nalysis, considering variables such as age, sex, type of anesthesia, surgery performed and complications, which were organized, analyzed and tabulated by the downstroke method. It was observed that 61 % underwent this surgical procedure with local anesthesia. The hospital indicators improved on being reported by this way 58.32 % of the total of operations. Females (63.38 %) and the age groups 15-24 and 35-44 predominated in our series. Multiple extractions with alveoloplasties and the exeresis of the retained tooth were the most frequent operations, with 48.02 and 38.60 %, respectively. There were no significant complications. The results are compared with those obtained by other authors that were very similar in the quantitative sense. The economic-social impact is evaluated due to the significant saving of resources this method represents., since there are no hospitalization costs and the relatives only have to be absent from work the day of the operation. They also prefer this method because they are closer to the patient.

Luis, Hernández Pedroso; Pedro A., Ducasse Olivera.

130

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

131

Liability for pharmaceutical products: a difficult attempt at harmonisation.  

Science.gov (United States)

On the 25 July 1985, the European Community adopted a Directive on liability for defective products. Doctors are very affected by this law because an injured person will possibly be able to take action against them. This directive had several aims: to harmonise member states' legislation concerning the legal protection of victims and to subject producers to the same framework of liability and competition rules. However, this directive currently remains relatively ineffective. Several reasons can be put forward to explain this failure. First, by leaving it open to member states to decide whether to opt for one or more derogations, the Directive has made it easier for different interpretations to emerge. Secondly, several ideas proposed by the Directive have not been defined. As a result, the different legal terminology used in different states makes the interpretation of these concepts more difficult. Our paper concludes that the Directive was soundly based. However, Member States must enquire about the solutions adopted in neighbouring countries, and the ECJ (European Court of Justice) should try to impress on states the importance of a community vision. Without an adequate level of convergence, the differences between national laws will encourage 'forum shopping' on the part of a claimant and the situation will become more difficult for prescribers. PMID:15270478

Rougé-Maillart, Clotilde; Jousset, Nathalie; Penneau, Michel

2004-01-01

132

How difficult is it to obtain restricted release authorization  

International Nuclear Information System (INIS)

Setting and implementing clean up standards for nuclear facilities pose some of the most significant policy and technical challenges facing the nuclear industry and regulators today. There continue to be challenges associated with the legal infrastructure and regulations for radioactive waste management, disposal, clearance and site release. Although progress on low-level waste (LLW) disposal sites has been achieved in some areas, we are still searching for safe, reliable and cost effective disposal solutions. In particular some facilities may not be able to decommission to levels that permit unrestricted use after decommissioning, in part because of the lack of cost effective disposal alternatives. The authors have worked on a number of approaches to addressing restricted release requirements for contaminated sites, and offer some perspective on this very difficult waste management issue. (authors)

2007-03-01

133

Management of difficult-to-treat atopic dermatitis.  

Science.gov (United States)

Atopic dermatitis is a complex disorder caused by the interplay between multiple genetic and environmental factors. Particularly in patients with severe disease, the effect is not just an itchy rash but also the secondary effects on the psychological well-being of the patient and their carers, particularly disturbed sleep. The aim of this review is to provide health care professionals with a holistic approach to the management of difficult-to-treat atopic dermatitis, defined as atopic dermatitis seemingly unresponsive to simple moisturizers and mild potency (classes VI and VII) topical corticosteroids. The critical importance of education and advice is emphasized, as is the seminal role of secondary bacterial infection and polyclonal T-cell activation in causing acute flares in patients with severe, generalized disease. In atypical cases or those that do not respond to treatment, alternative diagnoses should be considered. PMID:24565453

Arkwright, Peter D; Motala, Cassim; Subramanian, Hamsa; Spergel, Jonathan; Schneider, Lynda C; Wollenberg, Andreas

2013-03-01

134

How can schools build learning organisations in difficult education contexts?  

Directory of Open Access Journals (Sweden)

Full Text Available There is paucity in the study of learning organisations within the education sector and particularly in schools working in difficult socio-economic contexts, such as those studied in this investigation. In this qualitative study I therefore sought evidence from teachers, in one of the districts of Gauteng province, through in-depth, semi-structured focus group interviews to establish what a learning organisation is. Using data obtained through two in-depth, semi-structured focus group interviews with 16 teachers, themes were constructed to theorise their experiences on what a learning organisation is. The results showed that teacher commitment to personal learning enhanced student achievement. This study contributes to the understanding of theories on learning organisations from the experiences of these teachers working in disadvantaged townships schools.

Kholeka Constance Moloi

2010-01-01

135

Team Work in International Programs: Why is it so difficult?  

DEFF Research Database (Denmark)

Team Work in International Programs: Why is it so difficult? And what can we do about it? It is common knowledge that students often find it difficult to collaborate on assignments, projects, etc., but we require that they do so for a number of reasons, e.g. to learn how to work in teams or take advantage of the diversity represented by team members. In programmes that accept international students, these difficulties seem to increase. Home students are often reluctant to enter into collaboration with their international peers, whereas the international students tend to be much more open towards intercultural collaboration. The issues that arise seem to be grounded in linguistic, cultural and educational factors. This paper reports on and discusses a study of student responses to intercultural collaboration (in English) in two programmes at Aarhus University, Denmark. One conclusion is that the international students are more prepared to work in multicultural teams than their Danish peers. Another one tellsus that once students have experience with the diversity of these teams, at least some of them become more open towards working in such teams in the future. It is interesting to discuss the pedagogical and didactic implications of these findings. What can we as lecturers/teachers do in order to have students buy into the added value of diversity and multicultural teams from the beginning? The presenter will reflect on this in order to facilitate a discussion and exchange of experience among the participants. Participants may expect to obtain a raised awareness of the issues at stake as regards student collaboration in international programmes and to learn from the knowledge and experience of colleagues.

Lauridsen, Karen M.; Madsen, Henning

136

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

Science.gov (United States)

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

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

2014-02-01

137

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 â?? 5 drivers in each category were ranked with the level of uncertainty noted (high/medium/low) by experts from a range of backgrounds from Europe, Africa and the Middle-East, Asia and Australasia and the Americas. The likely impact of these drivers on various disease categories was considered, a preferred future scenario agreed and back-casting conducted at a workshop held in Moscow in June 2014. More than 40 veterinarians and animal health scientists from around the world outlined priorities in terms of research capability and capacity to attain the ideal future. Results: In each of the regions, the research capacity and knowledge networks required to optimise enablers and ameliorate barriers to our ability to meet future animal disease challenges were identified then grouped and prioritised across the regions to give an overall list in which transnational data sharing, knowledge transfer, public-private partnerships, vaccinology/immunology, vector control, antimicrobial resistance, socioeconomics, genetics/bioinformatics and utilisation of big data rated highly. Conclusion: The outputs of the STAR-IDAZ Foresight study will form the basis of a Global Strategic Research Agenda with which research funders and programme managers can prioritise and coordinate national research efforts to improve global collective preparedness for future animal, human and environmental challenges.

Møller, Kristian

138

What makes listening difficult. Factors affecting second language listening comprehension.  

Science.gov (United States)

To establish what is currently known about factors that affect foreign language listening comprehension, with a focus on characteristics of the listener, passage, and testing conditions. Research on second language (L2) listening comprehension strongly su...

A. Blodgett A. Bloomfield E. Rhoades J. Linck S. C. Wayland

2010-01-01

139

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

140

A technical solution to a difficult problem - An update  

International Nuclear Information System (INIS)

A goal of the Reduced Enrichment Research and Test Reactor Program (RERTR) established by the U.S. Department of Energy is to develop the technical means needed to utilize LEU instead of HEU fuels in research and test reactors and to do so without operational penalties and without affecting safety characteristics. This goal has been pursued now for seven years in cooperation with many of you who are participants in this conference. The program has made significant progress in the development, demonstration and application of new LEU research reactor fuels. According to recent projections, the percentage of HEU fuel in international commerce which is technically replaceable with LEU fuels has been growing steadily as research continues. There appears to be no technical barrier to eventual replacement of HEU fuel with LEU fuel in research and test reactors. While there are many politically complex and technically difficult issues involved in nonproliferation, I conclude that the use of highly enriched weapons grade uranium as a fuel in civilian research reactors stands out as one problem which has a straight forward technical solution. The technical solution is the effort you in the RERTR program are embarked on. Once that solution is in hand, the operators of research reactors are urged to take political and legal initiatives to make the conversion happen. By effecting this conversion they will help minimize the trade in highly enriched uranium and make the world a little safer

1985-10-14

 
 
 
 
141

Bronchogenic cyst in a patient with difficult asthma.  

Science.gov (United States)

Difficult to treat asthma is an asthma syndrome that brings in our mind other differentials. Mediastinal masses are not common findings, but are important variables. Bronchogenic cyst is a congenital anomaly of the foregut that is typically found in the mediastinum and diagnosed accidentally. We present a 4-year-old girl with allergic asthma that began at 8-months of age and finally a bronchogenic cyst was detected in this patient. The patient had history of asthma since she was eight months old. She had a history of several asthma attacks which had partly responded to asthma management. During the last episodes of asthma attacks, she was hospitalized in Pediatric Intensive Care Unit. Imaging studies showed a 4x3 cm mass in the posterior part of the thoracic cavity that had led to tracheal narrowing was found for which the patient underwent thoracotomy and in surgical exploration a cyst that had compressed the thoracic trachea. Pathological examination of the cyst revealed a bronchogenic cyst. Bronchogenic cyst is an uncommon developmental abnormality but in a patient with obstructive pattern of airways it should be considered in differential diagnosis of asthma, especially if the asthma management is not successful. PMID:20548134

Ben Razavi, Soheil; Bemanian, Mohammad Hassan; Taghipoor, Shokooh; Moghadam, Reza Nafisi; Behnamfar, Zahra

2010-03-01

142

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

143

Radionuclides difficult to measure in waste packages. Final report  

International Nuclear Information System (INIS)

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

1995-01-01

144

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

DEFF Research Database (Denmark)

The employee empowerment literature promises better organizational performance as well as more motivated and satisfied employees. However, this literature often neglects the specific context of public services in general, or the health care sector, hospitals, and nursing in particular. Nurses in Danish public hospitals work in a unique situation that makes the uncritical transfer of empowerment interventions intended to redesign their work difficult or even unfeasible. Analysis from an institutional perspective of the ongoing power struggle between agens of change at several levels in the Danish health care field indicates how norms originating from the public bureaucracy and medical comminities constrain such micro-level change initiatives. According to an organizational change perspective, narrow interventions would likely be inadequate, since conflict is likely given the particular characteristics of public organizations, and the specific attitudes of physicians and politicians and their desire to control the hospital sector. At the same time, this paper also emphasizes that the empowerment concept is likely to appeal to hospital managers and nurses in the Danish public hospital sector, since it builds on the nursing professions's self-conceptualization and is associated with better organizational performance. Our analysis starts by clarifying the concept of "nursing empowerment", and then applies a field perspective on Danish hospitals in order to identify the forces that may limit the possibility of empowering nurses and nursing. Based on this analysis, we discuss how to bring about successful nursing empowerment interventions.

Witt, Flemming; Nielsen, Jørn Flohr

2005-01-01

145

QUALIFYING LEGACY BY PARTICULAR TITLE – A DIFFICULT TASK  

Directory of Open Access Journals (Sweden)

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

Ilioara GENOIU

2014-06-01

146

QUALIFYING LEGACY BY PARTICULAR TITLE – A DIFFICULT TASK  

Directory of Open Access Journals (Sweden)

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

Ilioara GENOIU

2014-05-01

147

The Difficult Way of Social Psychology in Russia  

Directory of Open Access Journals (Sweden)

Full Text Available The article describes the main stages and directions of the development of social psychology in USSR and Russia. The comparison of theoretical approaches of Russian and Western social psychology is carried out. Special emphasis is made on the problem of social cognition and coping, which are important in the conditions of changing reality. New professional tasks of social psychology are discussed. The necessity of finding a new paradigm in social psychological investigations in conditions of cardinal transformations and ambiguity is stated as well as vectors and tendencies of its elaboration.

Galina M. Andreeva

2009-01-01

148

Busulfan 12 mg/kg plus melphalan 140 mg/m2 versus melphalan 200 mg/m2 as conditioning regimens for autologous transplantation in newly diagnosed multiple myeloma patients included in the PETHEMA/GEM2000 study  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Background The aim of this study was to compare the long-term safety and efficacy of oral busulfan 12 mg/kg plus melphalan 140 mg/m2 and melphalan 200 mg/m2 as conditioning regimens for autologous stem cell transplantation in newly diagnosed patients with multiple myeloma in the GEM2000 study.

2010-01-01

149

Including All the Lines  

CERN Multimedia

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

150

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

151

Interstitial ectopic pregnancy: A rare and difficult clinicosonographic diagnosis  

Digital Repository Infrastructure Vision for European Research (DRIVER)

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

Rastogi R; Meena G; Rastogi N; Rastogi V

2008-01-01

152

Interstitial ectopic pregnancy: A rare and difficult clinicosonographic diagnosis  

Directory of Open Access Journals (Sweden)

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

Rastogi R

2008-01-01

153

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

154

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

Scientific Electronic Library Online (English)

Full Text Available SciELO Cuba | Language: Spanish Abstract in spanish Introducción: La acondroplasia es la condición más común asociada a una estatura baja con grave desproporción anatómica. Las complicaciones de la vía respiratoria difícil constituyen una de las causas más frecuente de su morbilidad y mortalidad, entre las que se pueden citar: macroglosia, escasa ape [...] rtura bucal, presencia de una tráquea estrecha, limitación en la movilidad cervical, problemas pulmonares crónicos, mandíbula pequeña con aglomeración de la dentadura y mentón prominente. Objetivo: Describir la conducta anestésica de una paciente obstétrica acondroplásica con vía respiratoria difícil. Caso Clínico: Paciente del sexo femenino, de 20 años de edad, con diagnóstico de acondroplasia y asma bronquial. Embarazo gemelar de 34 semanas el cual le imposibilitaba la deambulación, la sostenibilidad, dificultad respiratoria y no tolerancia del decúbito supino. Se le practicó cesárea, abordaje de vía respiratoria difícil, intubación con máscara laríngea Fastrach colocación de tubo endotraqueal # 6.0, ventilación controlada adecuada, utilización de relajantes musculares no despolarizantes, estabilización hemodinámica intraoperatoria, recuperación. Se trasladó a Sala Recuperación Anestésica sin complicaciones. Alta médica a los 10 días de hospitalización. Conclusiones: El abordaje de la vía respiratoria de las pacientes con Acondroplasia constituye un enigma para los anestesiólogos, pero la discusión multidisciplinaria y la ejecución de un plan de actuación favoreció el buen resultado del binomio madre-feto. Abstract in english Introduction: The achondroplasia is the commonest condition associated with a low height with a severe anatomical disproportion. The complications of the difficult airway are one of the more frequent cause of morbility and mortality including: macroglossia, an scarce buccal aperture, presence of a n [...] arrow trachea, limitation of cervical mobility, chronic pulmonary problems, small mandible with teeth crowding and a prominent chin. Objective: To describe the anesthetic behavior of an obstetrics patient with achondroplasia and a difficult airway. Clinical case: A female patient aged 20 diagnosed with achondroplasia and bronchial asthma. A twin pregnancy of 34 weeks avoiding her to walk, to stand up, respiratory difficulty and no tolerance of supine decubitus. She undergoes a cesarean section, approach of the difficult airway, intubation with a Fastrach laryngeal mask, placement of the #6.0 endotracheal tube, appropriate controlled ventilation, use of non-depolarizing muscle relaxants, intraoperative hemodynamic stabilization, recovery. She was transferred to Anesthesia Recovery Ward with complications, was discharged at 10 days of hospitalization. Conclusions: The approach of the airway of patients with achondroplasia is an enigma for anesthesiologists, but the multidisciplinary discussion and the performance of action plan favored the good result of mother-fetus duo.

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

155

Busulfan 12 mg/kg plus melphalan 140 mg/m2 versus melphalan 200 mg/m2 as conditioning regimens for autologous transplantation in newly diagnosed multiple myeloma patients included in the PETHEMA/GEM2000 study  

Science.gov (United States)

Background The aim of this study was to compare the long-term safety and efficacy of oral busulfan 12 mg/kg plus melphalan 140 mg/m2 and melphalan 200 mg/m2 as conditioning regimens for autologous stem cell transplantation in newly diagnosed patients with multiple myeloma in the GEM2000 study. Design and Methods The first 225 patients received oral busulfan 12 mg/kg plus melphalan 140 mg/m2; because of a high frequency of veno-occlusive disease, the protocol was amended and a further 542 patients received melphalan 200 mg/m2. Results Engraftment and hospitalization times were similar in both groups. Oral busulfan 12 mg/kg plus melphalan 140 mg/m2 resulted in higher transplant-related mortality (8.4% versus 3.5%; P=0.002) due to the increased frequency of veno-occlusive disease in this group. Response rates were similar in both arms. With respective median follow-ups of 72 and 47 months, the median progression-free survival was significantly longer with busulfan plus melphalan (41 versus 31 months; P=0.009), although survival was similar to that in the melphalan 200 mg/m2 group. However, access to novel agents as salvage therapy after relapse/progression was significantly lower for patients receiving busulfan plus melphalan (43%) than for those receiving melphalan 200 mg/m2 (58%; P=0.01). Conclusions Conditioning with oral busulfan 12 mg/kg plus melphalan 140 mg/m2 was associated with longer progression-free survival but equivalent survival to that achieved with melphalan 200 mg/m2 but this should be counterbalanced against the higher frequency of veno-occlusive disease-related deaths. This latter fact together with the limited access to novel salvage therapies in patients conditioned with oral busulfan 12 mg/kg plus melphalan 140 mg/m2 may explain the absence of a survival difference. Oral busulfan was used in the present study; use of the intravenous formulation may reduce toxicity and result in greater efficacy, and warrants further investigation in myeloma patients. (Clinicaltrials.gov identifier: NCT00560053).

Lahuerta, Juan Jose; Mateos, Maria Victoria; Martinez-Lopez, Joaquin; Grande, Carlos; de la Rubia, Javier; Rosinol, Laura; Sureda, Anna; Garcia-Larana, Jose; Diaz-Mediavilla, Joaquin; Hernandez-Garcia, Miguel T.; Carrera, Dolores; Besalduch, Joan; de Arriba, Felipe; Oriol, Albert; Escoda, Lourdes; Garcia-Frade, Javier; Rivas-Gonzalez, Concepcion; Alegre, Adrian; Blade, Joan; San Miguel, Jesus F.

2010-01-01

156

Complications of patient selection: recognizing the difficult patient.  

Science.gov (United States)

This article reviews some basic principles of patient selection for facial plastic surgery. There are patients who are not good candidates, independent of the deformity and the ability of the surgeon. Reasons include subtle and not so subtle psychiatric disorders, unrealistic expectations, lack of communication despite multiple visits, and litigious patients. Complications or suboptimal results are not well handled in these patients and often produce an uncomfortable experience for the surgeon and staff in the postoperative period. These patients are best avoided or should be provided a much longer evaluation period prior to any surgery. PMID:24200376

Goode, Richard L

2013-11-01

157

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

Directory of Open Access Journals (Sweden)

Full Text Available Psoriasis is a common, chronic, inflammatory disease with a wide range of clinical presentations. The disease severity ranges from mild to severe. Plaque type of psoriasis is the most common. A number of factors like previous treatment history and comorbid conditions influence the treatment of psoriasis in an individual patient. Location of the lesions is also an important consideration. Psoriasis localized to certain areas of the body like scalp, nails, palms and soles remains difficult to treat. These sites have been referred to as the difficult locations in literature. This article covers the management of psoriasis limited to these special areas.

Handa Sanjeev

2010-01-01

158

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

Science.gov (United States)

Biomineralized exo- or endoskeletons of fossil marine invertebrates are widespread and diverse components of the Phanerozoic rock record of Earth's past and present oceans. Exoskeletons serve as protection against environmental pressure or predators, whilst endoskeletons can act as support or serve as an attachment for muscles and ligaments and hence as a mechanism for transmitting muscular forces. Biogenic hard parts represent sophisticated products resulting from the hierarchical interaction of inorganic minerals (95%) and macromolecular organic matrices, forming commonly less than 5%. The significance of many biogenic carbonate archives lies in the time-resolved growth patterns and their ability to record ambient environmental conditions in the form of multiple geochemical properties (multi-proxy archives) that have been widely used to assess past oceanic seawater properties. Here, we compile and review published work dealing with crystallization pathways of skeletal hard parts secreted by mollusks (i.e., bivalves and cephalopods) as well as brachiopods as widely used archives of ancient neritic epeiric settings. Bivalves and cephalopods (e.g., extinct ammonoids and belemnites and extant Sepia, Nautilus and Spirula) all form accretionary calcitic, aragonitic or vateritic skeletal hard parts. Despite the fact that mollusks and brachiopods form part of very different branches of the animal phylogenetic tree, their biomineralization strategies are surprisingly similar. Our main focus lies in a critical assessment of the complex pathways of ions and aquo-complexes from their source (seawater) to the final product (biomineral). We do this as an attempt to critically test the commonly held hypothesis that many fossil hard parts precipitated (under favorable conditions and pending subsequent diagenetic alteration) in equilibrium with seawater. Two main observations stand out: (1) the present knowledge on pathways and mechanisms (e.g., ion channel trans-membrane or endocytosis and vesicle transport, precursor mineralogies etc.) is surprisingly incomplete and in many cases based on descriptive rather than mechanistic approaches; (2) in analogy to all metazoans, biomineralization processes of mollusks and brachiopods are complex and involve different mechanisms for different elements. The combined uptake of specific elements both from inorganic and metabolic sources represents a major problem. Despite all of these problems, field experiments document that these biominerals respond to the aquatic geochemistry and the physical properties (temperature, salinity, pH etc.) of their environment, albeit in a more complex manner than conventionally assumed. Significant advances in multi-proxy research, however, require a more holistic view of the physico-chemical and biological processes involved. The present contribution represents a first tentative step towards this goal.

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

2013-12-01

159

To include NACE codes  

…the main polluting process For pigs and poultry enter: `110.05' Manure management for manure/slurry stores For pigs then enter: `110.04' Enteric fermentation If relevant, NOSE-P codes for other polluting processes on the site could be included. For example: `109.03' Incineration of animal carcasses and…

160

To include NACE codes  

…all processes regulated by EPR - the majority will not be applicable for farms. We believe that only ammonia, methane, nitrogen oxides and particulate matter (PM10) are relevant for farms. If you are aware that your installation has released additional substances please include these in the relevant…

 
 
 
 
161

CO insufflation for potentially difficult colonoscopies: Efficacy when used by less experienced colonoscopists  

Directory of Open Access Journals (Sweden)

Full Text Available AIM: To clarify the effectiveness of CO2 insufflation in potentially difficult colonoscopy cases, particularly in relation to the experience level of colonoscopists.METHODS: One hundred twenty potentially difficult cases were included in this study, which involved females with a low body mass index and patients with earlier abdominal and/or pelvic open surgery or previously diagnosed left-side colon diverticulosis. Patients receiving colonoscopy examinations without sedation using a pediatric variable-stiffness colonoscope were divided into two groups based on either CO2 or standard air insufflation. Both insufflation procedures were also evaluated according to the experience level of the respective colonoscopists who were divided into an experienced colonoscopist (EC group and a less experienced colonoscopist (LEC group. Study measurements included a 100-mm visual analogue scale (VAS for patient pain during and after colonoscopy examinations, in addition to insertion to the cecum and withdrawal times.RESULTS: Examination times did not differ, however, VAS scores in the CO2 group were significantly better than in the air group (P < 0.001, two-way ANOVA from immediately after the procedure and up to 2 h later. There were no significant differences between either insufflation method in the EC group (P = 0.29, however, VAS scores for CO2 insufflation were significantly better than air insufflation in the LEC group (P = 0.023 immediately after colonoscopies and up to 4 h afterwards.CONCLUSION: CO2 insufflation reduced patient pain after colonoscopy in potentially difficult cases when performed by LECs.

Toshio Uraoka, Jun Kato, Motoaki Kuriyama, Keisuke Hori, Shin Ishikawa, Keita Harada, Koji Takemoto, Sakiko Hiraoka, Hideyuki Fujita, Joichiro Horii, Yutaka Saito, Kazuhide Yamamoto

2009-11-01

162

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

163

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)

2012-01-01

164

Difficult to swallow: patient preferences for alternative valproate pharmaceutical formulations  

Directory of Open Access Journals (Sweden)

Full Text Available Monali Bhosle,1 Joshua S Benner,1 Mitch DeKoven,1 Jeff Shelton21Health Economics and Outcomes Research, IMS Health Inc, Falls Church, VA, USA; 2Answers and Insights Market Research, Inc, Indianapolis, IN, USAObjective: To determine the degree to which swallowing valproate (VP tablets is an issue, the proportion of patients who would prefer an alternative formulation, and the predictors of preference.Methods: A quantitative telephone survey of eligible adults (n = 400, ?18 years old who currently take (n = 236 or previously took (n = 164 VP tablets within the past 6 months was conducted.Results: More than half of the patients indicated that VP tablets were ‘uncomfortable to swallow’ (68.5%, n = 274 and were ‘very interested’ (65.8%, n = 263 in medications that were easier to swallow. When choosing conceptually between taking VP tablet once/day or an equally safe and effective but significantly smaller soft gel capsule twice per day, the 82.8%, (n = 331 preferred the soft gel capsule. In the multivariate regression analysis, perceiving soft gel capsules to be easier to swallow (OR = 73.54; 95% CI = 15.01 to 360.40 and taking VP more frequently (OR = 2.02; 95% CI = 1.13 to 3.61 were significant predictors of soft gel capsule treatment preference.Conclusion: VP users would prefer a formulation that is easier to swallow, even if it is needed to be taken twice per day. When choosing between medications with similar efficacy and safety, physicians can consider patient preferences to optimize conditions for medication adherence.Keywords: patient preference, valproate formulations, tablet characteristics

Monali Bhosle

2009-06-01

165

Difficult OptEase Filter Retrievals After Prolonged Indwelling Times  

International Nuclear Information System (INIS)

PurposeThe OptEase vena cave filter (Cordis, Piscataway, NJ) is commercially available as a retrievable or permanent filter with short recommended indwelling time, presumably due to extensive contact of the filter side struts with the inferior vena cava wall and subsequent neointimal hyperplasia leading to incorporation. Our purpose was to evaluate OptEase filter retrievals with a long indwelling time period that required unconventional retrieval techniques.Materials and MethodsWe retrospectively reviewed patients who underwent OptEase filter retrieval with long undwelling times requiring additional maneuvers for retrieval. Techniques used included rigid endobronchial forceps dissection and wire-through-loop snare. Each patient underwent postretrieval venogram to evaluate for possible complications. In addition, patients had clinical follow-up 2 weeks after the retrieval procedure.ResultsThere were three patients (2 women, 1 man; average age 64 years) who underwent OptEase filter retrieval. The mean indwelling time was 6.4 months. The indwelling filters were successfully retrieved. There were no complications. Postprocedural follow-up showed no clinical pathology.ConclusionUnconventional techniques aided in the retrieval of OptEase filters with long indwelling times

2013-08-01

166

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

167

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

168

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

Directory of Open Access Journals (Sweden)

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

Yakup Tomak

2012-09-01

169

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

International Nuclear Information System (INIS)

Scientific theories do not necessarily enable us to forecast the consequences of our actions on wildlife. Presumably, nature is able to adapt to environmental changes through variations on the genetic, species and ecosystem level; i.e. by means of biodiversity. The first studies conducted within the electricity sector show that the effects of emissions form an individual power plant on biodiversity are extremely difficult to assess because of long-range dispersion of the emission and many other factors simultaneously acting on the environment. Some concrete information about the impact of power transmission lines on biodiversity was obtained. These effects were primarily reversible. Some transmission line zones may even have favourable effects on biodiversity and on the living conditions of certain endangered species. (orig.)

1996-01-01

170

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

Energy Technology Data Exchange (ETDEWEB)

Scientific theories do not necessarily enable us to forecast the consequences of our actions on wildlife. Presumably, nature is able to adapt to environmental changes through variations on the genetic, species and ecosystem level; i.e. by means of biodiversity. The first studies conducted within the electricity sector show that the effects of emissions form an individual power plant on biodiversity are extremely difficult to assess because of long-range dispersion of the emission and many other factors simultaneously acting on the environment. Some concrete information about the impact of power transmission lines on biodiversity was obtained. These effects were primarily reversible. Some transmission line zones may even have favourable effects on biodiversity and on the living conditions of certain endangered species. (orig.)

Hongisto, M.; Nikula, A.

1996-11-01

171

Health activism: the way forward to improve health in difficult times.  

Science.gov (United States)

Health activism is an action on behalf of a cause, action that goes beyond what is conventional or routine in society. It involves a challenge to the existing order whenever it is perceived to lead to a social injustice or inequality. Today social injustice is killing people on a grand scale and it is timely for health activism to be used as a way forward to improve health during difficult economic and political times. Health activism is essential because it can create the necessary conditions for people to take control over their own lives when others cannot or will not act on their behalf. Health promotion agencies and the practitioners that they employ, professional organisations and researchers can also play an important role. What is clear is that if greedy corporations and complacent governments are not challenged, we will continue to have limited success in improving health. PMID:23986382

Laverack, Glenn

2013-09-01

172

Initial clinical assessment of a novel multifunctional topical ointment for difficult-to-heal wounds: a case series.  

Science.gov (United States)

Chronic wounds are characterized by prolonged inflammation, bacterial bioburden, and ischemia. These factors represent the barriers to wound healing that need to be addressed in order to achieve wound closure. The authors performed the initial clinical testing of WinVivo Wound Ointment ("WinVivo"), a novel topical ointment containing several botanicals that have been previously shown to promote favorable wound environment and advance wound healing. In this series of 13 patients with difficult-to-heal lower-extremity wounds, WinVivo was well tolerated and demonstrated the ability to simultaneously support granulation tissue formation; decrease the amount of exudate, edema, and malodor; and reduce pain. The ulcers included in this study have been present for a minimum of 3 weeks and a maximum of 5 years prior to the start of treatment with WinVivo. Eight of 13 wounds have previously been treated with at least 1 type of advanced wound healing modality, such as dermal substitutes or negative-pressure wound therapy. Treatment with WinVivo lasted for 3 to 12 weeks and resulted in a mean 88% wound closure, with 4 wounds healing completely. In addition to significant reduction in wound size, all patients have exhibited other clinical benefits, suggesting overall improvement in wound conditions. Future studies in a larger population, as well as case-control studies comparing WinVivo with a standard of care, are therefore warranted to further evaluate the efficacy of this new treatment. PMID:23151766

Reyzelman, Alexander M; Bazarov, Irina

2012-12-01

173

Management of a Case of Lipoma Neck Excision with Difficult Airway using Superficial Cervical Plexus Block  

Digital Repository Infrastructure Vision for European Research (DRIVER)

A mass in the neck could be associated with diifficult intubation, difficult mask ventilation, or both. We are reporting a case of lipoma of neck excision, with difficult airway, successfully managed by superficial cervical plexus nerve block.

Pradeep Hosagoudar; Jaganath A; Rajesh Hiremath; Sameena Kouser

2012-01-01

174

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

175

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

Science.gov (United States)

Difficult personalities come in a variety of roles in just about every setting. While types have been identified in the typical corporate and business culture, difficult work personalities also inhabit the world of early childhood education (ECE) workplaces. Because difficult people have an impact on workplace morale and productivity, the topic…

Hernandez, Luis; Smith, Connie Jo

2009-01-01

176

The difficult doctor? Characteristics of physicians who report frustration with patients: an analysis of survey data  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Background Literature on difficult doctor-patient relationships has focused on the "difficult patient." Our objective was to determine physician and practice characteristics associated with greater physician-reported frustration with patients. Methods We conducted a secondary analysis of the Physicians Worklife Survey, which surveyed a random national sample of physicians. Participants were 1391 family medicine, general internal medicine, and medicine subspecialty physicians. The survey assessed physician and practice characteristics, including stress, depression and anxiety symptoms, practice setting, work hours, case-mix, and control over administrative and clinical practice. Physicians estimated the percentage of their patients who were "generally frustrating to deal with." We categorized physicians by quartile of reported frustrating patients and compared characteristics of physicians in the top quartile to those in the other three quartiles. We used logistic regression to model physician characteristics associated with greater frustration. Results In unadjusted analyses, physicians who reported high frustration with patients were younger (p 55 per week, higher stress, practice in a medicine subspeciality, and greater number of patients with psychosocial problems or substance abuse. Conclusion Personal and practice characteristics of physicians who report high frustration with patients differ from those of other physicians. Understanding factors contributing to physician frustration with patients may allow us to improve the quality of patient-physician relationships.

Garrett Joanne M

2006-10-01

177

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

Digital Repository Infrastructure Vision for European Research (DRIVER)

Psoriasis is a common, chronic, inflammatory disease with a wide range of clinical presentations. The disease severity ranges from mild to severe. Plaque type of psoriasis is the most common. A number of factors like previous treatment history and comorbid conditions influence the treatment of psoriasis in an individual patient. Location of the lesions is also an important consideration. Psoriasis localized to certain areas of the body like scalp, nails, palms and soles remains difficult to t...

Handa Sanjeev

2010-01-01

178

Celecoxib reduces symptoms in men with difficult chronic pelvic pain syndrome (Category IIIA  

Directory of Open Access Journals (Sweden)

Full Text Available We investigated the effectiveness of celecoxib in reducing symptoms in patients with difficult chronic pelvic pain syndrome (CPPS, NIH category IIIA. Sixty-four patients with category IIIA CPPS were randomized into two groups of 32 subjects each. One group was treated with celecoxib (200 mg daily and the other with placebo. All patients underwent treatment for 6 weeks and were evaluated clinically before (baseline and after 1, 2, 4, 6, and 8 weeks of treatment. The evaluation included the NIH Chronic Prostatitis Symptom Index (NIH-CPSI and a subjective global assessment (SGA. Repeated measures analysis of variance was used to evaluate treatment and time effects and their interaction. A decrease (means ± SD in total NIH-CPSI score from 23.91 ± 5.27 to 15.88 ± 2.51 in the celecoxib group and from 24.25 ± 5.09 to 19.50 ± 2.50 in the placebo group was observed during treatment (0 to 6 weeks. A statistically significant decrease was observed in pain subscore (P < 0.006, quality of life subscore (P < 0.032 and total NIH-CPSI score (P < 0.015 after 2, 4 and 6 weeks, but not in urinary subscore. In addition, 38% of the celecoxib and 13% of the placebo subjects had at least a moderate improvement in SGA. The trend was similar for the NIH-CPSI scores. However, the response to treatment in terms of total NIH-CPSI score or subscore was not significantly different from placebo after interruption of treatment for 2 weeks. Our results show that celecoxib provides significant symptomatic improvement limited to the duration of the therapy in patients with difficult category IIIA CPPS compared to placebo.

W.P. Zhao

2009-10-01

179

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

International Nuclear Information System (INIS)

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

2009-04-01

180

Difficult conversations: teaching medical oncology trainees communication skills one hour at a time.  

Science.gov (United States)

Difficult conversations about prognosis, end of life, and goals of care arise commonly in medical oncology practice. These conversations are often highly emotional. Medical oncologists need outstanding, patient-centered communication skills to build trust and rapport with their patients and help them make well-informed decisions. Key skills include exploring patients' perspectives, responding to emotion with empathy, and maintaining mindfulness during highly charged conversations. These skills can be taught and learned. Most previously described communication skills training curricula for oncology providers involve multiday retreats, which are costly and can disrupt busy clinical schedules. Many curricula involve a variety of oncology providers, such as physicians and nurses, at various stages of their careers. The authors developed a monthly, one-hour communication skills training seminar series exclusively for physicians in their first year of medical oncology subspecialty training. The curriculum involved a variety of interactive and engaging educational methods, including sociodramatic techniques, role-play, reflective writing, and Balint-type case discussion groups. Medical oncologists in their second and third years of training served as teaching assistants and peer mentors. Learners had the opportunity to practice skills during sessions and with patients between sessions. Learners acquired important skills and found the curriculum to be clinically relevant, judging by anonymous surveys and anonymous responses on reflective writing exercises. Results from the current curriculum are preliminary but lay the foundation for enhanced and expanded communication skills training programs in the future. PMID:24556763

Epner, Daniel E; Baile, Walter F

2014-04-01

 
 
 
 
181

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

Energy Technology Data Exchange (ETDEWEB)

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

NONE

2006-07-01

182

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

183

The difficult doctor? Characteristics of physicians who report frustration with patients: an analysis of survey data  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Abstract Background Literature on difficult doctor-patient relationships has focused on the "difficult patient." Our objective was to determine physician and practice characteristics associated with greater physician-reported frustration with patients. Methods We conducted a secondary analysis of the Physicians Worklife Survey, which surveyed a random national sample of physicians. Participants were 1391 family medicine, general internal medicine, and medicine s...

Krebs Erin E; Garrett Joanne M; Konrad Thomas R

2006-01-01

184

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

185

The predictors of difficult tracheal intubations in patients undergoing thyroid surgery for euthyroid goitre  

International Nuclear Information System (INIS)

To evaluate the influence of goitre on anatomic features and the correlation of these changes with difficulty in intubation. Methods: A questionnaire was employed to assess 139 patients scheduled for elective surgery of euthyroid goitre to predict the potential of difficult intubation. These measurements were later correlated with the patients who eventually had difficult intubations. Neck circumference, mouth width, lip test, sternomental distance, thymomental distance, Mallampati score and laryngeal palpation were evaluated. Results: All predictors were found to be significant as single predictors but on logistic regression analysis it was found that the circumference of the neck alone, was the independent predictor for difficult intubation. Conclusion: Neck thickness in patients with goitre is a significant predictor of difficult intubation and should be used in preoperative assessment to anticipate difficult intubations. (author)

2010-09-01

186

3D seismology Ruehlermoor: Highly dissolved seismology under difficult conditions; 3D Seismik Ruehlermoor: Hochaufloesende Seismik unter schwierigen Bedingungen  

Energy Technology Data Exchange (ETDEWEB)

The previous structural plan of the petroleum deposit Ruehlermoor in Emsland (Federal Republic of Germany) only was based on the results of a multiplicity of drillings. In order to optimize the production and the EOR measures (EOR = Enhanced Oil Recovery), a highly soluble three-dimensional seismological measurement is accomplished. The goal of this measurement is the dissolution of disturbance displacements in an order of magnitude of five meters. The substantial problem is the fact that the oil field completely lies under a moorland which is dismounted industrially. The three-dimensional seismological measurements only can be accomplished in the winter months with mobile Sonic drilling equipment.

Koerbe, M.; Bartz, V. [Gaz de France Produktion Exploration Deutschland GmbH, Lingen (Germany)

2008-10-23

187

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

188

[Difficult airway management using the air-Q in a patient with Klippel-Feil syndrome].  

Science.gov (United States)

Patients with Klippel-Feil syndrome (KFS) frequently encounter difficult airway management due to skeletal abnormalities, including fusion of two or more vertebrae and short neck. We report successful tracheal intubation using the air-Q supraglottic airway device (air-Q). A 46-year-old woman (height, 149 cm; weight, 62 kg) with KFS was scheduled to undergo vertebral arch plasty for cervical spondylotic myelopathy. She could open her mouth sufficiently but could not tilt her head due to C1-3 fusion. Following administration of fentanyl 100 microg and propofol 120 mg, mask ventilation was achieved with jaw thrust maneuver. We then administered rocuronium 50 mg for immobilization and attempted tracheal intubation using the Pentax-AWS Airwayscope with a thin pediatric Intlock. However, we could not target the glottis, and ventilation via a size 3 i-gel or size 3.5 air-Q was unsuccessful. Using a size 2.5 air-Q, sufficient ventilation was finally achieved. We performed fiberoptic tracheal intubation through the air-Q using a tube with an internal diameter of 6.0-mm. We then exchanged the 6.0-mm tracheal tube with a 7.0-mm spiral tube using a 10 Fr tracheal tube introducer. PMID:24979859

Komasawa, Nobuyasu; Miyazaki, Shinichiro; Soen, Masako; Kusunoki, Tomohiro; Tatsumi, Shinichi; Minami, Toshiaki

2014-06-01

189

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

190

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

LENUS (Irish Health Repository)

The purpose of this study was to determine the potential for the Pentax AWS and the Glidescope to reduce the difficulty of tracheal intubation in patients at increased risk for difficult tracheal intubation, in a randomized, controlled clinical trial.

Malik, M A

2009-11-01

191

76 FR 66741 - Statutorily Mandated Designation of Difficult Development Areas and Qualified Census Tracts for 2012  

Science.gov (United States)

...representing the development cost of housing, was...5-year American Community Survey (ACS). This...calendar-year annual allocation cycle, HUD's standing...of Housing and Urban Development, or the Secretary's...Small Area Difficult Development Areas (SADDAs)...

2011-10-27

192

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

Directory of Open Access Journals (Sweden)

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

Svetlana P. Vovk

2012-05-01

193

Two cases of low grade astrocytoma difficult to distinguish by computed tomography (CT)  

International Nuclear Information System (INIS)

In two cases of low grade astrocytoma, preoperative diagnosis was difficult by CT alone. The cases are presented with other examinations. Clinical and CT features of low grade astrocytoma are discussed in contrast to cerebral infarction. (Kondo, M.)

1981-01-01

194

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

Digital Repository Infrastructure Vision for European Research (DRIVER)

Anesthetic technique in parturient with syringomyelia and Arnold–Chiari malformation is variable depending on the teams. Difficult intubation is one of the risks when general anesthesia is opted. Different devices have been used to manage the difficult intubation in pregnant women. We report the use of Airtraq™ laryngoscope after failed standard laryngoscopy in a parturient with syringomyelia and Arnold–Chiari type I malformation.

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

2011-01-01

195

Use of ultrasound to facilitate difficult lumbar puncture in the pediatric oncology population  

Digital Repository Infrastructure Vision for European Research (DRIVER)

In the pediatric hematology-oncology population, lumbar punctures (LP’s) are commonly performed to administer intrathecal chemotherapy and obtain CSF samples. Difficult LP’s can arise due to obesity, fibrous tissue formation due to repeated LP procedures, or spinal abnormalities. For difficult LP’s that require imaging-guidance, fluoroscopy is generally?? Fluoroscopy, however, subjects the patient and healthcare providers to radiation while also potentially increasing procedure cost and...

2013-01-01

196

Comparison of Easy and Difficult Embryo Transfer Outcomes in In Vitro Fertilization Cycles  

Directory of Open Access Journals (Sweden)

Full Text Available Background: The aim of this study was to compare the effects of easy and difficult embryotransfers (ET on implantation and pregnancy rates.Materials and Methods: In this prospective study, we analyzed the results of 706 ET proceduresover a 12-month period. An easy ET was defined as a transfer that occurred without the useof force or other instrumentation. A difficult ET was defined as the use of force for catheterplacement, and/or the use of additional instruments, and/or manipulation. Pregnancy rate wascompared between patients with easy or difficult ETs.Results: There was a significantly higher implantation rate in the easy group (21.7% comparedto the difficult group (12.1%, p<0.05.The easy group had a higher pregnancy rate (38.1%compared to patients who had difficult ETs (21.4%; p<0.05.Conclusion: Any uterine manipulation during ET adversely affects in vitro fertilization (IVF.Precaution should be taken to identify possibly difficult ET cases in advance.

Firouzeh Ghaffari

2013-01-01

197

Comparison of video laryngoscopy to direct laryngoscopy for intubation of patients with difficult airway characteristics in the emergency department.  

Science.gov (United States)

The objective of the study is to compare the efficacy of video laryngoscopy (VL) to direct laryngoscopy (DL) on the first pass intubation success of patients with difficult airway characteristics (DACs) in the emergency department (ED). Over a 6-year period, between July 1 2007 and June 30 2013, all intubations performed in an academic ED were recorded in a continuous quality improvement (CQI) database by the operators. The CQI form included information such as patient demographics, operator level of training, device(s) used, number of attempts and outcome of each attempt. In addition, operators performed a difficult airway assessment and noted the presence or absence of the following difficult airway characteristics (DACs): airway edema, cervical immobility, facial/neck trauma, large tongue, obesity, short neck, small mandible, and blood or vomit in the airway. Patients DAC [85.1 % (95 % CI 81.2-88.5 %) vs. 69.4 % (95 % CI 63.9-74.5 %)]; two DACs [(80.5 % (95 % CI 74.7-85.6 %) vs. 65.8 % (95 % CI 57.6-73.3 %)]; three or more DACs [68.9 % (95 % CI 63.8-73.7 %) vs. 54.1 % (95 % CI 46.3-61.8 %)]. After adjusting for potential confounders, VL was associated with higher odds of first pass success for patients with no DACs (aOR 2.0, 95 % CI 1.2-3.3), one DAC (aOR 3.2, 95 % CI 1.9-5.6), two DACs (aOR 2.3, 95 % CI 1.1-4.9), and three or more DACs (aOR 2.9, 95 % CI 1.5-5.5). In patients with DACs, VL was associated with a higher first pass success than DL. VL is recommended as the primary intubating device for patients with predicted difficult airways in the ED. PMID:24002788

Sakles, John Constantine; Patanwala, Asad E; Mosier, Jarrod M; Dicken, John Michael

2014-02-01

198

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

International Nuclear Information System (INIS)

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

2012-10-01

199

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

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Background Urinary tract infections (UTI are among the most common health problems seen in general practice. Evidence-based guidelines on UTI are available, but adherence to these guidelines varies widely among practitioners for reasons not well understood. The aim of this study was to identify the barriers to the implementation of a guideline on UTI perceived by Dutch general practitioners (GPs and to explore interventions to overcome these barriers. Methods A focus group study, including 13 GPs working in general practices in the Netherlands, was conducted. Key recommendations on diagnosis and treatment of uncomplicated UTI were selected from the guideline. Barriers to guideline adherence and possible interventions to address these barriers were discussed. The focus group session was audio-taped and transcribed verbatim. Barriers were classified according to an existing framework. Results Lack of agreement with the recommendations, unavailable and inconvenient materials (i.e. dipslides, and organisational constraints were perceived as barriers for the diagnostic recommendations. Barriers to implementing the treatment recommendations were lack of applicability and organisational constraints related to the availability of drugs in pharmacies. Suggested interventions were to provide small group education to GPs and practice staff members, to improve organisation and coordination of care in out of hour services, to improve the availability of preferred dosages of drugs, and to pilot-test guidelines regionally. Conclusions Despite sufficient knowledge of the recommendations on UTI, attitudinal and external barriers made it difficult to follow them in practice. The care concerning UTI could be optimized if these barriers are adequately addressed in implementation strategies. The feasibility and success of these strategies could be improved by involving the target group of the guideline in selecting useful interventions to address the barriers to implementation.

Zegers-van Schaick Judith M

2010-06-01

200

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

Science.gov (United States)

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

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

2014-01-01

 
 
 
 
201

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

Scientific Electronic Library Online (English)

Full Text Available SciELO Portugal | Language: Portuguese Abstract in portuguese Introdução: Os principais diagnósticos a considerar numa febre de etiologia indeterminada incluem as causas infecciosas, reumatológicas, imunológicas e neoplásicas. Caso clínico: Apresentamos o caso de uma criança de quatro anos do sexo masculino, observada por febre, cervicalgia e claudicação da ma [...] rcha. Detectou-se anemia e marcadores inflamatórios elevados. No internamento foi-se evidenciando palidez, exantema maculo-papular em pico febril e adenomegalias cervicais. A avaliação por Cardiologia evidenciou ectasia coronária, tendo iniciado imunoglobulina intravenosa (IGIV) por suspeita de Doença de Kawasaki atípica (DKa). Por persistência da febre invocou-se o diagnóstico mais provável de Artrite Idiopática Juvenil sistémica (AIJs). Discussão: Após a exclusão de outras causas, o diagnóstico diferencial entre DKa e AIJs é difícil pela inespecificidade dos achados. A suspeita de DKa, justifica a terapêutica com IGIV, mas a refractariedade a esta não a exclui (10% de casos refractários). Por outro lado, está descrita a presença de dilatações coronárias em contexto de quadro inflamatório sistémico, tornando este achado sugestivo mas não patognomónico de Doença de Kawasaki. Abstract in english Background: The most common causes of fever of unknown origin are infectious diseases, rheumatologic or immunologic diseases, and malignancies. Case report: The case of a four years old male child with fever, neck pain and limping gait is presented. He was anemic and had elevated inflammatory marker [...] s. He developed gradual pallor, maculopapular rash appearing with fever peaks, and cervical lymphadenopathy. Echocardiographic documentation of coronary artery ectasia, lead to intravenous immunoglobulin (IVIG) therapy for suspected atypical Kawasaki disease (aKD). The most probable diagnosis of systemic-onset Juvenile Idiopathic Arthritis (sJIA) was made after fever maintenance. Discussion: It is difficult to differentiate between aKD and sJIA because there are no specific findings. The suspicion of aKD should lead to IVIG therapy, but failure to respond is not an exclusion criterion (10% of patients are refractory cases). Systemic inflammatory disorders, like sJIA, may be associated with coronary artery dilation. This finding supports a diagnosis of aKD but is not specific for the condition.

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

202

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.

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

203

A no-go related prefrontal negativity larger to irrelevant stimuli that are difficult to suppress  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Background There is a wide debate in the literature about whether N2/P3 effects in no-go trials reflect the inhibition of an intended action, or the absence of a negative movement-related potential typical of go trials. The aim of this study was to provide an objective measure of the suppression of irrelevant information (in a conjoined selective visual attention task under conditions that were perfectly comparable from the viewpoint of the motoric processes involved. Methods Twenty-nine right-handed students took part in the study. Their EEGs were recorded from 128 scalp sites while they viewed gratings of four different spatial frequencies (from 0.75 to 6 c/deg randomly flashed in the four upper and lower quadrants of the visual field. The tasks consisted of attending and responding to a conjunction of spatial frequency and space location. Intermediate frequencies (1.5 and 3 c/deg acted as distracters or lures. Analysis of the ERPs elicited by the same physical stimulus, close in spatial frequency to the actual target and falling within the attended quadrant (pseudo-target vs. a non-target location, allowed us to identify the time course and neural bases of brain activation during the suppression of irrelevant information. Results FAs were on average 9% for pseudo-targets and 0.2% for other types of lures, indicating that the former were more difficult to suppress. Target-related ERP components (occipito/temporal selection negativity, posterior P3b and precentral motor N2 were greater to pseudo-targets than other distracters. A large prefrontal negativity (370–430 ms was also identified, much larger to pseudo-targets than non-targets (and absent in response to real targets, thus reflecting response inhibition and top-down cognitive control processes. Conclusion A LORETA inverse solution identified the neural generators of this effect in the left dorsolateral prefrontal cortex (DLPF, left and right fusiform gyri and bilateral superior temporal cortices. The tentative hypothesis is advanced that these activations might reflect the modulatory effects exerted by the fronto/temporal circuit for the suppression of irrelevant information.

Crotti Nicola

2009-06-01

204

Energy, entropy, environment: Why is protection of the environment objectively difficult?  

Energy Technology Data Exchange (ETDEWEB)

Evolution and man`s history indicate that the winners are the species and societies that act faster and consume more high-quality energy and materials: in other words, those which cause more pollution and faster growth of entropy. This could be the reason why protection of the environment is objectively difficult and, in particular, why it is almost impossible to considerably reduce man`s consumption of energy and materials in a world of competition. To escape this fatal evolutionary outcome, fundamentally new thinking is needed, thinking which takes the survival of mankind as the primary value. The role of religion in solving this tremendously difficult task should not be neglected

Rebane, Karl K. [Institute of Physics, Tartu (Estonia)

1995-05-01

205

The Role of Classroom Quality in Ameliorating the Academic and Social Risks Associated with Difficult Temperament  

Science.gov (United States)

The present study examines the moderating role first grade classroom quality may have on the relations between children's difficult temperament (assessed in infancy) and their academic and social outcomes in early elementary school (first grade). Using data from the National Institute of Child Health and Human Development's Study of Early Child…

Curby, Timothy W.; Rudasill, Kathleen Moritz; Edwards, Taylor; Perez-Edgar, Koraly

2011-01-01

206

"Making a Lion into a Pussycat": Working with Difficult Group Members  

Science.gov (United States)

Groups are defined as a small, interdependent group of individuals who share a common identity and interact with one another, usually face to face over time. While groups can be an effective way to explore issues and provide creative solutions to problems, rarely do members in groups get through the process without encountering a difficult group…

Eckstein, Nancy J.

2005-01-01

207

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

208

Attributable cost of methicillin resistance: an issue that is difficult to evaluate  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Estimating the consequences and the cost of methicillin resistance is a difficult challenge. Patients who develop methicillin-resistant ventilator-associated pneumonia (VAP) are very different from those who develop methicillin-sensitive VAP, and biased estimates are frequent. We reviewed some important confounding factors of which the reader should be aware.

Timsit, Jean-franc?ois

2006-01-01

209

Seeds of Wisdom: Adolescents' Knowledge and Judgment about Difficult Life Problems.  

Science.gov (United States)

Compared adolescents' (14 to 20 years) and young adults' (21 to 37 years) wisdom-related knowledge and judgment related to difficult and ill-defined life dilemmas. Rated responses along five wisdom criteria. Found that adolescents performed at lower levels than young adults but also demonstrated substantial age increments in performance.…

Pasupathi, Monisha; Staudinger, Ursula M.; Baltes, Paul B.

2001-01-01

210

Students Who Drive You Crazy: Succeeding with Resistant, Unmotivated, and Otherwise Difficult Young People.  

Science.gov (United States)

When educators face the stress and strain in the classroom brought on by disruptive and difficult students, solutions are not always readily available. In this book, a model for identifying, managing, avoiding, and rising above conflicted relationships is presented. This how-to guide blends theory and research with tangible examples gathered from…

Kottler, Jeffrey A.

211

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

212

mlg - construction including renewables removals  

Northern Ireland Guidance Construction (including renewables) and removals, under Part 4 of the Marine and Coastal Access Act 2009 August 2012 Contents Page 1.0 Introduction .... 3 1.1 Does the Project require a marine ...

213

A study to investigate the relationship between difficult intubation and prediction criterion of difficult intubation in patients with obstructive sleep apnea syndrome  

Science.gov (United States)

Background and Aim: Obstructive sleep apnea (OSA) syndrome is predisposed to the development of upper airway obstruction during sleep, and it poses considerable problem for anesthetic management. Difficult intubation (DI) is an important problem for management of anesthesia. In this clinical research, we aim to investigate the relationship between DI and prediction criteria of DI in cases with OSA. Materials and Methods: We studied 40 [OSA (Group O, n = 20) and non-OSA, (Group C, n = 20)] ASA I-II, adult patients scheduled tonsillectomy under general anesthesia. Same anesthetic protocol was used in two groups. Intubation difficulties were assessed by Mallampati grading, Wilson sum score, Laryngoscopic grading (Cormack and Lehane), a line joining the angle of the mouth and tragus of the ear with the horizontal, sternomental distance, and tyromental distance. Demographic properties, time-dependent hemodynamic variables, doses of reversal agent, anesthesia and operation times, and recovery parameters were recorded. Results: Significant difference was detected between groups in terms of BMI, Mallampati grading, Wilson weight scores, Laryngoscopic grading, sternomental distance, tyromental distance, doses of reversal agent, and recovery parameters. Conclusion: OSA patient's DI ratio is higher than that of non-OSA patients. BMI Mallampati grading, Wilson weight scores, Laryngoscopic grading, sternomental distance, and tyromental distance evaluation might be predictors for DI in patients with OSA.

Kurtipek, Omer; Isik, Berrin; Arslan, Mustafa; Unal, Yusuf; Kizil, Yusuf; Kemaloglu, Yusuf

2012-01-01

214

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

215

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

Science.gov (United States)

The aim of this study is the methodology of optimal choice of firefighters to solve difficult rescue tasks. 27 firefighters were analyzed: aged from 22-50 years of age, and with 2-27 years of work experience. Body balance disturbance tolerance skills (BBDTS) measured by the 'Rotational Test' (RT) and time of transition (back and forth) on a 4 meter beam located 3 meters above the ground, was the criterion for simulation of a rescue task (SRT). RT and SRT were carried out first in a sports tracksuit and then in protective clothing. A total of 4 results of the RT and SRT is the substantive base of the 4 rankings. The correlation of the RT and SRT results with 3 criteria for estimating BBDTS and 2 categories ranged from 0.478 (pSRT 0.911 (pSRT (0.860 and 0.844), while the 6 indicators of RT only 2 (0.396 and 0.381; pSRT, but there was an important partial correlation of these variables, but only then was the effect stabilized. The Rotational Test is a simple and easy to use tool for measuring body balance disturbance tolerance skills. However, the BBDTS typology is an accurate criteria for forecasting on this basis, including the results of accurate motor simulations, and the periodic ability of firefighters to solve the most difficult rescue tasks. PMID:24738515

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

2014-03-31

216

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

Science.gov (United States)

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

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

1982-03-01

217

Magnetic resonance scanning of the upper airway following difficult intubation reveals an unexpected lingual tonsil.  

Science.gov (United States)

We present a case of a 40-year-old woman requiring elective surgery who had an unexpected Grade 4 Cormack and Lehane laryngoscopy view. Both curved and straight laryngoscope blades in the sniffing and hyperextended head and neck positions were used. Endotracheal intubation was accomplished with some difficulty using a No. 3 Macintosh blade and Frova intubating catheter in the sniffing position. The cause of the difficult laryngoscopy was a lingual tonsil as shown in postoperative magnetic resonance scans. We feel that a comprehensive postoperative evaluation should be conducted after every difficult laryngoscopy (Cormack and Lehane Grade 3b and 4). The use of magnetic resonance imaging may provide important objective information for both the anaesthetist and the patient, allowing a better understanding of causes and possible solutions for future airway management. PMID:19400497

Greenland, K B; Cumpston, P H V; Huang, J

2009-03-01

218

[Role of the ORL anesthetist in foreseen or unforseen difficult intubations].  

Science.gov (United States)

Difficult intubation (DI) is a daily problem in a ENT unit. The place of the ENT anesthesiologist in the management of a DI is both in his own unit and in the hospital as an expert in DI. An anesthesiologist working in a ENT unit should be an expert in techniques allowing to manage intubation and oxygenation in every situations: i.e. fiberscopic intubation, LMA and intubating LMA and transtracheal ventilation. The ENT anesthesiologist may also play a role in the management of a DI in the hospital as an expert, both helping to cope with a difficult airway and teaching airway skills and the value of having a plan before managing any airway. PMID:10628208

Lopez, C; Cros, A M

1999-11-01

219

Difficult Beginning ? The early years of the Royal Academy of Arts in London  

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The Royal Academy of Arts was founded in London on December 10th 1768, after a long and arduous process of academic establishment. Its early days were difficult and uncertain: the legitimacy and rule of royal academicians was questioned by artists who had been excluded from the newly-created institution, which instead of figuring as a collaborative venture of the artistic community, had clearly been established by the former Directors of the Society of Artists of Great Britain - to the detrim...

Baudino, Isabelle

2013-01-01

220

Colorectal anastomosis after laparoscopic low anterior resection with total mesorectal excision: a difficult problem made simple.  

Science.gov (United States)

Laparoscopic anterior resection with total mesorectal excision for middle and lower third rectal cancer remains a difficult operation, in particular, in male patients with a narrow pelvis and bulky mesentery. In this type of patient, the available staplers do not allow an easy transection of the rectum close to the pelvic floor. A new approach that uses instruments (dilator, obturator, and pursestring anoscope) specifically designed for the technique of stapled hemorrhoidopexy and a common circular stapler can overcome all these issues. PMID:19934930

Limbert, M; de Almeida, J Mendes

2009-12-01

 
 
 
 
221

Machining of Some Difficult-to-Cut Materials with Rotary Cutting Tools  

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Automobile and aero industries have an increasing interestin materials with improved mechanical properties. However, manyof these new materials are classified as difficult-to-cut withconventional tools. It is obvious that tools, cutting processesand cutting models has to be devel-oped parallel to materialsscience. In this thesis rotary cutting tools are tested as analternative toexpensive diamond or cubic bore nitridetools. Metal matrix composites mostly consist of a light metalalloy (such as...

Stjernstoft, Tero

2004-01-01

222

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

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Critical issues in machining of difficult-to-cut materials are often associated with short tool-life and poor surface integrity, where the resulting tensile residual stresses on the machined surface significantly affect the component's fatigue life. This study presents the influence of cutting process parameters on machining performance and surface integrity generated during dry turning of Inconel 718 and austenitic stainless steel AISI 316L with coated and uncoated carbide tools. A three-dim...

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

2008-01-01

223

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

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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 p...

Ja, Tolman; Ma, Faulkner

2011-01-01

224

Endoscopic papillary large balloon dilation after limited sphincterotomy for difficult biliary stones  

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AIM: To assess the efficacy and safety of endoscopic papillary large balloon dilation after biliary sphincterotomy for difficult bile duct stones retrieval. METHODS: Retrospective review of consecutive patients submitted to the technique during 18 mo. The main outcomes considered were: efficacy of the procedure (complete stone clearance; number of sessions; need of lithotripsy) and complications. RESULTS: A total of 30 patients with a mean age of 68 ± 10 years, 23 female (77%) and 7 male...

2012-01-01

225

Managing difficult airway in patients with post-burn mentosternal and circumoral scar contractures  

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Securing the airway is a crucial aspect during reconstructive surgeries of patients with extensive post-burn mentosternal scar contractures; however, the American Society of Anesthesiologists Difficult Airway Management Algorithm recommendation of initial direct laryngoscopy may not be appropriate for these complicated patients. Consequently, there is a significant risk for failure of intubation and airway emergency. We suggest that initial attempts at securing the airway be made with indirec...

Han, Tae-hyung; Teissler, Hana; Han, Richard J.; Gaines, Joshua D.; Nguyen, Tho Qynh

2012-01-01

226

Refinements of the tongue flap for closure of difficult palatal fistulas.  

Science.gov (United States)

The posteriorly based tongue flap can be very useful to close difficult palatal fistulas, especially because the palatal sling prevents dehiscence of the tongue flap. However, special techniques may need to be employed with very large palatal fistulas or severely scarred palates. This technique has been used successfully in 5 patients. A detailed case report is presented, for which refinements of the tongue flap technique was required. PMID:8324083

Barone, C M; Argamaso, R V

1993-04-01

227

Gastric Tube Placement in Difficult Cases: An Extensive review of the Aternative Methods  

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Gastric tube placement for enteral feeding and gastric drainage is very commonly performed procedure in the ICU. The placement may sometimes be difficult or impossible in intubated and paralyzed patients due to impaction and/or coiling in the mouth. The recognition of the site/s of impaction and methods to overcome them have been described variously in literature with different degrees of success. Knowledge and practice of these alternative methods can be sometimes of great hel...

2008-01-01

228

Utility of single and double balloon endoscopy in patients with difficult colonoscopy: A randomized controlled trial  

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AIM: To compare the utility of single-balloon colonoscopy (SBC) or double-balloon colonoscopy (DBC) for difficult colonoscopies. METHODS: Between August 2008 and June 2010, patients in whom total colonoscopy failed within 30 min of insertion were assigned randomly to undergo either SBC or DBC. No sedatives were used. After the endoscopy, all patients were asked to evaluate pain during the procedure on a 10-point analog scale (1 = no pain; 10 = worst imaginable pain) with a questionnaire. The ...

Atsuo Yamada; Hirotsugu Watabe; Noriyuki Takano; Goichi Togo; Yutaka Yamaji; Haruhiko Yoshida; Takao Kawabe; Masao Omata; Kazuhiko Koike

2013-01-01

229

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

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

Takeshi Mizukami

2012-01-01

230

[Difficult necks. Diagnosis and treatment. Retrospective study of 145 cases using the method of Feldman].  

Science.gov (United States)

To identify a neck as difficult seems an easy thing. Nevertheless, we must admit that various clinical situations are represented under this single designation. A clinical and anatomical classification is proposed regarding the surgical strategy presented in this paper. Predominant tissue laxity and predominant fat accumulation are presented as progressive forms. Short platysma muscles and low hyoid bones are presented as constitutional. According to this classification, 145 patients among 438 facial rejuvenations were designated as difficult necks. The surgical strategy was intended, in each case, to address the underlying anatomical features, using a short incision system. A combination of wide skin undermining, fat removal under direct vision and corset platysmaplasty was performed in the 145 patients between November 2003 and May 2008. The average age was 59 years old and medium follow-up at 22 months. There was only 2% of secondary touch up for aesthetic reasons. Difficult necks, as described in this article, responded adequately to the present protocol. The postoperative results on the neck were consistent with the rest of the rejuvenated face and stood the test of time. PMID:20950920

Giordano, P; Mateu, J; Rouif, M; Laurent, B

2011-02-01

231

Human Rights promotion in Serbia: a difficult task for the European Union A promoção dos Direitos Humanos na Sérvia: uma difícil missão para a União Europeia  

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This article explores the role of the European Union in the human rights protection, implementation and promotion in Serbia. It is clear that the EU demands on democratisation in the region of Western Balkans are crucial to achieve the respect for human rights. The human rights standards as part of the conditionality criteria of the EU is a clear message towards the countries aspiring membership. However, Serbia progress in the field has been difficult due to several internal constraints. Thi...

Teresa Maria Cierco

2011-01-01

232

Percutaneous balloon pulmonary valvuloplasty: a modified over-the-wire Inoue balloon technique for difficult right ventricular anatomy.  

Science.gov (United States)

Percutaneous balloon pulmonary valvuloplasty (BPV) is the mainstay of treatment for significant pulmonary stenosis with doming leaflets. Various techniques have been described in the literature including the use of Inoue Percutaneous Transseptal Mitral Commissurotomy (PTMC) catheter with standard 0.025? guidewire. But if right ventricular anatomy is not suitable, 0.025? guidewire doesn't provide enough support to track the Inoue PTMC catheter. Here, we report a case of successful BPV using a novel technique of slenderizing the Inoue Percutaneous Transseptal Mitral Commissurotomy (PTMC) catheter over an Amplatz superstiff 0.035? guidewire. This technique may be useful during BPV in difficult right ventricular inflow and outflow tract anatomy in patients with congenital pulmonary valve stenosis. PMID:24814118

Deora, Surender; Vyas, Chirayu; Shah, Sanjay; Patel, Tejas

2014-01-01

233

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

Scientific Electronic Library Online (English)

Full Text Available SciELO Public Health | Language: Portuguese Abstract in portuguese Com objetivo de discutir e compreender as experiências de oncopediatras diante da tarefa de comunicar notícias difíceis (ND) a pacientes e familiares procedeu-se uma revisão bibliográfica a partir das bases de dados da Biblioteca Virtual em Saúde (BVS) que contém artigos divulgados por PubMed, Lilac [...] s, Scielo, Scopus e SciVerse, buscando a produção sobre o tema. Os artigos disponíveis, avaliados pela análise temática, evidenciam as seguintes questões: carência de estudos focando a percepção dos profissionais sobre as notícias difíceis; a comunicação como estratégia pela qual, aspectos psicossociais, culturais, bioéticos, legais e emocionais são tratados; expectativa de habilidades médicas para as quais esses profissionais não foram treinados. Observou-se também que informações e treinamento dos profissionais sobre estratégias a cerca dos modos de lidar com a comunicação de ND são insuficientes para acompanhar o dinamismo das ocorrências e das relações pessoais na área de oncologia onde o paciente costuma estar ou sentir-se em constante ameaça de vida. Abstract in english In order to discuss and understand the experiences of oncologists faced with the task of communicating difficult news to children and their close family members, a bibliographical review was conducted in the Virtual Health Library databases containing the literature published by PubMed, Lilacs, Scie [...] lo, Scopus and SciVerse with input on the theme. The articles available evaluated by thematic analysis reveal the following aspects: the lack of studies focusing on the perception of professionals about imparting difficult news; communication as a strategy by which psychosocial, cultural, bioethical, legal and emotional aspects are handled; that more is expected from physicians than they were trained for. It was also seen that the information and training of professionals in strategies regarding how to handle the communication of difficult news needs to be ongoing in order to keep up with the dynamism of the occurrences and the physician-patient relations in the oncological field in which patients tend to be or feel under constant life-threatening conditions.

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

234

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

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: Portuguese Abstract in portuguese Com objetivo de discutir e compreender as experiências de oncopediatras diante da tarefa de comunicar notícias difíceis (ND) a pacientes e familiares procedeu-se uma revisão bibliográfica a partir das bases de dados da Biblioteca Virtual em Saúde (BVS) que contém artigos divulgados por PubMed, Lilac [...] s, Scielo, Scopus e SciVerse, buscando a produção sobre o tema. Os artigos disponíveis, avaliados pela análise temática, evidenciam as seguintes questões: carência de estudos focando a percepção dos profissionais sobre as notícias difíceis; a comunicação como estratégia pela qual, aspectos psicossociais, culturais, bioéticos, legais e emocionais são tratados; expectativa de habilidades médicas para as quais esses profissionais não foram treinados. Observou-se também que informações e treinamento dos profissionais sobre estratégias a cerca dos modos de lidar com a comunicação de ND são insuficientes para acompanhar o dinamismo das ocorrências e das relações pessoais na área de oncologia onde o paciente costuma estar ou sentir-se em constante ameaça de vida. Abstract in english In order to discuss and understand the experiences of oncologists faced with the task of communicating difficult news to children and their close family members, a bibliographical review was conducted in the Virtual Health Library databases containing the literature published by PubMed, Lilacs, Scie [...] lo, Scopus and SciVerse with input on the theme. The articles available evaluated by thematic analysis reveal the following aspects: the lack of studies focusing on the perception of professionals about imparting difficult news; communication as a strategy by which psychosocial, cultural, bioethical, legal and emotional aspects are handled; that more is expected from physicians than they were trained for. It was also seen that the information and training of professionals in strategies regarding how to handle the communication of difficult news needs to be ongoing in order to keep up with the dynamism of the occurrences and the physician-patient relations in the oncological field in which patients tend to be or feel under constant life-threatening conditions.

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

235

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

Directory of Open Access Journals (Sweden)

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

Nagrath Naresh

2003-01-01

236

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

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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...

1993-01-01

237

More efficient cutting difficult-to-machine materials by rotary tool  

Energy Technology Data Exchange (ETDEWEB)

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)

Itakura, Katsutoshi [H.I.T. Polytechnic, Hiroshima (Japan); Kuroda, Motofumi; Myouji, Tetsuya; Tsukamoto, Hidehiko [Mitsubishi Heavy Industries Ltd., Tokyo (Japan); Itani, Hikotaro [Ryosen Engineers Co. Ltd., Hiroshima (Japan); Ariura, Yasutsune [Kyushu Univ., Fukuoka (Japan)

2000-06-01

238

The novel use of computer-generated virtual imaging to assess the difficult pediatric airway.  

Science.gov (United States)

In a patient with a known difficult airway, history and examination may be of limited use in formulating a management plan for subsequent tracheal intubation. Further detailed and descriptive review of the airway is necessary. Virtual imaging is a recent advance in radiology that offers noninvasive airway assessment. It creates a movie clip image of the upper airway akin to the view obtained through a fiberscope. We present a patient with Goldenhar syndrome in whom virtual imaging was used to identify the cause of a previous failed tracheal intubation. PMID:17456667

Ames, Warwick A; Macleod, David B; Ross, Allison K; Marcus, Jeffrey; Mukundan, Srinivasan

2007-05-01

239

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

240

Gastric Tube Placement in Difficult Cases: An Extensive review of the Aternative Methods  

Directory of Open Access Journals (Sweden)

Full Text Available Gastric tube placement for enteral feeding and gastric drainage is very commonly performed procedure in the ICU. The placement may sometimes be difficult or impossible in intubated and paralyzed patients due to impaction and/or coiling in the mouth. The recognition of the site/s of impaction and methods to overcome them have been described variously in literature with different degrees of success. Knowledge and practice of these alternative methods can be sometimes of great help particularly while facing difficulty

Prashant Kumar

2008-10-01

 
 
 
 
241

Neoclassical Transport Including Collisional Nonlinearity  

International Nuclear Information System (INIS)

In the standard ?f theory of neoclassical transport, the zeroth-order (Maxwellian) solution is obtained analytically via the solution of a nonlinear equation. The first-order correction ?f is subsequently computed as the solution of a linear, inhomogeneous equation that includes the linearized Fokker-Planck collision operator. This equation admits analytic solutions only in extreme asymptotic limits (banana, plateau, Pfirsch-Schlueter), and so must be solved numerically for realistic plasma parameters. Recently, numerical codes have appeared which attempt to compute the total distribution f more accurately than in the standard ordering by retaining some nonlinear terms related to finite-orbit width, while simultaneously reusing some form of the linearized collision operator. In this work we show that higher-order corrections to the distribution function may be unphysical if collisional nonlinearities are ignored.

2011-06-10

242

Brake assembly including torque monitor  

International Nuclear Information System (INIS)

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

1990-07-06

243

Wrinkled alfalfa seeds harbor more aerobic bacteria and are more difficult to sanitize than smooth seeds.  

Science.gov (United States)

At least 14 separate outbreaks of food poisoning attributed to either Salmonella enterica or Escherichia coli O157:H7 have been traced to sprouts in the past decade. Seeds contaminated with human pathogens caused most of these outbreaks, thus many sprout growers are now treating alfalfa seeds with the sanitizing agent, calcium hypochlorite (Ca[OCl]2), prior to sprouting. The efficacy of alfalfa seed sanitation varies between seed lots and between seeds within each lot. Alfalfa seeds from different seed lots were sorted by type in an effort to determine if certain seed types carry more aerobic bacteria than other seed types. Seeds with a wrinkled type, characteristic of lygus bug damage, had significantly higher levels of culturable aerobic bacteria and were more difficult to sanitize than smooth, healthy seeds. After sanitation, wrinkled alfalfa seeds that had been inoculated with S. enterica ser. Newport carried significantly higher levels of Salmonella Newport than smooth seeds. If S. enterica is present on wrinkled seeds in naturally contaminated seed lots, it may be difficult to chemically sanitize the seed lot. Removal of the wrinkled alfalfa seeds from the seed lots, perhaps by adapting color sorting equipment similar to that used to sort rice grains and other seeds, should reduce the level of aerobic bacteria in seed lots and may result in lower levels of human pathogens on contaminated alfalfa seeds. PMID:11563502

Charkowski, A O; Sarreal, C Z; Mandrell, R E

2001-09-01

244

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

245

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

246

Identification of abnormal operating conditions and intelligent decision system  

Science.gov (United States)

In earth pressure balance (EPB) shield construction, the "plastic flow state" is difficult to form using the soil dug in the capsule because it can cause three abnormal operating conditions, including occlusion, caking in the capsule, and spewing at the outlet of the dump device. These abnormal operating conditions can, in turn, trigger failure in tunneling, cutter-device damage, and even catastrophic incidents, such as ground settlement. This present paper effectively integrates the mechanism of abnormal operating conditions and knowledge of soil conditioning, and establishes a uniform model of identifying abnormal conditions and intelligent decision support system based on the belief rule-base system. The model maximizes knowledge in improving the soil, construction experience, and data to optimize the model online. Finally, a numerical simulation with specific construction data is presented to illustrate the effectiveness of the algorithm.

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

2011-12-01

247

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

Digital Repository Infrastructure Vision for European Research (DRIVER)

The study was designed to investigate the perception of students and teachers of the difficult topics in the lower secondary school science curriculum of Barbados; if there were statistically significant differences in (a) students’ perception and teacher perception of difficult topics and (b) students’ perception of difficult topics based on their gender, interest in science, study habits and school location and school category; as well as to determine the inter-relationships among the f...

Babalola Ogunkola; David Samuel

2011-01-01

248

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

249

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

250

Airway management of a difficult airway due to prolonged enlarged goiter using loco-sedative technique.  

Science.gov (United States)

Appropriate airway management is an essential part of anesthesiologist's role. Huge goiters can lead to distorted airway and difficulty in endotracheal intubation. In this report, we present a case of a 67-year-old woman with a huge toxic multinodular thyroid swelling, gradually increasing in size for last 20 years, where trachea was successfully intubated. She had a history of deferred surgery in June 2007 due to inability to intubate, despite 5-6 attempts using different laryngoscopes, bougie, and stylet. Patient was re-admitted in December 2011 for the surgery and was successfully intubated this time with help of fiberoptic intubation using loco-sedative technique. Patient was electively kept intubated postoperatively in view of chances of tracheomalacia due to prolonged large goiter. She was extubated successfully on post-op day 2 after demonstration of leak around trachea following tracheal tube cuff deflation. The different techniques of managing the difficult airway in these patients are discussed. PMID:23717240

Srivastava, Divya; Dhiraaj, Sanjay

2013-01-01

251

A case of hepatic angiomyolipoma difficult to distinguish from hepatocellular carcinoma  

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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

252

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

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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

253

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

254

Why Is It Difficult to Predict Language Impairment and Outcome in Patients with Aphasia after Stroke?  

Science.gov (United States)

One of the most devastating consequences of stroke is aphasia. Communication problems after stroke can severely impair the patient's quality of life and make even simple everyday tasks challenging. Despite intense research in the field of aphasiology, the type of language impairment has not yet been localized and correlated with brain damage, making it difficult to predict the language outcome for stroke patients with aphasia. Our primary objective is to present the available evidence that highlights the difficulties of predicting language impairment after stroke. The different levels of complexity involved in predicting the lesion site from language impairment and ultimately predicting the long-term outcome in stroke patients with aphasia were explored. Future directions and potential implications for research and clinical practice are highlighted.

Kasselimis, Dimitrios; Varkanitsa, Maria; Selai, Caroline; Potagas, Constantin; Evdokimidis, Ioannis

2014-01-01

255

[Patellar tendinopathy ('jumper's knee'); a common and difficult-to-treat sports injury].  

Science.gov (United States)

Patellar tendinopathy is a common and difficult-to-treat overuse injury of the patellar tendon with a very negative impact on the careers of many athletes. It appears to involve a failed healing process in the tendon--not inflammation--and has consequences for the treatment strategy. Rehabilitation programs are based on the principles of load reduction and an eccentric exercise program to improve muscle-tendon function and optimize the kinetic chain. Prolonged rehabilitation is necessary because of slow tendon recovery. Anti-inflammatory treatment is often unsuccessful. Surgery does not guarantee a quick symptom-free return to sport at the original level either. Extracorporeal shock wave therapy, ultrasound-guided sclerosing of new vessels and tendinous and peritendinous injections of aprotinin and autologous growth factors seem to be promising new treatment options. PMID:18783161

Zwerver, J

2008-08-16

256

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 25â??50â??µm. The relatively small Young's modulus for these elastomers is a requirement for actuation capabilities. However, peeling and release of such films during manufacture processes are very difficult. To ease the release of the films, techniques such as the use of release agents like surfactants and detergents, incorporating resins in the silicone matrix and grafting/adding low surface energy functionalities to the silicone elastomer have been tested. The methods used are required not to interfere with the Young's modulus and the dielectric permittivity in a negative way. Polysorbate-20, a non-ionic surfactant, fulfills all requirements and gives the lowest peel forces for the films.

Vudayagiri, Sindhu; Skov, Anne Ladegaard

2013-01-01

257

Some solutions to on-line radiological monitoring of difficult streams  

International Nuclear Information System (INIS)

On-line monitoring for radiological contamination of dirty, but normally not radioactive, streams is difficult. Described are several new, low-fouling units that are intended to replace the existing sensors that monitor both beta and gamma activity. A sensor was designed, using a thin-wall Geiger-Mueller tube for beta and gamma sensitivity, to monitor the influent of the sanitary sewage treatment plant. The new design eliminates dead volumes inherent in the old unit by use of a double-layer, helically wound solenoid made of 5/16-in.-OD thin-wall (0.02-in.) Teflon tubing. A 4-L Marinelli beaker-based system that used a 3 x 3 NaI(Tl) scintillator was replaced with a multilayer solenoid of 5/8-in.-OD Teflon. Two units for the detection of beta radiation are also described. 1 ref., 6 figs., 1 tab

1987-10-21

258

The venom optimisation hypothesis: a spider injects large venom quantities only into difficult prey types.  

Science.gov (United States)

The spider Cupiennius salei needs 0.01-10 microl venom to kill a prey item. Since its venom glands contain only 10 microl and regeneration requires 8-16 days C. salei should use its venom very economically. By a monoclonal antibody we measured, for the first time, the amounts of venom injected by a spider into different prey types. Crickets and stick insects, as victims without special defence mechanism, received only the minimum amount of venom which is not significantly different from the LD(50). Blowflies and ground beetles received considerably more venom because they are difficult to overwhelm or even endanger the spider by their defence behaviour. These results support our venom optimisation hypothesis which supposes that spiders use their venom as economically as possible. PMID:12175611

Wigger, Esther; Kuhn-Nentwig, Lucia; Nentwig, Wolfgang

2002-06-01

259

Pharmacotherapeutic and Non-Pharmacological Options for Refractory and Difficult-to-Treat Seizures  

Science.gov (United States)

It is currently estimated that about 20%–30% of adults and 10%–40% of children diagnosed with epilepsy suffer from uncontrolled or poorly controlled seizures, despite optimal medical management. In addition to its huge economic costs, treatment-refractory epilepsy has a widespread impact on patients’ health-related quality of life. The present paper focuses on the concepts of refractory and difficult-to-treat seizures and their pharmacological management. Evidence on efficacy and tolerability of rational pharmacotherapy with antiepileptic drug combinations and of non-pharmacological treatment options such as epilepsy surgery, neurostimulation, metabolic treatment and herbal remedies is reviewed. The importance of early identification of the underlying etiology of the specific epilepsy syndrome is emphasized, to inform early prognosis and therapeutic strategies.

Mitchell, James W.; Seri, Stefano; Cavanna, Andrea E.

2012-01-01

260

An operative case of hepatic pseudolymphoma difficult to differentiate from primary hepatic marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue  

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Abstract Hepatic pseudolymphoma (HPL) and primary hepatic marginal zone B cell lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma) are rare diseases and the differential diagnosis between these two entities is sometimes difficult. We herein report a 56-year-old Japanese woman who was pointed out to have a space occupying lesion in the left lateral segment of the liver. Hepatitis viral-associated antigen/antibody was negative and liver function tests including lactic dehydr...

Hayashi Michihiro; Yonetani Noboru; Hirokawa Fumitoshi; Asakuma Mitsuhiro; Miyaji Katsuhiko; Takeshita Atsushi; Yamamoto Kazuhiro; Haga Hironori; Takubo Takayuki; Tanigawa Nobuhiko

2011-01-01

 
 
 
 
261

Double guidewire technique vs transpancreatic precut sphincterotomy in difficult biliary cannulation  

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Full Text Available AIM: To compare the outcomes between double-guidewire technique (DGT and transpancreatic precut sphincterotomy (TPS in patients with difficult biliary cannulation. METHODS: This was a prospective, randomized study conducted in single tertiary referral hospital in Korea. Between January 2005 and September 2010. A total of 71 patients, who bile duct cannulation was not possible and selective pancreatic duct cannulation was achieved, were randomized into DGT (n = 34 and TPS (n = 37 groups. DGT or TPS was done for selective biliary cannulation. We measured the technical success rates of biliary cannulation, median cannulation time, and procedure related complications. RESULTS: The distribution of patients after randomization was balanced, and both groups were comparable in baseline characteristics, except the higher percentage of endoscopic nasobiliary drainage in the DGT group (55.9% vs 13.5%, P < 0.001. Successful cannulation rate and mean cannulation times in DGT and TPS groups were 91.2% vs 91.9% and 14.1 ± 13.2 min vs 15.4 ± 17.9 min, P = 0.732, respectively. There was no significant difference between the two groups. The overall incidence of post- endoscopic retrograde cholangiopancreatography (ERCP pancreatitis was 38.2% vs 10.8%, P < 0.011 in the DGT group and the TPS group; post-procedure pancreatitis was significantly higher in the DGT group. But the overall incidence of post-ERCP hyperamylasemia was no significant difference between the two groups; DGT group vs TPS group: 14.7% vs 16.2%, P < 1.0. CONCLUSION: When free bile duct cannulation was difficult and selective pancreatic duct cannulation was achieved, DGT and TPS facilitated biliary cannulation and showed similar success rates. However, post-procedure pancreatitis was significantly higher in the DGT group.

Young Wook Yoo

2013-01-01

262

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 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

1971-04-01

263

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 < .001). In addition, men, but not women, high in hostile sexist attitudes placed more blame on the victim when she was presented as a feminist woman (p < .001). These results underscore the importance of 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

264

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

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Background This study assessed the feasibility, self-efficacy and cost of providing a high fidelity medical simulation experience in the difficult environment of an air ambulance helicopter. Methods Seven of 12 EM residents in their first postgraduate year participated in an EMS flight simulation as the flight physician. The simulation used the Laerdal SimMan™ to present a cardiac and a trauma case in an EMS helicopter while running at flight idle. Before and after the simulation, subjects completed visual analog scales and a semi-structured interview to measure their self-efficacy, i.e. comfort with their ability to treat patients in the helicopter, and recognition of obstacles to care in the helicopter environment. After all 12 residents had completed their first non-simulated flight as the flight physician; they were surveyed about self-assessed comfort and perceived value of the simulation. Continuous data were compared between pre- and post-simulation using a paired samples t-test, and between residents participating in the simulation and those who did not using an independent samples t-test. Categorical data were compared using Fisher's exact test. Cost data for the simulation experience were estimated by the investigators. Results The simulations functioned correctly 5 out of 7 times; suggesting some refinement is necessary. Cost data indicated a monetary cost of $440 and a time cost of 22 hours of skilled instructor time. The simulation and non-simulation groups were similar in their demographics and pre-hospital experiences. The simulation did not improve residents' self-assessed comfort prior to their first flight (p > 0.234, but did improve understanding of the obstacles to patient care in the helicopter (p = 0.029. Every resident undertaking the simulation agreed it was educational and it should be included in their training. Qualitative data suggested residents would benefit from high fidelity simulation in other environments, including ground transport and for running codes in hospital. Conclusion It is feasible to provide a high fidelity medical simulation experience in the difficult environment of the air ambulance helicopter, although further experience is necessary to eliminate practical problems. Simulation improves recognition of the challenges present and provides an important opportunity for training in challenging environments. However, use of simulation technology is expensive both in terms of monetary outlay and of personnel involvement. The benefits of this technology must be weighed against the cost for each institution.

Holland Carolyn

2006-10-01

265

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

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Background In problem-based learning (PBL, tutors play an essential role in facilitating and efficiently structuring tutorials to enable students to construct individual cognitive networks, and have a significant impact on students' performance in subsequent assessments. The necessity of elaborate training to fulfil this complex role is undeniable. In the plethora of data on PBL however, little attention has been paid to tutor training which promotes competence in the moderation of specific difficult situations commonly encountered in PBL tutorials. Methods Major interactive obstacles arising in PBL tutorials were identified from prior publications. Potential solutions were defined by an expert group. Video clips were produced addressing the tutor's role and providing exemplary solutions. These clips were embedded in a PBL tutor-training course at our medical faculty combining PBL self-experience with a non-medical case. Trainees provided pre- and post-intervention self-efficacy ratings regarding their PBL-related knowledge, skills, and attitudes, as well as their acceptance and the feasibility of integrating the video clips into PBL tutor-training (all items: 100 = completely agree, 0 = don't agree at all. Results An interactive online tool for PBL tutor training was developed comprising 18 video clips highlighting difficult situations in PBL tutorials to encourage trainees to develop and formulate their own intervention strategies. In subsequent sequences, potential interventions are presented for the specific scenario, with a concluding discussion which addresses unresolved issues. The tool was well accepted and considered worth the time spent on it (81.62 ± 16.91; 62.94 ± 16.76. Tutors considered the videos to prepare them well to respond to specific challenges in future tutorials (75.98 ± 19.46. The entire training, which comprised PBL self-experience and video clips as integral elements, improved tutor's self-efficacy with respect to dealing with problematic situations (pre: 36.47 ± 26.25, post: 66.99 ± 21.01; p Conclusions The interactive tool with instructional video clips is designed to broaden the view of future PBL tutors in terms of recognizing specific obstacles to functional group dynamics and developing individual intervention strategies. We show that this tool is well accepted and can be successfully integrated into PBL tutor-training. Free access is provided to the entire tool at http://www.medizinische-fakultaet-hd.uni-heidelberg.de/fileadmin/PBLTutorTraining/player.swf.

Kirschfink Michael

2010-07-01

266

Suspected migration of cervical epidural catheter into the brainstem after a difficult catheter insertion.  

Science.gov (United States)

We report a case of diplopia during continuous epidural injection presumably caused by catheter migration. A 61-year-old woman underwent shoulder surgery under general anesthesia with cervical epidural anesthesia. The epidural catheter was placed in the C6-C7 epidural space with some difficulty before general anesthesia. The depth of the catheter placed under the skin was 10 cm. On POD 2, the patient noticed diplopia and developed dysarthria despite of good pain control so far. She complained of sudden headache after the rate of continuous epidural infusion was increased to relieve postoperative pain. Computed tomography and T2-weighted cerebral magnetic resonance imaging revealed an air image and surrounding edema in the pons. Diplopia and dysarthria disappeared after ceasing continuous epidural injection. A 15-cm-long mark under the skin and leak of colorless clear fluid from the puncture site were noted at removal of the catheter. On POD 13, diplopia recurred, which improved gradually. On the 9-month radiologic follow-up, we considered that the symptoms on POD 2 were caused by migration of the epidural catheter into the pons and that her later diplopia was induced by intracranial hypotension syndrome. One should be aware that such an unexpected migration of the catheter can occur following a difficult insertion. PMID:24141810

Asano, Maiko; Akatsuka, Masafumi; Uda, Rumiko; Son, Hiroki; Nagano, Yuuzou; Tatsumi, Toshiaki

2014-06-01

267

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

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

Carlos Villanueva

2010-12-01

268

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

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

N Botha

2008-06-01

269

Endoscopic papillary large balloon dilation after limited sphincterotomy for difficult biliary stones  

Directory of Open Access Journals (Sweden)

Full Text Available AIM: To assess the efficacy and safety of endoscopic papillary large balloon dilation after biliary sphincterotomy for difficult bile duct stones retrieval. METHODS: Retrospective review of consecutive patients submitted to the technique during 18 mo. The main outcomes considered were: efficacy of the procedure (complete stone clearance; number of sessions; need of lithotripsy and complications. RESULTS: A total of 30 patients with a mean age of 68 ± 10 years, 23 female (77% and 7 male (23% were enrolled. In 10 patients, a single stone was found in the common bile duct (33% and in 20 patients multiple stones (67% were found. The median diameter of the stones was 17 mm (12-30 mm. Dilations were performed with progressive diameter Through-The-Scope balloons (up to 12, 15 or 18 mm. Complete retrieval of stones was achieved in a single session in 25 patients (84% and in two sessions in 4 patients (13%. Failure occurred in 1 case (6%. Mechanical lithotripsy was performed in 6 cases (20%. No severe complications occurred. One patient (3% had mild-grade post-endoscopic retrograde cholangiopancreatography (ERCP pancreatitis. CONCLUSION: Endoscopic balloon dilatation with a large balloon after endoscopic sphincterotomy is a safe and effective technique that could be considered an alternative choice in therapeutic ERCP.

Ana Rebelo

2012-01-01

270

Use of the Rusch Flexi-Slip stylet for patients with difficult insertion of the ProSeal laryngeal mask airway.  

Science.gov (United States)

The ProSeal laryngeal mask airway (PLMA) offers a more effective seal and is easier for gastric tube placement to prevent aspiration than the classical laryngeal mask airway. However, it is more difficult to insert with the digital and introducer tooling techniques. The Rusch Flexi-Slip stylet (RFSS) is an accessory intubation tool that consists of a malleable coated wire and a soft atraumatic tip. It has been reported that it can facilitate easier insertion of the PLMA. Here, we report two cases in which the PLMA could not be inserted correctly on the initial attempts, and with successful placement of the PLMA after using an RFSS. In the first case, three attempts to insert the PLMA with the digital and introducer tooling techniques were unsuccessful. The second case was known to be difficult for PLMA placement because, in a previous operation, PLMA insertion for general anesthesia was unsuccessful, and in that instance required endotracheal intubation for general anesthesia. In both cases, the PLMA was successfully inserted using the RFSS technique, without difficulty. The RFSS technique offers several advantages for PLMA insertion, including the provision of effective support and a soft tip for the PLMA insertion. Other techniques to facilitate the insertion of the PLMA, including priming the drain tube with a guide are discussed. We recommend that the RFSS technique offers an effective method for cases with difficult insertion of the PLMA. PMID:20434112

Chen, Hung-Shu; Liu, Ping-Hsin; Chung, Kao-Chi; Hung, Kuo-Chuan

2010-03-01

271

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.

David Samuel

2011-10-01

272

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: 0.08-3.50] 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)

2007-06-01

273

Gold grain implants in resistant tumors- a useful modality in difficult head and neck sites  

International Nuclear Information System (INIS)

Management of resistant head and neck cancers after failure of surgery and radiation therapy is a daunting task. Treatment by interstitial implants is the only viable alternative since salvage or palliative surgery is often not feasible and external irradiation and or chemotherapy are of very limited benefit. In many events, the sites of failures are difficult to be implanted e.g. base of skull, parapharyngeal space ... etc. using standard afterloading 192Ir or the recently available permanent palladium seeds. In a comparative study of the biologic background of 103Pd. 198Au2 123I, it was shown that 198Au is the only seed that acts independently to the tumor doubling time (Tpot), with the least wasted dose 1 However problems with staff exposure and radiation safety have pushed the latter out of favor. We reviewed the charts of 94 Gold grain implant patients (1970-1995), in order to determine whether there is a continuing role of 198Au implant. Thirty seven had the implant in the head and neck region. We hereby present our experience in those cases and compare the feasibility of 198Au to 102Pa in the same cohort. Eight cases were located in supraglottic larynx, 5 in nasopharynx, 4 in retromolar trigone, 2 in oral cavity, 4 in base of tongue, 4 in maxillary antrum, 4 in palate, 2 in lymph nodes of unknown origin, 2 in tonsilar fossa, 1 in pyrifom fossa, 1 in posterior pharyngeal wall, and 1 in parotid gland. Twenty eight were recurrent cases, 6 were residual locally advanced and 3 had their implants for a second primary in an area that was irradiated before. Gold grain implants were performed under general anesthesia in (35(37)) patients using the Royal-Marsden gun. The activity of the gold grains used ranged from 3.5-4.9 mci per seed. The total activity of gold grain implants ranged from 13 to 160 mci with a median of 85 mci, the median number of seeds used was 34. The total radiation dose delivered at 0.5cm margin around the target volume ranged from 90 Gy to 220 Gy with a median of 100 Gy. Out of 37 sites implanted using 198Au, it was estimated that 103Pd could have been an alternative in 14 cases only. Comparative physics plans using 103Pd and 198Au in this subset were obtained and analyzed by 2 independent radiation oncologist (blind folded at the type of seeds). Results of the 2 types of seeds plans were comparable with no statistical significant difference) (P=0.988 for 103Pd). Local control was dependent on 2 factors 1) size of the lesion implanted; In 19 tumors with a diameter > 2.5, only 2 had local control, while of 14 patients who had lesions < 2.5.9(64 %) had local control (P:0.002) 2) site of primary and histology; palatal adenocystic arcomas tumors had average progression free survival of 52 months compared to 13.9 and 4 months in nasopharyngeal, oropharyngeal and supraglottic squamous cell carcinoma. Cessation of bleeding occurred in 50%, control of pain in 88% and relief of dysphagia in 60% average length of hospital stay was 6 days and the average bed side exposure was 40 mrem/hr. We conclude that gold grain implant has a continuing role in the palliation of recurrent head and neck tumors especially in sites difficult to reach with palladium e.g. supraglottic-larynx, base of tongue, hypopharynx, and nasopharynx. Local control is best in lesions <2.5cm in greatest dimension. Homogeneity of doses delivered is comparable to similar plans utilizing palladium seeds

1996-05-01

274

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; Paulsen, Rasmus Reinhold

2010-01-01

275

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

276

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

Directory of Open Access Journals (Sweden)

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

Bruce WJ

2000-06-01

277

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

278

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

Scientific Electronic Library Online (English)

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

Villanueva, Carlos; Hemstreet III, George P..

279

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)

2013-05-05

280

Dynamic stall simulation including turbulence modeling  

Energy Technology Data Exchange (ETDEWEB)

The objective of this study is to investigate the two-dimensional unsteady flow around an airfoil undergoing a Darrieus motion in dynamic stall conditions. For this purpose, a numerical solver based on the solution of the Reynolds-averaged Navier-Stokes equations expressed in a streamfunction-vorticity formulation in a non-inertial frame of reference was developed. The governing equations are solved by the streamline upwind Petrov-Galerkin finite element method (FEM). Temporal discretization is achieved by second-order-accurate finite differences. The resulting global matrix system is linearized by the Newton method and solved by the generalized minimum residual method (GMRES) with an incomplete triangular factorization preconditioning (ILU). Turbulence effects are introduced in the solver by an eddy viscosity model. The investigation centers on an evaluation of the possibilities of several turbulence models, including the algebraic Cebeci-Smith model (CSM) and the nonequilibrium Johnson-King model (JKM). In an effort to predict dynamic stall features on rotating airfoils, first the authors present some testing results concerning the performance of both turbulence models for the flat plate case. Then, computed flow structure together with aerodynamic coefficients for a NACA 0015 airfoil in Darrieus motion under stall conditions are presented.

Allet, A.; Halle, S.; Paraschivoiu, I. [Ecole Polytechnique de Montreal, Quebec (Canada). Dept. of Mechanical Engineering

1995-09-01

 
 
 
 
281

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

282

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...

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

2010-01-01

283

Test conditions greatly influence permeation of water soluble molecules through the intestinal mucosa: need for standardisation.  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Permeability tests are widely used to investigate the pathogenesis of various gastrointestinal diseases including coeliac disease, infectious diarrhoea, and inflammatory bowel disease. In Crohn's disease they are used as activity parameters by some investigators. Lack of standardisation, however, makes it very difficult to compare data reported in different studies. The aim of this study was to gather permeation data in well controlled test conditions to standardise the methods. Nine healthy ...

Peeters, M.; Hiele, M.; Ghoos, Y.; Huysmans, V.; Geboes, K.; Vantrappen, G.; Rutgeerts, P.

1994-01-01

284

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

285

Development of a detector system for measurement of contamination at places with difficult access  

International Nuclear Information System (INIS)

The objective of this research is the development and testing of the detector system for the measurement of very low-level radioactivity, even near background level, suitable for irregularly shaped surfaces like those inside small diameter tubes. The research carried out showed essential improvement of contamination measurements under real conditions (e.g. KRB-Gundremmingen, KKW-Biblis, ALKEM) by development of an integrated portable measuring device composed by a series of round and flat gas flow detectors

1989-01-01

286

Prolactinoma in a Diabetic Dialysis Patient with Erectile Dysfunction: A Difficult Differential Diagnosis  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Dialysis patients often suffer from erectile dysfunction. The prevalence of this symptom in the context of dialysis is as high as 90%. Diabetes, diffuse vascular disease and pharmacological therapy are attendant causes of this condition, severely impairing the quality of life. Due to the high frequency of erectile dysfunction in uremic patients, minimalist diagnostic approaches are often used. Nevertheless, a careful differential diagnosis is also warranted in well dialyzed patients to identi...

Piccoli, Giorgina B.; Bermont, Francesca; Magnano, Andrea; Soragna, Giorgio; Terzolo, Massimo

2006-01-01

287

Laser lithotripsy of difficult bile duct stones under direct visual control.  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Biliary laser lithotripsy was performed under direct visual control in 35 consecutive patients not amenable to routine endoscopy. The patients had 1-50 (median 1) bile duct stones with the greatest diameter of the largest stone being 9-42 mm (median 20 mm). Conventional endoscopic treatment had failed because of an inaccessible papilla (16 patients), biliary strictures (seven patients), and impaction or large size of calculi (12 patients). Twelve patients, depending on their anatomical condit...

Neuhaus, H.; Hoffmann, W.; Zillinger, C.; Classen, M.

1993-01-01

288

Principle conditioning  

Digital Repository Infrastructure Vision for European Research (DRIVER)

The definition of the conditional probability is very important in the theory of the probability. This definition is based on the fact, that random events can be simultaneously measurable. This paper deal with the problem of conditioning for such random events, which are not simultaneously measurable. This paper defines conditional states as convex combination of special states.

Nanasiova, Olga

2003-01-01

289

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.

2011-11-14

290

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

291

Management of acute esophageal variceal bleeding by endoscopic sclerotherapy in technically difficult endoscopic band ligation cases—A population based cohort study  

Directory of Open Access Journals (Sweden)

Full Text Available Endoscopic band ligation is regarded as the main therapeutic option for acute esophageal variceal bleeding, while sclerotherapy may be used in the acute setting if ligation is technically difficult. The incidence of difficult-to-perform band ligation in acute esophageal variceal bleeding, as well as the outcome of patients subjected to injection sclerotherapy as an alternative treatment, has not been clearly investigated. Our aim is to study the outcome of patients subjected to injection sclerotherapy in the acute setting of esophageal variceal bleeding when endoscopic band ligation is technically difficult to perform. We included 151 patients with acute esophageal variceal bleeding originnating from medium or large sized varices. All patients were planned for EBL as the 1st treatment option (EBL group 61.6%, meanwhile, EIS using 5% ethanolamine oleate was reserved as the 2nd treatment option when EBL was technically difficult (EIS group 38.4%. The mean time to restore hemodynamic stability was significantly prolonged in the EIS group (11.5 ± 6.5 hrs versus 9.5 ± 5.0 hrs, p 0.05. Initial control of bleeding was significantly higher in the EBL group versus the EIS group (96.7% vs 84.5%, p 0.021. Re-bleeding was more among the EIS group (42.9% vs 24.2%, p 0.04. There were no significant differences as regarding mortality and duration of hospital stay. So, a considerable proportion of cases presenting with acute variceal bleeding will have difficulty in performing EBL. In these patients, sclerotherapy is not a waning procedure with an accepted success rate, without much additional complications and without deranging mortality.

Gamal E. Esmat

2013-09-01

292

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

293

Power counting in baryon chiral perturbation theory including vector mesons  

International Nuclear Information System (INIS)

It is demonstrated that using a suitable renormalization condition one obtains a consistent power counting in manifestly Lorentz-invariant baryon chiral perturbation theory including vector mesons as explicit degrees of freedom

2003-11-20

294

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

295

Glidewire-assisted Foley catheter placement: a simple and safe technique for difficult male catheterization  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Difficulty in Foley catheter placement is a frequently encountered problem. We describe a simple and safe technique for this condition. Rather than using force, which may lead to the formation of a false passage, one should place a glidewire into the bladder through the area of resistance, followed by the placement of a Foley catheter over the glidewire. This is a very easy procedure and can be taught to nurses and nurse practitioners to avoid an unnecessary call for a urologist in the emerge...

Chiou, Rei K.; Aggarwal, Himanshu; Chen, Wen

2009-01-01

296

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.

297

A prospective analysis of consultation for difficult urinary catheter insertion at tertiary care centres in Northern Alberta  

Science.gov (United States)

Background: Difficult urinary catheterization (DUC) is a frequent reason for urologic consultation. Literature regarding DUC is limited. The objective of the study is to examine the current practice pattern of DUC and identify strategies to reduce its incidence and related adverse events. Methods: This is a prospective observational study of consultation for DUC at tertiary care centres in Edmonton, Alberta between October 2010 and February 2011. All urologic consultations for DUC in adults at the 2 tertiary hospitals were enrolled. Patients were managed according to the current regional standard of care established prior to the study. A clinical encounter questionnaire (CEQ) was completed by the urology service regarding details of the consultation and patient factors. CEQ results were tabulated and analyzed for trends, areas of strengths and weakness in the consultation process. Results: In total, 89 patients were accrued to the study. Mean age was 67 years and 91% were male. Seventeen percent of patients had history of previous DUC and 65% had urologic history. Forty-two percent of patients had catheter placement without any auxiliary tools. Adverse events, including urosepsis, bladder perforation, hydrouterus, paraphimosis and urethral trauma, were experienced by 37% of patients. Significant urethral injury as a result of catheterization attempts occurred in 32%. Forty-one percent of consultations were classified as inappropriate and 53% occurred between 5 pm and 6:30 am. Conclusion: DUC is associated with significant patient morbidity and may often be preventable. This study highlights the need for implementation of preventive strategies, widespread education and increased awareness regarding catheter care.

Bacsu, Chasta; Van Zyl, Stephan; Rourke, Keith Francis

2013-01-01

298

Including gauge corrections to thermal leptogenesis  

Energy Technology Data Exchange (ETDEWEB)

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

Huetig, Janine

2013-05-17

299

Including foundation effects on the vibration behaviour of rotating machinery  

Science.gov (United States)

Including foundation effects on rotating machinery vibrations is normally difficult and very approximate owing to the complicated foundation configuration and its interaction with the surrounding environment, necessitating experimental identification of the foundation parameters. This paper presents and evaluates numerically a promising technique for identifying mass, damping and stiffness parameters of a field foundation supporting unbalanced rotating machinery. All necessary measurements can be taken during a single run-down. Moreover, only a knowledge of the bearing characteristics and measurements of rotor and foundation motions at selected co-ordinates (including the connections) and at selected speeds are needed. In particular, the method does not require an accurate rotor model, nor a knowledge of the actual unbalance distribution.

Feng, N. S.; Hahn, E. J.

1995-05-01

300

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

Digital Repository Infrastructure Vision for European Research (DRIVER)

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

2012-01-01

 
 
 
 
301

Going Around the Bend: Deep Inspiration Facilitates Difficult Stent Delivery in the Native Coronary Arteries  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Percutaneous coronary intervention in tortuous or calcified vessels poses a substantial challenge for interventional cardiologists. Many techniques have been described to overcome the challenge, including the use of stiffer wires, buddy wires, the anchor balloon technique, and deep seating of the guide catheter. Herein, we describe a way to facilitate stent delivery in many tortuous, calcified, and acutely angled vessels: having the patient take a deep breath during the delivery. Deep inspira...

Attaran, Robert R.; Butman, Samuel; Movahed, Mohammad Reza

2011-01-01

302

A Difficult Laparoscopic Cholecystectomy That Requires Conversion to Open Procedure Can Be Predicted by Preoperative Ultrasonography  

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A prospective study was conducted from March 1999 to April 2000 that included 73 patients who underwent elective laparoscopic cholecystectomy for uncomplicated gallstone disease. The study was conducted at one surgical unit in the Department of Surgery and Department of Radio-diagnosis and one surgical unit in the Department of Surgery, Maulana Azad Medical College and the associated Lok Nayak Hospital, which is the largest referral hospital in northern India and is located in the capital of ...

Lal, Pawan; Agarwal, Pn; Malik, Vinod Kumar; Chakravarti, Al

2002-01-01

303

Difficult treatment of consumptive hypothyroidism in a child with massive parotid hemangioma.  

Science.gov (United States)

Consumptive hypothyroidism is a rare condition related to massive infantile hemangiomas producing an excess of the thyroid-hormone-inactivating enzyme type 3 iodothyronine deiodinase. We report the first case of consumptive hypothyroidism secondary to a large parotid hemangioma, highlighting the difficulties in selecting an adequate therapeutic strategy. The affected child was initially referred to our center for congenital hypothyroidism with a hypoplastic thyroid gland. L-Thyroxine (L-T4) replacement therapy was started at seven days of life. In the following weeks, the hemangioma rapidly increased in volume and the child developed severe hypothyroidism refractory to high doses of L-T4 therapy. The concentration of reverse triiodothyronine was elevated, suggesting that the underlying cause was an excessive conversion of thyroid hormones by high type 3 iodothyronine deiodinase levels in the tumor. Corticosteroid treatment showed only partial benefit. Introduction of propranolol instead led to normalization of thyroid hormones along with a dramatic involution of the hemangioma. PMID:22570966

Vigone, Maria Cristina; Cortinovis, Francesca; Rabbiosi, Sarah; Di Frenna, Marianna; Passoni, Arianna; Persani, Luca; Chiumello, Giuseppe; Gelmetti, Carlo; Weber, Giovanna

2012-01-01

304

Difficult intubation management in a child with I-cell disease  

Directory of Open Access Journals (Sweden)

Full Text Available I-cell disease (mucolipidosis II is a rare metabolic disorder resulting from the deficiency of a specific lysosomal enzyme, N-acetylglucosamine-1-phosphotransferease. Developmental delay and growth failure are common presentations of I-cell disease. Psychomotor deterioration is rapid and progressive. Some physical signs such as hip dislocations, inguinal hernia, hepatomegaly, joint limitation, and skin changes may be present at birth. Coarse facial features and skeletal abnormalities become more conspicuous with time. The life expectancy of children with this condition is poor, with death usually occurring around the fifth year. A case report of the anesthetic management of gingivectomy with multiple dental extractions in a 5-year-old Omani female with I-cell disease is presented. The problems faced and their management during anesthesia are described.

Mahfouz Abdul

2010-01-01

305

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

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.

307

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

International Nuclear Information System (INIS)

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

1993-11-01

308

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

Directory of Open Access Journals (Sweden)

Full Text Available 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 intubation with each of the 4 laryngoscopes in a high fidelity difficult laryngoscopy manikin. The time to successful intubation (TTSI was recorded for each device, along with failure rate, and the best view of the glottis obtained. Results Use of the Glidescope, CMAC and Storz videolaryngoscopes improved the view of the glottis compared with use of the Macintosh blade (GEE, p?=?0.000, p?=?0.002, p?=?0.000 respectively. Use of the CMAC resulted in an improved view compared with use of the Storz VL (Fishers, p?=?0.05. Use of the Glidescope or Storz videolaryngoscope blade resulted in a longer TTSI compared with either the Macintosh (GLM, p?=?0.000, p?=?0.029 respectively or CMAC blades (GLM, p?=?0.000, p?=?0.033 respectively. Conclusions Unsurprisingly, when used in a simulated difficult laryngoscopy, all the videolaryngoscopes resulted in a better view of the glottis than the Macintosh blade. However, interestingly the CMAC was found to provide a better laryngoscopic view that the Storz DCI Videolaryngoscope. Additionally, use of either the Glidescope or Storz DCI Videolaryngoscope resulted in a prolonged time to successful intubation compared with use of the CMAC or Macintosh blade. The use of the CMAC during manikin simulated difficult laryngoscopy combined the efficacy of attainment of laryngoscopic view with the expediency of successful intubation. Use of the Macintosh blade combined expedience with success, despite a limited laryngoscopic view. The limitations of a manikin model of difficult laryngoscopy limits the conclusions for extrapolation into clinical practice.

Healy David W

2012-06-01

309

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

Directory of Open Access Journals (Sweden)

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

Robbins RA

2011-11-01

310

Conditional Comonotonicity  

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In this paper we propose a generalization of the comonotonicity notion by introducing and exploring the concept of conditional comonotonicity. We characterize this notion and we show on examples that conditional comonotonicity is the natural extension of the concept of comonotonicity to dynamic settings.

Napp, Clotilde; Jouini, Elye?s

2005-01-01

311

Accurate SHAPE-directed RNA secondary structure modeling, including pseudoknots.  

Science.gov (United States)

A pseudoknot forms in an RNA when nucleotides in a loop pair with a region outside the helices that close the loop. Pseudoknots occur relatively rarely in RNA but are highly overrepresented in functionally critical motifs in large catalytic RNAs, in riboswitches, and in regulatory elements of viruses. Pseudoknots are usually excluded from RNA structure prediction algorithms. When included, these pairings are difficult to model accurately, especially in large RNAs, because allowing this structure dramatically increases the number of possible incorrect folds and because it is difficult to search the fold space for an optimal structure. We have developed a concise secondary structure modeling approach that combines SHAPE (selective 2'-hydroxyl acylation analyzed by primer extension) experimental chemical probing information and a simple, but robust, energy model for the entropic cost of single pseudoknot formation. Structures are predicted with iterative refinement, using a dynamic programming algorithm. This melded experimental and thermodynamic energy function predicted the secondary structures and the pseudoknots for a set of 21 challenging RNAs of known structure ranging in size from 34 to 530 nt. On average, 93% of known base pairs were predicted, and all pseudoknots in well-folded RNAs were identified. PMID:23503844

Hajdin, Christine E; Bellaousov, Stanislav; Huggins, Wayne; Leonard, Christopher W; Mathews, David H; Weeks, Kevin M

2013-04-01

312

Hybrid Aortic Arch Replacement: A Novel Surgical Technique for a Difficult Problem  

Directory of Open Access Journals (Sweden)

Full Text Available Aneurysms of the aortic arch and descending aorta are invariably fatal if left to expand, but also represent considerable surgical challenges. The development of endovascular stent grafts in combination with aortic debranching has produced results at least comparable to the more traditional surgical approach, but with considerably less comorbidity. We describe a technique for debranching of the aortic arch without the use of circulatory support, and in doing so creating a landing zone for thoracic endovascular aneurysm repair (TE-VAR. Although this procedure has been described, innovative features of our technique include transection of the left hemisternum to produce excellent surgical exposure, and ligation of the debranched arch vessels to prevent Type II endoleaks following TEVAR. Additionally, by not using mechanical circulatory support, we remove the associated pathophysiological insult, inflammatory response, and coagulopathy that is synonymous with cardiopulmonary bypass. There is also no need for circulatory arrest, with its associated perils.

Ravi de Silva

2011-08-01

313

A two-step procedure for pressure acid leaching of ores that are difficult to leach  

International Nuclear Information System (INIS)

A procedure is proposed for autoclave leaching of uranium-zirconium, titanium-zirconium and other ores with a complex mineral composition. In the first step, the ore pulp is leached with sulfuric acid at an acid concentration of 20 to 200 g/l and an oxidation-reduction potential of -300 to -700 mV for 0.2 to 5 hours. Thereafter, the reaction mixture is transferred to the second leaching step, where the concentration of the acid is increased by 1 to 180 g/l, the oxidation-reduction potential is -300 to -800 mV, and the leaching time is 0.5 to 6 hours. The temperature in the two steps is held within the region of 110 to 250 degC. Assets of this procedure include a faster transfer of the ore into the liquid phase and a lower consumption of sulfuric acid. (M.D.)

1987-02-25

314

Going around the bend: deep inspiration facilitates difficult stent delivery in the native coronary arteries.  

Science.gov (United States)

Percutaneous coronary intervention in tortuous or calcified vessels poses a substantial challenge for interventional cardiologists. Many techniques have been described to overcome the challenge, including the use of stiffer wires, buddy wires, the anchor balloon technique, and deep seating of the guide catheter. Herein, we describe a way to facilitate stent delivery in many tortuous, calcified, and acutely angled vessels: having the patient take a deep breath during the delivery. Deep inspiration displaces the diaphragm and the heart into a more vertical position and causes the coronary tree to straighten slightly, which facilitates balloon and stent delivery. We have found that this method minimizes patients' radiation exposure and saves substantial time and expense in many balloon and stent deliveries that would otherwise be challenging. PMID:21720470

Attaran, Robert R; Butman, Samuel; Movahed, Mohammad Reza

2011-01-01

315

Closure of difficult palatal fistulas using a "parachuting and anchoring" technique with the tongue flap.  

Science.gov (United States)

The tongue flap has been described in reconstructing palatal defects. Nevertheless, properly securing the flap to the palatal defect has continued to pose a challenge, especially because the flap becomes mobile with normal activities (i.e., speech and swallow). For this reason, alternative fixation schemes have been discussed in literature, but do not always solve the problem. In this article, we offer an alternative method for positioning and securing the tongue flap into the palatal defect. The authors of this article believe that advantages of this technique include an increase in flap security and immobility and a decrease in postoperative maxillomandibular fixation requirement. Although unanswered questions still remain regarding improved flap retention with this method, we believe that the "parachuting and anchoring" technique provides an alternative method that can most definitely add to the surgeon's armamentarium. PMID:21439863

Elyassi, Ali R; Helling, Eric R; Closmann, James J

2011-12-01

316

Environmental Sustainability - Including Land and Water Use  

Science.gov (United States)

Assessments of environmental sustainability can be conducted in many ways with one of the most quantitative methods including Life Cycle Impact Assessment (LCIA). While historically LCIA has included a comprehensive list of impact categories including: ozone depletion, global c...

317

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

318

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)

2013-04-14

319

Extended Exposure in Difficult Total Knee Arthroplasty Using Tibial Tubercle Osteotomy  

Science.gov (United States)

ABSTRACT Objectives: In some total knee arthroplasty cases, the usual medial parapatellar approach does not allow the appropriate patellar eversion and the desired exposure of the knee joint. Partial disinsertion of the patellar tendon doesn't substantially improve the surgical exposure and can lead to extensor apparatus weakening and complete secondary ruptures, while the V-Y quadricipital plasty leads to post-op immobilization of the knee, which delays the functional rehabilitation, with negative impact on the range of motion. The tibial tubercle osteotomy, however, allows an extension of the approach in total knee arthroplasty, without endangering the quadricipital extensor apparatus. Material and Methods: In this study we analysed the post-operative results of 11 cases of primary total knee arthroplasty in which a frontal plane osteotomy of the tibial tubercle was performed in addition to the standard medial parapatellar approach, as a result of the patients associated conditions, like rheumatoid arthritis with an extension deficit higher than 150, previous knee synovectomy by arthrotomy, progressive genu varum with more than 150 deviation, varus deviation of the lower limb with previous closing wedge proximal tibial osteotomy or patellar fractures with vicious consolidation. Outcomes: Overall, the results were more than satisfactory with a significant increase in the patients mean range of motion and Knee Society Score. There were some post-op issues in some of the patients, but they were adressed accordingly, having no long-term impact on the results. Conclusions:. We could thus conclude that, in special cases, the frontal plane tibial tubercle osteotomy is an effective technique which can provide a wide approach with appropriate protection of the knee extensor apparatus.

RADULESCU, Radu; BADILA, Adrian; NUTIU, Octavian; JAPIE, Ionut; TERINTE, Silvia; RADULESCU, Dragos; MANOLESCU, Robert

2013-01-01

320

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

Directory of Open Access Journals (Sweden)

Full Text Available Autoimmune pancreatitis (AIP is a rare disorder, although the exact prevalence is still unkown. It is a type of pancreatitis that is presumed to have an autoimmune aetiology, and is currently diagnosed based on a combination of 5 criteria. However, in this day and age, some patients with AIP are likely to be resected for the suspicion of malignancy. The authors report a case of pseudo-tumoral autoimmune pancreatitis, reviewing some literature about it and underlining the difficulty in the diagnosis. A 56- year-old patient was referred to our unit for upper abdominal pain. In his past medical history we note mellitus diabetes. The clinical examination was unremarkable. Laboratory data showed no abnormal values. Upper endoscopy showed antral gastritis. Transabdominal ultrasonography showed a hepatic steatosis and 5 angiomas. No computed tomography scan was made. Magnetic resonance imaging (MRI showed 5 angiomas and a lesion of 20x20 mm of the pancreatic tail with decreased signal intensity on T1-weighted MR images, increased signal intensity on T2-weighted MR images. Due to concerns of pancreatic malignancy, the patient underwent open distal spleno-pancreatectomy. Histolo gical analysis of the resected specimen revealed no malignancy. Postoperatively, immunoglobulin G fraction 4 was slightly above of the upper limit of the normal range. After corticotherapy the patient is getting better. This case underlines the difficulties still encountered in the diagnosis of AIP. It has been frequently misdiagnosed as pancreatic cancer and caused unnecessary resection. In order to avoid unnecessary resections for an otherwise benign and easily treatable condition, it is urgent to refine diagnostic criteria and to reach an international consensus.

Nizar Miloudi

2012-10-01

 
 
 
 
321

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

1981-01-01

322

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

323

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

324

Critical appraisal of pralatrexate in the management of difficult-to-treat peripheral T cell lymphoma  

Directory of Open Access Journals (Sweden)

Full Text Available M Casanova, A Medina-Pérez, M Moreno-Beltran, M Mata-Vazquez, A RuedaOncohematology Service, Hospital Costa del Sol, Marbella, SpainAbstract: Aggressive T cell lymphomas are a subgroup of lymphomas with a particularly poor prognosis. This is especially true for patients with recurrent or refractory disease, who typically have limited response to salvage therapy and extremely poor overall survival. For this reason, there is a strong need to develop potentially active drugs for these malignancies. Pralatrexate is a novel antifolate designed to have high affinity for reduced folate carrier type 1. Preclinical and clinical studies have demonstrated that pralatrexate has significant activity against T cell lymphomas. The dose-limiting toxicity for pralatrexate is mucositis, which can be abrogated with folic acid and vitamin B12 supplementation. Pralatrexate is the first single agent approved for the treatment of patients with relapsed or refractory peripheral T cell lymphoma. This approval was based on an overall objective response rate observed in the pivotal study. The overall response rate was 29%, with a median duration of 10.1 months. This article reviews the biochemistry, preclinical experience, metabolism, and pharmacokinetics of pralatrexate, including the clinical experience with this agent in lymphoma. Future areas of development are now focused on identifying synergistic combinations of pralatrexate with other agents and the evaluation of predictive markers for clinical benefit.Keywords: pralatrexate, peripheral T cell lymphoma

Casanova M

2011-10-01

325

[Combined use of the GlideScope and fiberoptic bronchoscope for tracheal intubation in a patient with difficult airway].  

Science.gov (United States)

We report a case of successful tracheal intubation of a double-lumen tube with combined use of a videolaryngoscope (GlideScope) and a fiberoptic bronchoscope, in a patient with difficult airway, in whom intubation using the GlideScope had failed. A 71-year-old man with lung cancer was scheduled for the middle lobe lobectomy under general anesthesia. Anesthesia was induced with propofol, fentanyl and sevoflurane, and after confirmation of adequate ventilation through a facemask, rocuronium was given. The GlideScope was inserted at first, but it was difficult to see the glottis (Cormack-Lehane classification III) and tracheal intubation of a 37 Fr double-lumen tube failed. While the GlideScope was in place to obtain a view near the glottis, a fiberoptic bronchoscope (passed through the double-lumen tube) was insertd into the trachea, and the tube was passed over the scope into the trachea. We believe that, when tracheal intubation of a double-lumen tube using a videolaryngoscope or fiberoptic bronchoscope is difficult, their combined use may be useful in a patient with difficult airway. PMID:24979855

Ara, Takero; Mori, Gakushi; Adachi, Eriko; Asai, Takashi; Okuda, Yasuhisa

2014-06-01

326

Awake Epidural Anaesthesia for Laparotomy in an Obese patient with severe Interstitial lung disease and Difficult Airway  

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Anaesthetizing a patient who has co-existing lung disease, difficult airway and obesity is a major anesthetic challenge. This case report describes the successful anesthetic management of such a patient under segmental epidural anaesthesia who underwent laparotomy for excision of a large mesenteric cyst

Ajeeth Baburajan; Fijul Komu; Kairali Krishnan; Salim Valiapurackal; Vijayakumar Damodharan

2009-01-01

327

A Longitudinal Study of Student-Teacher Relationship Quality, Difficult Temperament, and Risky Behavior from Childhood to Early Adolescence  

Science.gov (United States)

This study examines the mediating role of student-teacher relationship quality (conflict and closeness) in grades 4, 5, and 6 on the relation between background characteristics, difficult temperament at age 41/2 and risky behavior in 6th grade. The longitudinal sample of participants (N = 1156) was from the NICHD Study of Early Child Care and…

Rudasill, Kathleen Moritz; Reio, Thomas G., Jr.; Stipanovic, Natalie; Taylor, Jennifer E.

2010-01-01

328

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

329

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

Science.gov (United States)

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

Garrett, H. James

2011-01-01

330

Difficult Dialogues, Privilege and Social Justice: Uses of the Privileged Identity Exploration (PIE) Model in Student Affairs Practice  

Science.gov (United States)

This article will introduce the Privileged Identity Exploration (PIE) Model. This model identifies eight (8) defense modes associated with behaviors individuals display when engaged in difficult dialogues about social justice issues. Implications for the model and ways it can be used to assist facilitators as they engage participants in…

Watt, Sherry K.

2007-01-01

331

Immediate balloon deflation method in endoscopic papillary large balloon dilation for extraction of difficult bile duct stones  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Background/Aims: Recently, endoscopic papillary large balloon dilation (EPLBD) using a large balloon (12 - 20 mm) for extraction of difficult common bile duct (CBD) stones has been widely accepted with favorable outcomes. However, there is no consensus with regard to the ballooning time. The aim of our study was to evaluate the ...

2013-01-01

332

Strategy including high octane spark advance  

Energy Technology Data Exchange (ETDEWEB)

A method is described of controlling knock for an internal combustion engine, said method comprising the steps of: sensing a plurality of engine conditions; determining a maximum value of knock; determining whether a plurality of the sensed engine conditions have achieved predetermined values for updating the maximum value of knock; using an unmodified spark advance if the plurality of sensed engine conditions have not achieved predetermined values for updating the maximum value of knock; and modifying the spark advance if the plurality of sensed engine conditions have achieved predetermined values for updating the maximum value or knock.

Fodale, F.M.; Dykstra, G.J.; Lee, R.E.; Weber, G.T.; Witalec, J.M.; Wyrembelski, J.T.

1993-08-10

333

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

Directory of Open Access Journals (Sweden)

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

Gilberto Bercovici

2004-01-01

334

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

Science.gov (United States)

NASA has recently launched its Global Climate Change web site (http://climate.nasa.gov), and it has been very well received. It has now also launched in preliminary form an associated site for children and educators, with a plan for completion in the near future. The goals of the NASA Global Climate Change Education site are: To increase awareness and understanding of climate change science in upper-elementary and middle-school students, reinforcing and building upon basic concepts introduced in the formal science education curriculum for these grades; To present, insofar as possible, a holistic picture of climate change science and current evidence of climate change, describing Earth as a system of interconnected processes; To be entertaining and motivating; To be clear and easy to understand; To be easy to navigate; To address multiple learning styles; To describe and promote "green" careers; To increase awareness of NASA's contributions to climate change science; To provide valuable resources for educators; To be compliant with Section 508 of the Americans with Disabilities Act. The site incorporates research findings not only on climate change, but also on effective web design for children. It is envisioned that most of the content of the site will ultimately be presented in multimedia forms. These will include illustrated and narrated "slide shows," animated expositions, interactive concept-rich games and demonstrations, videos, animated fictionalized stories, and printable picture galleries. In recognition of the attention span of the audience, content is presented in short, modular form, with a suggested, but not mandatory order of access. Empathetic animal and human cartoon personalities are used to explain concepts and tell stories. Expository, fiction, game, video, text, and image modules are interlinked for reinforcement of similar ideas. NASA's Global Climate Change Education web site addresses the vital need to impart and emphasize Earth system science concepts at or near the beginning of the education pipeline.

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

2009-12-01

335

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

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Background The use of information and communication technologies in healthcare is seen as essential for high quality and cost-effective healthcare. However, implementation of e-health initiatives has often been problematic, with many failing to demonstrate predicted benefits. This study aimed to explore and understand the experiences of implementers -- the senior managers and other staff charged with implementing e-health initiatives and their assessment of factors which promote or inhibit the successful implementation, embedding, and integration of e-health initiatives. Methods We used a case study methodology, using semi-structured interviews with implementers for data collection. Case studies were selected to provide a range of healthcare contexts (primary, secondary, community care, e-health initiatives, and degrees of normalization. The initiatives studied were Picture Archiving and Communication System (PACS in secondary care, a Community Nurse Information System (CNIS in community care, and Choose and Book (C&B across the primary-secondary care interface. Implementers were selected to provide a range of seniority, including chief executive officers, middle managers, and staff with 'on the ground' experience. Interview data were analyzed using a framework derived from Normalization Process Theory (NPT. Results Twenty-three interviews were completed across the three case studies. There were wide differences in experiences of implementation and embedding across these case studies; these differences were well explained by collective action components of NPT. New technology was most likely to 'normalize' where implementers perceived that it had a positive impact on interactions between professionals and patients and between different professional groups, and fit well with the organisational goals and skill sets of existing staff. However, where implementers perceived problems in one or more of these areas, they also perceived a lower level of normalization. Conclusions Implementers had rich understandings of barriers and facilitators to successful implementation of e-health initiatives, and their views should continue to be sought in future research. NPT can be used to explain observed variations in implementation processes, and may be useful in drawing planners' attention to potential problems with a view to addressing them during implementation planning.

Wallace Paul

2011-01-01

336

Method and apparatus for processing high-ash coal slurries by flotation, particularly for processing gas coal and open burning coal which are difficult to float  

Energy Technology Data Exchange (ETDEWEB)

A method is proposed for processing high-ash coal sludges by flotation of a slurry in the cells of flotation units, particularly for processing gas coal and open burning coal which are difficult to float, in which the coal slurry to be processed flows through the cells of the flotation unit pre-conditioned and controllably, particularly with control of the dwell time. In a preferred embodiment, the control of the dwell time occurs by a controlled distribution of the slurry to cells of the flotation unit which operate in parallel. For the purpose of controlling the dwell time of the slurry in a flotation unit, cells which are traversed in parallel are additionally connected or disconnected as a function of operating parameters, such as slurry density or solids content or solids distribution.

Hellmann, K.

1984-10-16

337

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

1986-09-15

338

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

Science.gov (United States)

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

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

2012-03-01

339

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

Directory of Open Access Journals (Sweden)

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

Palmer, Glen A.

2006-01-01

340

The effects of sexism, psychological distress, and difficult sexual situations on U.S. women's sexual risk behaviors.  

Science.gov (United States)

Women represent almost half of the people living with HIV worldwide. Although social discrimination has been recognized as a major obstacle to HIV prevention, few empirical studies have examined the effects of sexism on women's HIV sexual risk behaviors. We analyzed data collected from an ethnically diverse sample of 754 women attending family planning clinics in the San Francisco Bay Area. A majority of respondents reported lifetime experiences of sexism (e.g., 94% reported sexual harassment). Structural equation modeling results demonstrated that experiences of sexism and reports of recent unprotected sex with a primary or a secondary sexual partner were linked through psychological distress and difficult sexual situations. Our results suggest the need to develop HIV prevention strategies for women that address two mechanisms-psychological distress and difficult sexual situations-that link social discrimination to women's sexual risk for HIV. PMID:22010804

Choi, Kyung-Hee; Bowleg, Lisa; Neilands, Torsten B

2011-10-01

 
 
 
 
341

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

Digital Repository Infrastructure Vision for European Research (DRIVER)

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

2014-01-01

342

Diagnostic utility of ?-methylacyl CoA racemase (P504S) & HMWCK in morphologically difficult prostate cancer  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Abstract Background To evaluate the diagnostic utility of alpha-methylacyl CoA racemase (P504S) & HMWCK (34beta E12) in morphologically difficult prostate cancer. Methods A total of 1034 cases were reviewed and divided into benign (585) malignant (399) and suspicious (50). Immunohistochemistry with HMWCK and AMACR was done on the 50 suspicious cases along with controls. Results Forty nine suspicious cases were resolved by using both markers where a...

Kumaresan K; Kakkar Nandita; Verma Alka; Mandal Arup; Singh Shrawan; Joshi Kusum

2010-01-01

343

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

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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

344

Treatment of severe and difficult cases of systemic lupus erythematosus with tacrolimus. A report of three cases  

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OBJECTIVES—An analysis of the efficacy of tacrolimus treatment in three patients with difficult and severe systemic lupus erythematosus (SLE) whose active disease had been previously poorly controlled by cyclosporine and cyclophosphamide.?METHODS—A review of patient notes.?RESULTS—Two patients are well controlled after six and nine months of treatment with tacrolimus 0.06 mg/kg/day and 0.18 mg/kg/day. Previous persistent vasculitis had resolved and other features of active...

Duddridge, M.; Powell, R.

1997-01-01

345

The videolanryngoscope is less traumatic than the classic laryngoscope for a difficult airway in an obese patient  

Digital Repository Infrastructure Vision for European Research (DRIVER)

This report describes the anesthetic management of an obese patient with a difficult airway and the merits of videolaryngoscopy, specifically in terms of the reduced risk of dental damage during intubation. A 49-year-old woman (body mass index; BMI, 36 kg.m(-2)), was scheduled to undergo an elective laparoscopic cholecystectomy because of cholelithiasis. Based upon the obesity of the patient and preoperative metrics (Mallampati grade IV; interdental distance of 2.9 cm; thyromental distance, 5...

Maassen, R.; Lee, R; Zundert, Adrien; Cooper, R.

2009-01-01

346

The videolaryngoscope is less traumatic than the classic laryngoscope for a difficult airway in an obese patient:  

Digital Repository Infrastructure Vision for European Research (DRIVER)

This report describes the anesthetic management of an obese patient with a difficult airway and the merits of videolaryngoscopy, specifically in terms of the reduced risk of dental damage during intubation. A 49-year-old woman (body mass index; BMI, 36 kg·m?2), was scheduled to undergo an elective laparoscopic cholecystectomy because of cholelithiasis. Based upon the obesity of the patient and preoperative metrics (Mallampati grade IV; interdental distance of 2.9 cm; thyromental distance, ...

Maassen, R.; Lee, R; Zundert, A.; Cooper, R.

2009-01-01

347

Bayesian Sampling using Condition Indicators  

DEFF Research Database (Denmark)

The problem of control quality of components is considered for the special case where the acceptable failure rate is low, the test costs are high and where it may be difficult or impossible to test the condition of interest directly. Based on the classical control theory and the concept of condition indicators introduced by Benjamin and Cornell (1970) a Bayesian approach to quality control is formulated. The formulation is then extended to the case where the quality control is based on sampling of indirect information about the condition of the components, i.e. condition indicators. This allows for a Bayesian formulation of the indicators whereby the experience and expertise of the inspection personnel may be fully utilized and consistently updated as frequentistic information is collected. The approach is illustrated on an example considering a concrete structure subject to corrosion. It is shown how half-cell potential measurements may be utilized to update the probability of excessive repair after 50 years.

Faber, Michael H.; Sørensen, John Dalsgaard

2002-01-01

348

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

349

Immediate balloon deflation method in endoscopic papillary large balloon dilation for extraction of difficult bile duct stones  

Directory of Open Access Journals (Sweden)

Full Text Available Background/Aims: Recently, endoscopic papillary large balloon dilation (EPLBD using a large balloon (12 - 20 mm for extraction of difficult common bile duct (CBD stones has been widely accepted with favorable outcomes. However, there is no consensus with regard to the ballooning time. The aim of our study was to evaluate the efficacy and safety of immediate balloon deflation in EPLBD for the treatment of difficult bile duct stone. Methods: This was a retrospective study of 80 consecutive patients with bile duct stones who were treated with an immediate balloon deflation method in EPLBD combined with endoscopic sphincterotomy (EST between January 2010 and December 2012. Overall success rate, success rate at first ERCP, and the frequency of mechanical lithotripsy for complete stone removal were assessed for efficacy and safety was evaluated by assessing major complications. Results: Overall success rate for complete stone removal was high (78/80, 97.5% and success rate for complete stone removal at first ERCP was 86.3% (69/80. The use of mechanical lithotripsy was 0% (0/80. The overall complication rate was favorable (5/80, 6.3%. PostERCP pancreatitis was observed in 3 patients (two: mild, one: moderate. In subgroup analysis, the presence of periampullary diverticulum was the only factor affecting the success rate at first ERCP. Conclusion: This study demonstrated the favorable outcome of immediate balloon deflation for treatment of difficult CBD stones and can be considered for clinical application.

Duk Joo Choi

2013-05-01

350

Difficult Decisions: Reproductive Technologies.  

Science.gov (United States)

Presents the arguments for and against artificial insemination and in-vitro fertilization. Cites various legal, moral, and ethical questions which can be used to promote discussion. Some people feel that the natural bond between parent and child could be weakened as a result of this new technology. (RT)

Parakh, Jal S.; Slesnick, Irwin L.

1988-01-01

351

[ICSI in difficult cases].  

Science.gov (United States)

The decision to offer ICSI is based on the quality of the semen, and the presence of severe oligospermia or azoospermia. In the case of severe asthenospermia, a second sample may be requested. In the case of complete asthenospermia, the fertilisation rate can be increased if the ICSI is carried out with spermatozoa selected using HOST (hypoosmotic swelling test). Not all morphological abnormalities have the same repercussions. Certain abnormalities should be excluded, in particular globozoospermia and macrocephalia. Secretory azoospermia may be known about or diagnosed on the first day of treatment, hence the advantage of freezing emergency straws in the event of severe oligoasthenoteratospermia. Meticulous microscopic observation of the ejaculate can allow the identification of occasional and even motile spermatozoa. Female infertility is no longer an indicator for ICSI treatment. In the event of IVF failure with normal sperm, switching to ICSI depends on oocyte quality and maturity. Regarding technical implementation of ICSI, equipment problems are as varied as the equipment is complex. It is conducted outside a sterilizer, thus requiring maintenance of the temperature, pH and sterility. Certain questions remain unanswered. Patients should be informed of the limited chances of success from ICSI, with high instances of aneuploidy and low pregnancy rates. PMID:18279727

Hamamah, S

2007-12-01

352

Why Skinner is difficult  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Skinner's views are commonly misrepresented. One reason for this difficulty is that changes in the way that Skinner formulated his views occurred in a gradual evolution over time throughout Skinner's career, and the changes and their significance were not as conspicuously marked as they might have been. Among these changes were a movement from a two-term necessity to a three-term contingency; a movement from discriminative stimulus to setting as the first term in his three-term contingency; a...

1998-01-01

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

Difficult wounds: radiation wounds  

International Nuclear Information System (INIS)

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

1979-01-01

355

Probabilistic analysis of limiting conditions for operation action requirements including risk of shutdown  

International Nuclear Information System (INIS)

When the systems needed to shut down a nuclear power plant are inoperable or degraded, the risk of shutting down the plant may be comparable to, or even higher than, that of continuing power operation with the equipment inoperable but giving priority to repairs. This concern arises because the plant may have insufficient capability for removing decay heat during the shutdown. However, in many cases, plant technical specifications require immediate shutdown of the plant. Risk-based analyses for various alternatives of operational policy available in such situations are examined. These analyses can be used to define the risk-effective requirements for those standby safety systems

1995-11-01

356

Cancer of the Soft Tissue including Heart  

Science.gov (United States)

... per 100,000 men and women per year based on 2007-2011 cases. Percent of New Cases by Age Group: Soft Tissue including Heart Cancer Soft tissue including heart cancer is most frequently diagnosed among people aged 55-64. Median Age At Diagnosis 59 SEER 18 2007-2011, All Races, Both ...

357

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

358

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

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.

359

Rescue therapy of difficult-to-treat indwelling central venous catheter-related bacteremias in cancer patients: a review for practical purposes.  

Science.gov (United States)

Device-related bacteremia is the most frequent complication in patients with indwelling central venous catheter. Guidelines recommend treatment based on epidemiology and antimicrobial susceptibility tests, but catheter removal is advocated in the presence of particular clinical conditions or pathogen isolations. Anti-infective drugs might become less effective in the presence of pathogens with increases in minimal inhibitory concentrations or slime production, and sometimes catheter removal is not feasible, for example, in patients with limited vascular sites or in the presence of life-threatening clinical conditions. Catheter lock with anti-infective drugs (antibacterials or antifungals) or other substances with anti-infective properties (e.g., taurolidine, 70% ethanol, 2M HCl) might represent a possible rescue treatment in the presence of difficult-to-treat infections and/or when the device cannot be removed. In the present review, the authors summarize these possible therapeutic options. The aim of the report is not to perform a systematic review of the literature, but to give an 'easy to read' text for everyday practice. PMID:23409823

Castagnola, Elio; Ginocchio, Francesca

2013-02-01

360

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.)

1986-10-29

 
 
 
 
361

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

Digital Repository Infrastructure Vision for European Research (DRIVER)

Objectives. To assess the induced sputum substance P (ISSP) levels in children having difficult-to-treat asthma (DA) with and without gastroesophageal reflux (GER). We aimed also to evaluate the association of GER with childhood DA, relationship of GER severity with childhood asthma control test (C-ACT), FEV1, peak expiratory flow (PEF) variability, and ISSP. Finally, we tried to evaluate esomeprazole treatment effect on C-ACT and FEV1 in children with DA. Methods. Spirometry, C-ACT, upper ga...

Bediwy, Adel Salah; Elkholy, Mohamed Gamal A.; Al-biltagi, Mohammed; Amer, Hesham Galal; Farid, Eman

2011-01-01

362

A rapidly enlarging neck mass: the role of the sitting position in fiberoptic bronchoscopy for difficult intubation.  

Science.gov (United States)

Difficult airway management is a dilemma for any anesthesiologist. Although practice guidelines and algorithms may help in such situations, the anesthesiologist's judgment and vigilance remain the primary means to save lives. In the following case, we encountered an acutely enlarging thyroid mass that was compromising the airway. This huge neck mass precluded tracheostomy under local anesthesia, and the patient could breathe only in the sitting position. Therefore, there were few safe strategies for airway management for general anesthesia. We reiterate the role of awake fiberoptic intubation in such circumstances. PMID:18931222

Dabbagh, Ali; Mobasseri, Naseraddin; Elyasi, Hedayatollah; Gharaei, Babak; Fathololumi, Mohammadreza; Ghasemi, Mahshid; Chamkhale, Iman Bandarchi

2008-11-01

363

mlg - construction including renewables removals-2  

Northern Ireland Guidance Construction (including renewables) and removals, under Part 4 of the Marine and Coastal Access Act 2009 August 2012 Contents Page 1.0 Introduction .... 3 1.1 Does the Project require a marine ...

364

mlg - construction including renewables removals-3  

Northern Ireland Guidance Construction (including renewables) and removals, under Part 4 of the Marine and Coastal Access Act 2009 August 2012 Contents Page .1 Does the Project require a marine licence? .... 3 .. 6 2.2...

365

42 CFR 410.100 - Included services.  

Science.gov (United States)

...dysfunction caused by illness or injury, and...preventing or reducing disability or pain and restoring...use. (h) Social and psychological services . Social and psychological services include...the potential impact of the home...

2009-10-01

366

Gas storage materials, including hydrogen storage materials  

Science.gov (United States)

A material for the storage and release of gases comprises a plurality of hollow elements, each hollow element comprising a porous wall enclosing an interior cavity, the interior cavity including structures of a solid-state storage material. In particular examples, the storage material is a hydrogen storage material such as a solid state hydride. An improved method for forming such materials includes the solution diffusion of a storage material solution through a porous wall of a hollow element into an interior cavity.

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

2013-02-19

367

Dragline gear monitoring under fluctuating conditions  

Digital Repository Infrastructure Vision for European Research (DRIVER)

The aim of this study is to apply computed order tracking with subsequent rotation domain averaging and statistical analysis to typical mining environments. Computed order tracking is a fault detection method that is unaffected by varying speed conditions often found in industry and has been proven effective in laboratory conditions. However in the controlled environment of a laboratory it is difficult to test the robustness of the order-tracking procedure. The need thus exists to adjust the ...

2008-01-01

368

Tracing the Origins of Verification Conditions  

Digital Repository Infrastructure Vision for European Research (DRIVER)

The typical program verification system is a batch tool that accepts as input a program annotated with Floyd-Hoare assertions, performs syntactic and semantic analysis on it, and generates a list of verification conditions that is subsequently submitted to a theorem prover. When a verification condition cannot be proved, this may be due to an error in the program or an inconsistency in the annotations. Unfortunately, it is very difficult to relate a failing proof attempt to a particular piece...

Fraer, Ranan

1996-01-01

369

Radiation treatment of organic substances which are difficult to decompose for utilizing sewage water again. Radiation decomposition of lignin  

International Nuclear Information System (INIS)

The sewerage model projects utilizing sewage-treated water and the sewerage model project for the future city executed in Tokyo are described. It is important to obtain the treated water which is suitable to purposes by setting up the target for control and reducing the organic contamination which is difficult to decompose. In fiscal year 1995, as to the decomposing treatment of lignin by radiation, the effect of reducing coloring and the influence when actual flowing-in sewage and treated water coexist were examined. The experimental samples were lignin aqueous solution, synthetic sewage and flowing-in sewage, treated water, and the mixture of treated water and synthetic sewage. The measurement of water quality is explained. The ? ray irradiation with a Co-60 source was carried out. The results of respective samples are reported. When total organic carbon was at the level in flowing-in sewage and treated water, irradiation was effective for eliminating coloring. The soluble organic substances which are difficult to decompose were efficiently decomposed by irradiation. (K.I.)

1996-11-01

370

The videolaryngoscope is less traumatic than the classic laryngoscope for a difficult airway in an obese patient.  

Science.gov (United States)

This report describes the anesthetic management of an obese patient with a difficult airway and the merits of videolaryngoscopy, specifically in terms of the reduced risk of dental damage during intubation. A 49-year-old woman (body mass index; BMI, 36 kg.m(-2)), was scheduled to undergo an elective laparoscopic cholecystectomy because of cholelithiasis. Based upon the obesity of the patient and preoperative metrics (Mallampati grade IV; interdental distance of 2.9 cm; thyromental distance, 5.5 cm) a difficult airway was anticipated. Classic direct laryngoscopy using a Macintosh blade size IV failed, despite three intubation attempts-each resulting in a Cormack-Lehane grade IV view. Intubation using a video-assisted Macintosh laryngoscope (V-Mac; Karl Storz, Tuttlingen, Germany) was successful upon the first attempt. The maximum force exerted on the patient's maxillary incisors was 61 N by direct laryngoscopy and 7.6 N using the indirect videolaryngoscope, both using a Macintosh blade. PMID:19685133

Maassen, Ralph; Lee, Ruben; van Zundert, André; Cooper, Richard

2009-01-01

371

Difícil manejo do paciente com distonia segmentar respiratória / The difficult management of patients with respiratory segmental dystonia  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: Portuguese Abstract in portuguese A forma respiratória da distonia laríngea é rara, de difícil diagnóstico e provoca restrição respiratória de graus variados. O objetivo deste trabalho é apresentar um caso de distonia respiratória envolvendo laringe e faringe e sua evolução em relação à intensidade dos espasmos e seu controle. ESTUD [...] O DE CASO: Paciente de 24 anos, sexo masculino, acompanhado por 5 anos: diagnóstico por nasofibroscopia e eletromiografia e tratamento com toxina botulínica conforme necessidade de controle dos sintomas. CONCLUSÃO: O difícil manejo se deve ao fato do desconhecimento da etiologia e a pouca opção de tratamento, bem como do envolvimento da função respiratória. Abstract in english Respiratory dystonia is a rare and difficult to diagnose disorder, that causes breathing restriction of various degrees. The objective of the study is to report the case of a patient with respiratory dystonia involving the larynx and the pharynx and its evolution concerning spasms intensity and cont [...] rol. CASE REPORT: A 24 year-old-man has been followed for 5 years. The diagnosis was made by means of nasofibroscopy and electromyography. Treatment was carried out with laryngeal and pharyngeal Botulin toxin injections, as it became necessary for symptoms control. CONCLUSION: The difficult management can be secondary to the lack of knowledge on the etiology and physiopathology of the impairment, and because of the limitations in the treatment of associated respiratory symptoms.

Noemi Grigoletto De, Biase; Paulo Augusto de Lima, Pontes; Vanier, Santos Junior; Vanessa Pedrosa, Vieira; Priscila, Zambonato; Reinaldo Kazuo, Yazaki.

372

Difícil manejo do paciente com distonia segmentar respiratória The difficult management of patients with respiratory segmental dystonia  

Directory of Open Access Journals (Sweden)

Full Text Available A forma respiratória da distonia laríngea é rara, de difícil diagnóstico e provoca restrição respiratória de graus variados. O objetivo deste trabalho é apresentar um caso de distonia respiratória envolvendo laringe e faringe e sua evolução em relação à intensidade dos espasmos e seu controle. ESTUDO DE CASO: Paciente de 24 anos, sexo masculino, acompanhado por 5 anos: diagnóstico por nasofibroscopia e eletromiografia e tratamento com toxina botulínica conforme necessidade de controle dos sintomas. CONCLUSÃO: O difícil manejo se deve ao fato do desconhecimento da etiologia e a pouca opção de tratamento, bem como do envolvimento da função respiratória.Respiratory dystonia is a rare and difficult to diagnose disorder, that causes breathing restriction of various degrees. The objective of the study is to report the case of a patient with respiratory dystonia involving the larynx and the pharynx and its evolution concerning spasms intensity and control. CASE REPORT: A 24 year-old-man has been followed for 5 years. The diagnosis was made by means of nasofibroscopy and electromyography. Treatment was carried out with laryngeal and pharyngeal Botulin toxin injections, as it became necessary for symptoms control. CONCLUSION: The difficult management can be secondary to the lack of knowledge on the etiology and physiopathology of the impairment, and because of the limitations in the treatment of associated respiratory symptoms.

Noemi Grigoletto De Biase

2007-04-01

373

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.

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

374

Scramjet including integrated inlet and combustor  

Energy Technology Data Exchange (ETDEWEB)

This patent describes a scramjet engine. It comprises: a first surface including an aft facing step; a cowl including: a leading edge and a trailing edge; an upper surface and a lower surface extending between the leading edge and the trailing edge; the cowl upper surface being spaced from and generally parallel to the first surface to define an integrated inlet-combustor therebetween having an inlet for receiving and channeling into the inlet-combustor supersonic inlet airflow; means for injecting fuel into the inlet-combustor at the step for mixing with the supersonic inlet airflow for generating supersonic combustion gases; and further including a spaced pari of sidewalls extending between the first surface to the cowl upper surface and wherein the integrated inlet-combustor is generally rectangular and defined by the sidewall pair, the first surface and the cowl upper surface.

Kutschenreuter, P.H. Jr.; Blanton, J.C.

1992-02-04

375

Nyquist stability conditions for laser feedback amplifiers with Gaussian or Lorentzian gain profiles  

Energy Technology Data Exchange (ETDEWEB)

In principle, high-gain laser amplifiers with negative feedback can perform spatial signal-processing operations analogous to the temporal operations performed by electronic d.c. operational amplifiers. In practice, it is difficult to achieve stability (prevent self-oscillation). Stability analysis is difficult because the overall transfer function for such an amplifier is a function not of one but of three frequencies: two spatial and one temporal. In the analysis presented here, an integral-equation formulation that specifically includes finite-lens-aperture effects permits stability analysis in terms of the temporal frequency alone. A Nyquist approach is then used to derive sufficient conditions for stability of a class of laser feedback amplifiers.

Hagler, M.O.; Bell, S.V.

1986-03-01

376

Electric Power Monthly, August 1990. [Glossary included  

Energy Technology Data Exchange (ETDEWEB)

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

1990-11-29

377

Condition monitoring  

Energy Technology Data Exchange (ETDEWEB)

Under construction in the Finnish town of Pori, is a new coal-fired power station. Scheduled to be in production by the end of 1993 the new 560MW Meri-Pori facility, in common with the others designed, constructed, commissioned and operated by Imatran Voima Oy (IVO), will operate at optimum efficiency levels. These levels will be achieved as they have at IVO's other stations - fired not only by coal but by peat, oil, nuclear reactors and combined cycle methods - by the use of predictive maintenance systems and methods. The more conventional systems of maintenance - run to failure and scheduled - may well result in a major breakdown or, less disastrously, in a lengthy but unnecessary overhaul. Predictive maintenance utilising continuous condition monitoring minimises unscheduled stoppages increasing plant availability and, as a result, profitability. Most power generators will be familiar with these procedures and would accept the advantages of predictive maintenance but may not be fully aware of the modus operandi of such systems or of their potential capabilities. The systems operating in some Finnish power plants are reviewed in this article. (author).

Kingston, J.

1992-01-01

378

An operative case of hepatic pseudolymphoma difficult to differentiate from primary hepatic marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Hepatic pseudolymphoma (HPL and primary hepatic marginal zone B cell lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma are rare diseases and the differential diagnosis between these two entities is sometimes difficult. We herein report a 56-year-old Japanese woman who was pointed out to have a space occupying lesion in the left lateral segment of the liver. Hepatitis viral-associated antigen/antibody was negative and liver function tests including lactic dehydrogenase, peripheral blood count, tumor markers and soluble interleukin-2 receptor were all within normal limit. Imaging study using computed tomography and magnetic resonance imaging were not typical for hepatocellular carcinoma, cholangiocarcinoma, or other metastatic cancer. Fluorodeoxyglucose-positron emission tomography examination integrated with computed tomography scanning showed high standardized uptake value in the solitary lesion in the liver. Under a diagnosis of primary liver neoplasm, laparoscopic-assisted lateral segmentectomy was performed. Liver tumor of maximal 1.0 cm in diameter was consisted of aggregation of lymphocytes of predominantly B-cell, containing multiple lymphocyte follicles positive for CD10 and bcl-2, consistent with a diagnosis of HPL rather than MALT lymphoma, although a definitive differentiation was pending. The background liver showed non-alcoholic fatty liver disease/early non-alcoholic steatohepatitis. The patient is currently doing well with no sign of relapse 13 months after the surgery. Since the accurate diagnosis is difficult, laparoscopic approach would provide a reasonable procedure of diagnostic and therapeutic advantage with minimal invasiveness for patients. Considering that the real nature of this entity remains unclear, vigilant follow-up of patient is essential.

Haga Hironori

2011-01-01

379

Secretory expression of Lentinula edodes intracellular laccase by yeast high-cell-density system: sub-milligram production of difficult-to-express secretory protein.  

Science.gov (United States)

While a number of heterologous expression systems have been reported for extracellular laccases, there are few for the intracellular counterparts. The Lentinula edodes intracellular laccase Lcc4 is an industrially potential enzyme with its unique substrate specificity. The heterologous production of the intracellular laccase, however, had been difficult because of its expression-dependent toxicity. We previously demonstrated that recombinant yeast cells synthesized and, interestingly, secreted Lcc4 only when they were suspended to an inducing medium in a high cell-density (J. Biosci. Bioeng., 113, 154-159, 2012). The high cell-density system was versatile and applicable to other difficult-to-express secretory proteins. Nevertheless, the system's great dependence on aeration, which was a practical obstacle to scale-up production of the enzyme and some other proteins, left the secretion pathway and enzymatic properties of the Lcc4 uncharacterized. In this report, we demonstrate a successful production of Lcc4 by applying a jar-fermentor to the high cell-density system. The elevated yield (0.6 mg L(-1)) due to the sufficient aeration allowed us to prepare and purify the enzyme to homogeneity. The enzyme had been secreted as a hyper-glycosylated protein, resulting in smear band-formations in SDS-PAGE. The amino acid sequencing analysis suggested that the N-terminal 17 residues had been recognized as a secretion signal. The recombinant enzyme showed similar enzymatic properties to the naturally occurring Lcc4. The characteristics of the scale-upped expression system, which includes helpful information for the potential users, have also been described. PMID:24411669

Kurose, Takeshi; Saito, Yuta; Kimata, Koichi; Nakagawa, Yuko; Yano, Akira; Ito, Keisuke; Kawarasaki, Yasuaki

2014-06-01

380

Nuclear Chemistry: Include It in Your Curriculum.  

Science.gov (United States)

Some of the topics that might be included in a nuclear chemistry section are explored. Offers radioactivity, closed shells in nuclei, energy of nuclear processes, nuclear reactions, and fission and fusion as topics of interest. Provided are ideas and examples for each. (MVL)

Atwood, Charles H.; Sheline, R. K.

1989-01-01

 
 
 
 
381

Rock mass evaluation for predicting tunnel constructability in the preliminary investigation stage. Phenomena causing difficult tunneling and rockburst prediction  

International Nuclear Information System (INIS)

For the selection of the Detailed Investigation Areas for HLW disposal, predicting the tunnel constructability is one of the requirements together with assessing long-term safety. This report is the 1st of the three papers dealing with the evaluation of tunnel constructability. This paper deals with the geological factors relating to difficult tunneling such as squeezing, rockburst, and others. Also it deals with the prediction of rockburst. The 2nd paper will deal with the prediction of squeezing. The 3rd paper deals with the engineering characteristics of rock mass through rock mass classification. This paper about difficult tunneling has been based upon analysis of more than 500 tunneling reports about 280 tunnel constructions. The causes of difficult tunneling are related to (1) underground water, (2) mechanical properties of the rock, or (3) others such as gas. The geological factors for excessive water inflow are porous volcanic product of Quarternary, fault crush zone and hydrothermally altered zone of Green Tuff area, and degenerated mixed rock in accretionary complex. The geological factors for squeezing are solfataric clay at Quarternary volcanic zone, fault crush zone and hydrothermally altered zone of Green Tuff area, mudstone and fault crush zone of sedimentary rock of Neogene and later. Information useful for predicting rockburst has been gathered from previous reports. In the preliminary investigation stage, geological survey, geophysical survey and borehole survey from the surface are the source of information. Therefore rock type, P-wave velocity from seismic exploration and in-situ rock stress from hydrofracturing have been considered. Majority of rockburst events occurred at granitic rock, excluding coal mine where different kind of rockburst occurred at pillars. And P-wave velocity was around 5 km/s at the rock of rockburst events. Horizontal maximum and minimum stresses SH and Sh have been tested as a criterion for rockburst. It has been inferred that SH - Sh > 30MPa is a good criterion for rockburst occurrence. When rock stress data is not available, continuous occurrence of borehole breakout is also a good indicator of rockburst. (author)

2011-03-01

382

Rotor assembly including superconducting magnetic coil  

Energy Technology Data Exchange (ETDEWEB)

Superconducting coils and methods of manufacture include a superconductor tape wound concentrically about and disposed along an axis of the coil to define an opening having a dimension which gradually decreases, in the direction along the axis, from a first end to a second end of the coil. Each turn of the superconductor tape has a broad surface maintained substantially parallel to the axis of the coil.

Snitchler, Gregory L. (Shrewsbury, MA); Gamble, Bruce B. (Wellesley, MA); Voccio, John P. (Somerville, MA)

2003-01-01

383

Nuclear reactor shield including magnesium oxide  

Energy Technology Data Exchange (ETDEWEB)

An improvement in nuclear reactor shielding of a type used in reactor applications involving significant amounts of fast neutron flux, the reactor shielding including means providing structural support, neutron moderator material, neutron absorber material and other components as described below, wherein at least a portion of the neutron moderator material is magnesium in the form of magnesium oxide either alone or in combination with other moderator materials such as graphite and iron.

Rouse, Carl A. (Del Mar, CA); Simnad, Massoud T. (La Jolla, CA)

1981-01-01

384

Electric power monthly, September 1990. [Glossary included  

Energy Technology Data Exchange (ETDEWEB)

The purpose of this report is to provide energy decision makers with accurate and timely information that may be used in forming various perspectives on electric issues. The power plants considered include coal, petroleum, natural gas, hydroelectric, and nuclear power plants. Data are presented for power generation, fuel consumption, fuel receipts and cost, sales of electricity, and unusual occurrences at power plants. Data are compared at the national, Census division, and state levels. 4 figs., 52 tabs. (CK)

1990-12-17

385

Cementing system including real time display  

Energy Technology Data Exchange (ETDEWEB)

A cementing system is described cooperative with a cement pumping apparatus including a connective manifold from the pumping apparatus to a well head for cementing the well in the completion thereof and wherein fluid pumped at the well head is pumped into a pipe string in the well the string having at least two sections serially joined wherein the sections have different physical characteristics of flow of fluid. The cementing system consists of: (a) transducer means for measuring parameters of flow to the well from the pumping apparatus including means for determining well head pressure, the transducer means being located at the surface and obtaining surface measurements; (b) data conversion means connected to the transducer means for determining down hole parameters including bottom hole pressure as a function of well head pressure from the surface measurement obtained by the transducer means; (c) output means for providing output data indicative of down hole parameters occurring during the pumping the fluid into the well; and (d) output means providing a visual display to an operator wherein the visual display sets forth down hole parameters.

St. Onge, K.J.

1986-02-25

386

[Value of the use of tissue adhesive (Braun Histoacryl) and its importance as a safety measure in difficult anastomoses].  

Science.gov (United States)

In an experimental and then clinical investigation, the intention has been to demonstrate that tissue adhesive (Histoacryl Braun) is a useful safety factor in a wide variety of difficult intestinal sutures, in both emergency surgery and in that of choice. Experiments were carried out on about a hundred rabbits which received colic anastomosis, after clean, complete section, anastomosis of the viscera, with four cardinal sutures in 000 silk and the remaining suture of a diameter of about 3 cm with adhesive. This stage having been surmounted with excellent results, work continued with the experiment in emergency surgery and surgery of choice, on the basis of the criterion of greater safety as a complement of the traditional high dehiscence risk suture technique. The clinical results obtained thus far have been encouraging enough to suggest its experiments. PMID:7243001

Bertolotto, E; Botta, L; Torelli, P; Buscaglia, M; Steinweg, M

1981-04-30

387

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

Directory of Open Access Journals (Sweden)

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

Ahmad Raja

2009-11-01

388

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  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Although most hypothyroid patients do well with one single tablet of thyroxine daily, approximately 10% are dissatisfied and another important group of patients is difficult to control. We reviewed the most common causes for frequent-dose adjustment or high-dose requirement, including poor compliance with therapy and inadequate medication. Since these two causes have been ruled out, drug interaction and other concomitant diseases need to be investigated. Requirements of thyroxine increase in ...

Ward, Laura S.

2010-01-01

389

First clinical evaluation of the C-MAC D-Blade videolaryngoscope during routine and difficult intubation.  

Science.gov (United States)

In the present preliminary study we evaluated the C-MAC® D-Blade (Karl Storz, Tuttlingen, Germany), a new videolaryngoscopic C-MAC blade for difficult intubation, during both routine and difficult intubations. First, both the conventional direct laryngoscopy and the D-Blade were used in 15 consecutive patients with normal airways during routine induction of anesthesia. Second, the D-Blade was used as a rescue device in 20 of 300 (6.7%) consecutive patients, when conventional direct laryngoscopy failed. In the 15 patients during routine induction of anesthesia, with direct laryngoscopy, a Cormack-Lehane (C/L) grade 1 and grade 2a view was seen in 7 and 8 patients, respectively. It was possible to insert the D-Blade and to get a video view of the glottis on the first attempt in all patients; with the D-Blade, all 15 patients had a C/L 1 view. The time to successful intubation with the D-Blade was 15 (8-26) seconds (median (range)). In the 20 patients, in whom unexpected difficulty with direct laryngoscopy was observed, C/L grades 3 and 4 were present in 15 and 5 patients, respectively. With the use of the D-Blade, indirect C/L video view improved to C/L class 1 in 15 patients, and to 2a in 5 patients, respectively. The time from touching the laryngoscope to optimal laryngoscopic view was 11 (5-45) seconds and for successful intubation 17 (3-80) seconds. In all 35 patients, with the D-Blade no direct view of the glottis was possible and subsequently a semiflexible tube guide was required. PMID:21156978

Cavus, Erol; Neumann, Tobias; Doerges, Volker; Moeller, Thora; Scharf, Edwin; Wagner, Klaus; Bein, Berthold; Serocki, Goetz

2011-02-01

390

Structure of parton showers including quantum interference  

CERN Multimedia

It is useful to describe a leading order parton shower as the solution of a linear equation that specifies how the state of the partons evolves. This description involves an essential approximation of a strong ordering of virtualities as the shower progresses from a hard interaction to softer interactions. If this is to be the only approximation, then the partons should carry color and spin and quantum interference graphs should be included. We explain how the evolution equation for this kind of a shower can be formulated. We discuss briefly our efforts to implement this evolution equation numerically.

Nagy, Zoltan

2008-01-01

391

Including Absorption in Gordon's Optical Metric  

CERN Document Server

We show that Gordon's optical metric on a curved spacetime can be generalized to include absorption by allowing the metric to become complex. We demonstrate its use in the realm of geometrical optics by giving three simple examples. We use one of these examples to compute corrected distance-redshift relations for Friedman-Lema\\^itre-Robertson-Walker models in which the cosmic fluid has an associated complex index of refraction that represents grey extinction. We then fit this corrected Hubble curve to the type Ia supernovae data.

Chen, B

2009-01-01

392

A kicked quantum system including the continuum  

International Nuclear Information System (INIS)

The behaviour of a quantum particle in a separable one-term potential with three-dimensional form factor is investigated under the influence of an external force which alters the potential strength periodically or quasiperiodically. The unperturbed system possesses one bound state and a continuum of scattering states which has treated almost analytically. First numerical results, fully including the emission channel, indicate, for certain parameter combinations with commensurate or incommensurate frequency ratios, either a regular or an irregular dynamical behaviour of the system. 17 refs.; 3 figs

1988-01-01

393

Efficacy of a Multimodal Cognitive Rehabilitation Including Psychomotor and Endurance Training in Parkinson's Disease  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Mild cognitive impairment, especially executive dysfunction might occur early in the course of Parkinson's disease. Cognitive training is thought to improve cognitive performance. However, transfer of improvements achieved in paper and pencil tests into daily life has been difficult. The aim of the current study was to investigate whether a multimodal cognitive rehabilitation programme including physical exercises might be more successful than cognitive training programmes without motor train...

2012-01-01

394

Production and exploitation of thermoelectric air conditioning systems for vehicles  

Energy Technology Data Exchange (ETDEWEB)

In the paper more than 10-year experience of thermoelectric devices batch manufacturing is described for the field of their obvious advantages. This field of application includes thermoelectric air conditioning systems which have shown their competitive advantage when used in vehicles of elevated vibration where compressor equipment application is difficult because of leakage of refrigerant. Energy characteristics of air conditioners for tractors, excavators, tanks, locomotive driver's cabins and cranes are described. Thermoelectric (TE) air conditioners mechanical test data as well as operation experience in vehicles are presented. It is shown that consumption of tellurium, which is a strategic component for thermoelectric materials manufacturing, may be lowered to 40 grams per 1 kW of cooling. (orig.)

Dudnik, Vladimir [Conditioner Ltd, Gagarin (Russian Federation); Skipidarov, Sergey [SCTB NORD, Moskau (Russian Federation); Rapp, Axel [Quick-Ohm Kupper und Co. GmbH, Wuppertal-Cronenberg (Germany)

2011-07-01

395

Eigenstates of Moebius nanostructures including curvature effects  

International Nuclear Information System (INIS)

Moebius-shell structures and their physical properties have recently received considerable attention experimentally and theoretically. In this work, eigenstates and associated eigenenergies are determined for a quantum-mechanical particle bounded to a Moebius shell including curvature contributions to the kinetic-energy operator. This is done using a parametrization of the Moebius shell-found by minimizing the elastic energy of the full structure-and employing differential-geometry methods. It is shown that inclusion of curvature contributions to the kinetic energy leads to splitting of the otherwise doubly degenerate groundstate and significantly alters the form of the groundstate and excited-state wavefunctions. Hence, we anticipate qualitative changes in the physical properties of Moebius-shell structures due to surface confinement and curvature effects

2005-09-01

396

CLIC expands to include the Southern Hemisphere  

CERN Multimedia

Australia has recently joined the CLIC collaboration: the enlargement will bring new expertise and resources to the project, and is especially welcome in the wake of CERN budget redistributions following the recent adoption of the Medium Term Plan.   The countries involved in CLIC collaboration With the signing of a Memorandum of Understanding on 26 August 2010, the ACAS network (Australian Collaboration for Accelerator Science) became the 40th member of in the multilateral CLIC collaboration making Australia the 22nd country to join the collaboration. “The new MoU was signed by the ACAS network, which includes the Australian Synchrotron and the University of Melbourne”, explains Jean-Pierre Delahaye, CLIC Study Leader. “Thanks to their expertise, the Australian institutes will contribute greatly to the CLIC damping rings and the two-beam test modules." Institutes from any country wishing to join the CLIC collaboration are invited to assume responsibility o...

Roberto Cantoni

2010-01-01

397

CERN Technical Training: LABVIEW courses include RADE  

CERN Multimedia

The contents of the "LabView Basic I" and "LabView Intermediate II" courses have recently been changed to include, respectively, an introduction to and expert training in the Rapid Application Development Environment (RADE). RADE is a LabView-based application developed at CERN to integrate LabView in the accelerator and experiment control infrastructure. It is a suitable solution to developing expert tools, machine development analysis and independent test facilities. The course names have also been changed to "LabVIEW Basics I with RADE Introduction" and "LabVIEW Intermediate II with Advanced RADE Application". " LabVIEW Basics I with RADE Introduction" is designed for: Users preparing to develop applications using LabVIEW, or NI Developer Suite; users and technical managers evaluating LabVIEW or NI Developer Suite in purchasing decisions; users pursuing the Certified LabVIEW Developer certification. The course prepares participants to develop test and measurement, da...

HR Department

2009-01-01

398

CERN Technical Training: LABVIEW courses include RADE  

CERN Document Server

The contents of the "LabView Basic I" and "LabView Intermediate II" courses have recently been changed to include, respectively, an introduction to and expert training in the Rapid Application Development Environment (RADE). RADE is a LabView-based application developed at CERN to integrate LabView in the accelerator and experiment control infrastructure. It is a suitable solution to developing expert tools, machine development analysis and independent test facilities. The course names have also been changed to "LabVIEW Basics I with RADE Introduction" and "LabVIEW Intermediate II with Advanced RADE Application". " LabVIEW Basics I with RADE Introduction" is designed for: Users preparing to develop applications using LabVIEW, or NI Developer Suite; users and technical managers evaluating LabVIEW or NI Developer Suite in purchasing decisions; users pursuing the Certified LabVIEW Developer certification. The course pr...

HR Department

2009-01-01

399

CERN Technical Training: LABVIEW courses include RADE  

CERN Document Server

The contents of "LabView Basic I" and "LabView Intermediate II" trainings have been recently changed to include, respectively, an introduction and an expert training on the Rapid Application Development Environment (RADE). RADE is a LabView-based application developed at CERN to integrate LabView in the accelerator and experiment control infrastructure. It is a suitable solution to develop expert tools, machine development analysis and independent test facilities. The course names have also been changed to "LabVIEW Basics I with RADE Introduction" and "LabVIEW Intermediate II with Advanced RADE Application". " LabVIEW Basics I with RADE Introduction" is designed for: Users preparing to develop applications using LabVIEW, or NI Developer Suite; users and technical managers evaluating LabVIEW or NI Developer Suite in purchasing decisions; users pursuing the Certified LabVIEW Developer certification. The course prepare...

HR Department

2009-01-01

400

Optical panel system including stackable waveguides  

Science.gov (United States)

An optical panel system including stackable waveguides is provided. The optical panel system displays a projected light image and comprises a plurality of planar optical waveguides in a stacked state. The optical panel system further comprises a support system that aligns and supports the waveguides in the stacked state. In one embodiment, the support system comprises at least one rod, wherein each waveguide contains at least one hole, and wherein each rod is positioned through a corresponding hole in each waveguide. In another embodiment, the support system comprises at least two opposing edge structures having the waveguides positioned therebetween, wherein each opposing edge structure contains a mating surface, wherein opposite edges of each waveguide contain mating surfaces which are complementary to the mating surfaces of the opposing edge structures, and wherein each mating surface of the opposing edge structures engages a corresponding complementary mating surface of the opposite edges of each waveguide.

DeSanto, Leonard (Dunkirk, MD) [Dunkirk, MD; Veligdan, James T. (Manorville, NY) [Manorville, NY

2007-11-20

 
 
 
 
401

Drapery assembly including insulated drapery liner  

Energy Technology Data Exchange (ETDEWEB)

A drapery assembly is disclosed for covering a framed wall opening, the assembly including drapery panels hung on a horizontal traverse rod, the rod having a pair of master slides and means for displacing the master slides between open and closed positions. A pair of insulating liner panels are positioned behind the drapery, the remote side edges of the liner panels being connected with the side portions of the opening frame, and the adjacent side edges of the liner panels being connected with a pair of vertically arranged center support members adapted for sliding movement longitudinally of a horizontal track member secured to the upper horizontal portion of the opening frame. Pivotally arranged brackets connect the center support members with the master slides of the traverse rod whereby movement of the master slides to effect opening and closing of the drapery panels effects simultaneous opening and closing of the liner panels.

Cukierski, Gwendolyn (Ithaca, NY)

1983-01-01

402

Multiverse rate equation including bubble collisions  

CERN Document Server

The volume fractions of vacua in an eternally inflating multiverse are described by a coarse-grain rate equation, which accounts for volume expansion and vacuum transitions via bubble formation. We generalize the rate equation to account for bubble collisions, including the possibility of classical transitions. Classical transitions increase the connectedness of the landscape---with possible implications for the so-called staggering issue---however the basic intuition developed in prior literature for understanding the aforementioned volume fractions is easily updated to account for the effects. Whether or not our vacuum is likely to have been established by a classical transition depends on the detailed relationships among transition rates in the landscape.

Salem, Michael P

2012-01-01

403

The Maxwell equations including magnetic monopoles  

CERN Document Server

The derivation of the Maxwell equations is reproduced whereby magnetic charges are included. This ansatz yields following results: 1) Longitudinal Ampere forces in a differential magnetostatic force law are improbable. Otherwise a electric current would generate magnetic charges. 2) Simple magnetic and electric induced polarization phenomena are completely analogous and are described by a Laplace equation. 3) Permanent magnetic fields can be understood to be caused by magnetic charges. Consequently, a moving permanent magnet represents a magnetic current which generates a electric field. 4) The electromagnetic tensors of energy and momentum have some additional terms which are written down generally. 5) If the electric material parameters are influenced by non-electric variables (for instance temperature or pressure), the formalism of electrodynamics is not sufficient to describe the system and has to be completed by further differential equations from the other areas of physics. 6) Nonlinear electro-thermody...

Bauer, W D

2004-01-01