WorldWideScience

Sample records for conditions including difficult

  1. [Endoprosthesis of great joints of extremities in difficult anatomic conditions].

    Science.gov (United States)

    Buachidze, O Sh; Onoprienko, G A; Voloshin, V P; Zubikov, V S; Martynenko, D V

    2004-01-01

    Experience in endoprosthesis of great joints in 408 patients in difficult clinical cases associated with defects and deformations of bones of posttraumatic, oncological, dysplastic and systemic character, and also in the cases of complications after primary endoprosthesis is analyzed. Special constructions of implants, instruments, surgical technique were used depending on anatomic and functional changes. Results of endoprosthesis of great joints were accessed as successful in 95% patients in maximal period of follow-up during 13 years. PMID:15477827

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

    OpenAIRE

    Sirvinskiene Giedre; Zemaitiene Nida; Zaborskis Apolinaras; Markuniene Egle; Jusiene Roma

    2012-01-01

    Abstract Background Problems experienced within the first year of an infant's life can be precursors of later mental health conditions. The purpose of this study was to examine the frequency and continuity of difficult behaviors in infants at 3 and 6 months of age and the associations of these difficulties with biomedical and psychosocial factors. Methods This study was a part of an ongoing prospective birth-cohort study. Study participants were 189 uniparous mothers and their full-term newbo...

  3. Difficult asthma

    OpenAIRE

    Ahmet Uslu; Tülay Özdemir

    1989-01-01

    Difficult asthma is a distinct entity of asthma, comprising approximately %5 of asthmatic patients. There is no agreed definition of difficult asthma. It will include asthma uncontrolled by new standard therapy, steroid dependent, steroid resistant and severe asthma. In this study difficult asthma; clinical features, risk factors, pathophysiology and novel therapies are summarized by literatures.

  4. RESEARCH OF FACTORS PROVOKING DIFFICULT ADAPTATION TO CONDITIONS OF PRESCHOOL EDUCATIONAL INSITUTIONS FOR EARLY AGE CHILDREN

    Directory of Open Access Journals (Sweden)

    Nadezda Vladimirovna Motorina

    2015-06-01

    Full Text Available The conducted complex research of early ager’s adaptation to conditions of preschool educational insitutions was aimed at investigation of factors having a negative impact on the course of adaptation period. Methods of questionnaire and testing were used during the investigation. On the first stage we rendered to the investigation of peculiarities of mother-and-child interaction. We have concluded that the development of difficult forms of adaptation is provoked by such peculiarities of intrafamilial education as hyperprotection, conniving, lack of demands, prohibitions and sanctions altogether with excessive care, close emotional connection and symbiotic relations of mother and child. On the second stage of research our main task was to discover the level of emotional intelligence of preschol teachers having in a group two or more children with difficult form of adaptation. The results of investigation revealed that most of teachers are characterised by insufficient level of emotional control and low ability to operate their own and others’ emotional display. The final stage of our research was devoted to investigation of personal mental peculiarities of children with dificult form of adaptation. While analyzing the data we noted the difficulties of child and grown-up interaction and low level of initiative in the process of communication. The results of investigation can be applied for the development of program of mental and educational support for children with difficult form of adaptation based on the marked and relevant conclusions.

  5. Energy principle with included boundary conditions

    International Nuclear Information System (INIS)

    Earlier comments by the author on the limitations of the classical form of the extended energy principle are supported by a complementary analysis on the potential energy change arising from free-boundary displacements of a magnetically confined plasma. In the final formulation of the extended principle, restricted displacements, satisfying pressure continuity by means of plasma volume currents in a thin boundary layer, are replaced by unrestricted (arbitrary) displacements which can give rise to induced surface currents. It is found that these currents contribute to the change in potential energy, and that their contribution is not taken into account by such a formulation. A general expression is further given for surface currents induced by arbitrary displacements. The expression is used to reformulate the energy principle for the class of displacements which satisfy all necessary boundary conditions, including that of the pressure balance. This makes a minimization procedure of the potential energy possible, for the class of all physically relevant test functions which include the constraints imposed by the boundary conditions. Such a procedure is also consistent with a corresponding variational calculus. (Author)

  6. Consolidating the budget under difficult conditions: Ten guidelines viewed against Europe's beginning consolidation programme

    OpenAIRE

    Aiginger, Karl; Schratzenstaller, Margit

    2011-01-01

    There is evidence that a budget consolidation strategy can work with only a small and shortlived negative impact on growth. However, many countries are currently trying to consolidate at the same time as firms and consumers are deleveraging. We develop ten guidelines for consolidation during such a difficult economic period and cross-check whether the upcoming consolidation programmes being implemented in the EU countries comply with our guidelines. We propose following a 'high road' on cutti...

  7. Difficult birth, difficult life?

    OpenAIRE

    Tuin-Batstra, Laura van der,

    2004-01-01

    The aim of this thesis was to study associations of perinatal conditions with cognitive and psychiatric problems in later life. Most epidemiological studies on the effects of perinatal circumstances on future (mental) health focus on specific obstetric complications – like complications during delivery, low birth weight, or maternal smoking during pregnancy – as specific risk factors for specific disorders. However, pregnancy and delivery are complex processes, and i...

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

    Directory of Open Access Journals (Sweden)

    Antonov Sergej Vasil'evich

    2011-09-01

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

  9. Conflict Management: Difficult Conversations with Difficult People

    OpenAIRE

    Overton, Amy R.; Lowry, Ann C.

    2013-01-01

    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.

  10. Difficult and unlikeable parents.

    OpenAIRE

    Meadow, R

    1992-01-01

    Children of parents who are perceived as difficult or unlikeable are at risk of receiving less good medical care. Therefore a postal questionnaire was sent to 100 hospital doctors dealing with children asking which features made them consider a parent to be difficult or unlikeable. Seventy eight responded. Most problems arose from parents who displayed aggression, disparagement of their child, unacknowledged anxiety, or fixed ideas about the medical condition and its management. Other unpopul...

  11. Site selection for a mine roadway driven close to the goaf under conditions of roofs difficult to break down

    Energy Technology Data Exchange (ETDEWEB)

    Srebnyi, M.A.; Chel' tsova, N.M.; Kostomarov, N.E.

    1982-09-01

    This paper evaluates methods of strata control in mine roadways driven close to the goaf under conditions of thick sandstone layers in the roof in the Intaugol' mines. Geologic and mining conditions in the Intaugol' mines are described. Leaving 4 m thick coal support pillars between a roadway and goaf is not efficient as it does not prevent support deformation. This is caused by hanging over of thick sandstone layers. Use of new, more successful methods of roadway protection from rock strata stresses is analyzed. A number of methods for preventing support deformation in mine roadways is evaluated. Two trends are discussed: increasing support capacity by installation of support systems with increased yield strength, installation of extra supports (e.g. wooden props) and reducing size of sandstone layers hanging over a roadway by explosive fracturing. Two blasting systems are used: so-called microhydrotorpedoing and cutting boreholes. The microhydrotorpedoing method consists in drilling 25 m long boreholes at an angle of 25 degrees in relation to a roadway and at an angle of 15 degrees to the coal seam. Distance between boreholes amounts to 20 m. Small charges of chemical explosive are blasted in boreholes filled with water under pressure from 2 to 4 MPa. Water causes an additional hydraulic shock and creates a fissure system in sandstone strata. The cutting borehole system consists in drilling a row of boreholes (42 mm in diameter from 9 to 10 m long) and blasting small charges. Distance between boreholes depends on sandstone properties and thickness.

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

    Science.gov (United States)

    Flouris, Triant; Walker, Thomas

    2005-01-01

    This paper examines the stock market s reaction to JetBlue s Initial Public Offering (1PO) and subsequent price movements of the stock. In particular, w e examine whether the euphoria surrounding JetBlue s IPO carried over to other firms in the sector by testing whether the shares of JetBlue s competitors showed a significant price reaction to JetBlue s IPO. JetBlue's IPO took place just a few months following September 11, 2001. These events resulted in dramatic changes in the airline industry and had significant implications on the economic gains of airlines. We examine JetBlue s accounting and stock performance and compare it to the relative performance of Southwest Airlines (SWA), a representative of the loa-cost carrier group. In addition, we compare both JetBlue's and SWA's financial condition and the relative performance of their stock to two mainline U S. carriers, Continental and Northwest. representatives of the conventional-cost carrier group. We analyze whether there are any performance differences among the low-cost carriers and between low-cost carriers and conventional-cost carriers. In particular, we examine whether low-cost carriers were able to sustain the economic impacts of 9/11 better than the conventional-cost carriers.

  13. A Three-Dimensional Thermal Model Including Thermal Boundary Conditions for High Power IGBT Modules

    DEFF Research Database (Denmark)

    Bahman, Amir Sajjad; Ma, Ke

    2016-01-01

    Accurate thermal dynamics of high power IGBT modules is important information for the reliability analysis and thermal design of the power electronics system. However, the existing thermal models have their limits to correctly predict these complicated thermal behaviors in the IGBTs: The typically used thermal model based on one-dimensional RC lumps have limits to provide temperature distributions inside the device, moreover some variable factors in the real-field applications like the cooling and heating conditions of converter cannot be adapted. On the other hand, the more advanced thermal analysis based on Finite Element Methods (FEM) need massive computations, which make the long-term thermal dynamics disturbed by mission profiles difficult. In this paper, a new three-dimensional thermal model is proposed, which can be easily characterized from FEM simulation and can acquire the critical thermal distribution under long-term analysis. Meanwhile the boundary conditions for thermal analysis are modelled and included, which can be adapted to different real field applications of power electronic converter. Finally, the accuracy of the proposed thermal model is verified by both FEM simulations and experimental results.

  14. Hepatic epithelioid haemangioendothelioma: difficult name, difficult diagnosis?

    OpenAIRE

    Cobden, I.; Johri, S.; Terry, G; Robinson, K. B.; Bennett, M K; Lendrum, R

    1988-01-01

    Two patients with epithelioid haemangioendotheliomata of the liver are described. Both presented with abdominal pain and malaise, with hepatomegaly and a variable degree of hepatocellular dysfunction. Diagnosis was delayed in both cases, each patient undergoing a protracted series of investigations including repeated liver biopsies. The major obstacles to early diagnosis were a lack of clinical awareness of the condition and difficulties in interpretation of the liver histology: the widesprea...

  15. 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

  16. Difficult colon polypectomy

    Directory of Open Access Journals (Sweden)

    Klaus Vormbrock

    2012-01-01

    Full Text Available Colorectal cancer (CRC is one of the leading causes of death from cancer in the world. We now know that 90% of CRC develop from adenomatous polyps. Polypectomy of colon adenomas leads to a significant reduction in the incidence of CRC. At present most of the polyps are removed endoscopically. The vast majority of colorectal polyps identified at colonoscopy are small and do not pose a significant challenge for resection to an appropriately trained and skilled endoscopist. Advanced polypectomy techniques are intended for the removal of difficult colon polyps. We have defined a “difficult polyp” as any lesion that due to its size, shape or location represents a challenge for the colonoscopist to remove. Although many “difficult polyps” will be an easy target for the advanced endoscopist, polyps that are larger than 15 mm, have a large pedicle, are flat and extended, are difficult to see or are located in the cecum or any angulated portion of the colon should be always considered difficult. Although very successful, advanced resection techniques can potentially cause serious, even life-threatening complications. Moreover, post polypectomy complications are more common in the presence of difficult polyps. Therefore, any endoscopist attempting advanced polypectomy techniques should be adequately supervised by an expert or have an excellent training in interventional endoscopy. This review describes several useful tips and tricks to deal with difficult polyps.

  17. Tackling difficult estates

    OpenAIRE

    Richardson, Liz

    1998-01-01

    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 discus...

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

    OpenAIRE

    Åström, Peter

    2013-01-01

    This dissertation has examined the conditions for teachers who teach Physical Education and Health (PEH) in elementary school (age 11-12) and their opportunities to pursue inclusive teaching with the aim of reaching all pupils. The compilation thesis consists of four different articles and provides knowledge from the perspectives of pupils and teachers, but it also includes teaching and learning processes that were studied in situ. The first article contributes to knowledge on how different r...

  19. 78 FR 34708 - Proposed Information Collection (Foot (Including Flatfeet (pes planus)) Conditions Disability...

    Science.gov (United States)

    2013-06-10

    ...Conditions Disability Benefits Questionnaire)'' in any correspondence...Conditions Disability Benefits Questionnaire), VA Form 21-0960M-6...Conditions Disability Benefits Questionnaire). Type of Review: New data...

  20. The difficult primary total knee arthroplasty: a review.

    Science.gov (United States)

    Baldini, A; Castellani, L; Traverso, F; Balatri, A; Balato, G; Franceschini, V

    2015-10-01

    Primary total knee arthroplasty (TKA) is a reliable procedure with reproducible long-term results. Nevertheless, there are conditions related to the type of patient or local conditions of the knee that can make it a difficult procedure. The most common scenarios that make it difficult are discussed in this review. These include patients with many previous operations and incisions, and those with severe coronal deformities, genu recurvatum, a stiff knee, extra-articular deformities and those who have previously undergone osteotomy around the knee and those with chronic dislocation of the patella. Each condition is analysed according to the characteristics of the patient, the pre-operative planning and the reported outcomes. When approaching the difficult primary TKA surgeons should use a systematic approach, which begins with the review of the existing literature for each specific clinical situation. Cite this article: Bone Joint J 2015;97-B(10 Suppl A):30-9. PMID:26430084

  1. Making marketing difficult

    DEFF Research Database (Denmark)

    Meyer, Gitte

    2005-01-01

    A critique of conventional science journalism is offered in this paper. The convention of science journalism as science transmission is claimed to be incapable of coping with challenges emerging from the present commercialization of science - letting science into society by embracing and being embraced by the market-place, while maintaining the old scientific alienation from political life. The case is made that modern science was born ambiguous towards the market-place, and that such ambivalence - relating to different interpretations of the idea of knowledge as a common good - is still to be encountered among scientists. Drawing on series of interviews with scientists from bioscience and biotechnology it is argued that, on the one hand, scientists are into marketing and PR exercises; but, on the other hand, they also voice a demand that journalists should make such marketing difficult. It is the conlusion of the paper that journalists must break with the convention of science transmission in order to fulfil that demand, and in order to spur a political discussion, among scientists and in public, on how to maintain the idea of knowledge as a common good.

  2. Robust Face Recognition under Difficult Lighting Conditions

    Directory of Open Access Journals (Sweden)

    S.S. Ghatge

    2012-08-01

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

  3. 78 FR 68907 - Agency Information Collection (Foot (Including Flatfeet (pes planus)) Conditions Disability...

    Science.gov (United States)

    2013-11-15

    ...Conditions Disability Benefits Questionnaire, VA Form 21-0960M-5 and...Conditions Disability Benefits Questionnaire). Type of Review: New data collection...Conditions Disability Benefits Questionnaire, will be used for...

  4. Difficult to control atopic dermatitis

    DEFF Research Database (Denmark)

    Darsow, Ulf; Wollenberg, Andreas

    2013-01-01

    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.

  5. The Genus Aloe: Phytochemistry and Therapeutic Uses Including Treatments for Gastrointestinal Conditions and Chronic Inflammation.

    Science.gov (United States)

    Cock, I E

    2015-01-01

    Plants of the genus Aloe have perhaps the longest recorded history of medicinal usage and are amongst the most widely used plants for traditional medicinal purposes worldwide. Aloe vera, Aloe ferox, Aloe arborescens and Aloe perryi are the best known and most widely used, but many other species are also used for their therapeutic properties. The Aloes have been used since ancient times, particularly for the treatment of microbial infections, gastrointestinal disorders and inflammatory conditions. In addition to their myriad uses in traditional therapeutics, the Aloes have also been used as components of cosmetic formulations, and in the food and beverage industries. Despite their wide acceptance, studies from different laboratories often report wide variations in the therapeutic bioactivities from within the same Aloe species, even when the same extraction procedures are used. Furthermore, leaves from individual Aloe plants within the same species may have widely varying levels of the bioactive phytochemicals. Phytochemical analyses have shown that many Aloe species contain various carbohydrate polymers (notably glucomannans) and a range of other low molecular weight phenolic compounds including alkaloids, anthraquinones, anthrones, benzene and furan derivatives, chromones, coumarins, flavonoids, phytosterols, pyrans and pyrones. There has been a wealth of information published about the phytochemistry and therapeutic potential of the Aloes (especially Aloe vera). Much of this has been contradictory. Intra- and interspecies differences in the redox state of the individual Aloe components and in the ratios of these components may occur between individual plants. These factors may all affect the physiological properties of Aloe extracts. Due to the structure and chemical nature of many of the Aloe phytochemicals, it is likely that many of the reported medicinal properties are due to antioxidant or prooxidant effects. The antioxidant/prooxidant activities of many Aloe phytochemicals depend not only on their individual levels, but also on the ratios between the various components and their individual redox states. Therefore, discrepancies between bioactivity studies are likely when using different crude mixtures. This report aims to summarise the phytochemistry of the Aloes and (a) examine how their constituents may be responsible for their medicinal properties and (b) some possible reasons for the wide variations reported for their medicinal properties and (c) their therapeutic mechanisms. Some future areas of research into the medicinal activities of this important genus are also highlighted. PMID:26462368

  6. Quest of separation conditions for CZE analyses based on an information system including similarity search.

    Czech Academy of Sciences Publication Activity Database

    K?ivánková, Ludmila; O?ko, M.; Popelínský, L.; Bo?ek, Petr

    Helsinki : University of Helsinki, 2002, s. 42. [ITP 2002. International Symposium on Capillary Electroseparation Techniques /13./. Helsinki (FI), 01.09.2002-04.09.2002] R&D Projects: GA ?R GA203/02/0023; GA ?R GA203/01/0401; GA AV ?R IAA4031103 Institutional research plan: CEZ:AV0Z4031919 Keywords : expert system * capillary zone electrophoresis * separation conditions Subject RIV: CB - Analytical Chemistry, Separation

  7. Fault diagnosis of industrial systems by conditional Gaussian network including a distance rejection criterion

    OpenAIRE

    Verron, Sylvain; Tiplica, Teodor; Kobi, Abdessamad

    2010-01-01

    The purpose of this article is to present a method for industrial process diagnosis with Bayesian network, and more particularly with conditional Gaussian network (CGN). The interest of the proposed method is to combine a discriminant analysis and a distance rejection in a CGN in order to detect new types of fault. The performances of this method are evaluated on the data of a benchmark example: the Tennessee Eastman Process. Three kinds of fault are taken into account on this complex process...

  8. 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)

    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

    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

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

    International Nuclear Information System (INIS)

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

  10. Does Working Memory Training Transfer? A Meta-Analysis Including Training Conditions as Moderators

    Science.gov (United States)

    Schwaighofer, Matthias; Fischer, Frank; Bühner, Markus

    2015-01-01

    A meta-analysis was undertaken to reexamine near- and far-transfer effects following working-memory training and to consider potential moderators more systematically. Forty-seven studies with 65 group comparisons were included in the meta-analysis. Results showed near-transfer effects to short-term and working-memory skills that were sustained at…

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

    Science.gov (United States)

    Nichiporuk, Igor; Ivanov, Oleg

    Activity of the cosmonaut demands high level of psychomotor reactions (PMR) which can vary during space flight under the influences of psychophysiological state’s variability and unusual inhabitancy that causes the necessity of PMR estimation’s inclusion into quality monitoring of capacity for work (CW). A main objective of research was a study of features of visual-motor reactions (VMR) and elements of CW of the person within simulation of microgravity effects via 7-day dry immersion (DI) in healthy male-volunteers 20-35 years old. The experimental data were received which testified to peculiarities of VMR and recognition of simple figures of main colors of a visible spectrum (red, green, blue, the RGB-standard) in the conditions of the DI characterized by support deprivation and decreased proprioceptive afferentation - in a control series and in a series with use of mioelectrostimulation as a countermeasure.

  12. 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.

  13. Novel shield support for coal faces worked by shearer loaders in difficult geological conditions with modern ergonomic layout. Neuartiger Schildausbau fuer Walzenladerbetriebe mit schwierigen geologischen Verhaeltnissen bei neuzeitlicher ergonomischer Gestaltung

    Energy Technology Data Exchange (ETDEWEB)

    Schneider, W.J.

    1984-08-01

    An appropriate shield support system had to be developed and tested for the 200-280 cm thick coal bed N. Up until now it has not been possible to work the coal bed economically due to the thin accompanying coal beds O and M situated at short vertical distances in the roof viz. floor of coal bed N as well as due to the irregular sandstone intrusions. In the course of the project a 2-leg shield support unit equipped with retractable canopy extension was developed which allowed coal bed N, to be worked economically even in very difficult geological conditions, e.g. dip ranges up to 36 g, local through configurations in short sections of the face and up to 20 g rising in the working direction. The face was extracted with an optimum face support concept. Valuable know-how was obtained about forepoling which, generally speaking, may be transferred to the shield support concept in coal beds of less than 2.00 m thickness. Furthermore, during the project, the electro-magnetic by-pass control for retractable and extension roof bars as well as for coal face bumpers was purchased and tested which had been developed jointly by Messrs. Hemscheidt and Eickhoff. This approach oepns up a certain potential for automating the sequential control of shield support advancing.

  14. LIHTC Difficult to Develop Areas

    Data.gov (United States)

    Department of Housing and Urban Development — A Difficult Development Area (DDA) for the Low Income Housing Tax Credit program is an area designated by the U.S. Department of Housing and Urban Development (HUD)...

  15. 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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2013-12-15

    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.

  17. Difficult Bond. Derrida and Jewishness

    DEFF Research Database (Denmark)

    Siegumfeldt, Inge Birgitte

    2013-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Zarogoulidis P

    2012-06-01

    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

  19. 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

  20. Review article: Extubation of the difficult airway and extubation failure.

    Science.gov (United States)

    Cavallone, Laura F; Vannucci, Andrea

    2013-02-01

    Respiratory complications after tracheal extubation are associated with significant morbidity and mortality, suggesting that process improvements in this clinical area are needed. The decreased rate of respiratory adverse events occurring during tracheal intubation since the implementation of guidelines for difficult airway management supports the value of education and guidelines in advancing clinical practice. Accurate use of terms in defining concepts and describing distinct clinical conditions is paramount to facilitating understanding and fostering education in the treatment of tracheal extubation-related complications. As an example, understanding the distinction between extubation failure and weaning failure allows one to appreciate the need for pre-extubation tests that focus on assessing airway patency in addition to evaluating the ability to breathe spontaneously. Tracheal reintubation after planned extubation is a relatively rare event in the postoperative period of elective surgeries, with reported rates of reintubation in the operating room and postanesthesia care unit between 0.1% and 0.45%, but is a fairly common event in critically ill patients (0.4%-25%). Conditions such as obesity, obstructive sleep apnea, major head/neck and upper airway surgery, and obstetric and cervical spine procedures carry significantly increased risks of extubation failure and are frequently associated with difficult airway management. Extubation failure follows loss of upper airway patency. Edema, soft tissue collapse, and laryngospasm are among the most frequent mechanisms of upper airway obstruction. Planning for tracheal extubation is a critical component of a successful airway management strategy, particularly when dealing with situations at increased risk for extubation failure and in patients with difficult airways. Adequate planning requires identification of patients who have or may develop a difficult airway, recognition of situations at increased risk of postextubation airway compromise, and understanding the causes and underlying mechanisms of extubation failure. An effective strategy to minimize postextubation airway complications should include preemptive optimization of patients' conditions, careful timing of extubation, the presence of experienced personnel trained in advanced airway management, and the availability of the necessary equipment and appropriate postextubation monitoring. PMID:23302983

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

    Science.gov (United States)

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

    2012-05-14

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

  2. Solving difficult hepatobiliary problems in children

    Scientific Electronic Library Online (English)

    A J W, Millar.

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

  3. Foreign body aspiration masquerading as difficult asthma

    Directory of Open Access Journals (Sweden)

    Rai S

    2007-01-01

    Full Text Available It is important to assess patients of difficult/therapy resistant asthma carefully in order to identify whether there are any correctable factors that may contribute to their poor control. It is critical to make a diagnosis of asthma and to exclude other airway diseases. A 65-years-old lady presented with repeated acute episodes of dyspnoea and wheezing. She was on regular medication for bronchial asthma for 18 years. There was no history of foreign body aspiration or loss of consciousness. Her chest radiograph was normal. She showed poor response to corticosteroids and bronchodilators. Fibreoptic bronchoscopy (FOB showed intracordal cyst of the left vocal cord and 1cm size irregular piece of betel nut in right main bronchus, which was removed endoscopically with the help of dormia basket, following which her condition improved and asthma was controlled on inhaled bronchodilators.

  4. Clostridium difficile phages: still difficult?

    Directory of Open Access Journals (Sweden)

    MarthaRebecca JaneClokie

    2014-04-01

    Full Text Available Phages that infect Clostridium difficile were first isolated for typing purposes in the 1980s, but their use was short lived. However, the rise of C. difficile epidemics over the last decade has triggered a resurgence of interest in using phages to combat this pathogen. Phage therapy is an attractive treatment option for C. difficile infection, however developing suitable phages is challenging. In this review we summarise the difficulties faced by researchers in this field, and we discuss the solutions and strategies used for the development of C. difficile phages for use as novel therapeutics.Epidemiological data has highlighted the diversity and distribution of C. difficile, and shown that novel strains continue to emerge in clinical settings. In parallel with epidemiological studies, advances in molecular biology have bolstered our understanding of C. difficile biology, and our knowledge of phage-host interactions in other bacterial species. These three fields of biology have therefore paved the way for future work on C. difficile phages to progress and develop. Benefits of using C. difficile phages as therapeutic agents include the fact that they have highly specific interactions with their bacterial hosts. Studies also show that they can reduce bacterial numbers in both in vitro and in vivo systems. Genetic analysis has revealed the genomic diversity among these phages and provided an insight into their taxonomy and evolution.No strictly virulent C. difficile phages have been reported and this contributes to the difficulties with their therapeutic exploitation. Although treatment approaches using the phage-encoded endolysin protein have been explored, the benefits of using “whole-phages” are such that they remain a major research focus. Whilst we don’t envisage working with C. difficile phages will be problem free, sufficient study should inform future strategies to facilitate their development to combat this problematic pathogen.

  5. Current Trends in the Management of Difficult Urinary Catheterizations

    OpenAIRE

    Paul A Willette; Scott K Coffield

    2012-01-01

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

  6. 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.)

  7. Ensuring good rice plant nitrogen assimilation under difficult growing conditions

    Science.gov (United States)

    Nitrogen is one of the major nutrients essential for growth and development of rice. Each year growers invest billions of dollars towards fertilizers. However, these applications are efficient only if plants successfully take up, assimilate and retain nitrogen. These processes occur in the roots and...

  8. [Metal intolerance. A frequent condition, but difficult to diagnose].

    Science.gov (United States)

    Wirz, Jakob; Schmidli, Fredy; Petrini, Michele Giorgio

    2003-01-01

    Many of the methods and devices used for incompatibility testing of metals and alloys today are of questionable scientific value. Neither epicutaneous testing nor other diagnostic adjuncts from the realm of alternative medicine, nor patient-history data contained in so-called dental alloy passports, are generally able to yield any useful information. Analysis is particularly difficulty in situations where metallic components are cemented in place in the oral cavity. For many years now, the so-called splinter test has proven its value as a means of non-destructively identifying the type of alloy used. It can also be used for detecting persistent corrosion-prone adhesive oxides and soldering joints as causative agents of metal-related noxious processes. This article presents a number of case reports to demonstrate the reliability and the precision of the splinter test. Over a period of 10 years, more than 1600 splinter analyses have been performed at the University of Basle Center of Dentistry. According to a pertinent survey, these analyses were able to contribute to full treatment success in 63% of the cases, to partial success in 27% of the cases, and to no success in only 10% of the cases. PMID:12708327

  9. Two tests for underground laboratories under difficult conditions

    International Nuclear Information System (INIS)

    Two tests for underground pilots and the relevant instrumentation problems are described: Schelle (Belgium) cryogenic pilot cavity: the test gallery built in Boom clay was progressively cooled down to -1960C during 9 months, and remained filled with liquid nitrogen during 2 months. Vexin (France) heavy fuel pilot cavity: the gallery built in chalk was kept at 800C during 1 month. In conclusion, some rules derived from these tests are given which could be applied to underground laboratories concerning radioactive wastes repository. 5 figs

  10. 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

  11. Aerodynamics of spheres for Mach numbers from 0.6 to 10.5 including some effects of test conditions

    Science.gov (United States)

    Spearman, M. Leroy

    1991-01-01

    Wind tunnel tests were made for spheres of various sizes over a range of Mach numbers and Reynolds numbers. The results indicated some conditions where the drag was affected by changes in the afterbody pressure due to a shock reflection from the tunnel wall. This effect disappeared when the Mach number was increased for a given sphere size or when the sphere size was decreased for a given Mach number. Drag measurements and Schlieren photographs show the possibility of obtaining inaccurate data when tests are made with a sphere too large for the test section size and Mach number. Tests were also made of an oblate spheroid. The results indicated a region at high Mach numbers where inherent positive static stability might occur with the oblate-face forward. The drag results are compared with those for a sphere and those for various other shapes. The drag results for the oblate spheriod and the sphere are also compared with some calculated results.

  12. Northern Adriatic Sea hydrographic conditions from October 2002 – September 2003, including the climatic heating anomaly of summer 2003

    Directory of Open Access Journals (Sweden)

    Nastjenjka SUPI?

    2006-12-01

    Full Text Available CTD data were collected during 38 cruises in the northeastern Adriatic from October 2002 to September 2003 and were analyzed in the context of long-term variability (from data collected over a period of 38 years. A prognostic statistical model was created to fit the long-term data and predicted values were compared to those of the in situ CTD measurements. As with air temperatures, values attained by the sea in summer 2003 far exceeded those expected by predictive models and were induced by very large heat input from the atmosphere. In conditions of very low regional freshwater input and intrusions of more saline water masses from the south, salinity values in the spring/summer period lay far outside typical salinity values for the area.

  13. Navigating the Difficult Robotic Assisted Pyeloplasty

    OpenAIRE

    David D. Thiel

    2012-01-01

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

  14. Factors associated with difficult neuraxial blockade

    Directory of Open Access Journals (Sweden)

    Ružman T

    2014-10-01

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

  15. The analysis of 146 patients with difficult laparoscopic cholecystectomy

    Science.gov (United States)

    Bat, Orhan

    2015-01-01

    Introduction: Laparoscopic cholecystectomy (LC) is very commonly performed surgical intervention. Acute or chronic cholecystitis, adhesions due to previous upper abdomen surgeries, Mirrizi’s syndrome and obesity are common clinical conditions that can be associated with difficult cholecystectomy. In this study, we evaluated and scored the patients with difficult surgical exploration during laparoscopic cholecystectomy. Material and Method: All patients who underwent LC from 2010 to 2015 were retrospectively rewieved. According to intraoperative findings DLC cases were described and classified. Class I difficulty: Adhesion of omentum majus, transverse colon, duodenum to the fundus of the gallbladder. Class II difficulty: Adhesions in Calot’s triangle and difficulty in dissection of cystic artery and cystic duct Class III difficulty: Difficulty in dissection of gallbladder bed (scleroathrophic gallbladder, hemorrhage from liver during dissection of gallbladder, chirotic liver). Class IV difficulty: Difficulty in exploration of gallbladder due to intraabdominal adhesions including technical problems. Results: A total of 146 patients were operated with DLC. The most common difficulty type was Class I difficulty (88 patients/60.2%). Laparoscopic cholecystectomy was converted to laparotomy in 98 patients. Operation time was found to be related with conversion to open surgery (P<0.05). Wound infection rate was also statistically higher in conversion group (P<0.05). The opertion time was found to be longest with Class II difficulty. Conversion rate to open surgery was also highest with Class II difficulty group. Conclusion: Class II difficulty characterized by severe adhesions in calot’s triangle is most serious problem among all DLC cases. They have longer operation time and higher conversion rate. PMID:26629124

  16. Difficult Channel Generation Using Genetic Algorithm

    Directory of Open Access Journals (Sweden)

    Siddhartha Banerjee

    2010-10-01

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

  17. Protection of mineral deposits - a way towards difficult compromises

    Science.gov (United States)

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

    2014-05-01

    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.

  18. Recent advances in endoscopic management of difficult bile duct stones.

    Science.gov (United States)

    Yasuda, Ichiro; Itoi, Takao

    2013-07-01

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

  19. Managing Difficult to Control Tarnished Plant Bugs in Cotton

    Science.gov (United States)

    This article summarizes the current situation with tarnished plant bugs in cotton. Resistance to the organophosphate insecticides appears to be increasing and many populations are becoming difficult to control. Topics addressed include rotation of insecticide classes during the season, cultural meth...

  20. What's Difficult about Chemistry? An Irish Perspective

    Science.gov (United States)

    Childs, Peter E.; Sheehan, Maria

    2009-01-01

    This semi-longitudinal investigation identified the chemistry topics that the majority of Irish chemistry pupils/students find difficult, from Junior Certificate level (age 15/16 years) right the way through to University level (age 18+). Pupils/students completed a five point, Likert-type questionnaire listing the topics covered in the different…

  1. Mind wandering while reading easy and difficult texts.

    Science.gov (United States)

    Feng, Shi; D'Mello, Sidney; Graesser, Arthur C

    2013-06-01

    Mind wandering is a phenomenon in which attention drifts away from the primary task to task-unrelated thoughts. Previous studies have used self-report methods to measure the frequency of mind wandering and its effects on task performance. Many of these studies have investigated mind wandering in simple perceptual and memory tasks, such as recognition memory, sustained attention, and choice reaction time tasks. Manipulations of task difficulty have revealed that mind wandering occurs more frequently in easy than in difficult conditions, but that it has a greater negative impact on performance in the difficult conditions. The goal of this study was to examine the relation between mind wandering and task difficulty in a high-level cognitive task, namely reading comprehension of standardized texts. We hypothesized that reading comprehension may yield a different relation between mind wandering and task difficulty than has been observed previously. Participants read easy or difficult versions of eight passages and then answered comprehension questions after reading each of the passages. Mind wandering was reported using the probe-caught method from several previous studies. In contrast to the previous results, but consistent with our hypothesis, mind wandering occurred more frequently when participants read difficult rather than easy texts. However, mind wandering had a more negative influence on comprehension for the difficult texts, which is consistent with the previous data. The results are interpreted from the perspectives of the executive-resources and control-failure theories of mind wandering, as well as with regard to situation models of text comprehension. PMID:23288660

  2. How democracy resolves conflict in difficult games

    OpenAIRE

    Brams, Steven J.; Kilgour, D. Marc

    2008-01-01

    Democracy resolves conflicts in difficult games like Prisoners’ Dilemma and Chicken by stabilizing their cooperative outcomes. It does so by transforming these games into games in which voters are presented with a choice between a cooperative outcome and a Pareto-inferior noncooperative outcome. In the transformed game, it is always rational for voters to vote for the cooperative outcome, because cooperation is a weakly dominant strategy independent of the decision rule and the number of vo...

  3. Clinical review: Management of difficult airways

    OpenAIRE

    Langeron, Olivier; Amour, Julien; Vivien, Benoît; Aubrun, Frédéric

    2006-01-01

    Difficulties or failure in airway management are still important factors in morbidity and mortality related to anesthesia and intensive care. A patent and secure airway is essential to manage anesthetized or critically ill patients. Oxygenation maintenance during tracheal intubation is the cornerstone of difficult airway management and is always emphasized in guidelines. The occurrence of respiratory adverse events has decreased in claims for injuries due to inadequate airway management mainl...

  4. 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

  5. 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)

    Pruess, K.

    2011-05-15

    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.

  6. Genetic and epidemiological studies of Dystocia : Difficult labour

    OpenAIRE

    Algovik, Michael

    2008-01-01

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

  7. Best of care: most difficult of circumstances.

    Science.gov (United States)

    Cohen, Bob

    2007-01-01

    Adopting clinical best practices in home care and hospice can be a real challenge, even under the very best of circumstances. What happens when the patient's life circumstances are anything but the best? Poverty. Social isolation. Poor diet. Substance abuse. Crime. Language or cultural barriers. Or even those who must try to safeguard their health while piecing a life back together after a natural disaster. All of these factors and more are part of the day-to-day working reality for many home care providers. To not just cope but to exercise best health care practices in oftentimes very difficult situations, home care nurses need to become in part detective, social worker, technologist, innovator, risk taker, and most of all, trusted friends. PMID:19361129

  8. Difficult weaning in delayed onset diaphragmatic hernia

    Directory of Open Access Journals (Sweden)

    Ahmed Syed

    2009-01-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

    Pruess, Karsten

    2003-03-31

    The critical point of CO{sub 2} is at temperature and pressure conditions of T{sub crit} = 31.04 C, P{sub crit} = 73.82 bar. At lower (subcritical) temperatures and/or pressures, CO{sub 2} 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 CO{sub 2} into brine formations would be made at supercritical pressures. However, CO{sub 2} escaping from the storage reservoir may migrate upwards towards regions with lower temperatures and pressures, where CO{sub 2} would be in subcritical conditions. An assessment of the fate of leaking CO{sub 2} requires a capability to model not only supercritical but also subcritical CO{sub 2}, as well as phase changes between liquid and gaseous CO{sub 2} in sub-critical conditions. We have developed a methodology for numerically simulating the behavior of water-CO{sub 2} mixtures in permeable media under conditions that may include liquid, gaseous, and supercritical CO{sub 2}. This has been applied to simulations of leakage from a deep storage reservoir in which a rising CO{sub 2} plume undergoes transitions from supercritical to subcritical conditions. We find strong cooling effects when liquid CO{sub 2} rises to elevations where it begins to boil and evolve a gaseous CO{sub 2} phase. A three-phase zone forms (aqueous - liquid - gas), which over time becomes several hundred meters thick as decreasing temperatures permit liquid CO{sub 2} to advance to shallower elevations. Fluid mobilities are reduced in the three-phase region from phase interference effects. This impedes CO{sub 2} upflow, causes the plume to spread out laterally, and gives rise to dispersed CO{sub 2} discharge at the land surface. Our simulation suggests that temperatures along a CO{sub 2} leakage path may decline to levels low enough so that solid water ice and CO{sub 2} hydrate phases may be formed.

  10. [Complicated urachal cyst: a difficult differential diagnosis].

    Science.gov (United States)

    Bianchi, A; Toia, G; Rovellini, P; Bottanelli, A; Baroni, G; Sciaraffia, G; Marcelli, G; Guarneri, A

    1997-06-01

    Embryologically, the allantois connects the urogenital sinus with the navel. Normally, the allantois is oblitered before the birth and is represented by a fibrous cord, called urachus, extending from the dome of the bladder to the navel. Urachal formation is directly related to bladder descent. Incomplete obliteration sometimes occurs. Disease rarely occurs in urachus, but adenocarcinoma is the most fearful and rare, and it represents the 0.01% of the whole adult carcinoma, the 0.17-0.34% of the whole bladder malignancy, and the 20-30% of the bladder adenocarcinoma. Yet urachus may be seat of other kinds of benign pathologies characterized by incomplete obliteration of its lumen. Only if the ends of the urachus seal off, a cyst of that body may form and may become quite large, presenting a low midline abdomen mass. Adenocarcinoma may occur in a urachal cyst, particularly at its vescical extremity. Cystis usually have an asymtomatic course. Occasionally these cystis can be discovered during sonographic examination. If the cyst becomes infected, signs of general and local sepsis will develop, sometimes involving the peritoneum. Sometimes, in these cases, it is difficult to diagnose the presence of an adenocarcinoma and, particularly, its cystic variant. By using the common diagnostic instrumental device, we cannot reach a certain diagnosis, essential to perform a correct medical or surgical treatment. The case reported concerns a twenty-five years old man, over and over again examined, complaining of ipo-mesogastric abdominal pain, mild fever, increment of flogosis index and transaminasis, microscopic hematuria and urinal discomfort. Sonographic suprapubic examination, performed during urological consultation, showed an urachal neoplasm. Cystoscopy and TC evaluation didn't permit a certain preoperative diagnosis. A surgical explorative operation was performed and the neoplasm, a part of a bladder dome, omental flap and a part of rectus muscles, were removed. In order to reconstruct the abdominal wall we used a large Polypropilene patch. The hystological report outlined a large urachal cyst, a flogosis and a purulent necrosis invading the surrounding tissue and the peritoneum. The patient was discharged after twenty-five days and he had a good functional performance. In the light of the reported case, the surgical treatment seems to be the best solution before the onset of complications that should expose patients to difficult and demolitive surgical operations and that should protract the hospitalization. PMID:9273086

  11. Streamflow and water-quality conditions including geologic sources and processes affecting selenium loading in the Toll Gate Creek watershed, Aurora, Arapahoe County, Colorado, 2007

    Science.gov (United States)

    Paschke, Suzanne S.; Runkel, Robert L.; Walton-Day, Katherine; Kimball, Briant A.; Schaffrath, Keelin R.

    2013-01-01

    Toll Gate Creek is a perennial stream draining a suburban area in Aurora, Colorado, where selenium concentrations have consistently exceeded the State of Colorado aquatic-life standard for selenium of 4.6 micrograms per liter since the early 2000s. In cooperation with the City of Aurora, Colorado, Utilities Department, a synoptic water-quality study was performed along an 18-kilometer reach of Toll Gate Creek extending from downstream from Quincy Reservoir to the confluence with Sand Creek to develop a detailed understanding of streamflow and concentrations and loads of selenium in Toll Gate Creek. Streamflow and surface-water quality were characterized for summer low-flow conditions (July–August 2007) using four spatially overlapping synoptic-sampling subreaches. Mass-balance methods were applied to the synoptic-sampling and tracer-injection results to estimate streamflow and develop spatial profiles of concentration and load for selenium and other chemical constituents in Toll Gate Creek surface water. Concurrent groundwater sampling determined concentrations of selenium and other chemical constituents in groundwater in areas surrounding the Toll Gate Creek study reaches. Multivariate principal-component analysis was used to group samples and to suggest common sources for dissolved selenium and major ions. Hydrogen and oxygen stable-isotope ratios, groundwater-age interpretations, and chemical analysis of water-soluble paste extractions from core samples are presented, and interpretation of the hydrologic and geochemical data support conclusions regarding geologic sources of selenium and the processes affecting selenium loading in the Toll Gate Creek watershed. Streamflow conditions observed and measured during the synoptic water-quality study represent summer base-flow conditions and rainfall conditions for July 2007. The lack of large tributary inflows and the spatial distribution of small tributary inflows, seeps, and springs indicate that diffuse and discrete groundwater inflow supports streamflow during low-flow conditions along the entire 18-kilometer stream reach. Concentrations of dissolved selenium within all subreaches of Toll Gate Creek exceeded the Colorado aquatic-life standard of 4.6 micrograms per liter in 2007. Concentrations of selenium in the upper portion of the Toll Gate Headwaters subreach (TGH) remained close to the aquatic-life standard at about 5 micrograms per liter. Downstream from a concrete-lined channel section, inflows with selenium concentrations greater than the stream contribute selenium load to surface water. However, stream selenium concentrations were less than 20 micrograms per liter all along Toll Gate Creek. Concentrations of selenium in groundwater were in general substantially greater than the Colorado aquatic-life standard of 4.6 micrograms per liter and at some locations were greater than the U.S. Environmental Protection Agency primary drinking-water standard for selenium of 50 micrograms per liter. The distribution of selenium concentrations in groundwater, springs, and the 11 inflows with the greatest selenium concentrations indicates that shallow groundwater in surficial materials and the Denver Formation bedrock is a source of selenium loading to Toll Gate Creek and that selenium loading is distributed along the entire length of the study reach downstream from the concrete-lined channel. Water-quality and solids-sampling results from this study indicate weathering processes release water-soluble selenium from the underlying Denver Formation claystone bedrock with subsequent cycling of selenium in the aquatic environment of Toll Gate Creek. Exposure of the Denver Formation selenium-bearing bedrock to oxidizing atmospheric conditions, surface water, and groundwater, oxidizes selenide, held as a trace element in pyrite or in complexes with organic matter, to selenite and selenate. Secondary weathering products including iron oxides and selenium-bearing salts have accumulated in the weathered zone in the semiarid climate and also can serve as sources or sinks of selenium. P

  12. Facial Image Analysis for Fully-Automatic Prediction of Difficult Endotracheal Intubation

    OpenAIRE

    Cuendet, Gabriel Louis; Schoettker, Patrick; Yuce, Anil; Sorci, Matteo; Gao, Hua; Perruchoud, Christophe; Thiran, Jean-Philippe

    2015-01-01

    Goal: Difficult tracheal intubation is a major cause of anesthesia related injuries with potential life threatening complications. Detection and anticipation of difficult airway in the preoperative period is thus crucial for the patients’ safety. We propose an automatic face analysis approach to detect morphological traits related to difficult intubation and improve its prediction. Methods: For this purpose, we have collected a database of 970 patients including photos, videos and ground trut...

  13. Phlebosclerotic colitis that was difficult to distinguish from collagenous colitis.

    Science.gov (United States)

    Hozumi, Hideaki; Hokari, Ryota; Shimizu, Motonori; Maruta, Koji; Narimatsu, Kazuyuki; Sato, Hirokazu; Sato, Shingo; Ueda, Toshihide; Higashiyama, Masaaki; Watanabe, Chikako; Komoto, Shunsuke; Tomita, Kengo; Kawaguchi, Atsushi; Nagao, Shigeaki; Miura, Soichiro

    2014-07-01

    Phlebosclerotic colitis is a rare and recently known disease entity and its etiology is still to be elucidated. Some phlebosclerotic colitis cases are difficult to distinguish from collagenous colitis because of the similarity of pathological findings. In all Japanese case reports of phlebosclerotic colitis in which an association with the use of Chinese herbal medicine is suspected, sansisi (gardenia fruit) was included, suggesting pathogenesis of this disease. We report a case of phlebosclerotic colitis that wasdifficult to be distinguished from collagenous colitis, and an association with the use of Chinese herbal medicine was suspected as the cause of the disease. PMID:23902595

  14. Modulite: a simple solution to a difficult problem.

    Science.gov (United States)

    Lewis, D A; Ganderton, D; Meakin, B J; Brambilla, G

    2005-01-01

    The development of HFA-based pMDIs has proved difficult due to differences in the physico-chemical properties of CFC and HFA propellants. However, the development of solution formulations instead of suspensions has provided a way to formulate products whose cloud characteristics can be modulated in a controlled manner by permitting different formulation and device hardware variables. The new approach has proved successful in formulating several different drugs including steroids and has now been applied to developing a formoterol Modulite solution formulation characterized by good chemical stability, delivery performance, and clinical results. PMID:15915006

  15. Abdominal Wall Modification for the Difficult Ostomy

    OpenAIRE

    Beck, David E.

    2008-01-01

    A select group of patients with major stomal problems may benefit from operative modification of the abdominal wall. Options may include a modified abdominoplasty (abdominal wall contouring), localized flaps, or liposuction. Although frequently successful, these techniques have the potential for significant morbidity.

  16. Application of three dimensional seismic techniques to difficult areas

    Energy Technology Data Exchange (ETDEWEB)

    Minegishi, Masato [Japan National Oil Corpration Technology Research Center, Chiba (Japan); Tanaka, Hideki; Nakagami, Koichi [Japan Petroleum Exploration Corp., Tokyo (Japan); Abe, Susumu; Nishiki, Tsukasa [JAPEX Geoscience Institute Corp., Tokyo (Japan)

    1998-12-01

    A three dimensional (3D) seismic survey was conducted to obtain precise geological structure images in a culturally congested difficult area. Here, Difficult areas area defined as those where conventional seismic surveys are ineffective in estimating geological structures, resulting in limited exploration activities. Our experiment area is characterized by various constrains on seismic data acquisition, and a very complicated geological structure with several faulted blocks. Previous two dimensional (2D) seismic explorations had failed to obtain the clear subsurface image at the deep partly because of the contamination of side scattering seismic waves. Under these situations, a 3D seismic survey designed for the difficult area has been required. An elaborated planning work flow for our 3D seismic data acquisition, which includes reviewing existing data, careful field scouting, and seismic wave propagation modeling, was established and used. The survey area was decided based on the existing structural interpretations and the expected exploration target depth of about 2,500 meters. For the determination of the acquisition parameters, seismic wave characteristics were studied based on the past 2D seismic data and the well log data. Also, a 3D velocity model was created for the simulation of seismic wave propagation. The results helped to confirm the appropriate shot-receiver configurations and evaluate the expected seismograms. Many unexpected constraints on our 3D seismic data acquisition were realized during survey planning, and caused source and receiver relocations. Although this resulted in the irregularity in the acquisition geometry, close cooperation of the data acquisition contractor led to good acquisition performance at a realistic cost. Resultant data quality was generally good compared with that from other difficult areas in Japan. However, some shot records showed extremely poor quality. A study of normalized average shot amplitudes revealed anomalous shot point regions which provided those poor quality records, and good agreement between the anomalous regions and the Sakasagawa fault was found. These results exhibit the advantage of the 3D seismic survey which gives areal distribution of seismic characteristics. The 3D time migration image obtained through our time domain data processing is consistent with the existing well information at the shallow. On the other hand, data quality is not good enough to examine deep structures, and the result suggests several problems to be solved in the future. Those problems are mainly related to the irregular data acquisition geometry and inherent in difficult areas. A proposal of the further investigation for those problems is described to give our future research direction. (author)

  17. Management of difficult airway in intratracheal tumor surgery

    Directory of Open Access Journals (Sweden)

    Agarwal Surendra K

    2005-06-01

    Full Text Available Abstract Background Tracheal malignancies are usual victim of delay in diagnosis by virtue of their symptoms resembling asthma. Sometimes delayed diagnosis may lead to almost total airway obstruction. For difficult airways, not leaving any possibility of manipulation into neck region or endoscopic intervention, femorofemoral cardiopulmonary bypass can be a promising approach. Case Presentation We are presenting a case of tracheal adenoid cystic carcinoma (cylindroma occupying about 90% of the tracheal lumen. It was successfully managed by surgical excision of mass by sternotomy and tracheotomy under femorofemoral cardiopulmonary bypass (CPB. Conclusion Any patient with recurrent respiratory symptoms should be evaluated by radiological and endoscopic means earlier to avoid delay in diagnosis of such conditions. Femorofemoral cardiopulmonary bypass is a relatively safe way of managing certain airway obstructions.

  18. Orthostatic hypotension: managing a difficult problem.

    Science.gov (United States)

    Jones, Pearl K; Shaw, Brett H; Raj, Satish R

    2015-11-01

    Orthostatic hypotension (OH) leads to a significant number of hospitalizations each year, and is associated with significant morbidity and mortality among affected individuals. Given the increased risk for cardiovascular events and falls, it is important to identify the underlying etiology of OH and to choose appropriate therapeutic agents. OH can be non-neurogenic or neurogenic (arising from a central or peripheral lesion). The initial evaluation includes orthostatic vital signs, complete history and a physical examination. Patients should also be evaluated for concomitant symptoms of post-prandial hypotension and supine hypertension. Non-pharmacologic interventions are the first step for treatment of OH. The appropriate selection of medications can also help with symptomatic relief. This review highlights the pathophysiology, clinical features, diagnostic work-up and treatment of patients with neurogenic OH. PMID:26427904

  19. Penile Corporeal Reconstruction during Difficult Placement of a Penile Prosthesis

    Directory of Open Access Journals (Sweden)

    Sherif R. Aboseif

    2008-11-01

    Full Text Available For some patients with impotence and concomitant severe tunical/corporeal tissue fibrosis, insertion of a penile prosthesis is the only option to restore erectile function. Closing the tunica over an inflatable penile prosthesis in these patients can be challenging. We review our previous study which included 15 patients with severe corporeal or tunical fibrosis who underwent corporeal reconstruction with autologous rectus fascia to allow placement of an inflatable penile prosthesis. At a mean follow-up of 18 months (range 12 to 64, all patients had a prosthesis that was functioning properly without evidence of separation, herniation, or erosion of the graft. Sexual activity resumed at a mean time of 9 weeks (range 8 to 10. There were no adverse events related to the graft or its harvest. Use of rectus fascia graft for coverage of a tunical defect during a difficult penile prosthesis placement is surgically feasible, safe, and efficacious.

  20. Percutaneous transhepatic cholelithotripsy for difficult common bile duct stones.

    DEFF Research Database (Denmark)

    Stage, J G; Moesgaard, F

    1998-01-01

    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.

  1. Obstetric Anaesthetists' Association and Difficult Airway Society guidelines for the management of difficult and failed tracheal intubation in obstetrics.

    Science.gov (United States)

    Mushambi, M C; Kinsella, S M; Popat, M; Swales, H; Ramaswamy, K K; Winton, A L; Quinn, A C

    2015-11-01

    The Obstetric Anaesthetists' Association and Difficult Airway Society have developed the first national obstetric guidelines for the safe management of difficult and failed tracheal intubation during general anaesthesia. They comprise four algorithms and two tables. A master algorithm provides an overview. Algorithm 1 gives a framework on how to optimise a safe general anaesthetic technique in the obstetric patient, and emphasises: planning and multidisciplinary communication; how to prevent the rapid oxygen desaturation seen in pregnant women by advocating nasal oxygenation and mask ventilation immediately after induction; limiting intubation attempts to two; and consideration of early release of cricoid pressure if difficulties are encountered. Algorithm 2 summarises the management after declaring failed tracheal intubation with clear decision points, and encourages early insertion of a (preferably second-generation) supraglottic airway device if appropriate. Algorithm 3 covers the management of the 'can't intubate, can't oxygenate' situation and emergency front-of-neck airway access, including the necessity for timely perimortem caesarean section if maternal oxygenation cannot be achieved. Table 1 gives a structure for assessing the individual factors relevant in the decision to awaken or proceed should intubation fail, which include: urgency related to maternal or fetal factors; seniority of the anaesthetist; obesity of the patient; surgical complexity; aspiration risk; potential difficulty with provision of alternative anaesthesia; and post-induction airway device and airway patency. This decision should be considered by the team in advance of performing a general anaesthetic to make a provisional plan should failed intubation occur. The table is also intended to be used as a teaching tool to facilitate discussion and learning regarding the complex nature of decision-making when faced with a failed intubation. Table 2 gives practical considerations of how to awaken or proceed with surgery. The background paper covers recommendations on drugs, new equipment, teaching and training. PMID:26449292

  2. Use of the Flugelman index for identifying patients who are difficult to discharge from the hospital

    Directory of Open Access Journals (Sweden)

    Chiara Bozzano

    2013-03-01

    Full Text Available Introduction: To evaluate the use of multidimensional assessment based on the Fluegelman Index (FI to identify internal medicine patients who are likely to be difficult to discharge from the hospital. Materials and methods: Have been evaluated all patients admitted to the medical wards of the District General Hospital of Arezzo from September 1 to October 31, 2007. We collected data on age, sex, socioeconomic condition, cause of admission, comorbidity score preadmission functional status (Barthel Index, incontinence, feeding problems, length of hospitalization, condition at discharge, and type of discharge. The FI cut off for difficult discharge was > 17. Results: Of the 413 patients (mean age 80 + 11.37 years; percentage of women, 56.1% included in the study, 109 (26.39% had Flugelman Index > 17. These patients were significantly older than the patients with lower FIs (85 + 9.35 vs 78 + 11.58 years, p < 0.001, more likely to be admitted for pneumonia (22% vs. 4.9% of those with lower FIs; p < 0,001. They also had more comorbidity, loss of autonomy, cognitive impairment, social frailty, and nursing care needs. The subgroup with FIs>17 had significantly higher in-hospital mortality (30.28% vs 6.25%, p < 0.001, longer hospital stay (13 vs. 10 days, p < 0.05, and higher rates of discharge to nursing homes. Conclusions: Evaluation of internal medicine patients with the Flugelman Index may be helpful for identifying more critical patients likely to require longer hospitalization and to detect factors affecting the hospital stay. This information can be useful for more effective discharge planning.

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

    International Nuclear Information System (INIS)

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

  4. Difficult Airway Society 2015 guidelines for management of unanticipated difficult intubation in adults†.

    Science.gov (United States)

    Frerk, C; Mitchell, V S; McNarry, A F; Mendonca, C; Bhagrath, R; Patel, A; O'Sullivan, E P; Woodall, N M; Ahmad, I

    2015-12-01

    These guidelines provide a strategy to manage unanticipated difficulty with tracheal intubation. They are founded on published evidence. Where evidence is lacking, they have been directed by feedback from members of the Difficult Airway Society and based on expert opinion. These guidelines have been informed by advances in the understanding of crisis management; they emphasize the recognition and declaration of difficulty during airway management. A simplified, single algorithm now covers unanticipated difficulties in both routine intubation and rapid sequence induction. Planning for failed intubation should form part of the pre-induction briefing, particularly for urgent surgery. Emphasis is placed on assessment, preparation, positioning, preoxygenation, maintenance of oxygenation, and minimizing trauma from airway interventions. It is recommended that the number of airway interventions are limited, and blind techniques using a bougie or through supraglottic airway devices have been superseded by video- or fibre-optically guided intubation. If tracheal intubation fails, supraglottic airway devices are recommended to provide a route for oxygenation while reviewing how to proceed. Second-generation devices have advantages and are recommended. When both tracheal intubation and supraglottic airway device insertion have failed, waking the patient is the default option. If at this stage, face-mask oxygenation is impossible in the presence of muscle relaxation, cricothyroidotomy should follow immediately. Scalpel cricothyroidotomy is recommended as the preferred rescue technique and should be practised by all anaesthetists. The plans outlined are designed to be simple and easy to follow. They should be regularly rehearsed and made familiar to the whole theatre team. PMID:26556848

  5. Condition Number Regularized Covariance Estimation*

    OpenAIRE

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

    2012-01-01

    Estimation of high-dimensional covariance matrices is known to be a difficult problem, has many applications, and is of current interest to the larger statistics community. In many applications including so-called the “large p small n” setting, the estimate of the covariance matrix is required to be not only invertible, but also well-conditioned. Although many regularization schemes attempt to do this, none of them address the ill-conditioning problem directly. In this paper, we propose a max...

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

    OpenAIRE

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

    2009-01-01

    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...

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

    Energy Technology Data Exchange (ETDEWEB)

    Andresen, Elisa, E-mail: 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

    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.

  8. Aerodynamics of a sphere and an oblate spheroid for Mach numbers from 0.6 to 10.5 including some effects of test conditions

    Science.gov (United States)

    Spearman, M. Leroy; Braswell, Dorothy O.

    1993-01-01

    Wind-tunnel tests were made for spheres of various sizes over a range of Mach numbers and Reynolds numbers. The results indicated some conditions where the drag was affected by changes in the afterbody pressure due to a shock reflection from the tunnel wall. This effect disappeared when the Mach number was increased for a given sphere size or when the sphere size was decreased for a given Mach number. Drag measurements and Schlieren photographs are presented that show the possibility of obtaining inaccurate data when tests are made with a sphere too large for the test section size and Mach number. Tests were also made of an oblate spheroid. The results indicated a region at high Mach numbers where inherent positive static stability might occur with the oblate-face forward. The drag results are compared with those for a sphere as well as those for various other shapes. The drag results for the oblate spheroid and the sphere are also compared with some calculated results.

  9. 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

  10. Analysis of the hydrographic conditions and cyst beds in the San Jorge Gulf, Argentina, that favor dinoflagellate population development including toxigenic species and their toxins

    Science.gov (United States)

    Krock, Bernd; Borel, C. Marcela; Barrera, Facundo; Tillmann, Urban; Fabro, Elena; Almandoz, Gastón O.; Ferrario, Martha; Garzón Cardona, John E.; Koch, Boris P.; Alonso, Cecilia; Lara, Rubén

    2015-08-01

    The overlay of cooler nutrient enriched Beagle-Magellan water with warmer nutrient depleted shelf water and a strong stratification of the water column in the San Jorge Gulf region, Argentina, coincided with relatively high dinoflagellate abundances in April 2012, up to 34,000 cells L- 1. This dinoflagellate proliferation was dominated by Ceratium spp., but environmental conditions also favored to a lesser amount the occurrence of toxigenic dinoflagellates, such as Alexandrium tamarense and Protoceratium reticulatum, whose toxins were hardly detected in any other areas along the expedition transect of the R/V Puerto Deseado between 38 and 56°S (Ushuaia-Mar del Plata) in March/April 2012. Generally vegetative cells of A. tamarense and P. reticulatum co-occurred with their respective phycotoxins in the water column and their cysts in the upper sediment layers. Two strains of A. tamarense were isolated from the bloom sample and morphologically characterized. Their PSP toxin profiles consisted of C1/2, gonyautoxins 1/4 and to a lesser amount of neosaxitoxin and confirmed earlier data from this region. The ratios between autotrophic picoplankton and heterotrophic bacteria were higher in shelf waters in the north than in Beagle-Magellan waters in the south of San Jorge Gulf.

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

    Science.gov (United States)

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

    2003-01-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2013-11-01

    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.

  13. The Difficult Chore of Measuring Coordination by EXAFS

    International Nuclear Information System (INIS)

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

  14. Preoperative Prediction of Difficult Laparoscopic Cholecystectomy: A Scoring Method

    Science.gov (United States)

    Agrawal, Nikhil; Singh, Sumitoj; Khichy, Sudhir

    2015-01-01

    Background: Laparoscopic cholecystectomy (LC) has become the procedure of choice for management of symptomatic gallstone disease. At times, it is difficult and takes longer time or has to be converted to an open procedure. This study is undertaken to determine the predictive factors for difficult LC. Aim: The aim was to evaluate a scoring method to predict difficult LC preoperatively. Materials and Methods: There were 30 cases operated by a single experienced surgeon. There are total 15 score from history, clinical and sonological findings. Score up to 5 predicted easy, 6–10 difficult and >10 are very difficult. Results: Prediction came true in 76.4% for easy and 100% difficult cases; there were no cases with a score above 10. The factors like previous history of hospitalization (P - 0.004), clinically palpable gallbladder (GB) (P - 0.009), impacted GB stone (P - 0.001), pericholecystic collection (P - 0.04), and abdominal scar due to previous abdominal surgery (P - 0.009) were found statistically significant in predicting difficult LC. Conclusion: The proposed scoring system is reliable with a sensitivity of 76.47% and specificity of 100%. PMID:26425067

  15. Difficult Behaviors in the Emergency Department: A Cohort Study of Housed, Homeless and Alcohol Dependent Individuals

    Science.gov (United States)

    Svoboda, Tomislav

    2015-01-01

    Background This study contrasted annual rates of difficult behaviours in emergency departments among cohorts of individuals who were homeless and low-income housed and examined predictors of these events. Methods Interviews in 1999 with men who were chronically homeless with drinking problems (CHDP) (n = 50), men from the general homeless population (GH) (n = 61), and men residing in low-income housing (LIH) (n = 58) were linked to catchment area emergency department records (n = 2817) from 1994 to 1999. Interview and hospital data were linked to measures of difficult behaviours. Results Among the CHDP group, annual rates of visits with difficult behaviours were 5.46; this was 13.4 (95% CI 10.3–16.5) and 14.3 (95% CI 11.2–17.3) times higher than the GH and LIH groups. Difficult behaviour incidents included physical violence, verbal abuse, uncooperativeness, drug seeking, difficult histories and security involvement. Difficult behaviours made up 57.54% (95% CI 55.43–59.65%), 24% (95% CI 19–29%), and 20% (95% CI 16–24%) of CHDP, GH and LIH visits. Among GH and LIH groups, 87% to 95% were never involved in verbal abuse or violence. Intoxication increased all difficult behaviours while decreasing drug seeking and leaving without being seen. Verbal abuse and violence were less likely among those housed, with odds ratios of 0.24 (0.08, 0.72) and 0.32 (0.15, 0.69), respectively. Conclusions Violence and difficult behaviours are much higher among chronically homeless men with drinking problems than general homeless and low-income housed populations. They are concentrated among subgroups of individuals. Intoxication is the strongest predictor of difficult behaviour incidents. PMID:25919015

  16. How libraries make tough choices in difficult times purposeful abandonment

    CERN Document Server

    Stern, David

    2013-01-01

    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

  17. Difficult Sudoku Puzzles Created by Replica Exchange Monte Carlo Method

    OpenAIRE

    WATANABE, HIROSHI

    2013-01-01

    An algorithm to create difficult Sudoku puzzles is proposed. An Ising spin-glass like Hamiltonian describing difficulty of puzzles is defined, and difficult puzzles are created by minimizing the energy of the Hamiltonian. We adopt the replica exchange Monte Carlo method with simultaneous temperature adjustments to search lower energy states efficiently, and we succeed in creating a puzzle which is the world hardest ever created in our definition, to our best knowledge. (Adde...

  18. ECO2M: A TOUGH2 Fluid Property Module for Mixtures of Water, NaCl, and CO2, Including Super- and Sub-Critical Conditions, and Phase Change Between Liquid and Gaseous CO2

    Energy Technology Data Exchange (ETDEWEB)

    Pruess, K.

    2011-04-01

    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.

  19. 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)

  20. Clustering is difficult only when it does not matter

    CERN Document Server

    Daniely, Amit; Saks, Michael

    2012-01-01

    Numerous papers ask how difficult it is to cluster data. We suggest that the more relevant and interesting question is how difficult it is to cluster data sets {\\em that can be clustered well}. More generally, despite the ubiquity and the great importance of clustering, we still do not have a satisfactory mathematical theory of clustering. In order to properly understand clustering, it is clearly necessary to develop a solid theoretical basis for the area. For example, from the perspective of computational complexity theory the clustering problem seems very hard. Numerous papers introduce various criteria and numerical measures to quantify the quality of a given clustering. The resulting conclusions are pessimistic, since it is computationally difficult to find an optimal clustering of a given data set, if we go by any of these popular criteria. In contrast, the practitioners' perspective is much more optimistic. Our explanation for this disparity of opinions is that complexity theory concentrates on the wors...

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

    Directory of Open Access Journals (Sweden)

    Hyung Hun Kim

    2012-01-01

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

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

    OpenAIRE

    Bowie, Dennis M.

    1991-01-01

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

  3. Difficult Biliary Access: Advanced Cannulation and Sphincterotomy Technique.

    Science.gov (United States)

    Mammen, Anish; Haber, Gregory

    2015-10-01

    Many devices and techniques have been developed to assist in cases of difficult biliary cannulation. Guidewire-assisted cannulation has become the first-line technique for biliary cannulation. Precut sphincterotomy can be safe and effective if used soon after encountering difficulty. Pancreatic duct stents are an important adjunct to reduce the risk of post-endoscopic retrograde cholangiopancreatography pancreatitis in difficult access. Ultimately, cannulation success of greater than 95% and complication rates of less than 5% is the standard that endoscopists doing ERCP should achieve. PMID:26431594

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

    DEFF Research Database (Denmark)

    Lauridsen, Karen M.; Madsen, Henning

    2013-01-01

    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 collaboratio...

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

    Science.gov (United States)

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

    2013-01-01

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

  6. Myth 5: Creativity Is Too Difficult to Measure

    Science.gov (United States)

    Treffinger, Donald J.

    2009-01-01

    In his 1982 response to the myth that "creativity is too difficult to measure," Dr. Joe Khatena (a long-time contributor to the literature on creativity), characterized creativity as the "most exciting dimension of mental functioning." Building on a three-dimensional view of creativity (emphasizing the "individual," the "environment," and the…

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

    LENUS (Irish Health Repository)

    Walsh, K

    2012-02-03

    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.

  8. Tracheal intubation in patients with anticipated difficult airway using Boedeker intubation forceps and McGrath videolaryngoscope

    DEFF Research Database (Denmark)

    StrØm, C; Barnung, S

    2015-01-01

    BACKGROUND: Videolaryngoscopes with sharp angulated blades improve the view of the vocal cords but this does not necessarily result in higher success rates of intubation The aim of this study was to evaluate the efficacy of using Boedeker intubation forceps in conjunction with McGrath Series 5 Videolaryngoscope (MVL) in patients with predictors for difficult intubation. METHODS: The study was conducted at the Department of Anaesthesia, Copenhagen University Hospital from September to December 2013. Patients with one or more predictors of difficult intubation scheduled for general anaesthesia were assessed for eligibility. Patients were intubated using Boedeker intubation forceps and MVL. The primary endpoint was time to intubation. The secondary endpoints were intubation success rate, number of intubation attempts, intubation conditions and post-operative hoarseness. RESULTS: Thirty-three patients were assessed for eligibility, and 25 patients were included in the study with a median SARI score of 3 (IQR 3-4). Twenty-two (88%, 95% confidence interval [74-100%]) of the patients were successfully intubated by the method with a median time to intubation of 115 s (IQR 78-247). Steering and advancement of the tube were reported as acceptable in 21 (84%) and 22 cases (88%), respectively, and excellent in 10 cases (45%) for both measures. Ten cases (40%) were intubated on the first attempt. There were three cases (12%) of failed intubation; in these cases, successful intubation was obtained by using a styletted tube. CONCLUSION(S): Most patients with anticipated difficult intubation can be successfully intubated with Boedeker intubation forceps and MVL. However, endotracheal tube placement failed in 3/25 patients despite a good laryngeal view.

  9. Difficult airway management from Emergency Department till Intensive Care Unit.

    Science.gov (United States)

    Pradhan, Debasis; Bhattacharyya, Prithwis

    2015-09-01

    We report a case of "can ventilate but can't intubate" situation which was successfully managed in the Emergency Department and Intensive Care Unit by the use of ProSeal laryngeal mask airway and Frova Intubating Introducer as bridging rescue devices. Use of appropriate technique while strictly following the difficult airway algorithm is the mainstay of airway management in unanticipated difficult airway situations. Although the multiple airway devices were used but each step took not more than 2 min and "don't struggle, skip to the next step principle" was followed. With the availability of many advanced airway management tools, the intensivists should have a training and experience along with preparedness in order to perform such lifesaving airway managements. PMID:26430345

  10. If it's difficult to pronounce, it must be risky.

    Science.gov (United States)

    Song, Hyunjin; Schwarz, Norbert

    2009-02-01

    Low processing fluency fosters the impression that a stimulus is unfamiliar, which in turn results in perceptions of higher risk, independent of whether the risk is desirable or undesirable. In Studies 1 and 2, ostensible food additives were rated as more harmful when their names were difficult to pronounce than when their names were easy to pronounce; mediation analyses indicated that this effect was mediated by the perceived novelty of the substance. In Study 3, amusement-park rides were rated as more likely to make one sick (an undesirable risk) and also as more exciting and adventurous (a desirable risk) when their names were difficult to pronounce than when their names were easy to pronounce. PMID:19170941

  11. Difficult intubation due to chronic hiccup: a case report

    Directory of Open Access Journals (Sweden)

    Ismail Hakki Hamzaoglu

    2011-01-01

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

  12. Endoscopic management of difficult common bile duct stones

    Directory of Open Access Journals (Sweden)

    Guru Trikudanathan

    2013-01-01

    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.

  13. 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.)

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

    Directory of Open Access Journals (Sweden)

    Nadir Bafadin oqlu Agayev

    2013-12-01

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

  15. Does "difficult patient" status contribute to de facto demedicalization? The case of borderline personality disorder.

    Science.gov (United States)

    Sulzer, Sandra H

    2015-10-01

    A diagnosis of Borderline Personality Disorder (BPD) often signals the quintessential "difficult patient" status to clinicians, with at least one scholar arguing the condition itself was created to name and group difficult patients. While patients who are deemed difficult are often dispreferred for care, does this have an impact on their overall status as medicalized patients who have successfully achieved a sick role? This study relies on (n = 22) in-depth interviews with mental health clinicians in the United States from 2012 to evaluate how they describe patients with BPD, how the diagnosis of BPD affects the treatment clinicians are willing to provide, and the implications for patients. My findings suggest patients with BPD are routinely labeled "difficult," and subsequently routed out of care through a variety of direct and indirect means. This process creates a functional form of demedicalization where the actual diagnosis of BPD remains de jure medicalized, but the de facto or treatment component of medicalization is harder to secure for patients. PMID:26298091

  16. Including an Analysis of Difficult Behaviour in the Assessment of Children with an Autism Spectrum Disorder: Implications for School Psychologists

    Science.gov (United States)

    Bitsika, Vicki

    2008-01-01

    School psychologists who contribute to the assessment of children with an autism spectrum disorder (ASD) are required by various Australian state government authorities to use standardised testing of cognitive skills, adaptive behaviour and some autism-based symptomatology to demonstrate the eligibility of those children for support funding in the…

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

    Directory of Open Access Journals (Sweden)

    G?ska A.

    2014-02-01

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

  18. A Difficult Choice for Newspapers: Advertisers or Readers?

    Directory of Open Access Journals (Sweden)

    Bar?? Bulunmnaz

    2012-03-01

    Full Text Available Almost entire advertisement revenues are acquired by newspapers in print media. Along with rapid technological developments and the intensive competitive climate in newspaper sector; the gulf between high cost and low revenue has widened, and newspapers are obliged to subsidize this deficit with advertisement revenues. Newspapers in Turkey have two separate groups of customers. The first one of those groups is the advertisers and the other is the readers of that newspaper. Due to economic reasons, this compulsory dependency on advertisement revenue causes newspapers to fall into a paradox between advertisers and readers. In this article we will firstly explain advertisement and its place in marketing; then give information about the advertising sector and the distribution of Turkish advertising pie among media. Later, the relation between advertisers and readers that place newspapers in difficult circumstances will be explicated in detail, analysis and assessments will be made regarding about it.

  19. [Fire-eater's pneumonia--a difficult differential diagnosis].

    Science.gov (United States)

    Bulava, A; Kolek, V; Lukl, J

    2001-04-26

    Acute aspiration of petroleum or other hydrocarbon products can cause a distinct type of chemical pneumonitis known as fire-eater's pneumonia. Initial findings on chest X-rays are ambiguous and not uniform in nature. Among the most common belong mottled or patchy, local or diffuse perihilar and basal uni- or bilateral infiltrates, areas of atelectasis, tumor-like lesions and rarely pleural effusions. CT finding often shows formation of smaller or larger pneumatoceles. Those cavities tend to regress spontaneously over weeks or months. Clinical diagnosis is sometimes very difficult, especially in cases, when past history of "fire-eating" is not known to the physician. The authors present clinical manifestation, sequential X-ray and CT findings in one patient with fire-eater's pneumonia. To diagnose the disease, not only paraclinical exploration is needed, but also the patient's past history plays an important role. Without it this puzzling clinical unit can remain undiagnosed. PMID:11392042

  20. Performance specifications: the nearly impossible versus the merely difficult

    Science.gov (United States)

    Hopper, Darrel G.

    2000-08-01

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

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

    DEFF Research Database (Denmark)

    Lauridsen, Karen M.; Madsen, Henning

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

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

    Directory of Open Access Journals (Sweden)

    M. Vélez González

    2010-06-01

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

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

    Scientific Electronic Library Online (English)

    M., Vélez González.

    2010-06-01

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

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

    Science.gov (United States)

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

    2013-05-01

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

  5. Prediction is difficult, preparation is critical and possible

    DEFF Research Database (Denmark)

    Zilli, Romano; Dalton, Luke

    Problem Statement: Animal disease challenges appear to be ever increasing with new and emerging conditions rapidly becoming global problems due to factors such as climate change and globalisation of trade. Avian Influenza, Ebola, African Swine Fever and Porcine Epidemic Diarrhoea are just a few of the many transboundary diseases for which global cooperation in research is vital. These diseases can cause serious social, economic and environmental damage and in some cases also threaten human health. Various social, technological, economic, environmental, political and biological driving forces act at the level of the source of infection, transmission pathways, and the outcomes. Changes to such challenges and uncertainties are inevitable and foresight in identifying strategies is required for us to prepare for a sustainable future. The EU-funded Global Network on Infectious Diseases of Animals and Zoonoses (STAR-IDAZ) conducted foresight studies as part of its objective to improve coordination of research activities on the major infectious diseases of animals (including zoonoses) to hasten the delivery of improved control methods. The aim of these studies was to identify the scientific and technological needs, including research capacity and support structures to prevent, control or mitigate animal health and zoonotic challenges for 2030 and beyond. While our ability to predict the future is often limited, being prepared to engage with whatever may happen is critical. Methods: Foresight workshops were initially conducted in the Americas involving consideration of scenarios developed in Canada, Asia and Australasia based on the seven questions method, and in Europe involving scenario building and back-casting. Following these regional exercises, critical drivers already identified in a range of other related foresight projects were classified under eight categories and the top 3 – 5 drivers in each category were ranked with the level of uncertainty noted (high/medium/low) by experts from a range of backgrounds from Europe, Africa and the Middle-East, Asia and Australasia and the Americas. The likely impact of these drivers on various disease categories was considered, a preferred future scenario agreed and back-casting conducted at a workshop held in Moscow in June 2014. More than 40 veterinarians and animal health scientists from around the world outlined priorities in terms of research capability and capacity to attain the ideal future. Results: In each of the regions, the research capacity and knowledge networks required to optimise enablers and ameliorate barriers to our ability to meet future animal disease challenges were identified then grouped and prioritised across the regions to give an overall list in which transnational data sharing, knowledge transfer, public-private partnerships, vaccinology/immunology, vector control, antimicrobial resistance, socioeconomics, genetics/bioinformatics and utilisation of big data rated highly. Conclusion: The outputs of the STAR-IDAZ Foresight study will form the basis of a Global Strategic Research Agenda with which research funders and programme managers can prioritise and coordinate national research efforts to improve global collective preparedness for future animal, human and environmental challenges.

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

    DEFF Research Database (Denmark)

    Witt, Flemming; Nielsen, JØrn Flohr

    2005-01-01

    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.

  7. QUALIFYING LEGACY BY PARTICULAR TITLE – A DIFFICULT TASK

    Directory of Open Access Journals (Sweden)

    Ilioara GENOIU

    2014-05-01

    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.

  8. QUALIFYING LEGACY BY PARTICULAR TITLE – A DIFFICULT TASK

    Directory of Open Access Journals (Sweden)

    Ilioara GENOIU

    2014-06-01

    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.

  9. Precut sphincterotomy: A reliable salvage for difficult biliary cannulation

    Directory of Open Access Journals (Sweden)

    Ulku Saritas

    2013-01-01

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

  10. Nuclear energy and public opinion - a difficult relationship

    International Nuclear Information System (INIS)

    Nuclear energy remains an explosive subject. Less people demand to give up nuclear energy at once but the emotional and cognitive environment of attitudes to nuclear energy makes this relative 'peaceabilty' seem a very precarious issue. The Chernobyl shock is still active. The future will depend on whether new accidents will occur in nuclear power stations and how dangerous they will be. The highly political nature and the polarization of the subject together with an assumingly still negative coverage by the mass media and a general distrust of the people in established politics will make it very difficult to influence attitudes by means of information. We should attempt to bring sober facts and objectiveness to the discussion of nuclear energy and to involve citizens more actively than in the past while ensuring that there is less auto-selectivity (bias). What we also need is the basic and credible readiness of all participants to accept the results of a democratic process of the development of opinion. (orig./HSCH)

  11. Percutaneous lithotripsy for removing difficult bile duct stones using endoscopy

    International Nuclear Information System (INIS)

    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

  12. Percutaneous lithotripsy for removing difficult bile duct stones using endoscopy

    Energy Technology Data Exchange (ETDEWEB)

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

    2008-03-15

    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.

  13. ADEM-DIOS: an SCF convergence algorothm for difficult cases

    Science.gov (United States)

    Sellers, Harrell

    1991-05-01

    We present an SCF convergence algorithm which we call ADEM-DIOS for accelerated direct energy minimization-direct inversion in the optimized subspace. This method employs the direct energy minimization (steepest descent) procedure outlined by Seeger and Pople to generate a set of "optimized" approximate solutions that form a basis for a least squares interpolation based on the DIIS method of Pulay. In all of our test cases, which we chose because damped Roothaan—Hall iterations, ordinary DIIS, level shifting, and variable metric second-order optimization failed to bring about convergence, the ADEM-DIOS method achieved convergence in a fraction of the number of steps required when direct energy minimization was used alone. This method can be thought of as being essentially the DIIS convergence acceleration technique applied to an "iterative subspace" generated by the direct energy minimization procedure. While we do not expect ADEM-DIOS to be significantly faster per cycle than second-order optimization algorithms based on Bacskay's method, the convergence ability of ADEM-DIOS is insensitive to the initial parameter set and should be more applicable in difficult cases. We consider th usefulness of this new algorithm to be in those cases in which other algorithms have difficulty in achieving convergence.

  14. The difficult hair loss patient: a particular challenge.

    Science.gov (United States)

    Trüeb, Ralph M

    2013-07-01

    Few dermatologic complaints carry as much emotional overtones as hair loss. Adding to the patient's worry may be prior frustrating experiences with physicians, who trivialize hair loss. A detailed patient history, physical examination and few pertinent screening blood tests usually establish a specific diagnosis. Once the diagnosis is certain, treatment appropriate for that diagnosis is likely to control the problem. Treatment options are available, though limited, in terms of indications and efficacy. Success depends both on comprehensions of the underlying pathology and on unpatronizing sympathy from the part of the physician. Ultimately, patients need to be educated about the basics of the hair cycle and why considerable patience is required for effective cosmetic recovery. Communication is an important component of patient care. For a successful encounter at an office visit, one needs to be sure that the patient's key concerns have been addressed. Physicians should recognize that alopecia goes well beyond the simple physical aspects of hair loss. Patients' psychological reactions to hair loss are less related to physicians' ratings than to patients' own perceptions. Some of the patients have difficulties adjusting to hair loss. The best way to alleviate the emotional distress is to eliminate the hair disease that is causing it. Treatment success relies on patient compliance. Rather than being the patient's failure, patient non-compliance results from failure of the physician to ensure confidence and motivation. Finally, patients with hypochondriacal, body dysmorphic, somatoform, or personality disorders remain difficult to manage. The physician should be careful not to be judgmental or scolding because this may rapidly close down communication. The influence of the prescribing physician should be kept in mind, since inspiring confidence versus scepticism and fear clearly impacts the outcome of treatment. Sometimes the patient gains therapeutic benefit just from venting concerns in a safe environment with a caring physician. PMID:24574686

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

    Scientific Electronic Library Online (English)

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

    2012-08-01

    Full Text Available Introducción: La acondroplasia es la condición más común asociada a una estatura baja con grave desproporción anatómica. Las complicaciones de la vía respiratoria difícil constituyen una de las causas más frecuente de su morbilidad y mortalidad, entre las que se pueden citar: macroglosia, escasa ape [...] rtura bucal, presencia de una tráquea estrecha, limitación en la movilidad cervical, problemas pulmonares crónicos, mandíbula 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.

  16. Prediction is difficult, preparation is critical and possible

    DEFF Research Database (Denmark)

    Zilli, Romano; Dalton, Luke; Ooms, Wim; Schobesberger, Hermann; Imberechts, Hein; Egan, John; Møller, Kristian; 'Astiz, Susanna; Black, Peter; Renwick, Shane; Nunn, Mike; Bagni, Marina

    2014-01-01

    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 healt...

  17. Atrophic Vaginitis in Breast Cancer Survivors: A Difficult Survivorship Issue

    Directory of Open Access Journals (Sweden)

    Joanne Lester

    2015-03-01

    Full Text Available Management of breast cancer includes systematic therapies including chemotherapy and endocrine therapy can lead to a variety of symptoms that can impair the quality of life of many breast cancer survivors. Atrophic vaginitis, caused by decreased levels of circulating estrogen to urinary and vaginal receptors, is commonly experienced by this group. Chemotherapy induced ovarian failure and endocrine therapies including aromatase inhibitors and selective estrogen receptor modulators can trigger the onset of atrophic vaginitis or exacerbate existing symptoms. Symptoms of atrophic vaginitis include vaginal dryness, dyspareunia, and irritation of genital skin, pruritus, burning, vaginal discharge, and soreness. The diagnosis of atrophic vaginitis is confirmed through patient-reported symptoms and gynecological examination of external structures, introitus, and vaginal mucosa. Lifestyle modifications can be helpful but are usually insufficient to significantly improve symptoms. Non-hormonal vaginal therapies may provide additional relief by increasing vaginal moisture and fluid. Systemic estrogen therapy is contraindicated in breast cancer survivors. Continued investigations of various treatments for atrophic vaginitis are necessary. Local estrogen-based therapies, DHEA, testosterone, and pH-balanced gels continue to be evaluated in ongoing studies. Definitive results are needed pertaining to the safety of topical estrogens in breast cancer survivors.

  18. What Makes Biology Learning Difficult and Effective: Students' Views

    Science.gov (United States)

    Cimer, Atilla

    2012-01-01

    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…

  19. HIV and AIDS--employers grapple with difficult issues.

    Science.gov (United States)

    Pranschke, S C; Wright, B M

    1995-01-01

    HIV infection and AIDS pose special challenges to employers. Myriad laws affect how the employer must respond when an applicant or employee is infected with HIV or is ill due to AIDS. An overall compliance strategy should include thorough knowledge of those laws and a policy on HIV and AIDS, put in place before a crisis occurs. PMID:10172437

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

    Directory of Open Access Journals (Sweden)

    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

    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.

  1. Distraction during learning with hypermedia: Difficult tasks help to keep task goals on track

    Directory of Open Access Journals (Sweden)

    KatharinaScheiter

    2014-03-01

    Full Text Available In educational hypermedia environments, students are often confronted with potential sources of distraction arising from additional information that, albeit interesting, is unrelated to their current task goal. The paper investigates the conditions under which distraction occurs and hampers performance. Based on theories of volitional action control it was hypothesized that interesting information, especially if related to a pending goal, would interfere with task performance only when working on easy, but not on difficult tasks. In Experiment 1, 66 students learned about probability theory using worked examples and solved corresponding test problems, whose task difficulty was manipulated. As a second factor, the presence of interesting information unrelated to the primary task was varied. Results showed that students solved more easy than difficult probability problems correctly. However, the presence of interesting, but task-irrelevant information did not interfere with performance. In Experiment 2, 68 students again engaged in example-based learning and problem solving in the presence of task-irrelevant information. Problem-solving difficulty was varied as a first factor. Additionally, the presence of a pending goal related to the task-irrelevant information was manipulated. As expected, problem-solving performance declined when a pending goal was present during working on easy problems, whereas no interference was observed for difficult problems. Moreover, the presence of a pending goal reduced the time on task-relevant information and increased the time on task-irrelevant information while working on easy tasks. However, as revealed by mediation analyses these changes in overt information processing behavior did not explain the decline in problem-solving performance. As an alternative explanation it is suggested that goal conflicts resulting from pending goals claim cognitive resources, which are then no longer available for learning and problem solving.

  2. Distraction during learning with hypermedia: difficult tasks help to keep task goals on track.

    Science.gov (United States)

    Scheiter, Katharina; Gerjets, Peter; Heise, Elke

    2014-01-01

    In educational hypermedia environments, students are often confronted with potential sources of distraction arising from additional information that, albeit interesting, is unrelated to their current task goal. The paper investigates the conditions under which distraction occurs and hampers performance. Based on theories of volitional action control it was hypothesized that interesting information, especially if related to a pending goal, would interfere with task performance only when working on easy, but not on difficult tasks. In Experiment 1, 66 students learned about probability theory using worked examples and solved corresponding test problems, whose task difficulty was manipulated. As a second factor, the presence of interesting information unrelated to the primary task was varied. Results showed that students solved more easy than difficult probability problems correctly. However, the presence of interesting, but task-irrelevant information did not interfere with performance. In Experiment 2, 68 students again engaged in example-based learning and problem solving in the presence of task-irrelevant information. Problem-solving difficulty was varied as a first factor. Additionally, the presence of a pending goal related to the task-irrelevant information was manipulated. As expected, problem-solving performance declined when a pending goal was present during working on easy problems, whereas no interference was observed for difficult problems. Moreover, the presence of a pending goal reduced the time on task-relevant information and increased the time on task-irrelevant information while working on easy tasks. However, as revealed by mediation analyses these changes in overt information processing behavior did not explain the decline in problem-solving performance. As an alternative explanation it is suggested that goal conflicts resulting from pending goals claim cognitive resources, which are then no longer available for learning and problem solving. PMID:24723907

  3. Penile Corporeal Reconstruction during Difficult Placement of a Penile Prosthesis

    OpenAIRE

    Aboseif, Sherif R.; Kim, Dennis H.; Lesser, Timothy F.; Tran, Viet Q.

    2008-01-01

    For some patients with impotence and concomitant severe tunical/corporeal tissue fibrosis, insertion of a penile prosthesis is the only option to restore erectile function. Closing the tunica over an inflatable penile prosthesis in these patients can be challenging. We review our previous study which included 15 patients with severe corporeal or tunical fibrosis who underwent corporeal reconstruction with autologous rectus fascia to allow placement of an inflatable penile prosthesis. At a mea...

  4. Asthma of difficult handling, not all that hiss is asthma

    International Nuclear Information System (INIS)

    The paper tries about a patient of masculine sex 13 years old who consults initially for square that begins in February of 1999, consistent in cough, breathlessness and difficulty to breathe, he consults to one hospital where it is managed with beta two micronebulized, corticoids endovenous and oxygen being obtained improvement, reason why they give exit. Three days later he consults again for similar square; receiving the same treatment; a week later he presents cough and severe breathing difficulty, for that again consult and he is remitted to the Hospital San Rafael (Bogota) for no-improvement of the square. The paper includes the antecedents, exams, clinical evolution and paraclinics

  5. Difficult-to-treat-pediatric Crohn's disease: focus on adalimumab

    Directory of Open Access Journals (Sweden)

    Zeisler B

    2015-04-01

    Full Text Available Bella Zeisler, Jeffrey S Hyams Division of Digestive Diseases, Hepatology, and Nutrition, Connecticut Children's Medical Center Hartford, University of Connecticut School of Medicine, Department of Pediatrics, Farmington, CT, USA Abstract: Adalimumab is a fully humanized anti-tumor necrosis factor alpha monoclonal antibody that was recently granted regulatory approval in the USA for the treatment of moderate to severe Crohn’s disease (CD in children. Like infliximab, the first biologic agent used to treat pediatric CD, regulatory approval was secured many years following approval for adults. The long delay between adult and pediatric approval has led to many years of off-label use of adalimumab, although it is anticipated that the use of adalimumab may further increase with official regulatory approval. To date, pediatric literature on the use of adalimumab for treatment of CD is limited, and pediatric practitioners have mostly extrapolated from research and experience provided by the adult literature. The aim of this paper is to review the literature regarding adalimumab for the treatment of pediatric CD, and includes a review of landmark adult studies as well as the pivotal pediatric study that facilitated regulatory approval. We also discuss the role of anti-tumor necrosis factor alpha agents including adalimumab in the current treatment paradigm for pediatric CD. Keywords: pediatrics, Crohn's disease, adalimumab, biologic agent

  6. The Lula Government’s First Year: The Difficult Transition

    Directory of Open Access Journals (Sweden)

    Sonia Fleury

    2004-05-01

    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.

  7. 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.)

  8. 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)

  9. Difficult to swallow: patient preferences for alternative valproate pharmaceutical formulations

    Directory of Open Access Journals (Sweden)

    Monali Bhosle

    2009-06-01

    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

  10. Easy and Difficult Performance-Approach Goals: Their moderating effect on the link between task interest and performance attainment

    Directory of Open Access Journals (Sweden)

    Monica Blaga

    2008-06-01

    Full Text Available The purpose of this study was to demonstrate that the positive link between task interest and performance attainment can be negatively affected by the pursuit of difficult performance-approach goals. This was tested in a sample of 60 undergraduate students at a Dutch university. In line with expectations, for difficult performance-approach goals there was no link between task interest and performance attainment. Furthermore, among women this relation turned out to be negative. In an easy performance-approach goal condition, a positive link between task interest and performance attainment was found for both men and women, while in the control condition the same expected positive relation was not found. Theoretical and practical implications of these findings are discussed.

  11. Meeting the challenge of constructing a uniquely difficult barrier wall

    International Nuclear Information System (INIS)

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

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

    Science.gov (United States)

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

    2002-06-13

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

  13. Prediction is Difficult, Especially the Future: A Progress Report

    Directory of Open Access Journals (Sweden)

    Andrew Booth

    2007-03-01

    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.

  14. Difficult OptEase Filter Retrievals After Prolonged Indwelling Times

    Energy Technology Data Exchange (ETDEWEB)

    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

    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.

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

    Directory of Open Access Journals (Sweden)

    Garrett Joanne M

    2006-10-01

    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.

  16. Difficult-to-treat gouty arthritis: a disease warranting better management.

    Science.gov (United States)

    Schlesinger, Naomi

    2011-07-30

    Gouty arthritis is the most common inflammatory arthritis in adults and is characterized by very painful flares. Gouty arthritis results from an elevated body uric acid pool, which leads to deposition of monosodium urate crystals, mainly in the joints. These crystals trigger the release of proinflammatory cytokines, in particular interleukin (IL)-1?, which stimulates inflammation. Gouty arthritis can progress to a chronic, deforming and physically disabling disease through the development of disfiguring tophi, joint destruction and persistent pain. Standard treatments are effective in most patients. Acutely, anti-inflammatory therapies provide rapid pain relief and resolution of flares. Chronically, urate-lowering therapies reduce serum urate levels and, in combination with anti-inflammatory prophylaxis, reduce the risk of flares. However, for a growing number of patients, current standard treatments are ineffective or are contraindicated, largely due to the presence of co-morbidities. Indeed, metabolic syndrome, hypertension, dyslipidaemia, cardiovascular disease, diabetes mellitus and renal impairment are all highly prevalent in individuals with gouty arthritis, and may lead to standard treatments being ineffective or inappropriate. Such patients with difficult-to-treat disease require alternative therapies. Gouty arthritis can have a major impact on health-related quality of life (HR-QOL), especially in patients with difficult-to-treat disease, as revealed by recent studies comparing HR-QOL for patients with gouty arthritis with that of the general population. All studies revealed clinically significant reductions in physical functioning for individuals with gouty arthritis compared with the general population. The difference was particularly marked for patients with difficult-to-treat disease. Gouty arthritis also constitutes an important economic burden through absence from work and medical costs. Again, the burden is greater in patients with difficult-to-treat disease. The development of difficult-to-treat disease reflects the short-comings of current standard treatments in a growing number of gouty arthritis patients. This has been recognized by the pharmaceutical industry and has promoted the development of innovative therapies. An appreciation of the key role of IL-1? in inflammation in gouty arthritis has led to the development of a new class of anti-inflammatory agents that block IL-1? signal transduction. The current IL-1? blockers in trials are rilonacept and canakinumab. Canakinumab, a fully human anti-IL-1? monoclonal antibody, has been shown to produce rapid and sustained pain relief from acute flares in patients with difficult-to-treat disease, and both rilonacept and canakinumab have been shown to reduce the risk of recurrent flares. Promising new therapies for reducing serum urate levels are also being developed. These include the recently approved therapies pegloticase (a pegylated form of the enzyme uricase that converts urate to allantoin), inhibitors of renal urate transporter proteins, and inhibitors of purine nucleotide phosphorylase, an enzyme involved in purine metabolism. Further studies are warranted to establish the value and role of these new therapies in the management of gouty arthritis. These new options should help reduce the growing human burden associated with gouty arthritis, lowering the tophaceous burden, minimizing the risk of flares, and enabling patients to achieve rapid and effective pain relief when flares do occur. PMID:21812506

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

    Science.gov (United States)

    Hernandez, Luis; Smith, Connie Jo

    2009-01-01

    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…

  18. Lung Disease Including Asthma and Adult Vaccination

    Science.gov (United States)

    ... Home Recommended Vaccines for Adults Share Compartir Lung Disease including Asthma and Adult Vaccination Vaccines are especially critical for ... chronic health conditions such as lung disease including asthma. Lung Disease including asthma Influenza vaccine each year to protect ...

  19. Difficult embryo transfers or blood on catheter and assisted reproductive outcomes: a systematic review and meta-analysis.

    Science.gov (United States)

    Phillips, James A S; Martins, Wellington P; Nastri, Carolina O; Raine-Fenning, Nicholas J

    2013-06-01

    We performed a systematic review and meta-analysis to examine whether a difficult embryo transfer or the presence of blood on the transfer catheter affects assisted reproduction outcomes. We searched the following databases: Cochrane Central Register of Controlled Trials (CENTRAL), Database of Abstracts of Reviews of Effects (DARE), MEDLINE, Embase, PsycINFO, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS). We aimed to determine the risk ratio (RR) associated with difficult embryo transfer or the presence of blood on the transfer catheter for the following outcomes: live birth, clinical pregnancy, and miscarriage. We identified 3066 papers, of which 194 were reviewed and nine were included. The outcome of live birth was not reported in any of the included studies and the effect on miscarriage was too imprecise for any conclusions. Pooled analysis of five studies demonstrated lower clinical pregnancy rates following a non-easy embryo transfer (RR=0.75; 95% CI=0.66-0.86). This included three studies showing subjectively difficult transfers reducing clinical pregnancies (RR=0.67; 95% CI=0.51-0.87) and two studies in which the need for additional manoeuvers reduced clinical pregnancies (RR=0.78; 95% CI=0.67-0.91). The presence of blood on the transfer catheter did not affect clinical pregnancy rates (RR=0.96; 95% CI=0.82-1.14) in five studies. We concluded that low quality evidence suggests that a difficult embryo transfer but not a bloody catheter reduces the chance of achieving a clinical pregnancy. More good quality studies are needed to evaluate the effect of difficult embryo transfer and the presence of blood on the catheter on the main outcomes of assisted reproduction. PMID:23347607

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2012-07-01

    Some of refractory gold ores represent one of the difficult processable ores due to fine dissemination and interlocking of the gold grains with the associated sulphide minerals. This makes it impossible to recover precious metals from sulphide matrices by direct cyanide leaching even at high consumption of cyanide solution. Research to solve this problem is numerous. Application of bacteria shows that, some types of bacteria have great affect on sulphides bio-oxidation and consequently facilitate the leaching process. In this paper, leaching of Saudi gold ore, from Alhura area, containing sulphides before cyanidation is studied to recover gold from such ores applying bacteria. The process is investigated using stirred reactor bio-leaching rather than heap bio-leaching. Using statistical analysis the main affecting variables under studied conditions were identified. The design results indicated that the dose of bacteria, retention time and nutrition K{sub 2}SO{sub 4} are the most significant parameters. The higher the bacterial dose and the bacterial nutrition, the better is the concentrate grade. Results show that the method is technically effective in gold recovery. A gold concentrate containing > 100 g/t gold was obtained at optimum conditions, from an ore containing < 2 g/t gold i.e., 10 ml bacterial dose, 6 days retention time, and 6.5 kg/t K{sub 2}SO{sub 4}as bacteria nutrition. (orig.)

  1. Forming competing fear learning and extinction memories in adolescence makes fear difficult to inhibit.

    Science.gov (United States)

    Baker, Kathryn D; Richardson, Rick

    2015-11-01

    Fear inhibition is markedly impaired in adolescent rodents and humans. The present experiments investigated whether this impairment is critically determined by the animal's age at the time of fear learning or their age at fear extinction. Male rats (n = 170) were tested for extinction retention after conditioning and extinction at different ages. We examined neural correlates of impaired extinction retention by detection of phosphorylated mitogen-activated protein kinase immunoreactivity (pMAPK-IR) in several brain regions. Unexpectedly, adolescent rats exhibited good extinction retention if fear was acquired before adolescence. Further, fear acquired in adolescence could be successfully extinguished in adulthood but not within adolescence. Adolescent rats did not show extinction-induced increases in pMAPK-IR in the medial prefrontal cortex or the basolateral amygdala, or a pattern of reduced caudal central amygdala pMAPK-IR, as was observed in juveniles. This dampened prefrontal and basolateral amygdala MAPK activation following extinction in adolescence occurred even when there was no impairment in extinction retention. In contrast, only adolescent animals that exhibited impaired extinction retention showed elevated pMAPK-IR in the posterior paraventricular thalamus. These data suggest that neither the animal's age at the time of fear acquisition or extinction determines whether impaired extinction retention is exhibited. Rather, it appears that forming competing fear conditioning and extinction memories in adolescence renders this a vulnerable developmental period in which fear is difficult to inhibit. Furthermore, even under conditions that promote good extinction, the neural correlates of extinction in adolescence are different than those recruited in animals of other ages. PMID:26472643

  2. Condition Number Regularized Covariance Estimation.

    Science.gov (United States)

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

    2013-06-01

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

  3. Predictive value of preoperative tests in estimating difficult intubation in patients who underwent direct laryngoscopy in ear, nose, and throat surgery

    Directory of Open Access Journals (Sweden)

    Osman Karakus

    2015-04-01

    Full Text Available BACKGROUND AND OBJECTIVES: Predictive value of preoperative tests in estimating difficult intubation may differ in the laryngeal pathologies. Patients who had undergone direct laryngoscopy (DL were reviewed, and predictive value of preoperative tests in estimating difficult intubation was investigated. METHODS: Preoperative, and intraoperative anesthesia record forms, and computerized system of the hospital were screened. RESULTS: A total of 2611 patients were assessed. In 7.4% of the patients, difficult intubations were detected. Difficult intubations were encountered in some of the patients with Mallampati scoring (MS system Class 4 (50%, Cormack-Lehane classification (CLS Grade 4 (95.7%, previous knowledge of difficult airway (86.2%, restricted neck movements (cervical ROM (75.8%, short thyromental distance (TMD (81.6%, vocal cord mass (49.5% as indicated in parentheses (p < 0.0001. MS had a low sensitivity, while restricted cervical ROM, presence of a vocal cord mass, short thyromental distance, and MS each had a relatively higher positive predictive value. Incidence of difficult intubations increased 6.159 and 1.736-fold with each level of increase in CLS grade and MS class, respectively. When all tests were considered in combination difficult intubation could be classified accurately in 96.3% of the cases. CONCLUSION: Test results predicting difficult intubations in cases with DL had observedly overlapped with the results provided in the literature for the patient populations in general. Differences in some test results when compared with those of the general population might stem from the concomitant underlying laryngeal pathological conditions in patient populations with difficult intubation.

  4. Reducing the Burden of Difficult-to-Treat Major Depressive Disorder: Revisiting Monoamine Oxidase Inhibitor Therapy

    OpenAIRE

    Culpepper, Larry

    2013-01-01

    Objective: Difficult-to-treat depression (eg, depression with atypical or anxious symptoms, treatment-resistant depression, or depression with frequent recurrence) is a challenging real-world health issue. This critical review of the literature focuses on monoamine oxidase inhibitor (MAOI) therapy and difficult-to-treat forms of depression.

  5. Deciphering the Distance between Distance Education and Working Professionals in Difficult Geographies

    Science.gov (United States)

    Pandey, Jatin; Singh, Manjari

    2015-01-01

    This study investigates the factors that draw working professionals towards distance education programs, and the factors that sustain their distance education experience. The study is conducted in difficult terrains of Uttarakhand, a hilly state in India which helps us investigate the phenomenon in difficult geographies. Through interviews of ten…

  6. Conditional Sampling for Max-Stable Random Fields

    CERN Document Server

    Wang, Yizao

    2010-01-01

    Max-stable random fields play a central role in modeling extreme value phenomena. Their conditional distributions, however, are notoriously difficult to handle. This makes the prediction problem for such random fields a formidable challenge. Here, we obtain an explicit formula for the conditional probability in general max-linear models, which include a large class of max-stable random fields. As a consequence, we develop an algorithm for efficient and exact sampling from the conditional distributions. Our method provides a computational solution to the difficult prediction problem for max-stable random fields with discrete spectrum. This work offers new tools and a new perspective to many statistical inference problems for spatial extremes, arising, for example, in meteorology, geology, and environmental applications. The results are illustrated with simulated and real data.

  7. Difficult laryngoscopy and intubation in the Indian population: An assessment of anatomical and clinical risk factors

    Directory of Open Access Journals (Sweden)

    Smita Prakash

    2013-01-01

    Full Text Available Background and Aim: Differences in patient characteristics due to race or ethnicity may influence the incidence of difficult airway. Our purpose was to determine the incidence of difficult laryngoscopy and intubation, as well as the anatomical features and clinical risk factors that influence them, in the Indian population. Methods: In 330 adult patients receiving general anaesthesia with tracheal intubation, airway characteristics and clinical factors were determined and their association with difficult laryngoscopy (Cormack and Lehane grade 3 and 4 was analysed. Intubation Difficulty Scale score was used to identify degree of difficult laryngoscopy. Results: The incidence of difficult laryngoscopy and intubation was 9.7% and 4.5%, respectively. Univariate analysis showed that increasing age and weight, male gender, modified Mallampati class (MMC 3 and 4 in sitting and supine positions, inter-incisor distance (IID ?3.5 cm, thyromental (TMD and sternomental distance, ratio of height and TMD, short neck, limited mandibular protrusion, decreased range of neck movement, history of snoring, receding mandible and cervical spondylosis were associated with difficult laryngoscopy. Multivariate analysis identified four variables that were independently associated with difficult laryngoscopy: MMC class 3 and 4, range of neck movement <80°, IID ? 3.5 cm and snoring. Conclusions: We found an incidence of 9.7% and 4.5% for difficult laryngoscopy and difficult intubation, respectively, in Indian patients with apparently normal airways. MMC class 3 and 4, range of neck movement <80°, IID ? 3.5 cm and snoring were independently related to difficult laryngoscopy. There was a high incidence (48.5% of minor difficulty in intubation.

  8. Endostitch-assisted endoscopic Zenker's diverticulostomy: a tried approach for difficult cases.

    Science.gov (United States)

    Nicholas, B D; Devitt, S; Rosen, D; Spiegel, J; Boon, M

    2010-05-01

    The aim was to describe a tried approach to endoscopic Zenker's diverticulostomy, especially in those patients with unfavorable anatomy or smaller pouches who may otherwise be relegated to open repair. The study design was a retrospective case series The setting was an urban, tertiary care university medical center There were seven patients, both inpatient and outpatient, with chief complaints of dysphagia. All had a documented Zenker's diverticulum (ZD) on barium swallow. All of the patients were deemed by the primary surgeon to have some anatomic factor that limited exposure of the diverticulum. The patients underwent Endostitch-assisted endoscopic Zenker's diverticulostomy. Records were retrospectively reviewed, including preoperative and postoperative swallowing status, radiographic findings, operative findings, and follow-up results. Seven patients were reviewed, each of whom had successful endoscopic treatment of ZD. Notably, in each case, an anatomical factor precluded the seating of the gastrointestinal anastomosis (GIA) stapler on the cricopharyngeal bar without the use of endoscopic retention sutures. The majority of the patients were discharged on postoperative day one. All but one patient noted a marked improvement in swallowing function immediately following the procedure and at their outpatient follow-up visit. Endoscopic Zenker's diverticulostomy has been well-described and established as a reliable technique in a majority of cases. We report on our experience using a previously described technique specifically for difficult, unfavorable, or contraindicated cases and suggest the employment of this technique as an alternative method to facilitate endoscopic repair and possibly limit the need for an open approach. PMID:20095994

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

    Scientific Electronic Library Online (English)

    W.P., Zhao; Z.G., Zhang; X.D., Li; D., Yu; X.F., Rui; G.H., Li; G.Q., Ding.

    2009-10-01

    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

  10. Prediction of difficult intubations using conventional indicators; Does rapid sequence intubation ease difficult intubations? A prospective randomised study in a tertiary care teaching hospital

    Directory of Open Access Journals (Sweden)

    Gangadharan Lakshmi

    2011-01-01

    Full Text Available Background : Endotracheal intubations performed in the Emergency Department. Aims : To assess whether conventional indicators of difficult airway can predict a difficult intubation in the Emergency Setting and to investigate the effect of rapid sequence intubation (RSI on ease of intubation. Settings and Design : A prospective randomized study was designed involving 60 patients requiring intubation, over a period of 4 months. Materials and Methods : Demographic profile, details of methods used, airway assessment, ease of intubation, and Cormack and Lehane score were recorded. Airway assessment score and ease of intubation criteria were devised and assessed. Statistical Analysis : Descriptive statistical analysis was carried out. Chi-square/2 × 2, 2 × 3, 3 × 3, Fisher Exact test have been used to find the significance of study parameters on categorical scale between two or more groups. Results : Patients with a Mallampatti score of three or four were found to have worse laryngoscopic views (Cormack-Lehane score, 3 or 4. Of all airway indicators assessed, an increased Mallampatti score was found to have significant correlation with increased difficulty in intubation. The use of RSI was associated with better laryngoscopic views, and easier intubations. Conclusions : An airway assessment using the Mallampatti score is invaluable as a tool to predict a difficult airway and should be performed routinely if possible. RSI aids intubation ease. If not otherwise contraindicated, it should be performed routinely for all intubations in the ED.

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

    Directory of Open Access Journals (Sweden)

    Svetlana P. Vovk

    2012-05-01

    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.

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

    LENUS (Irish Health Repository)

    Malik, M A

    2009-11-01

    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.

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

    Science.gov (United States)

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

  14. Entry on difficult export markets by Chinese domestic firms: the role of foreign export spillovers

    OpenAIRE

    Mayneris, Florian; Poncet, Sandra

    2011-01-01

    In this study, we explore how the intensity of foreign export spillovers in China varies depending on the difficulty of entry on export markets. We rely on different proxies to define what a "difficult" country is and we find that the presence of surrounding foreign exporting firms helps domestic ones to start exporting, especially when destination countries are difficult. While on average exposure to foreign exporters is associated with a 10% increase of the probability that domestic firms f...

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

    OpenAIRE

    Garrett Joanne M; Krebs Erin E; Konrad Thomas R

    2006-01-01

    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 sur...

  16. New Methodologies for Development of High Efficient Machining of Difficult to Cut Materials

    International Nuclear Information System (INIS)

    The article focuses on the automotive and aerospace industries. In these industries the need for enhanced materials performance is necessary if they are to remain competitive in global terms. Unfortunately the material properties, which make them so attractive to the aerospace and automotive industry can also make them difficult to machine. This paper will discuss integrated developments in machining techniques and cutting tools, which are emerging to cope with difficult to cut materials.

  17. Supporting clinical management of the difficult-to-treat TB cases: the ERS-WHO TB Consilium

    Directory of Open Access Journals (Sweden)

    Lia D’Ambrosio

    2015-03-01

    The primary objective of the ERS/WHO TB Consilium is to provide clinical consultation for drug-resistant TB and other difficult-to-treat TB cases, including co-infection with HIV and paediatric cases. Through technical guidance to clinicians managing complex TB cases, the main contribution and outcome of the initiative will be a public health response aimed at achieving correct treatment of affected patients and preventing further development of drug resistance. The Consilum's secondary objective is to ensure monitoring and evaluation of clinical practices on the ground (diagnosis, treatment and prevention.

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

    Scientific Electronic Library Online (English)

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

    Full Text Available 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.

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

    Scientific Electronic Library Online (English)

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

    2013-07-01

    Full Text Available La colecistectomía laparoscópica es uno de los procedimientos quirúrgicos practicados más frecuentemente por el cirujano general y en un importante número de casos se efectúa en pacientes mayores con gran inflamación vesicular, lo que pone a prueba los conocimientos y habilidades del cirujano. Es pe [...] rfectamente posible reconocer, antes del acto quirúrgico, en cuáles pacientes este resultará difícil en mayor o menor grado, para así 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.

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

    Directory of Open Access Journals (Sweden)

    Mary Breheny

    2011-01-01

    Full Text Available Attempts to understand difficult family relationships have ignored the inextricable links between positive and negative relationships. Narrative analysis provides insight into complex relationships within social context. We analysed interviews with older people in New Zealand using levels of narrativity to reveal the negotiations required to manage personal identity at the intersection of competing public narratives. Participants and interviewers used public narratives of family life that reinforce family roles while simultaneously drawing upon alternative narratives of identity and morality. Investigating narratives of difficult family relationships reveals the influence of dominant social norms on the negotiation of social identities through personal stories.

  1. Integration of a difficult airway response team into a hospital emergency response system.

    Science.gov (United States)

    Chmielewska, Monika; Winters, Bradford D; Pandian, Vinciya; Hillel, Alexander T

    2015-06-01

    Hospital-wide emergency response teams have been an area of development for several decades. Highly specialized to address emergent needs, they mimic the cardiac-pulmonary arrest teams established at hospitals nationwide, such as heart attack, brain attack, medical emergency, rapid response, and difficult airway response teams (DART). The DART at Johns Hopkins Hospital is a collaboration of the Anesthesiology and Critical Care Medicine, Otolaryngology-Head and Neck Surgery, General Surgery, and Emergency Medicine departments. This successful model may be used by other hospitals to establish improved and comprehensive care of the difficult airway patient. PMID:25999009

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

    CERN Document Server

    Shaw, Peter J A

    2010-01-01

    You are faced with so many difficult decisions. Often your decision making seems random. It can be swayed by different situations and emotions. You need to be more rigorous in the way you make decisions and yet you have very little time to do so. Experience from others who have made tough decisions and a framework to help you do so would be invaluable. The courage to make decisions is sometimes a bit elusive. It is difficult to find the calmness to be able to make and live with those decisions. There is so much that can be learned from the experience of others. After working through this boo

  3. Difficult Life Events, Selective Migration and Spatial Inequalities in Mental Health in the UK

    Science.gov (United States)

    Tunstall, Helena; Shortt, Niamh K.; Pearce, Jamie R.; Mitchell, Richard J.

    2015-01-01

    Objective Research has indicated that people moving towards neighbourhoods with disadvantaged socio-economic status have poor health, in particular mental health, but the reasons for this are unclear. This study aims to assess why people moving towards more socio-economically deprived areas have poor mental health. It focuses upon the role of difficult life events that may both trigger moves and damage mental health. This study investigates how mental health and socio-spatial patterns of mobility vary between people moving following difficult life events and for other reasons. Methods Longitudinal analysis of British Household Panel Survey data describing adults’ moves between annual survey waves, pooled over ten years, 1996-2006 (N=122,892 observations). Respondents were defined as ‘difficult life event movers’ if they had experienced relationship breakdown, housing eviction/repossession, or job loss between waves. Respondents were categorised as moving to more or less deprived quintiles using their Census Area Statistic residential ward Carstairs score. Mental health was indicated by self-reported mental health problems. Binary logistic regression models of weighted data were adjusted for age, sex, education and social class. Results The migration rate over one year was 8.5%; 14.1% of movers had experienced a difficult life event during this time period. Adjusted regression model odds of mental health problems among difficult life event movers were 1.67 (95% CI 1.35-2.07) relative to other movers. Odds of difficult life events movers, compared to other movers, moving to a less deprived area, relative to an area with a similar level of deprivation, were 0.70 (95% CI 0.58-0.84). Odds of mental health problems among difficult life event movers relocating to more deprived areas were highly elevated at 2.40 (95% CI 1.63-3.53), relative to stayers. Conclusion Difficult life events may influence health selective patterns of migration and socio-spatial trajectories, reducing moves to less deprived neighbourhoods among people with mental illness. PMID:26018595

  4. Identification of abnormal operating conditions and intelligent decision system

    Science.gov (United States)

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

    2011-12-01

    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.

  5. Identificación de factores predictores de técnica epidural dificultosa en la paciente obstétrica / Identifying predictors of difficult epidural technique in pregnant

    Scientific Electronic Library Online (English)

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

    2013-10-01

    Full Text Available Introducción: Los intentos repetidos de punción son factores de riesgo para la aparición de complicaciones neurológicas secundarias a la práctica de la analgesia espinal y aumentan la ansiedad del paciente. El objetivo de este estudio es determinar qué factores son mejores predictores de la colocaci [...] ón dificultosa del catéter epidural en la paciente obstétrica. Material y método: Estudio observacional y prospectivo en 120 gestantes a término que solicitan la analgesia epidural para el trabajo de parto. Se recogen variables demográficas y antecedentes de anestesia espinal previa no exitosa o considerada dificultosa por la paciente. Se identifican variables anatómicas y se clasifica la calidad de los puntos de referencia anatómicos según los criterios publicados por Chien en cuatro grados. Las condiciones de la técnica y la experiencia del anestesiólogo son similares en todos casos. Consideramos punción dificultosa si se necesita más de una punción en la piel o una punción pero más de un cambio de dirección de aguja en el espacio interespinoso. Se recoge el éxito obtenido y las complicaciones de la técnica. Resultados: Fueron calificadas de punción difícil según los criterios del estudio en el 36,67 % de los casos. En la mayoría de los casos la técnica fue efectiva obteniendo una adecuada analgesia. La incidencia de repunción epidural fue de 5 %. En las pacientes clasificadas en el grado 4, la tasa de punción epidural considerada dificultosa supuso un 90 %, necesitando en el 80 % de esos casos 3 o más intentos. En las pacientes con antecedentes personales de técnica neuroaxial dificultosa se encontró dificultad de punción epidural en un 28,57 % de los casos. El hábito corporal no tuvo efecto significativo sobre la tasa de éxito con el primer intento. Discusión: Nuestro estudio representa una buena estimación de la dificultad técnica de un bloqueo neuroaxial. Seria difícil saber si los datos reflejados serían extrapolables a la realización de la técnica en decúbito lateral, donde los puntos de referencia anatómicos son más difíciles de identificar. Conclusiones: Nuestra recogida concluye que el método más fiable para determinar de antemano la posibilidad de una dificultad técnica de colocación del catéter epidural lumbar es un examen de la espalda de la paciente para identificar la calidad de los puntos de referencia anatómicos e identificar la deformidad obvia de la columna vertebral. Abstract in english Introduction: Repeated attempts punctureare risk factors for the appearance of neurologic complications caused by the practice of spinal analgesia and increase patient anxiety. The purpose of this study is to determine which factor sare better predictors of difficult epidural catheter placement in t [...] he obstetric patient. Material and methods: Prospective observational study in 120 pregnant women at term who request edepidural analgesia during labor. Demographic variables and history of difficult or unsuccessful spinal anesthesia were collected. Anatomical variables were identified and the quality of anatomical landmarks was classified according to criteria published by Chien in four grades. The conditions of the technique and the experience of anesthesiologists were similar in all cases. It was considered as difficult puncture that in which was made more than one attempt on skin or more than one change of direction with the epidural needle in interspinous space. We collected the successand complications of the technique. Results: 36.67 % of cases were classified as difficult punctures according to the criteria of the study. In most cases the technique was effective obtaining asuccessful analgesia. The incidence of repeat epidural puncture was 5 %. In patients classified in grade 4, the percentage of difficult epidural puncture was 90 %, requiring in 80 % of the cases 3 or more attempts. In patients with a history of difficult neuraxial technique in 28.57 % of the cases was found difficulty in epidural puncture. Body habitus had no signif

  6. When I Whisper, Nobody Listens: Helping Young People Write about Difficult Issues.

    Science.gov (United States)

    Frost, Helen

    This book offers guidance on how teachers can help their students write about sensitive topics or provide pragmatic suggestions for developing the skill and sensitivity necessary to venture into such difficult terrain. The book addresses students' need to articulate their thoughts and feelings about violence, anger, drug use, peer pressure, and…

  7. Carotid artery stenting by non-femoral arterial approach in patients with difficult anatomy

    Directory of Open Access Journals (Sweden)

    R V Narayana

    2013-01-01

    Full Text Available Background: Carotid endarterectomy (CEA and carotid artery stenting (CAS are safe, effective, and standard methods to treat significant carotid artery stenosis. CAS is generally performed through femoral arterial access. We had six patients with significant carotid artery stenosis, who had difficult anatomy prohibiting a trans-femoral CAS. Those patients were given an option for CEA. However, they refused for surgical intervention. Aim: We investigated the feasibility of performing CAS from a non-femoral arterial approach in patients with difficult anatomies like severe aortic/aorto-iliac disease, tortuous aortic arch, and tortuous carotid artery origin. Materials and Methods: Six patients with difficult anatomy presented to us with either transient ischemic attack or stroke with high-grade carotid artery stenosis. Out of the six patients, three had aorto-iliac disease, one had high-grade coarctation of aorta, two had tortuous aortic arch and or tortuous carotid artery origin. All these patients were treated with CAS though non-femoral arterial route. Results: CAS could be done successfully in all these six patients; four of them were done through trans-brachial arterial route and two were done through a direct carotid artery puncture. There were no new neurological deficits seen in any of the patient post-procedure. Conclusion: CAS can be done safely through non-femoral arterial approach in patients with difficult anatomy.

  8. Comparison of different tests to determine difficult intubation in pediatric patients

    Directory of Open Access Journals (Sweden)

    Mehmet Turan Inal

    2014-12-01

    Full Text Available Background: The difficulties with airway management is the main reason for pediatric anesthesia-related morbidity and mortality. Objective: To assess the value of modified Mallampati test, Upper-Lip-Bite test, thyromental distance and the ratio of height to thyromental distance to predict difficult intubation in pediatric patients. Design: Prospective analysis. Measurements and results: Data were collected from 5 to 11 years old 250 pediatric patients requiring tracheal intubation. The Cormack and Lehane classification was used to evaluate difficult laryngoscopy. Sensitivity, specificity, positive predictive value and AUC values for each test were measured. Results: The sensitivity and specificity of modified Mallampati test were 76.92% and 95.54%, while those for ULBT were 69.23% and 97.32%. The optimal cutoff point for the ratio of height to thyromental distance and thyromental distance for predicting difficult laryngoscopy was 23.5 (sensitivity, 57.69%; specificity, 86.61% and 5.5 cm (sensitivity, 61.54%; specificity, 99.11%. The modified Mallampati was the most sensitive of the tests. The ratio of height to thyromental distance was the least sensitive test. Conclusion: These results suggested that the modified Mallampati and Upper-Lip-Bite tests may be useful in pediatric patients for predicting difficult intubation.

  9. Reaction Workup Planning: A Structured Flowchart Approach, Exemplified in Difficult Aqueous Workup of Hydrophilic Products

    Science.gov (United States)

    Hill, George B.; Sweeney, Joseph B.

    2015-01-01

    Reaction workup can be a complex problem for those facing novel synthesis of difficult compounds for the first time. Workup problem solving by systematic thinking should be inculcated as mid-graduate-level is reached. A structured approach is proposed, building decision tree flowcharts to analyze challenges, and an exemplar flowchart is presented…

  10. How to Handle Difficult Parents: Proven Solutions for Teachers. Second Edition

    Science.gov (United States)

    Tingley, Suzanne Capek

    2012-01-01

    "How to Handle Difficult Parents" is a funny, but practical, guide to working effectively with parents and avoiding unnecessary conflict. Whether you're a teacher (regular or special education) or a coach, this book will give you practical suggestions regarding what to say and how to say it to parents who question your lesson plans, challenge your…

  11. Carcinoma of the laryngeal saccule: a novel biopsy technique to make a difficult diagnosis.

    Science.gov (United States)

    Habashi, S; Padel, A F; Capper, J W

    1989-07-01

    Tumours of the laryngeal ventricle and saccule are rare and difficult to diagnose endoscopically. We present a case in which the tumour remained confined within the saccule, and describe how the problem of obtaining a positive biopsy was overcome. PMID:2760526

  12. Sensory Correlates of Difficult Temperament Characteristics in Preschool Children with Autism

    Science.gov (United States)

    Chuang, I-Ching; Tseng, Mei-Hui; Lu, Lu; Shieh, Jeng-Yi

    2012-01-01

    This study was aimed to investigate the rate of co-occurring sensory processing (SP) dysfunction in children with autism who had a difficult temperament characteristics, and the relationship between SP dysfunction and temperament characteristics in preschool children with autism. A total of 111 children aged 48-84 months, 67 children with autism…

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

    Directory of Open Access Journals (Sweden)

    A. Lesco

    2006-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Bruno Rosa

    2013-01-01

    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.

  15. Psychodynamics and psychopharmacotherapy in the treatment of difficult patients with personality and eating disorders.

    Science.gov (United States)

    Mar?inko, Darko

    2015-09-01

    The complex inter-relationship between external and internal reality, a source of interest and controversy in psychiatry, has come to the foreground more prominently in the context of more integrative understanding of psychopharmacotherapy. This paper discusses the meaning and clinical applications of the psychodynamic related to psychopharmacotherapy for difficult personality and eating disorders patients. The one of the psychodynamic explanations for patients' being difficult is related to their perceived lack of mentalizing (reflective) capacities. Lack of mentalizing capacity implies disturbed view of psychopharmacotherapy. Therapeutic relationship and optimal alliance offers the frame for acceptance of psychiatric drugs as positive and useful for personality and eating disorder patients. Mentalization and intersubjectivity theories have direct implications for clinical practice, and that the notion of the third is particularly useful in understanding what happens in the patient-doctor relationship. PMID:26400147

  16. Detailed statistical analysis plan for the difficult airway management (DIFFICAIR) trial

    DEFF Research Database (Denmark)

    Nørskov, Anders Kehlet; Lundstrøm, Lars Hyldborg; Rosenstock, Charlotte Vallentin; Wetterslev, Jørn

    2014-01-01

    BACKGROUND: Preoperative airway assessment in Denmark is based on a non-specific clinical assessment left to the discretion of the responsible anesthesiologist. The DIFFICAIR trial compares the effect of using a systematic and consistent airway assessment versus a non-specific clinical assessment on the frequency of unanticipated difficult airway management.To prevent outcome bias and selective reporting, we hereby present a detailed statistical analysis plan as an amendment (update) to the prev...

  17. Methods for health surveys in difficult settings: charting progress, moving forward

    OpenAIRE

    Tam Clarence C; Morgan Oliver W; Fenn Bridget; Bilukha Oleg O; Bostoen Kristof; ter Veen Annemarie; Checchi Francesco

    2007-01-01

    Abstract Health surveys are a very important component of the epidemiology toolbox, and play a critical role in gauging population health, especially in developing countries. Research on health survey methods, however, is sparse. In particular, current sampling methods are not well adapted for certain 'difficult' settings, such as emergencies, remote regions without easily available sampling frames, hidden and vulnerable population groups, urban slums and populations living under strong polit...

  18. Difficult Airway due to Retropharyngeal Hematoma after Stabbing to the Neck

    Directory of Open Access Journals (Sweden)

    Kouhei Iwashita

    2014-07-01

    Full Text Available Reports of retropharyngeal hematoma have been scarce in the anesthesiology literature. We report a patient whose trachea was difficult to intubate due to retropharyngeal hematoma after stabbing to the neck. A woman with a knife injury to the common carotid artery required emergency carotid arterioplasty. When tracheal intubation was attempted, marked swelling of the posterior pharyngeal wall made the vocal cords impossible to visualize. Preoperative computed tomography showed a retropharyngeal hematoma. The patient required mechanical ventilation for 2 days.

  19. Use of Adult Fibreoptic Bronchoscope for Difficult Paediatric Intubation: A Case Report

    Directory of Open Access Journals (Sweden)

    Kundan Sandugir Gosavi

    2015-06-01

    Full Text Available Difficult airway management in paediatric patients may require a technique different from the standard one. We report the use of an adult fibreoptic bronchoscope and J tipped guidewire to intubate a child having temporo-mandibular joint ankylosis. Spontaneous respiration was maintained and local anaesthesia was provided to the upper airway during the procedure and the successful use of this technique avoided the requirement of surgical airway.

  20. Extending the use of familiar microswitches to difficult daily situations: two case evaluations.

    Science.gov (United States)

    Lancioni, G E; Singh, N N; O'Reilly, M F; Campodonico, F; Scalini, L; Oliva, D

    2003-06-01

    This study assessed the possibility of successfully extending the use of familiar microswitches by two adults with multiple disabilities to a difficult, standing-with-support situation. Analysis showed that the introduction of the familiar microswitches into this situation increased the participants' constructive engagement; they had repeated contacts with the microswitch systems and activated them fairly consistently. For one of the participants, improvement also occurred in terms of mood (smiling) and standing time. PMID:12831272

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

    OpenAIRE

    Bruce WJ; Rooney J; Hutabarat SR; Atkinson MC; Goldberg JA; Walsh WR

    2000-01-01

    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 osteoto...

  2. Rhinoplasty. The Difficult Nasal Tip: Total Resection of the Alar Cartilages

    OpenAIRE

    Rodriguez-Camps, Salvador

    2008-01-01

    There are many ways to reconstruct and make nasal tips more attractive. Sometimes we cannot find the best way unless we at least remove all surplus from the tip. This may occur in primary or secondary rhinoplasty. In principle, anything is possible when relocating and reconstructing. However, sometimes we face reality when we uncover the tip: broken or bulging cartilages that are difficult to put right. For this reason, in 1987 we thought of totally resectioning the alar cartilages in a case ...

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

    OpenAIRE

    Ana Rebelo; Pedro Moutinho Ribeiro; António Pinto Correia; José Cotter

    2012-01-01

    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...

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

    OpenAIRE

    Subramani, Sudhakar; Poopalalingam, Ruban

    2014-01-01

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

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

    OpenAIRE

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

    2014-01-01

    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 hi...

  6. Retroperitoneal non-functioning paraganglioma: A difficult tumour to diagnose and treat

    Directory of Open Access Journals (Sweden)

    Emma Gannan

    2015-01-01

    Full Text Available Paragangliomas are rare neoplasms arising from cells of the primitive neural crest. These tumours are often difficult to diagnose and treat. We report a case of a 42 year old female presenting with abdominal pain who had a retroperitoneal tumour situated at the aortic bifurcation. Serum catecholamine levels were normal. Complete resection of the tumour was performed. The histological examination and immunohistochemical analyses concluded the diagnosis of an organ of Zuckerkandl paraganglioma.

  7. 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)

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

    2013-09-01

    Full Text Available 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.

  8. Bayesian Sampling using Condition Indicators

    DEFF Research Database (Denmark)

    Faber, Michael H.; Sørensen, John Dalsgaard

    2002-01-01

    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 ...

  9. Combined radiological-endoscopic management of difficult bile duct stones: 18-year single center experience

    Science.gov (United States)

    Cannavale, Alessandro; Bezzi, Mario; Cereatti, Fabrizio; Lucatelli, Pierleone; Fanello, Gianfranco; Salvatori, Filippo Maria; Fanelli, Fabrizio; Fiocca, Fausto; Donatelli, Gianfranco

    2015-01-01

    Objectives: Clinical evidence regarding radiological–endoscopic management of intrahepatic bile duct stones is currently lacking. Our aim is to report our 18-year experience in combined radiological–endoscopic management of intrahepatic difficult bile duct stones. Methods: From June 1994 to June 2012, 299 symptomatic patients with difficult bile duct stones were admitted to our institution. Percutaneous transhepatic cholangiography (PTC)/biliary drainage/s was performed, dilating the PTC track to 10 or 16 French within 3–7 days. Afterward we carried out percutaneous transhepatic cholangioscopy (PTCS) with electrohydraulic lithotripsy (EHL) and/or interventional radiology techniques. Follow up was made with clinical/laboratory tests and ultrasound (US). We retrospectively analyzed our radiological–endoscopic approach and reported our technical and clinical outcomes. Results: Complete stone clearance was achieved in 298 patients after a maximum of 4 consecutive sessions. Most patients (64.6%) were treated with PTCS/EHL alone, while the remaining with radiological techniques alone (26%) or a combination of both techniques (13.3%). Recurrence of stones occurred in 45 cases (15%, Tsunoda class III and class IV) within 2 years and were successfully retreated. Major adverse events were: 5 (1.6%) cases of massive bleeding that required embolisation, 2 (0.66%) perforations of the common bile duct and 31 cases (10.3%) of acute cholangitis managed with medical therapy or intervention. Conclusion: After 18 years of experience we demonstrated that our combined radiological–endoscopic approach to ‘difficult bile duct stones‘ may result in both immediate and long-term clearance of stones with a low rate of adverse events. PMID:26557890

  10. Debris-filled biliary system: a difficult diagnosis on MRI and MRCP.

    Science.gov (United States)

    Shaikh, Faiq; Elazzazi, Mohamed; Ryan, Andrew; Semelka, Richard C

    2012-01-01

    We describe a debris-filled biliary system as a difficult diagnosis using magnetic resonance imaging and magnetic resonance cholangiopancreatography (MRCP). A male patient aged 60 years showed a nonvisualized biliary system due to complete filling with debris. The following imaging features were observed: mild heterogeneity of intermediate signal on T2-weighted, MRCP and T1-weighted images and mild heterogeneous enhancement of periportal tissue on early and late postcontrast images. The absence of simple-appearing bile on T2 or MRCP images made the diagnosis of dilated, debris-filled biliary system challenging. PMID:22370138

  11. Decontamination estimate and demonstration test results on road in the return difficult area

    International Nuclear Information System (INIS)

    This paper compared evaluation results of decontamination simulation with the actual decontamination result. One of the major factors that decontamination does not proceed, is that the decontamination results are unpredictable. JAEA has developed the software that can be predictive simulation of decontamination with a simple user interface. The purpose of this study is that to evaluate the simulation accuracy. JAEA evaluated accuracies that compared simulation results of decontamination simulation with the actual decontamination result using ultra-high water jet in the returning difficult area. Prediction accuracy was consistent with the range of ±50%. (author)

  12. Difficult diagnosis of the fragile X syndrome made possible by direct detection of DNA mutations.

    OpenAIRE

    Tarleton, J; Wong, S; Heitz, D.; Schwartz, C

    1992-01-01

    Genetic recombination near the fragile X locus (Xq27.3) has frequently been a problem in linkage studies of families in which the fragile X is segregating. This case report illustrates the resolution of a difficult situation in a fragile X family for whom cytogenetic studies were inconclusive and where recombination had twice confounded attempts at prenatal DNA diagnosis by RFLP analysis. Using a newly developed DNA probe, StB12.3, for direct detection of DNA instability in the fragile X locu...

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

    DEFF Research Database (Denmark)

    Skak, Morten; Bloze, Gintautas

    2013-01-01

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

  14. Effect of Tracheostomy on Weaning Parameters in Difficult-to-Wean Mechanically Ventilated Patients: A Prospective Observational Study

    Science.gov (United States)

    Lim, Chor-Kuan; Ruan, Sheng-Yuan; Lin, Feng-Ching; Wu, Chao-Ling; Chang, Hou-Tai; Jerng, Jih-Shuin; Wu, Huey-Dong; Yu, Chong-Jen

    2015-01-01

    Background and Objective Weaning parameters are commonly measured through an endotracheal tube in mechanically ventilated patients recovering from acute respiratory failure, however this practice has rarely been evaluated in tracheostomized patients. This study aimed to investigate changes in weaning parameters measured before and after tracheostomy, and to explore whether the data measured after tracheostomy were associated with weaning outcomes in difficult-to-wean patients. Methods In a two-year study period, we enrolled orotracheally intubated patients who were prepared for tracheostomy due to difficult weaning. Weaning parameters were measured before and after the conversion to tracheostomy and compared, and the post-tracheostomy data were tested for associations with weaning outcomes. Results A total of 86 patients were included. After tracheostomy, maximum inspiratory pressure (mean difference (?) = 4.4, 95% CI, 2.7 to 6.1, P<0.001), maximum expiratory pressure (? = 5.4, 95% CI, 2.9 to 8.0, P<0.001) and tidal volume (? = 33.7, 95% CI, 9.0 to 58.5, P<0.008) significantly increased, and rapid shallow breathing index (? = -14.6, 95% CI, -25.4 to -3.7, P<0.009) and airway resistance (? = -4.9, 95% CI, -5.8 to -4.0, P<0.001) significantly decreased. The patients who were successfully weaned within 90 days of the initiation of mechanical ventilation had greater increments in maximum inspiratory pressure (5.9 vs. 2.4, P = 0.04) and maximum expiratory pressure (8.0 vs. 2.0, P = 0.02) after tracheostomy than those who were unsuccessfully weaned. Conclusions In conclusion, the conversion from endotracheal tube to tracheostomy significantly improved the measured values of weaning parameters in difficult-to-wean patients who subsequently weaned successfully from the mechanical ventilator. The change was significant only for airway resistance in patients who failed weaning. Trial Registration ClinicalTrials.gov NCT01312142 PMID:26379127

  15. Evaluation of Rapid Molecular Detection Assays for Salmonella in Challenging Food Matrices at Low Inoculation Levels and Using Difficult-to-Detect Strains.

    Science.gov (United States)

    Ryan, Gina; Roof, Sherry; Post, Laurie; Wiedmann, Martin

    2015-09-01

    Assays for detection of foodborne pathogens are generally initially evaluated for performance in validation studies carried out according to guidelines provided by validation schemes (e.g., AOAC International or the International Organization for Standardization). End users often perform additional validation studies to evaluate the performance of assays in specific matrices (e.g., specific foods or raw material streams of interest) and with specific pathogen strains. However, these types of end-user validations are typically not well defined. This study was conducted to evaluate a secondary end user validation of four AOAC-validated commercial rapid detection assays (an isothermal nucleic acid amplification, an immunoassay, and two PCR-based assays) for their ability to detect Salmonella in two challenging matrices (dry pet food and dark chocolate). Inclusivity was evaluated with 68 diverse Salmonella strains at low population levels representing the limit of detection (LOD) for each assay. One assay detected all strains at the LOD, two assays detected multiple strains only at 10 times the LOD, and the fourth assay failed to detect two strains (Salmonella bongori and S. enterica subsp. houtenae) even at 1,000 times the LOD; this assay was not further evaluated. The three remaining assays were subsequently evaluated for their ability to detect five selected Salmonella strains in food samples contaminated at fractional levels. Unpaired comparisons revealed no significant difference between the results for each given assay and the results obtained with the reference assay. However, analysis of paired culture-confirmed results revealed assay false-negative rates of 4 to 26% for dry pet food and 12 to 16% for dark chocolate. Overall, our data indicate that rapid assays may have high false-negative rates when performance is evaluated under challenging conditions, including low-moisture matrices, strains that are difficult to detect, injured cells, and low inoculum levels. PMID:26319716

  16. Sieve Wald and QLR Inferences on Semi/nonparametric Conditional Moment Models

    OpenAIRE

    Chen, Xiaohong; Pouzo, Demian

    2014-01-01

    This paper considers inference on functionals of semi/nonparametric conditional moment restrictions with possibly nonsmooth generalized residuals, which include all of the (nonlinear) nonparametric instrumental variables (IV) as special cases. These models are often ill-posed and hence it is difficult to verify whether a (possibly nonlinear) functional is root-$n$ estimable or not. We provide computationally simple, unified inference procedures that are asymptotically valid ...

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

    OpenAIRE

    Babalola Ogunkola; David Samuel

    2011-01-01

    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 ...

  18. Too difficult to govern? An assessment of the governability of transport biofuels in the EU

    International Nuclear Information System (INIS)

    Transport biofuels are currently the subject of heated debate in the EU. In the past decade the deployment of these technologies has been justified by claims of attractive environmental, geopolitical and rural development benefits. However, expectations have rapidly turned into deep criticism regarding the sustainability of these technologies and the desirability of pursuing the biofuel path. This situation has generated an on-going controversy and policy deadlock at EU level. This study explores these issues from a governance perspective. Employing the concept of system governability, derived from interactive governance theory, it attempts to shed some light on the problems facing the governance of biofuels and on how the quality of the governance system could be improved. The analysis showed that the governability of the system decreased substantially in the period 2003–2012 due to increasing governing needs and decreasing governing capacity. The quality of the governance system can be improved by (i) improving governing capacity by reducing conflicts among governing actors, advancing consistency among institutions and creating capacity at international and global level; and (ii) promoting advanced technologies and adjusting societal ambitions and expectations regarding biofuels. - highlights: • Biofuels in the EU are significantly more difficult to govern today than in 2003. • This is due to the qualities of the system to be governed and the governing system. • Sustainable biofuel systems are inherently difficult to govern

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

    LENUS (Irish Health Repository)

    Maharaj, C H

    2008-02-01

    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.

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

    Directory of Open Access Journals (Sweden)

    AndreasVon Leupoldt

    2010-11-01

    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.

  1. ?Use of a Novel Hydrosurgery Device in Surgical Debridement of Difficult-to-heal Wounds???.

    Science.gov (United States)

    Pascone, Prof Michelle; Papa, Giovanni; Ranieri, Alessandro

    2008-05-01

    ??? Debridement is a fundamental step in the management of all chronic and acute cutaneous wounds. Versajet™ Hydrosurgery System (Smith & Nephew, Hull, UK) is a novel waterjet dissection device designed to surgically debride difficult wounds. The authors used this new system on a variety of difficult chronic and acute lesions of different etiology (eg, necrotic infected traumatic and chronic wounds, burns, and post-surgical wounds), which were then managed with adequate dressings or different wound closure techniques such as skin grafting, use of dermal substitutes, negative pressure wound therapy (V.A.C.®, KCI, San Antonio, Tex), or treatment by secondary intention.Debridement can be safely accomplished in a brief operating time with sufficient tissue selectivity and eclecticism. Satisfactory results often were obtained with a single operating session. After debridement, the quality of the wound bed was ideal for accelerating endogenous wound healing or maximizing the effectiveness of other therapeutic measures. The authors believe this hydrosurgery device (Versajet) is a selective, safe, and innovative tool for debridement that allows for better control, can reduce collateral damage, and subsequently achieve overall better outcomes than conventional debridement techniques. PMID:25942415

  2. The clinical practice with difficult patients in the collective imaginary of psychology students

    Directory of Open Access Journals (Sweden)

    Heloisa Aguetoni Cambuí

    2014-06-01

    Full Text Available The conducts that occur in the context of intersubjectivity are arranged from unconscious psychological fields which influence individual and collective practices. Therefore, it becomes important to consider the collective imagination of psychology students as this may interfere about the exercise of their clinical practice. The aim of this study was to investigate the collective imaginary of psychology students about the clinical practice with patients considered difficult in the analytic setting. Based on the psychoanalytic method, this research utilized the Procedure of Drawings-Stories with Theme in group interview, for the purpose of discuss on the vicissitudes of contemporary clinical work with these patients. In the present study, participated eight undergraduates of the eighth semester of a psychology course.The resulting material of the interview constituted by drawings-stories and the narrative was psychoanalytically analyzed, in the light of the Multiple Fields Theory proposed by Herrmann and in dialogue with the winnicottian thought, allowing to apprehend the follows fields of affective-emotional meaning: “Insecurity”, “Perfect Therapist”, “Mutuality”, “Experience”, “Negation of Madness” and “Madness as tal”. In general the imaginary manifestations of psychology students constitute the analytic relationship with the difficult patients by mobilizing feelings of insecurity, distress, anxiety, incapacity and helplessness.

  3. Ant colonies outperform individuals when a sensory discrimination task is difficult but not when it is easy.

    Science.gov (United States)

    Sasaki, Takao; Granovskiy, Boris; Mann, Richard P; Sumpter, David J T; Pratt, Stephen C

    2013-08-20

    "Collective intelligence" and "wisdom of crowds" refer to situations in which groups achieve more accurate perception and better decisions than solitary agents. Whether groups outperform individuals should depend on the kind of task and its difficulty, but the nature of this relationship remains unknown. Here we show that colonies of Temnothorax ants outperform individuals for a difficult perception task but that individuals do better than groups when the task is easy. Subjects were required to choose the better of two nest sites as the quality difference was varied. For small differences, colonies were more likely than isolated ants to choose the better site, but this relationship was reversed for large differences. We explain these results using a mathematical model, which shows that positive feedback between group members effectively integrates information and sharpens the discrimination of fine differences. When the task is easier the same positive feedback can lock the colony into a suboptimal choice. These results suggest the conditions under which crowds do or do not become wise. PMID:23898161

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

    Directory of Open Access Journals (Sweden)

    Ileana Valdivia Álvarez

    2009-09-01

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

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

    Scientific Electronic Library Online (English)

    Ileana, Valdivia Álvarez; Rogelio, Odales Ibarra.

    2009-09-01

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

  6. Open Boundary Conditions for Dissipative MHD

    Energy Technology Data Exchange (ETDEWEB)

    Meier, E T

    2011-11-10

    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.

  7. Successful management of a difficult cancer pain patient by appropriate adjuvant and morphine titration

    Directory of Open Access Journals (Sweden)

    Shiv PS Rana

    2011-01-01

    Full Text Available Morphine has been used for many years to relieve cancer pain. Oral morphine (in either immediate release or modified release form remains the analgesic of choice for moderate or severe cancer pain. The dose of oral morphine is titrated up to achieve adequate relief from pain with minimal side effects. Antidepressant and anticonvulsant drugs, when used in addition to conventional analgesics, give excellent relief from cancer pain. Most cancer pain responds to pharmacological measures with oral morphine but some pain like neuropathic and bony pain, pain in children and elderly age group, and advanced malignancy pain are very difficult to treat. Here, we report the management of a similar patient of severe cancer pain and the difficulty that we came across during dose titration of oral morphine and adjuvant analgesic.

  8. 980nm laser for difficult-to-treat basal cell carcinoma

    Science.gov (United States)

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

    2013-06-01

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

  9. Plasma-activated sintering (PAS) - A new consolidation method for difficult-to-sinter materials

    Science.gov (United States)

    Hensley, Jonathan, Jr.; Shan, Chien H.; Risbud, Subhash H.; Groza, Joanna R.

    Plasma-activated sintering (PAS) is a novel powder consolidation method that densifies materials in a very short time at high temperature in a high current discharge. We assume that the application of instantaneous pulsed electric power activates the particle surface and this surface activation contributes to enhanced sintering due to the 'in-situ' cleaning of particle surfaces and concentrated heating. The accelerated densification in PAS is also attributed to the effects of subsequent resistance heating and pressure application. We summarize examples of the PAS consolidation process as applied to difficult-to-sinter powder materials, such as covalent, additive-free AlN, Nb3Al, and superconducting (Bi(1.7),Pb(0.3))Sr2Ca(2.1)Cu(3.1)O(x) ceramics. The absence of significant grain growth during the densification process and related microstructural benefits of PAS processing are highlighted.

  10. Virtual endoscopy-a new assessment tool in difficult airway management.

    Science.gov (United States)

    Ahmad, I; Millhoff, B; John, M; Andi, K; Oakley, R

    2015-09-01

    Preemptive mapping of the airway is a useful adjunct to conventional clinical assessments when airway management planning for patients with complex head and neck pathology. Nasendoscopy is frequently used for this purpose but is also invasive and poorly tolerated in a subset of patients and, even in expert hands, may not allow complete visualization of the glottis and subglottic structures. We present a novel tool for difficult airway management planning in the form of virtual endoscopy by applying free online OsiriX software to head and neck computed tomographic scans to generate a "fly-through" airway reconstruction. To highlight how well virtual endoscopy correlates to conventional fibreoscopy, we compare both of these assessment tools in 3 patients with glottic, subglottic, and multilevel airway pathologies. Virtual endoscopy represents a unique, noninvasive, safe, and accurate airway assessment and educational resource, which warrants further exploration. PMID:26229015

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

    International Nuclear Information System (INIS)

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

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

    Directory of Open Access Journals (Sweden)

    Navratil Marta

    2013-01-01

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

  13. The Brain Mechanisms Underlying the Cognitive Benefits of Bilingualism may be Extraordinarily Difficult to Discover

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    Kenneth R. Paap

    2014-12-01

    Full Text Available The hypothesis that coordinating two or more languages leads to an enhancement in executive functioning has been intensely studied for the past decade with very mixed results. The purpose of this review and analysis is to consider why it has been (and will continue to be difficult to discover the brain mechanisms underlying any cognitive benefits to bilingualism. Six reasons are discussed: 1 the phenomenon may not actually exist; 2 the cognitive neuroscientists investigating bilingual advantages may have been studying the wrong component of executive functioning; 3 most experiments use risky small numbers of participants and are underpowered; 4 the neural differences between groups do not align with the behavioral differences; 5 neural differences sometimes suffer from valence ambiguity, that is, disagreements whether “more” implies better or worse functioning and 6 neural differences often suffer from kind ambiguity, that is, disagreements regarding what type of mental events the pattern of activation in a region-of-interest actually reflects.

  14. Impact of online training on delivering a difficult medical diagnosis: Acquiring communication skills.

    Science.gov (United States)

    Saint-Dizier de Almeida, Valérie; Agnoletti, Marie-France

    2015-09-01

    This paper deals with developing and assessing the training of physicians to deliver a difficult diagnosis to patients. The training is provided by a web-based self-training package. This online training emphasizes the structural, functional and relational dimensions of interviews delivering a serious diagnosis, and a logical set of recommendations for behavior towards the patient. The content is illustrated by numerous delivery interview sequences that are described and for which commentary is provided. This online package was expected to enable physicians to acquire new skills and change their mental picture of diagnosis delivery. Here we discuss the assessment of training in managing the delivery of a serious diagnosis. The approach taken and the methods used to measure knowledge and skills are presented. PMID:25959340

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

    DEFF Research Database (Denmark)

    Vudayagiri, Sindhu; Skov, Anne Ladegaard

    2014-01-01

    Silicone elastomers are used as dielectric electroactive polymers for making actuators, generators, sensors, and as artificial muscles in medical applications. Current requirements in the actuator manufacturing put a strict limitation on the thickness of the elastomers, such that a maximum permissible thickness is around 25–50?µm. The relatively small Young's modulus for these elastomers is a requirement for actuation capabilities. However, peeling and release of such films during manufacture processes are very difficult. To ease the release of the films, techniques such as the use of release agents like surfactants and detergents, incorporating resins in the silicone matrix and grafting/adding low surface energy functionalities to the silicone elastomer have been tested. The methods used are required not to interfere with the Young's modulus and the dielectric permittivity in a negative way. Polysorbate-20, a non-ionic surfactant, fulfills all requirements and gives the lowest peel forces for the films.

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

    International Nuclear Information System (INIS)

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

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

    Directory of Open Access Journals (Sweden)

    Adrienne van Randen

    2009-04-01

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

  18. Difficult Hypertension Clinic Utilizing a Nurse Specialist: A Cost-Efficient Model for the Modern Era?

    Science.gov (United States)

    van der Merwe, Walter; van der Merwe, Veronica

    2015-09-01

    In the modern era in New Zealand, there has been a lack of specialist hypertension clinics where family practitioners might refer patients with difficult-to-treat or resistant hypertension. A new specialist referral hypertension clinic was established in 2009 at North Shore Hospital, Auckland, employing a model of care where much of the follow-up work is done by a nurse specialist. The authors review data from the first 1000 patients discharged from the clinic. Mean (treated) blood pressure improved by -26/12 mm Hg over an average of three visits, two thirds of which were to nurse specialist clinics. The authors propose this as a cost-efficient model that could easily be duplicated in other centers. PMID:25991503

  19. Categories children find easy and difficult to process in figural analogies

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    ClaireEStevenson

    2014-08-01

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

  20. Double guidewire technique vs transpancreatic precut sphincterotomy in difficult biliary cannulation

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    Young Wook Yoo

    2013-01-01

    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.

  1. Evaluation of Success Rate of Ultrasound-Guided Venous Cannulation in Patients with Difficult Venous Access

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    S Etezazizn

    2010-10-01

    Full Text Available "nBackground/Objective: We evaluated a new ultrasound-guided approach to percutaneous cephalic vein or basilic vein cannulation in patients with difficult intravenous access. "nPatients and Methods: Patients who required intravenous access and were candidates for surgical approach, or central venous catheterization were enrolled into the study. They had at least three unsuccessful attempts at establishing a peripheral intravenous line. By using a 7.5-MHz ultrasound probe, the cephalic or basilic vein was identified and then cannulated with a conventional venous cannula. The time from probe placement to cannulation, the number of attempts and complications were recorded. "nResults: Eighty-eight patients were enrolled; 28 (31.8% female and 60 (68.2% male. The intravenous (IV drug abusers consisted of 29 patients (33% which were all men (48% of males. The procedure was successful in 94.3% and failed in five cases (5.7% after three attempts. The mean time of procedure was 175±153 seconds. There was a significant difference between IV drug abusers (231±203 and non IV drug abusers (149±118 regarding access time (p-value=0.012. The procedure was successful after one attempt in 61 patients (73.5%, two attempts in 20 patients (24.1% and three attempts in two patients (2.4%. The cannula was dislodged in three cases after one hour of follow-up. No other complications happened. Conclusion: Ultrasound-guided cephalic and basilic vein cannulation is safe and time saving, has a high success rate in patients with difficult peripheral intravenous access, and may be used as the first step in these patients before the other more invasive alternatives.  

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

    DEFF Research Database (Denmark)

    Rosenstock, Charlotte Vallentin; ThØgersen, Bente

    2012-01-01

    Awake flexible fiberoptic intubation (FFI) is the gold standard for management of anticipated difficult tracheal intubation. The purpose of this study was to compare awake FFI to awake McGrath® video laryngoscope, (MVL), (Aircraft Medical, Edinburgh, Scotland, United Kingdom) intubation in patients with an anticipated difficult intubation. The authors examined the hypothesis that MVL intubation would be faster than FFI.

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

    Directory of Open Access Journals (Sweden)

    Holland Carolyn

    2006-10-01

    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.

  4. Laparoscopic liver resection for hepatocellular carcinoma in cirrhotic patients. Feasibility of nonanatomic resection in difficult tumor locations

    Directory of Open Access Journals (Sweden)

    Marco Casaccia

    2011-01-01

    Full Text Available Background: Surgical resection for hepatocellular carcinoma (HCC in cirrhotic patients remains controversial because of high morbidity and recurrence rates. Laparoscopic resection of liver tumors has recently been developed and could reduce morbidity. The aim of this study was to evaluate retrospectively our results for laparoscopic liver resection (LLR for HCC including lesions in the posterosuperior segments of the liver in terms of feasibility, outcome, recurrence and survival. Materials and Methods: Between June 2005 and February 2009, we performed 20 LLR for HCC. Median age of the patients was 66 years. The underlying cirrhosis was staged as Child A in 17 cases and Child B in 3. Results: LLR included anatomic resection in six cases and nonanatomic resection in 14. Eleven procedures were associated in nine (45% patients. Median tumor size and surgical margins were 3.1 cm and 15 mm, respectively. A conversion to laparotomy occurred in one (5% patient for hemorrhage. Mortality and morbidity rates were 0% and 15% (3/20. Median hospital stay was 8 days (range: 5-16 days. Over a mean follow-up period of 26 months (range: 19-62 months, 10 (50% patients presented recurrence, mainly at distance from the surgical site. Treatment of recurrence was possible in all the patients, including orthotopic liver transplantation in three cases. Conclusions: LLR for HCC in selected patients is a safe procedure with good short-term results. It can also be proposed in tumor locations with a difficult surgical access maintaining a low morbidity rate and good oncological adequacy. This approach could have an impact on the therapeutic strategy of HCC complicating cirrhosis as a treatment with curative intent or as a bridge to liver transplantation.

  5. PREDICTING DIFFICULT INTUBATION IN SURGICAL PATIENT S SCHEDULED FOR GENERAL ANAESTHESIA: A PROSPECTIVE ST UDY OF 435 PATIENTS

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    Udita

    2013-04-01

    Full Text Available ABSTRACT: BACKGROUND: Unanticipated difficult tracheal intubation is a si gnificant source of morbidity and mortality in anaesthetic practice whic h can be reduced by identification of potential difficult intubation. OBJECTIVE: We aimed the present study to know the incidence of difficult intubation, factors associated with it an d the predictive value of various airway predictors in anticipating difficult visualization of larynx and difficult intubation. METHODS: 435 adult patients (>18 year undergoing general ana esthesia with intubation were examined preoperatively for demographic details (age, sex, weig ht, dentition, airway pathology and six airway predictors i.e. Inter Incisor Gap (IIG, Modif ied Mallampatti Grading (MMPG, Upper lip bite test (ULBT, Thyromental distance (TMD, Stern omental distance (SMD and subluxation of mandible (SLM. All patients were anaesthetized usi ng standard protocol with thiopentone (5mg/kg and succinylcholine (1.5 mg/kg. On direct laryngoscopy, Cormack Lehane (CL grading was noted. CL grade I, II was defined as ea sy visualization of larynx (EVL and CL grade III, IV as difficult visualization of larynx (DVL. Difficult intubation score (DIS was calculated as sum of CL grade and number of intubation attempts. D IS of less than or equal to 4 was defined as easy intubation (EI and DIS > 4 was defined as difficult intubation (DI.Sensitivity, specificity, positive and negative predictive value, po sitive and negative likelihood ratios(LR and odd’s ratio value for six airway predictor tests was calculated by standard formulae. RESULTS: Incidence of DVL was 12.65% (n=55 and DI was 9.65 % (n=42, with no failed intubation. All airway tests had very high negative predictive value (>90% which implicates they identify easy intubations more precisely. MMPG and ULBT were found as nearly perfect airway predictors for difficult intubation having od ds ratio of 85.23 (95% CI 25.42- 285.89% and 65.45 (95% CI 25.69-166.7% respectively, along with very high sensitivity of 92.80% and 85.7% respectively. Presence of ULBT III is the best predictor of difficult intubation (+LR 21.97 and absence of MMPG III, IV is the best predictor of difficult intubation (-LR 0.091. Abnormal dentition and airway pathology also increase the ris k of difficult intubation, P<0.001. CONCLUSION: We conclude that ULBT and MMPG are “nearly perfect” airway predictors and should be used routinely during pre-anesthetic visit for screening of difficult intubation.

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

    OpenAIRE

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

    2008-01-01

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

  7. Fluoroscopy-guided lumbar drainage of cerebrospinal fluid for patients in whom a blind beside approach is difficult

    Energy Technology Data Exchange (ETDEWEB)

    Chee, Choong Guen; Lee, Guen Young; Lee, Joon Woo; Lee, Eu Gene; Kang, Heung Sik [Dept. of Radiology, Seoul National University Bundang Hospital, Seongnam (Korea, Republic of)

    2015-08-15

    To evaluate the rates of technical success, clinical success, and complications of fluoroscopy-guided lumbar cerebrospinal fluid drainage. This retrospective study was approved by the Institutional Review Board of our hospital, and informed consent was waived. Ninety-six procedures on 60 consecutive patients performed July 2008 to December 2013 were evaluated. The patients were referred for the fluoroscopy-guided procedure due to failed attempts at a bedside approach, a history of lumbar surgery, difficulty cooperating, or obesity. Fluoroscopy-guided lumbar drainage procedures were performed in the lateral decubitus position with a midline puncture of L3/4 in the interspinous space. The catheter tip was positioned at the T12/L1 level, and the catheter was visualized on contrast agent-aided fluoroscopy. A standard angiography system with a rotatable C-arm was used. The definitions of technical success, clinical success, and complications were defined prior to the study. The technical and clinical success rates were 99.0% (95/96) and 89.6% (86/96), respectively. The mean hospital stay for an external lumbar drain was 4.84 days. Nine cases of minor complications and eight major complications were observed, including seven cases of meningitis, and one retained catheter requiring surgical removal. Fluoroscopy-guided external lumbar drainage is a technically reliable procedure in difficult patients with failed attempts at a bedside procedure, history of lumbar surgery, difficulties in cooperation, or obesity.

  8. Fluoroscopy-guided lumbar drainage of cerebrospinal fluid for patients in whom a blind beside approach is difficult

    International Nuclear Information System (INIS)

    To evaluate the rates of technical success, clinical success, and complications of fluoroscopy-guided lumbar cerebrospinal fluid drainage. This retrospective study was approved by the Institutional Review Board of our hospital, and informed consent was waived. Ninety-six procedures on 60 consecutive patients performed July 2008 to December 2013 were evaluated. The patients were referred for the fluoroscopy-guided procedure due to failed attempts at a bedside approach, a history of lumbar surgery, difficulty cooperating, or obesity. Fluoroscopy-guided lumbar drainage procedures were performed in the lateral decubitus position with a midline puncture of L3/4 in the interspinous space. The catheter tip was positioned at the T12/L1 level, and the catheter was visualized on contrast agent-aided fluoroscopy. A standard angiography system with a rotatable C-arm was used. The definitions of technical success, clinical success, and complications were defined prior to the study. The technical and clinical success rates were 99.0% (95/96) and 89.6% (86/96), respectively. The mean hospital stay for an external lumbar drain was 4.84 days. Nine cases of minor complications and eight major complications were observed, including seven cases of meningitis, and one retained catheter requiring surgical removal. Fluoroscopy-guided external lumbar drainage is a technically reliable procedure in difficult patients with failed attempts at a bedside procedure, history of lumbar surgery, difficulties in cooperation, or obesity

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

    Directory of Open Access Journals (Sweden)

    Kirschfink Michael

    2010-07-01

    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.

  10. Principle conditioning

    OpenAIRE

    Nanasiova, Olga

    2003-01-01

    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.

  11. Resilience and responses to the experience of trauma – a fascinating but difficult study area

    Directory of Open Access Journals (Sweden)

    Szwajca, Krzysztof

    2014-06-01

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

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

    Directory of Open Access Journals (Sweden)

    N Botha

    2008-06-01

    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.

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

    DEFF Research Database (Denmark)

    Damgaard, Christian

    2011-01-01

    A novel method for measuring plant-plant interactions in undisturbed semi-natural and natural plant communities where it is difficult to distinguish individual plants is discussed. It is assumed that the ecological success of the different plant species in the plant community may be adequately measured by plant cover and vertical density (a measure that is correlated to the 3-dimensional space occupancy and biomass). Both plant cover and vertical density are measured in a standard pin-point analysis in the beginning and at the end of the growing season. In the outlined competition model the vertical density at the end of the growing season is assumed to be a function of the cover of all species at the start of the growing season, and the cover at the start of the growing season is assumed to be a function of the vertical density of all species at the end of the previous growing season. The method allows direct measurements of the competitive effects of neighbouringzplants on plant performance and the estimation of parameters that describe the ecological processes of plantplant interactions during the growing season as well as the process of survival and recruitment between growing seasons. Additionally, the presented method is suited for testing different ecological hypothesis on competitive interactions along environmental gradients, investigating the importance of competition, as well as predicting the likelihood of different ecological scenarios.

  14. Physical constraint as psychological holding: Mental-health treatment for difficult and violent adolescents in France.

    Science.gov (United States)

    Gansel, Yannis; Lézé, Samuel

    2015-10-01

    The phrase "Contraindre est thérapeutique"-constraining is therapeutic-underpins the principle of numerous interventions within the field of mental health in France, ranging from traditional psychiatric units to the courthouse to violence management and prevention of dangerousness. The treatment of violence in "difficult and violent adolescents" provides a paradigmatic and revealing example of this tendency. The aim of this article is to understand how the clinical category-contenir, or "to contain"-was formed and is used. The perspective taken is that of the political anthropology of mental health and the article combines a genealogical approach of the notion with a multisite ethnographical study (conducted between September 2008 and June 2012 in three facilities for adolescent care). This study will show how "psychological holding" is used to justify "physical constraint" in the treatment of adolescent crisis and violence. Furthermore, we will see how this "dirty work", delegated to front-line professionals (educators, social workers, nurses), is used within a moral economy of suffering that promotes care and control measures in a population largely from immigrant backgrounds, judged to be both potentially vulnerable and dangerous. PMID:26048583

  15. [A case of Salmonella-infected thoracoabdominal aortic aneurysm making final diagnosis difficult].

    Science.gov (United States)

    Tokuno, Osamu; Kagawa, Daiki; Uchida, Daisuke; Kinoshita, Shouhiro; Iwata, Kentaro

    2011-05-01

    We report a case of thoracoabdominal aortic aneurysm (TAAA) due to Salmonella Enteritidis making final diagnosis difficult. A 63-year-old man with a history of diabetes mellitus, hypertension, and cerebral infarction was seen elsewhere for a 40 degrees C fever, vomiting, and shaking on day 1 after onset. He was diagnosed with Salmonella bacteremia and hospitalized by us for intensive care. Computed tomography (CT), magnetic resonance imaging (MRI), and ultrasound imaging did not, however, show critical findings of aneurysm, endocarditis, or osteomyelitis, and laboratory testing suggest significant inflammatory symptoms. He did not respond to antibiotics, but had an intermittent low fever during the first hospitalization. On day 48 after onset during the second hospitalization, abdominal CT showed an aneurysm -3 cm in diameter in the thoracoabdominal aorta above the renal artery- small enough to have been missed in earlier diagnosis. Surgery and TAAA graft replacement were done on day 64. Bacterial culture of the graft showed no Salmonella growth due to long-term in vivo antibiotic exposure. He recovered without significant complications, with oral ciprofloxacin antibiotic therapy continued to the present. This case indicates the importance of an early diagnosis through continuous blood culture and imaging for Salmonella sp blood stream infection. PMID:21706850

  16. Difficult case of a trans-septal puncture: Use of a "SafeSept" guidewire.

    Science.gov (United States)

    Zucchetti, Martina; Casella, Michela; DelloRusso, Antonio; Fassini, Gaetano; Carbucicchio, Corrado; Russo, Eleonora; Marino, Vittoria; Catto, Valentina; Tondo, Claudio

    2015-08-26

    A 69-year-old man was admitted to our center to undergo catheter ablation of paroxysmal atrial fibrillation refractory to antiarrhythmic drug therapy. This procedure required access to the left atrium through the interatrial septum. During hospitalization, the patient performed routinely pre-procedure transthoracic echocardiography and gadolinium-enhanced cardiac magnetic resonance showing a normal anatomy of both the fossa ovalis and the interatrial septum. Access to the left atrium proved difficult and several unsuccessful attempts to perform the trans-septal puncture were made under both fluoroscopy and intracardiac echocardiography guidance, even with radiofrequency energy delivery. Finally, trans-septal puncture was successfully carried out using a novel nitinol J-shaped "SafeSept" trans-septal guidewire, designed to cross the interatrial septum through the trans-septal needle thanks to a special sharp tip. Moreover, thanks to its rounded J shape that reduces the risk of atrial perforation, the "SafeSept" guidewire, when advanced into the left atrium, becomes atraumatic. PMID:26322190

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

    DEFF Research Database (Denmark)

    Whiteley, Louise Emma; Borgelt, Emily L

    2015-01-01

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

  18. Difficult case of a trans-septal puncture: Use of a “SafeSept” guidewire

    Science.gov (United States)

    Zucchetti, Martina; Casella, Michela; DelloRusso, Antonio; Fassini, Gaetano; Carbucicchio, Corrado; Russo, Eleonora; Marino, Vittoria; Catto, Valentina; Tondo, Claudio

    2015-01-01

    A 69-year-old man was admitted to our center to undergo catheter ablation of paroxysmal atrial fibrillation refractory to antiarrhythmic drug therapy. This procedure required access to the left atrium through the interatrial septum. During hospitalization, the patient performed routinely pre-procedure transthoracic echocardiography and gadolinium-enhanced cardiac magnetic resonance showing a normal anatomy of both the fossa ovalis and the interatrial septum. Access to the left atrium proved difficult and several unsuccessful attempts to perform the trans-septal puncture were made under both fluoroscopy and intracardiac echocardiography guidance, even with radiofrequency energy delivery. Finally, trans-septal puncture was successfully carried out using a novel nitinol J-shaped “SafeSept” trans-septal guidewire, designed to cross the interatrial septum through the trans-septal needle thanks to a special sharp tip. Moreover, thanks to its rounded J shape that reduces the risk of atrial perforation, the “SafeSept” guidewire, when advanced into the left atrium, becomes atraumatic. PMID:26322190

  19. Strontium isotopes as an indicator of human migration – easy questions, difficult answers

    Directory of Open Access Journals (Sweden)

    Szostek Krzysztof

    2015-06-01

    Full Text Available Isotope analyses of bones and teeth allow us to study phenomena which occurred in the history of human species and which are difficult to capture by traditional anthropological methods. Measuring oxygen, nitrogen and carbon isotope levels in the skeleton makes it possible to reconstruct climatic changes, diet and/or the weaning process. Among isotopes used in such analyses are strontium isotopes, helpful in analysing migration and studying the mobility of historical and prehistoric human populations. In this respect, the proportion of two isotopes, the heavier 87Sr and the lighter 86Sr, is measured, following their extraction from the bioapatite of the bone mineral. Released from rocks in the weathering process, strontium permeates individual components of inanimate and animate environments, and then finds its way, together with food, to the human body. Thanks to comprehensive environmental studies and the measurement of the strontium ratio 87Sr/86Sr in various animal tissues it is possible to determine the local isotope background for the environment. Values obtained by analysing human skeletons referenced against the range of environmental isotope variability enable researchers to trace back the location inhabited by the individual or group.

  20. Structured parallel therapy with parents in time-limited psychotherapy with children experiencing difficult family situations.

    Science.gov (United States)

    Haugvik, Marianne

    2013-10-01

    The aim of this article is to discuss how parallel therapy work with parents can be structured to achieve the goals of therapy with their children. Time-limited psychotherapy with children is a structured therapeutic method, where the goal and the number of sessions are contracted together with the child and parents. In this study, we focus on parallel parental therapy for three separate families whose children are experiencing difficult family situations. Six main themes emerge from our interviews with the parents and an analysis of session notes: The parents expressed positive experiences with the therapy; their perspectives about the family situation changed; they reported positive changes on behalf of the children, and they reported an increasing number of factors to explain these changes. In addition, a number of positive changes in the family situation itself were reported, and the parents were increasingly concerned with understanding their children's expressions. Our findings indicate that this therapy method gives parents an opportunity for reflection and mentalization, which is found to be crucial to the child's mental health. Based on these findings, we suggest some guidelines for effectively engaging in therapy work with parents. PMID:23060603

  1. Vía aérea difícil en pediatría: signos predictores. Artículo de revisión Difficult airway in pediatrics. Predicting signs

    Directory of Open Access Journals (Sweden)

    Judith Pérez Lara

    2007-03-01

    Full Text Available El manejo de la Vía Aérea es la A del ABC de la medicina moderna y representa un reto para el anestesiólogo experto, y aún más para el que se encuentra en entrenamiento. Una intubación difícil no anticipada es una emergencia médica, si no es tratada con rapidez y de forma apropiada, puede condicionar problemas serios y hasta la muerte del paciente. En el presente artículo se hace una revisión del diagnóstico precoz de esta entidad, mediante signos predictores, teniendo en cuenta algunas de las características principales de la vía aérea del niño que la diferencian del adulto.The management of the airway is the A in the ABC of current medicine, and represents a challenge for an expert in anestesiology, and much more for those in the training process. An anticipated difficult intubation is a medical emergency which must be treated rapidly and properly because it can result in serious problems and lead to death. In this article a review of the early diagnosis of this entity through predicting signs , considering some main features at the child airway which are different from the adult's was carried out.

  2. Vía aérea difícil en pediatría: signos predictores. Artículo de revisión / Difficult airway in pediatrics. Predicting signs

    Scientific Electronic Library Online (English)

    Judith, Pérez Lara; Alina, Acosta Menoya; Emilio, Díaz Gener; Ángel, González Martínez.

    2007-03-01

    Full Text Available El manejo de la Vía Aérea es la A del ABC de la medicina moderna y representa un reto para el anestesiólogo experto, y aún más para el que se encuentra en entrenamiento. Una intubación difícil no anticipada es una emergencia médica, si no es tratada con rapidez y de forma apropiada, puede condiciona [...] r problemas serios y hasta la muerte del paciente. En el presente artículo se hace una revisión del diagnóstico precoz de esta entidad, mediante signos predictores, teniendo en cuenta algunas de las características principales de la vía aérea del niño que la diferencian del adulto. Abstract in english The management of the airway is the A in the ABC of current medicine, and represents a challenge for an expert in anestesiology, and much more for those in the training process. An anticipated difficult intubation is a medical emergency which must be treated rapidly and properly because it can resul [...] t in serious problems and lead to death. In this article a review of the early diagnosis of this entity through predicting signs , considering some main features at the child airway which are different from the adult's was carried out.

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

    Directory of Open Access Journals (Sweden)

    Ana Rebelo

    2012-01-01

    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.

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

    Directory of Open Access Journals (Sweden)

    Andrea Pizzini

    2007-06-01

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

  5. Effect of 2.4-D addition to glyphosate for difficult control weeds species

    Directory of Open Access Journals (Sweden)

    Hudson Kagueyama Takano

    2013-04-01

    Full Text Available The 2,4-D has been one of the most widely used herbicide in combination with glyphosate, especially in applications desiccation pre-planting. The objective of this study was to evaluate the effect of adding 2,4-D to glyphosate for the control of weed species considered difficult to control (Commelina benghalensis, Richardia brasiliensis, Euphorbia heterophylla, Spermacoce latifolia, Ipomoea grandifolia e Conyza spp.. The experimental design was completely randomized, and treatments were arranged in a 3 x 4 factorial design with four replications. The first factor was composed of stages of development of weeds (2-4, 4-6 e >10 leaves and the second factor by treatment with glyphosate (720 g i.a. ha-1, 2,4-D (670 g i.a. ha-1 glyphosate+2,4-D (720+670 g i.a. ha-1 and a treatment without herbicide (control. For Conyza spp. in green house, were performed three additional herbicide treatments varying doses of glyphosate and 2,4-D. The addition of 2,4-D to glyphosate is crucial to accelerate and improve weed control considered unwieldy as those studied in this work.

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

    Scientific Electronic Library Online (English)

    Jon M., Hanifin.

    2007-02-01

    Full Text Available Esta revisão resume a abordagem geral e a filosofia na conduta de casos difíceis de dermatite atópica. Existe uma variedade de tratamentos, assim como de médicos, mas muitos falham e não propiciam um alívio adequado aos pacientes, o que leva a uma alternativa dispendiosa, ou seja, um atitude que vis [...] a procurar alergias e complica ainda mais o tratamento desses pacientes. Se nós, como dermatologistas, oferecermos um aconselhamento racional sobre prevenção e cuidados com a pele, junto com uma terapia antiinflamatória eficaz e estável, nossos pacientes irão parar de procurar abordagens irracionais. O novo fluxo de informações sobre a barreira epidérmica propicia uma base para investigar e tratar as doenças xeróticas em uma fase mais precoce durante o primeiro ano de vida, com a esperança de que os problemas crescentes relacionados à dermatite atópica e asma possam ser atenuados com medidas simples e seguras. Abstract in english This review summarizes the general approach and philosophy of managing difficult atopic dermatitis. There are as many regimens as there are physicians, but too many fail to provide patients with adequate relief. This leads to the wasteful alternative - an allergy-seeking behavior that makes caring f [...] or these patients even more complicated. If we, as dermatologists, provide rational counseling on prevention and skin care along with effective, stable, anti-inflammatory therapy, our patients may stop seeking irrational approaches. The new flood of information relating to epidermal barrier provides a basis for seeking and treating xerotic conditions earlier during infancy with the hope that the increasing problems with atopic dermatitis and asthma may be lessened with simple and safe measures.

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

    Directory of Open Access Journals (Sweden)

    Jon M. Hanifin

    2007-02-01

    Full Text Available This review summarizes the general approach and philosophy of managing difficult atopic dermatitis. There are as many regimens as there are physicians, but too many fail to provide patients with adequate relief. This leads to the wasteful alternative - an allergy-seeking behavior that makes caring for these patients even more complicated. If we, as dermatologists, provide rational counseling on prevention and skin care along with effective, stable, anti-inflammatory therapy, our patients may stop seeking irrational approaches. The new flood of information relating to epidermal barrier provides a basis for seeking and treating xerotic conditions earlier during infancy with the hope that the increasing problems with atopic dermatitis and asthma may be lessened with simple and safe measures.Esta revisão resume a abordagem geral e a filosofia na conduta de casos difíceis de dermatite atópica. Existe uma variedade de tratamentos, assim como de médicos, mas muitos falham e não propiciam um alívio adequado aos pacientes, o que leva a uma alternativa dispendiosa, ou seja, um atitude que visa procurar alergias e complica ainda mais o tratamento desses pacientes. Se nós, como dermatologistas, oferecermos um aconselhamento racional sobre prevenção e cuidados com a pele, junto com uma terapia antiinflamatória eficaz e estável, nossos pacientes irão parar de procurar abordagens irracionais. O novo fluxo de informações sobre a barreira epidérmica propicia uma base para investigar e tratar as doenças xeróticas em uma fase mais precoce durante o primeiro ano de vida, com a esperança de que os problemas crescentes relacionados à dermatite atópica e asma possam ser atenuados com medidas simples e seguras.

  8. Spine Conditioning Program

    Science.gov (United States)

    ... in this conditioning program include: • Cervical spine (neck) • Trapezius (neck and upper back) • Latissimus dorsi (side and ... Head Rolls _______________________________________________________________________ Main muscles worked: Cervical spine muscles, trapezius You should feel this stretch all around your ...

  9. Learning Increases the Survival of Newborn Neurons Provided that Learning Is Difficult to Achieve and Successful

    Science.gov (United States)

    Curlik, Daniel M., II; Shors, Tracey J.

    2011-01-01

    Learning increases neurogenesis by increasing the survival of new cells generated in the adult hippocampal formation [Shors, T. J. Saving new brain cells. "Scientific American," 300, 46-52, 2009]. However, only some types of learning are effective. Recent studies demonstrate that animals that learn the conditioned response (CR) but require more…

  10. Audiometry for the Retarded: With Implications for the Difficult-to-Test.

    Science.gov (United States)

    Fulton, Robert T., Ed.; And Others

    Directed to professionals with a basic knowledge of audiological principles, the text presents a review of audiological assessment procedures and their applicability to the retarded. Pure-tone, speech, and Bekesy audiometry are described. Also discussed are differential diagnosis of auditory impairments, conditioning and audiological assessment,…

  11. Study of issues in difficult-to-weld thick materials by hybrid laser arc welding

    Science.gov (United States)

    Mazar Atabaki, Mehdi

    There is a high interest for the high strength-to-weight ratio with good ductility for the welds of advanced alloys. The concern about the welding of thick materials (Advanced high strength steels (AHSS) and 5xxx and 6xxx series of aluminum alloys) has stimulated the development of manufacturing processes to overcome the associated issues. The need to weld the dissimilar materials (AHSS and aluminum alloys) is also required for some specific applications in different industries. Hence, the requirement in the development of a state-of-the-art welding procedure can be helpful to fulfill the constraints. Among the welding methods hybrid laser/arc welding (HLAW) has shown to be an effective method to join thick and difficult-to-weld materials. This process benefits from both advantages of the gas metal arc welding (GMAW) and laser welding processes. The interaction of the arc and laser can help to have enough penetration of weld in thick plates. However, as the welding of dissimilar aluminum alloys and steels is very difficult because of the formation of brittle intermetallics the present work proposed a procedure to effectively join the alloys. The reports showed that the explosively welded aluminum alloys to steels have the highest toughness, and that could be used as an "insert" (TRICLAD) for welding the thick plates of AHSS to aluminum alloys. Therefore, the HLAW of the TRICLAD-Flange side (Aluminum alloy (AA 5456)) to the Web side (Aluminum alloys (AA 6061 and AA 5456)) and the TRICLAD-Flange side (ASTM A516) to the Web side (AHSS) was studied in the present work. However, there are many issues related to HLAW of the dissimilar steels as well as dissimilar aluminum alloys that have to be resolved in order to obtain sound welds. To address the challenges, the most recent welding methods for joining aluminum alloys to steels were studied and the microstructural development, mechanical properties, and on-line monitoring of the welding processes were discussed as well. The heat and mass transfer and the issues in joining of dissimilar alloys by the hybrid laser/arc welding process (HLAW) were explicitly explained in details. A finite element model was developed to simulate the heat transfer in HLAW of the aluminum alloys. Two double-ellipsoidal heat source models were considered to describe the heat input of the gas metal arc welding and laser welding processes. An experimental procedure was also developed for joining thick advanced high strength steel plates by using the HLAW, by taking into consideration different butt joint configurations. The geometry of the weld groove was optimized according to the requirements of ballistic test, where the length of the softened heat affected zone should be less than 15.9 mm measured from the weld centerline. Since the main issue in HLAW of the AHSS was the formation of the pores, the possible mechanisms of the pores formation and their mitigation methods during the welding process were investigated. Mitigation methods were proposed to reduce the pores inside in the weld area and the influence of each method on the process stability was investigated by an on-line monitoring system of the HLAW process. The groove angle was optimized for the welding process based on the allowed amount of heat input along the TRICLADRTM interface generated by an explosive welding. The weld was fractured in the heat affected zone of the aluminum side in the tensile test. The microharness was shown that the temperature variation caused minor softening in the heat affected zone satisfying the requirement that the width of the softened heat affected zone in the steel side falls within 15.9 mm far away from the weld centerline. The microstructure analysis showed the presence of tempered martensite at the vicinity of the weld area, which it was a cause of softening in the heat affected zone.

  12. Easy and Difficult Performance-Approach Goals: Their moderating effect on the link between task interest and performance attainment

    OpenAIRE

    Monica Blaga; Van Yperen, Nico W.

    2008-01-01

    The purpose of this study was to demonstrate that the positive link between task interest and performance attainment can be negatively affected by the pursuit of difficult performance-approach goals. This was tested in a sample of 60 undergraduate students at a Dutch university. In line with expectations, for difficult performance-approach goals there was no link between task interest and performance attainment. Furthermore, among women this relation turned out to be negative. In an easy perf...

  13. The Vanishing Veins: Difficult Venous Access in a Patient Requiring Translumbar, Transhepatic, and Transcollateral Central Catheter Insertion

    OpenAIRE

    YAACOB, Yazmin; Zakaria, Rozman; Mohammad, Zahiah; Ralib, Ahmad Razali MD; Muda, Ahmad Sobri

    2011-01-01

    Central venous catheter placement is indicated in patients requiring long-term therapy. With repeated venous catheterisations, conventional venous access sites can be exhausted. This case illustrates the expanding role of radiology in managing difficult venous access. We present a case of translumbar, transhepatic, and transcollateral placement of central catheter in a woman with a difficult venous access problem who required lifelong parenteral nutrition secondary to short bowel syndrome. Th...

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

    OpenAIRE

    Palmer, Glen A.; Boykin, Angela M.; Bizzell, Dan L.; Daiss, Doyle D.

    2006-01-01

    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 administ...

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

    Scientific Electronic Library Online (English)

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

    2013-06-01

    Full Text Available Aim: precut sphincterotomy refers to a variety of endoscopic techniques that are used in order to access the bile duct when conventional methods of cannulation have failed. There are not significant data (such as efficacy, safety) about the use of different techniques of precutting at the same sessi [...] on. We have described our experience with combined precut sphincterotomy (CPS) and we have compared our results to the use of an isolated precut. Patients and methods: we have performed 247 precuts of a total of 2.390 ERCPs. Patients were distributed according to the type of precut practiced: Needle-knife, transpancreatic and combined precut sphincterotomies. "Combined precut" consisted in performing first a transpancreatic sphincterotomy and, if the access was not achieved, then performing a needle-knife sphincterotomy in the same session. The data about safety and efficacy were prospectively collected. The complications were defined according to the consensus criteria. Results: we performed precutting techniques in 247 patients. Needle-knife, transpancreatic, and combined precuts were performed in 125 (6.9%), 74 (4.1%) and 48 (2.6%) patients, respectively. Bile duct cannulation was successful in 48 patients (100%) in the group of combined precut, 121 patients (96.8%) in the transpancreatic group, and 67 patients (90.5%) in the needle-knife group (p = 0.03). There were not differences in complications rates between the three groups. There was no pancreatitis in the combined precut group. The complications were successfully managed with conservative treatment. Conclusions: combined precut sphincterotomy seems to be a safe and successful technique in those cases of difficult bile duct cannulation.

  16. Stepwise optimization of a low-temperature Bacillus subtilis expression system for "difficult to express" proteins.

    Science.gov (United States)

    Welsch, Norma; Homuth, Georg; Schweder, Thomas

    2015-08-01

    In order to improve the overproduction of "difficult to express" proteins, a low-temperature expression system for Bacillus subtilis based on the cold-inducible promoter of the desaturase-encoding des gene was constructed. Selected regulatory DNA sequence elements from B. subtilis genes known to be cold-inducible were fused to different model genes. It could be demonstrated that these regulatory elements are able to mediate increased heterologous gene expression, either by improved translation efficiency or by higher messenger RNA (mRNA) stability. In case of a cold-adapted ?-galactosidase from Pseudoalteromonas haloplanktis TAE79A serving as the model, significantly higher expression was achieved by fusing its coding sequence to the so-called "downstream box" sequence of cspB encoding the major B. subtilis cold-shock protein. The combination of this fusion with a cspB 5'-UTR stem-loop structure resulted in further enhancement of the ?-galactosidase expression. In addition, integration of the transcription terminator of the B. subtilis cold-inducible bkd operon downstream of the target genes caused a higher mRNA stability and enabled thus a further significant increase in expression. Finally, the fully optimized expression system was validated by overproducing a B. subtilis xylanase as well as an ?-glucosidase from Saccharomyces cerevisiae, the latter known for tending to form inclusion bodies. These analyses verified the applicability of the engineered expression system for extracellular and intracellular protein synthesis in B. subtilis, thereby confirming the suitability of this host organism for the overproduction of critical, poorly soluble proteins. PMID:25851716

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

    Scientific Electronic Library Online (English)

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

    2003-08-01

    Full Text Available OBJETIVOS: O objetivo deste estudo foi analisar a eficácia do método laparoscópico em casos de abdome agudo inflamatório de difícil avaliação, quanto à acurácia, sensibilidade, especificidade e valores preditivos positivo e negativo. MÉTODO: Foram examinados, prospectivamente, 29 doentes com suspeit [...] a clínica de abdome agudo inflamatório, que após exames clínico e complementares não esclarecedores, foram submetidos à laparoscopia diagnóstica e/ou terapêutica. RESULTADOS: A precisão diagnóstica do exame foi de 96,5%. Com relação à terapêutica, 58,6 % dos doentes foram tratados por laparoscopia, 34,4% clinicamente e 6,8 % por laparotomia. A taxa de complicação foi de 10,3%, com ausência de mortalidade nesta série. Os doentes submetidos ao tratamento laparoscópico, tiveram alta hospitalar em média 36 horas após o procedimento. CONCLUSÕES: A laparoscopia mostrou-se um método de elevada acurácia diagnóstica, que permitiu manejo terapêutico satisfatório, associado à baixa morbidez e à recuperação pós-operatória precoce. Abstract in english OBJECTIVE: The aim of this study is to analize the efficacy of laparoscopy in cases of acute inflamatory abdomen of difficult diagnosis, according to accuracy, sensitivity, specificity and negative and positive predictive values. METHODS: The authors studied, prospectively, 29 patients with clinical [...] suspicion of inflamatory acute abdomen, that, after inconclusive clinical and complemental investigations were submitted to diagnostic and / or therapeutic laparoscopy. RESULTS: In 96,5 % of the patients the procedure confirmed the diagnosis; 58,6 % of the patients were treated by laparoscopy, 6,8% by laparotomy and 34,4% received clinical treatment. The complication rate was 10,3 %, with no mortality in this study. Patients treated by laparoscopy were discharged from hospital in 36 hours after the procedure. CONCLUSIONS: Laparoscopy proved to be a good diagnostic and therapeutic method in acute inflamatory diseases of the abdomen and is associated with lower hospitalization time and lower rate of complications.

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

    Directory of Open Access Journals (Sweden)

    Maria Eduarda da Mota Rocha

    2009-09-01

    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.

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

    Directory of Open Access Journals (Sweden)

    Bruce WJ

    2000-06-01

    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.

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

    DEFF Research Database (Denmark)

    Thorup, Signe Strann; Darvann, T.A.

    2010-01-01

    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.

  1. [A Case of Pyoderma Gangrenosum of the Penis Difficult to Distinguish from Fournier Gangrene].

    Science.gov (United States)

    Taguchi, Makoto; Inoue, Takaaki; Nishida, Teruhisa; Kawabata, Takashi; Kawakita, Shigenari; Muguruma, Kouei; Murota, Takashi; Kinoshita, Hidefumi; Matsuda, Tadashi

    2015-11-01

    Here, we report a case of pyoderma gangrenosum of the penis which was difficult to distinguish from Fournier gangrene. The patient was a 54-year-old male who was aware of redness and swelling of the glanspenis for 1 month prior to a consultation at our department. Although he was diagnosed with herpes andtreated at a nearby hospital, his symptoms did not improve. Subsequently, the patient visited ourdepartment following the onset of pain and fever. During his initial consultation, he had a fever of 39 °C as well as redness and swelling of the glans penis with partial spontaneous purulent discharge. His blood test revealed an elevated white blood cell count (20, 000/?l) and C-reactive protein (19.1 mg/dl). Because Fournier gangrene was suspected, administration of broad-spectrum antimicrobial agents was initiated butproved to be ineffective. An abscess (2 cm in diameter) was also noted in the umbilical region.Enterococcus faecalis was detected by the bacterial culture ; and therefore, Fournier gangrene was diagnosed. A partial penectomy was performed to control the infection. Pathological findings showed only non-specific inflammation ; however, fever persisted postoperatively and blood test results showed no improvement. Furthermore, new abscess lesions emerged on the right heel and back. Because the re-performed abscess bacterial culture test result was negative, pyoderma gangrenosum was suspected, and he was started on oral prednisolone (20 mg/day). On the following day, his fever subsided and his blood test results also showed improvement. A final diagnosis of pyoderma gangrenosum was ultimately made. PMID:26699892

  2. 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)

    Akinfiev, Nikolay N.; Plyasunov, Andrey V.

    2014-02-01

    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:

  3. Camera calibration under optimal conditions

    OpenAIRE

    Ricolfe Viala, Carlos; Sánchez Salmerón, Antonio José

    2011-01-01

    Different methods based on photogrammetry or self-calibration exist to calibrate intrinsic and extrinsic camera parameters and also for data pre- and post-processing. From a practical viewpoint, it is quite difficult to decide which calibration method gives accurate results and even whether any data processing is necessary. This paper proposes a set of optimal conditions to resolve the calibration process accurately. The calibration method uses several images of a 2D pattern. Optimal conditio...

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

    Science.gov (United States)

    Parakh, Jal S.; Slesnick, Irwin L.

    1989-01-01

    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)

  5. Condition numbers and scale free graphs

    OpenAIRE

    Acosta, Gabriel; Graña, Matías; Pinasco, Juan Pablo

    2006-01-01

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

  6. Distraction during learning with hypermedia: difficult tasks help to keep task goals on track

    OpenAIRE

    Scheiter, Katharina; Gerjets, Peter; Heise, Elke

    2014-01-01

    In educational hypermedia environments, students are often confronted with potential sources of distraction arising from additional information that, albeit interesting, is unrelated to their current task goal. The paper investigates the conditions under which distraction occurs and hampers performance. Based on theories of volitional action control it was hypothesized that interesting information, especially if related to a pending goal, would interfere with task performance only when workin...

  7. Distraction during learning with hypermedia: Difficult tasks help to keep task goals on track

    OpenAIRE

    KatharinaScheiter; ElkeHeise

    2014-01-01

    In educational hypermedia environments, students are often confronted with potential sources of distraction arising from additional information that, albeit interesting, is unrelated to their current task goal. The paper investigates the conditions under which distraction occurs and hampers performance. Based on theories of volitional action control it was hypothesized that interesting information, especially if related to a pending goal, would interfere with task performance only when workin...

  8. 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

  9. Optimal for difficult roofs. East-west orientation; Optimal fuer schwierige Daecher. Ost-West-Ausrichtung

    Energy Technology Data Exchange (ETDEWEB)

    Bouattour, Mohamed Ali [Solar Frontier Europe GmbH, Muenchen (Germany)

    2013-10-01

    With the help of CIS solar modules the unfavorable east-west roofs can be also use efficiently and profitably, since the good weak-light performance almost compensates the weak light components characterized irradiation conditions. [German] Mit Hilfe der CIS-Solarmodule lassen sich auch die unguenstige Ost-West-Daecher effizient und profitabel nutzen, da das gute Schwachlichtverhalten die hier von schwachen Lichtanteilen gepraegten Einstrahlungsverhaeltnisse nahezu kompensiert.

  10. “Well, it’s Difficult, Very Difficult

    OpenAIRE

    Jonsson, Anna; Lind, Therese; Lindgren, Johanna

    2008-01-01

    This paper examines how gender equality work aimed at users is practised at three public libraries in Gothenburg. The underlying factors if gender equality work is not practised are also explored. The theoretical starting point for the study is the gender system with its two leading principles, the hierarchy and the dichotomy, as described by the Swedish historian Yvonne Hirdman. Data was gathered by qualitative, semi-structured interviews with three head librarians. The results show tha...

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

    Scientific Electronic Library Online (English)

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

    2014-04-01

    Full Text Available Introducción: La trombosis venosa cerebral, una enfermedad cerebro vascular rara, afecta fundamentalmente niños y mujeres en edad fértil. Caso clínico: Paciente de sexo femenino, 45 años de edad, evaluada en otro establecimiento de salud donde le diagnosticaron fiebre tifoidea, acudió a emergencia r [...] efiriendo un tiempo de enfermedad de 14 días, con cefalea frontal de moderada intensidad, náuseas y vómitos, fue hospitalizada por una probable hemorragia subaracnoidea. Al examen físico tenía funciones vitales estables y examen neurológico normal; la tomografia cerebral mostró edema cerebral difuso, la angiotomografía cerebral y resonancia magnética de encéfalo evidenciaron trombosis del seno sagital superior, transverso y sigmoide derecha. Los exámenes de analítica sanguínea fueron normales. Se diagnosticó trombosis venosa cerebral y se inició tratamiento antiedema cerebral y anticoagulación con heparina de bajo peso molecular y después con warfarina, siendo dada de alta sin compromiso neurológico. Discusión: La Trombosis venosa cerebral es una entidad rara y presenta síntomas inespecíficos; siendo el más frecuente la cefalea recurrente, persistente y refractaria al tratamiento, algunos casos son de díficil diagnóstico, el método diagnóstico de elección es la resonancia magnética en fase venosa y su tratamiento se realiza con anticoagulantes. Abstract in english Introduction: Cerebral venous thrombosis, rarely cerebrovascular disease, affects mainly children and women of childbearing age. Case report:. Female patient, 45 years of age, evaluated at another health center where she was diagnosed with typhoid fever, she went to emergency referring a time of ill [...] ness 14 days, with frontal headache of moderate intensity, nausea and vomiting, she was hospitalized with a probable subarachnoid hemorrhage. On physical examination, she had stable vital functions and normal neurological examination, brain tomography showed diffuse cerebral edema, cerebral angiography and MRI of the brain showed thrombosis of the sagittal sinus, transverse and sigmoid. Blood tests were normal. Cerebral venous thrombosis was the diagnosis and she was treated with antiedema cerebral and started anticoagulation with low molecular weight heparin and then with warfarin, after was discharged without neurological impairment. Discussion: Cerebral venous thrombosis is a rare entity and presents inespecific symptoms, the most frequent is persistent headache refractory to treatment, some cases are of difficult diagnosis, the diagnostic method of choice is MRI in venous phase and the treatment is with anticoagulants.

  12. Targeted phototherapy using 308 nm Xecl monochromatic excimer laser for psoriasis at difficult to treat sites.

    Science.gov (United States)

    Al-Mutairi, Nawaf; Al-Haddad, Ahmad

    2013-07-01

    Psoriasis is a chronic inflammatory multisystem disease involving skin and joints affecting 1-3 % of the world population. The 308-nm excimer laser has been recently used in the treatment of psoriasis, especially localized psoriasis of scalp and palm and soles. The objective of the study is to evaluate the therapeutic efficacy and safety of a 308-nm excimer laser for the treatment of scalp and palmoplantar psoriasis. A total of 41 adult patients (25 males and 16 females) were enrolled in this study, of which 26 patients had lesions localized to scalp, and 15 patients had involvement of palm and soles. The mean age was 44.5 years (range 18-73). And, the mean duration of psoriasis in our patients was 15 years. They were treated with a 308-nm excimer laser. The initial dose was based on multiples of a predetermined minimal erythema dose, twice weekly for a maximum 12 weeks. Twenty-two of the 23 patients with scalp psoriasis showed improvement, while one patient showed no change; none experienced worsening of symptoms. The mean minimal erythema dose (MED) was found to be 383 mJ/cm(2) (range 180-650 mJ/cm(2)). The cumulative dose of irradiation was 1,841 mJ/cm(2) (range 600-2,500). The percentage improvement from baseline in PSSI score was 78.57 %. Side effects were seen in 20 patients (86.96 %) mainly in the form of erythema. Four patients developed mild relapse at the end of 6 months after the therapy. In 15 patients with palmoplantar psoriasis, the mean MED was found to be 415 mJ/cm(2) (range 200-950 mJ/cm(2)). The cumulative dose of irradiation was 28.4-115.5 J?cm(2) (mean 59.1 J?cm(2)). The mean number of treatments to achieve clearance (equal to 90 % reduction of PSI score) was 16. Two patients relapsed at the end of 6 months after the therapy. The 308-nm excimer laser is an effective, safe, easy, and relatively quicker method for the treatment of psoriasis at difficult to treat sites, with good results in a somewhat short time. PMID:23053247

  13. Perinatal risk factors including malformation

    International Nuclear Information System (INIS)

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

  14. Engineering classification of karst ground conditions

    OpenAIRE

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

    2005-01-01

    On a world scale, the dissolution of limestone and gypsum by natural waters creates extensive karst landforms that can be very difficult ground for civil engineers. Caves threaten foundation integrity, notably where their width is greater than their roof thickness. Sinkholes pose many problems, and are classified into six types, including subsidence sinkholes formed in soil cover within karst terrains. Rockhead morphology varies from uniform to pinnacled, also creating difficult ground to exc...

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

    Scientific Electronic Library Online (English)

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

    2007-12-01

    Full Text Available 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 uncontrolled asthma.

  16. Skin Conditions

    Science.gov (United States)

    ... itching. Allergies, irritants, your genetic makeup, and certain diseases and immune system problems can cause rashes, hives, and other skin conditions. Many skin problems, such as acne, also affect ...

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

    OpenAIRE

    Hyung Hun Kim; Seun Ja Park; Moo In Park; Won Moon; Sung Eun Kim

    2012-01-01

    AIM: To investigate the efficacy of cap-fitted colonoscopy (CFC) with regard to cecal intubation time. METHODS: Two hundred and ninety-five patients undergoing screening colonoscopy at Gospel Hospital, Kosin University College of Medicine were enrolled in this randomized controlled trial between January and December 2010. Colonoscopies were conducted by a single endoscopist. Patient characteristics including age, sex, body mass index, history of abdominal surgery, quality of preparation, and ...

  18. What's conditioned in conditioned place preference?

    Science.gov (United States)

    Huston, Joseph P; Silva, Maria A de Souza; Topic, Bianca; Müller, Christian P

    2013-03-01

    Conditioned place preference (CPP) is a learned behavior shown in many vertebrates, including humans. CPP occurs when a subject comes to prefer one place more than others because the preferred location has been paired previously with rewarding events. The CPP paradigm is widely used to explore the reinforcing effects of natural and pharmacological stimuli, including drugs of addiction. There is a general assumption that an acquired place preference is based on classical conditioning derived 'incentive motivation'. However, this may be an oversimplification of the multiple learning processes involved. We argue that although CPP may appear as an incentive-driven behavior related to secondary reinforcers, it may also be a result of operant conditioning of behavior prevailing at the conditioning site, as well as a result of conditioned treatment effects. Here, we outline alternative explanations for an observed CPP, which may fundamentally affect the interpretation of results with this paradigm in its use as a screening tool for rewarding properties of treatments. PMID:23384389

  19. Bayesian Sampling using Condition Indicators

    DEFF Research Database (Denmark)

    Faber, Michael H.; SØrensen, John Dalsgaard

    2002-01-01

    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.

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

    Directory of Open Access Journals (Sweden)

    Healy David W

    2012-06-01

    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.

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

    Directory of Open Access Journals (Sweden)

    Gruenbaum Shaun E

    2012-04-01

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

  2. A Study on the Operation Strategy for Combined Accident including TLOFW accident

    International Nuclear Information System (INIS)

    It is difficult for operators to recognize the necessity of a feed-and-bleed (F-B) operation when the loss of coolant accident and failure of secondary side occur. An F-B operation directly cools down the reactor coolant system (RCS) using the primary cooling system when residual heat removal by the secondary cooling system is not available. The plant is not always necessary the F-B operation when the secondary side is failed. It is not necessary to initiate an F-B operation in the case of a medium or large break because these cases correspond to low RCS pressure sequences when the secondary side is failed. If the break size is too small to sufficiently decrease the RCS pressure, the F-B operation is necessary. Therefore, in the case of a combined accident including a secondary cooling system failure, the provision of clear information will play a critical role in the operators' decision to initiate an F-B operation. This study focuses on the how we establish the operation strategy for combined accident including the failure of secondary side in consideration of plant and operating conditions. Previous studies have usually focused on accidents involving a TLOFW accident. The plant conditions to make the operators confused seriously are usually the combined accident because the ORP only focuses on a single accident and FRP is less familiar with operators. The relationship between CET and PCT under various plant conditions is important to decide the limitation of initiating the F-B operation to prevent core damage

  3. A Study on the Operation Strategy for Combined Accident including TLOFW accident

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Bo Gyung; Kang, Gook Young [KAIST, Daejeon (Korea, Republic of); Yoon, Ho Joon [Khalifa University, Abu Dhabi (United Arab Emirates)

    2014-10-15

    It is difficult for operators to recognize the necessity of a feed-and-bleed (F-B) operation when the loss of coolant accident and failure of secondary side occur. An F-B operation directly cools down the reactor coolant system (RCS) using the primary cooling system when residual heat removal by the secondary cooling system is not available. The plant is not always necessary the F-B operation when the secondary side is failed. It is not necessary to initiate an F-B operation in the case of a medium or large break because these cases correspond to low RCS pressure sequences when the secondary side is failed. If the break size is too small to sufficiently decrease the RCS pressure, the F-B operation is necessary. Therefore, in the case of a combined accident including a secondary cooling system failure, the provision of clear information will play a critical role in the operators' decision to initiate an F-B operation. This study focuses on the how we establish the operation strategy for combined accident including the failure of secondary side in consideration of plant and operating conditions. Previous studies have usually focused on accidents involving a TLOFW accident. The plant conditions to make the operators confused seriously are usually the combined accident because the ORP only focuses on a single accident and FRP is less familiar with operators. The relationship between CET and PCT under various plant conditions is important to decide the limitation of initiating the F-B operation to prevent core damage.

  4. Rheumatic conditions in human immunodeficiency virus infection.

    Science.gov (United States)

    Walker, U A; Tyndall, A; Daikeler, T

    2008-07-01

    Many rheumatic diseases have been observed in HIV-infected persons. We, therefore, conducted a comprehensive literature search in order to review the prevalence, presentation and pathogenesis of rheumatic manifestations in HIV-infected subjects. Articular conditions (arthralgia, arthritis and SpAs) are either caused by the HIV infection itself, triggered by adaptive changes in the immune system, or secondary to microbial infections. Muscular symptoms may result from rhabdomyolysis, myositis or from side-effects of highly active anti-retroviral therapy (HAART). Osseous complications include osteonecrosis, osteoporosis and osteomyelitis. Some conditions such as the diffuse infiltrative lymphocytosis syndrome and sarcoidosis affect multiple organ systems. SLE may be observed but may be difficult to differentiate from HIV infection. Some anti-retroviral agents can precipitate hyperuricaemia and are associated with arthralgia. When indicated, immunosuppressants and even anti-TNF-alpha agents can be used in the carefully monitored HIV patient. Thus, rheumatic diseases and asymptomatic immune phenomena remain prevalent in HIV-infected persons even after the widespread implementation of highly active anti-retroviral therapy. PMID:18413346

  5. Difficult decisions: Migration from Small Island Developing States under climate change

    Science.gov (United States)

    Kelman, Ilan

    2015-04-01

    The impacts of climate change on Small Island Developing States (SIDS) are leading to discussions regarding decision-making about the potential need to migrate. Despite the situation being well-documented, with many SIDS aiming to raise the topic to prominence and to take action for themselves, limited support and interest has been forthcoming from external sources. This paper presents, analyzes, and critiques a decision-making flowchart to support actions for SIDS dealing with climate change-linked migration. The flowchart contributes to identifying the pertinent topics to consider and the potential support needed to implement decision-making. The flowchart has significant limitations and there are topics which it cannot resolve. On-the-ground considerations include who decides, finances, implements, monitors, and enforces each decision. Additionally, views within communities differ, hence mechanisms are needed for dealing with differences, while issues to address include moral and legal blame for any climate change-linked migration, the ultimate goal of the decision-making process, the wider role of migration in SIDS communities and the right to judge decision-making and decisions. The conclusions summarize the paper, emphasizing the importance of considering contexts beyond climate change and multiple SIDS voices.

  6. Can Health Trainers Make a Difference With Difficult-to-Engage Clients? A Multisite Case Study.

    Science.gov (United States)

    Bailey, Di; Kerlin, Lianne

    2015-09-01

    A political attempt in the United Kingdom to address health inequalities in the past decade has been the government's initiative to employ local health trainers (HTs) or health trainer champions (HTCs) to support disadvantaged individuals with aspects of their health-related behaviors. HT/HTCs provide health-related information and support to individuals with healthy eating, physical activity, and smoking cessation. They undertake community engagement and direct individuals to relevant health services. They differ in that HTs are trained to provide health interventions to individuals or groups and to make referrals to specialist health care services when necessary. This article provides an evaluation of HT/HTCs interventions across three sites, including one prison, one probation service (three teams), and one mental health center. An evaluation framework combining process and outcome measures was employed that used mixed methods to capture data relating to the implementation of the service, including the context of the HT/HTCs interventions, the reactions of their clients, and the outcomes reported. It was found that HT/HTCs interventions were more effective in the prison and mental health center compared with the probation site largely as a result of contextual factors. PMID:25794692

  7. 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

  8. Device including a contact detector

    DEFF Research Database (Denmark)

    Petersen, Dirch Hjorth Technical University of Denmark,

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

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

    Science.gov (United States)

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

    2012-07-01

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

  10. High cell-density expression system: yeast cells in a phalanx efficiently produce a certain range of "difficult-to-express" secretory recombinant proteins.

    Science.gov (United States)

    Kawarasaki, Yasuaki; Kurose, Takeshi; Ito, Keisuke

    2015-01-01

    Yeast's extracellular expression provides a cost-efficient means of producing recombinant proteins of academic or commercial interests. However, depending on the protein to be expressed, the production occasionally results in a poor yield, which is frequently accompanied with a deteriorated growth of the host. Here we describe our simple approach, high cell-density expression, to circumvent the cellular toxicity and achieve in a production of a certain range of "difficult-to-express" secretory protein in preparative amount. The system features an ease of performing: (1) precultivate yeast cells to the stationary phase in non-inducing condition, (2) suspend the cells to a small aliquot of inducing medium to form a high cell-density suspension or "a phalanx," and then (3) give a sufficient aeration to the phalanx. Factors and pitfalls that affect the system's performance are also described. PMID:25447864

  11. Statement on smoking cessation in COPD and other pulmonary diseases and in smokers with comorbidities who find it difficult to quit.

    Science.gov (United States)

    Jiménez-Ruiz, Carlos A; Andreas, Stefan; Lewis, Keir E; Tonnesen, Philip; van Schayck, C P; Hajek, Peter; Tonstad, Serena; Dautzenberg, Bertrand; Fletcher, Monica; Masefield, Sarah; Powell, Pippa; Hering, Thomas; Nardini, Stefano; Tonia, Thomy; Gratziou, Christina

    2015-07-01

    Chronic obstructive pulmonary disease (COPD), lung cancer, asthma and pulmonary tuberculosis are common pulmonary diseases that are caused or worsened by tobacco smoking. Growing observational evidence suggests that symptoms and prognosis of these conditions improve upon smoking cessation. Despite increasing numbers of (small) randomised controlled trials suggesting intensive smoking cessation treatments work in people with pulmonary diseases many patients are not given specific advice on the benefits or referred for intensive cessation treatments and, therefore, continue smoking.This is a qualitative review regarding smoking cessation in patients with COPD and other pulmonary disorders, written by a group of European Respiratory Society experts. We describe the epidemiological links between smoking and pulmonary disorders, the evidence for benefits of stopping smoking, how best to assess tobacco dependence and what interventions currently work best to help pulmonary patients quit. Finally, we describe characteristics and management of any "hardcore" smoker who finds it difficult to quit with standard approaches. PMID:25882805

  12. Helical tomotherapy based intensity modulated radiotherapy for the management of difficult clinical situations in breast cancer

    Directory of Open Access Journals (Sweden)

    Animesh Saha

    2015-01-01

    Full Text Available Helical tomotherapy (HT can achieve a homogenous dose distribution in the planning target volume while minimizing the dose to the organ at risk. Tomotherapy has been used for complex breast cancer radiotherapy including bilateral breast irradiation, pectus excavatum, and internal mammary chain (IMC nodal irradiation. This report details our experience of using HT in breast cancers in newer clinical indications. Three patients with SCF nodal involvement (case 1, high level III axillary node recurrence (case 2, and composite irradiation of SCF, IMC, and whole breast (case 3 were treated using brachial plexus sparing HT. It was possible to boost the SCF, reirradiate the high level III axillary nodal recurrence and treat complex volume of breast, SCF, and IMC with acceptable and safe dose volume histogram constraints and with good homogeneity and conformity indices. The treatment was successful in controlling disease locoregionally at a 15 months follow-up. No patients reported symptoms suggestive of brachial plexopathy

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

    Scientific Electronic Library Online (English)

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

    2011-02-01

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

  14. 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)

  15. Politics and IMF Conditionality

    OpenAIRE

    Dreher, Axel; Sturm, Jan-Egbert; Vreeland, James Raymond

    2013-01-01

    Bailouts sponsored by the International Monetary Fund (IMF) are famous for their conditionality: in return for continued installments of desperately needed loans, governments must comply with austere policy changes. Many have suggested, however, that politically important countries face rather weak stringency. Obstacles to testing this hypothesis include finding a measure of political importance that is not plagued by endogeneity and obtaining data on IMF conditionality. We propose to measure...

  16. Choice and conditioned reinforcement.

    OpenAIRE

    Fantino, E; Freed, D.; Preston, R.A.; Williams, W.A.

    1991-01-01

    A potential weakness of one formulation of delay-reduction theory is its failure to include a term for rate of conditioned reinforcement, that is, the rate at which the terminal-link stimuli occur in concurrent-chains schedules. The present studies assessed whether or not rate of conditioned reinforcement has an independent effect upon choice. Pigeons responded on either modified concurrent-chains schedules or on comparable concurrent-tandem schedules. The initial link was shortened on only o...

  17. ??????????????????: ??????????????? A Survey of Circulation Librarians’ Emotional Labor and Emotional Exhaustion: The Case of Difficult Patron Service in University Libraries

    Directory of Open Access Journals (Sweden)

    Chen Su-May Sheih

    2012-11-01

    Full Text Available ???????????,????????????,??????????????,???????????????????????????????,????????????????????????????????????????????,??,???????????????????????????????????????,???????????????????????????????????,????????????????????????,????????????????????????????,????????????????,???????????????????????????????,????????????????????????????,?????????????????????????,???????????????????????At the front line of library service, circulation librarians devote considerable efforts to performing “emotional labor”, i.e., maintaining a pleasant manner while dealing with difficult patrons. Using questionnaires, this study examines frequency of encountering difficult patrons, emotional labor, and degree of emotional exhaustion among university circulation librarians in Taiwan. Meanwhile, the current study also analyzes effects of circulation librarians’ personal background factors on these three variables, and the correlation between them. The results suggested that university circulation librarians “scarcely” or “occasionally” encountered difficult patrons, among whom the most frequently encountered types were the “externally attributive” and “critical” ones. Nevertheless, circulation librarians were found high emotional labor workers who mostly performed emotional labor along the dimensions of “dealing with others’ negative emotions” and “expressing one’s positive emotions”. Besides, circulation librarians “scarcely” or “occasionally” felt emotionally exhausted. In general, a positive correlation was found between librarians’ frequency of encountering difficult patrons and degree of emotional exhaustion, while a negative correlation was found between librarians’ emotional labor and degree of emotional exhaustion.

  18. 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)

    Vani V

    2000-04-01

    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.

  19. Poetry and Prose as Pedagogical Tools for Addressing Difficult Knowledges: Translocational Positionality and Issues of Collective Political Agency

    Science.gov (United States)

    Keddie, Amanda

    2012-01-01

    In this paper the focus is on the possibilities that poetry and prose offer as pedagogical tools that can both accommodate and address difficult and painful knowledges. The paper presents and analyses poems and prose written by students at a non-traditional secondary school for disadvantaged girls (many of whom identify as Indigenous Australian).…

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

    Scientific Electronic Library Online (English)

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

    2014-10-01

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

  1. Including Pharmacist on Medical Team May Aid Blood Pressure Control

    Science.gov (United States)

    ... 40 years that including pharmacists on medical care teams improved blood pressure control and the management of many chronic conditions," study leader Barry Carter, a pharmacy professor, said in the ...

  2. 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

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

    Scientific Electronic Library Online (English)

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

    2014-10-01

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

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

    Directory of Open Access Journals (Sweden)

    Vassiliou A

    2011-01-01

    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.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    1997-12-31

    Jet grouting is being used as part of a groundwater cutoff wall system in a major New York City subway construction project to limit drawdowns in an adjacent PCB contamination plume. A circular test shaft of jet grout columns was conducted during the design phase to obtain wall installation parameters. The test program also included shaft wall mapping, and measurements of; inflows, piezometric levels, ground heave and temperature, and jet grout hydraulic conductivity. An axisymmetric finite element method groundwater model was established to back calculate the in-situ hydraulic conductivities of both the surrounding glacial soils and the jet grout walls by matching observed inflows and piezometric levels. The model also verified the use of packer permeability test as a tool in the field to evaluate the hydraulic conductivities of jet grout columns. Both the test program and analytic studies indicated that adjustments to the construction procedures would be required to obtain lower hydraulic conductivities of the jet grout walls for construction. A comparison is made with the conductivities estimated from the test program/analytic studies with those from the present construction.

  6. Antiphospholipid Syndrome of Late Onset: A Difficult Diagnosis of a Recurrent Embolic Stroke.

    Science.gov (United States)

    Delgado, Montserrat G; Rodríguez, Sergio; García, Raquel; Sánchez, Pablo; Sáiz, Antonio; Calleja, Sergio

    2015-08-01

    A 77-year-old woman with atrial fibrillation (AF) treated with warfarin had a cortical left middle cerebral artery (MCA) stroke (October 2009, international normalized ratio [INR], 1.6) and a cortical left frontal stroke (October 2011, INR, 1.9). Anticoagulation was adjusted. In October 2011, she had a right frontal stroke (INR, 2.3). Acetylsalicylic acid (ASA) was temporally added to the treatment. In June 2013, she had a left occipital stroke (INR, 2.3). Warfarin was changed to rivaroxaban. In August 2013, she had a right occipital stroke. ASA 100 was added to the treatment. On all occasions, repeated neurovascular studies and echocardiography were normal. Diagnoses were cardioembolic stroke. In November 2013, she was admitted because of a left MCA stroke. A complete blood analysis showed the presence of anticardiolipin, anti-b2-glycoprotein antibodies, and lupus anticoagulant. Primary antiphospholipid syndrome (APS) was later confirmed. APS should be considered in young stroke patients, however is not frequent in stroke patients older than 70 years with several cerebrovascular risk factors. The existence of AF in our patient with several embolic strokes made the cardiembolic etiology likely. Uncommon causes of stroke were not considered despite the repetition of the ischemic events. Thus, a wider etiological study should be made in all patients with a recurrent stroke regardless of age, such as a complete blood analysis including immunology study in order to exclude an APS of late onset. PMID:25979425

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

    Directory of Open Access Journals (Sweden)

    Casanova M

    2011-10-01

    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

  8. Politicizing risk assessment on vulnerability conditions

    OpenAIRE

    Rebotier, Julien

    2010-01-01

    Today, risks and climate change are among the top priorities on research or political agendas. But their unanimous legitimacy makes it difficult to contest. Yet the way we collect data, assess vulnerability, or choose monitored territories, is socially and politically constructed. They partly condition diagnostics aimed at improving adaptability, as well as the objective conditions of risks and its representations. These representations are territorialized and performative, and have concrete ...

  9. 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)

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

    2012-03-01

    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 (Pless likely to stand and walk within the first 3h after birth (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

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

    Directory of Open Access Journals (Sweden)

    Dionne Francois

    2011-07-01

    Full Text Available Abstract Objectives The aim of the project was to develop a plan to address a forecasted deficit of approximately $4.65 million for fiscal year 2010/11 in the Vancouver Communities division of the Vancouver Coastal Health Authority. For disinvestment opportunities identified beyond the forecasted deficit, a commitment was made to consider options for resource re-allocation within the Vancouver Communities division. Methods A standard approach to program budgeting and marginal analysis (PBMA was taken with a priority setting working committee and a broader advisory panel. An experienced, non-vested internal project manager worked closely with the two-member external research team throughout the process. Face to face evaluation interviews were held with 10 decision makers immediately following the process. Results The recommendations of the working committee included the implementation of 44 disinvestment initiatives with an annualized value of CAD $4.9 million, as well as consideration of possible investments if the realized savings match expectations. Overall, decision makers viewed the process favorably and the primary aim of addressing the deficit gap was met. Discussion A key challenge was the tight timeline which likely lead to less evidence informed decision making then one would hope for. Despite this, decision makers felt that better decisions were made then had the process not been in place. In the end, this project adds value in finding that PBMA can be used to cover a deficit and minimize opportunity cost through systematic application of criteria whilst ensuring process fairness through focusing on communication, transparency and decision maker engagement.

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

    Science.gov (United States)

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

    2009-12-01

    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.

  12. 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)

    Cordeiro Mendoca, K.

    2004-05-15

    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)

  13. The difficult challenge of a two-phase CFD modelling for all flow regimes

    International Nuclear Information System (INIS)

    Highlights: • The theoretical difficulties for modelling all flow regimes at CFD scale are identified. • The choice of the number of fields and of the time and space averaging or filtering are discussed and clarified. • Closure issues related to an all flow regime CFD model are listed and the main difficulties are identified. - Abstract: System thermalhydraulic codes model all two-phase flow regimes but they are limited to a macroscopic description. Two-phase CFD tools predict two-phase flow with a much finer space resolution but the current modelling capabilities are limited to dispersed bubbly or droplet flow and separate-phase flow. Much less experience exists on more complex flow regimes which combine the existence of dispersed fields with the presence of large interfaces such as a free surface or a film surface. A list of possible reactor issues which might benefit from an “all flow regime CFD model” is given. The first difficulty is to identify the various types of local flow configuration. It is shown that a 4-field model has much better capabilities than a two-fluid approach to identify most complex regimes. Then the choice between time averaging, space averaging, or even ensemble averaging is discussed. It is shown that only the RANS-2-fluid and a space-filtered 4-field model may be reasonably envisaged. The latter has the capabilities to identify all types of interfaces and should be privileged if a good accuracy is expected or if time fluctuations in intermittent flow have to be predicted while the former may be used when a high accuracy is not necessary and if time fluctuations in intermittent flow are not of interest. Finally the closure issue is presented including wall transfers, interfacial transfers, mass transfers between dispersed and continuous fields, and turbulent transfers. An important effort is required to model all interactions between sub-filter phenomena and the transfers from the sub-filter domain to the simulated domain. The main difficulties are expected in modelling the transfer of sub-filter interfaces to predicted interfaces and the multiple effects of sub-filter deformations of large interfaces on inter-field transfers

  14. 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)

    Laura S., Ward.

    Full Text Available 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.

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

    Science.gov (United States)

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

    2014-03-01

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

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

    OpenAIRE

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

    2012-01-01

    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...

  17. Ant colonies outperform individuals when a sensory discrimination task is difficult but not when it is easy

    OpenAIRE

    Sasaki, Takao; Granovskiy, Boris; Mann, Richard P.; Sumpter, David J. T.; Pratt, Stephen C.

    2013-01-01

    “Collective intelligence” and “wisdom of crowds” refer to situations in which groups achieve more accurate perception and better decisions than solitary agents. Whether groups outperform individuals should depend on the kind of task and its difficulty, but the nature of this relationship remains unknown. Here we show that colonies of Temnothorax ants outperform individuals for a difficult perception task but that individuals do better than groups when the task is easy. Subjects were required ...

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

    OpenAIRE

    Holland Carolyn; Williams Annette; Hinckley William R; Lindsell Christopher J; Wright Stewart W; Lewis Christopher H; Heimburger Gail

    2006-01-01

    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, su...

  19. Tracheal intubation in patients with anticipated difficult airway using Boedeker intubation forceps and McGrath videolaryngoscope

    DEFF Research Database (Denmark)

    Strøm, C; Barnung, S; Kristensen, M S; Bøttger, M; Tvede, M F; Rasmussen, Lars Simon

    2015-01-01

    BACKGROUND: Videolaryngoscopes with sharp angulated blades improve the view of the vocal cords but this does not necessarily result in higher success rates of intubation The aim of this study was to evaluate the efficacy of using Boedeker intubation forceps in conjunction with McGrath Series 5 Videolaryngoscope (MVL) in patients with predictors for difficult intubation. METHODS: The study was conducted at the Department of Anaesthesia, Copenhagen University Hospital from September to December 20...

  20. Modular Robotics for Delivering On-Site contamination Sensors and Mapping Systems to Difficult-to-Access Locations

    Energy Technology Data Exchange (ETDEWEB)

    Geisinger, Joseph

    2001-05-21

    Presently, characterization operations are scheduled for thousands of facilities and pieces of equipment throughout DOE sites, each of which requires manual surveying with handheld instruments and manual record keeping. Such work, particularly in difficult-to-access-areas, results in significant amounts of worker exposure, long timelines and additional secondary waste generation. Therefore, a distinct need exists for remote tools that can quickly deploy sensors and automated contamination mapping systems into these areas.

  1. Validation of modified Mallampati test with addition of thyromental distance and sternomental distance to predict difficult endotracheal intubation in adults

    Directory of Open Access Journals (Sweden)

    Bhavdip Patel

    2014-01-01

    Full Text Available Background and Aims: Intubation is often a challenge for anaesthesiologists. Many parameters assist to predict difficult intubation. The present study was undertaken to assess the validity of different parameters in predicting difficult intubation for general anaesthesia (GA in adults and effect of combining the parameters on the validity. Methods: The anaesthesiologist assessed oropharynx of 135 adult patients. Modified Mallampati test (MMT was used and the thyromental distance (TMD and sternomental distances (SMD for each of the patients were also measured. The Cormack and Lehane laryngoscopic grading was assessed following laryngoscopy. The validity parameters such as sensitivity, specificity, false positive and negatives values, positive and negative predictive values were calculated. The effect of combining different measurements on the validity was also studied. Univariate analysis was performed using the parametric method. Results: The study group comprised of 135 patients. The sensitivity and specificity of MMT were 28.6% and 93%, respectively. The TMD (<6.5 CM had sensitivity and specificity of 100% and 75.8%, respectively. The SMD (<12.5 CM had sensitivity and specificity of 91% and 92.7%, respectively. Combination of MMT grading and TMD and SMD measurements increased the validity (sensitivity of 100% and specificity of 92.7%. Conclusion: MMT had high specificity. The validity of combination of MMT, SMD and TMD as compared to MMT alone was very high in predicting difficult intubation in adult patients. All parameters should be used in assessing an adult patient for surgery under GA.

  2. 3D seismic experiment in difficult area in Japan; Kokunai nanchiiki ni okeru sanjigen jishin tansa jikken

    Energy Technology Data Exchange (ETDEWEB)

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

    1997-05-27

    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.

  3. To compare the accuracy of Prayer's sign and Mallampatti test in predicting difficult intubation in Diabetic patients

    International Nuclear Information System (INIS)

    Objective: To determine the accuracy of Prayer's sign and Mallampatti test in predicting difficult endotracheal intubation in diabetic patients. Methods: The cross-sectional study was performed at Aga Khan University Hospital, Karachi, over a period from January 2009 to April 2010, and comprised 357 patients who required endotracheal intubation for elective surgical procedures. Prayer's sign and Mallampatti tests were performed for the assessment of airway by trained observers. Ease or difficulty of laryngoscopy after the patient was fully anaesthetised with standard technique were observed and laryngoscopic view of first attempt was rated according to Cormack-Lehan grade of intubation. SPSS 15 was used for statistical analysis. Results: Of the 357 patients, 125(35%) were classified as difficult to intubate. Prayer's sign showed significantly lower accuracy, positive and negative predictive values than Mallampatti test. The sensitivity of Prayer's sign was lower 29.6 (95% Confidence Interval, 21.9-38.5) than Mallampatti test 79.3 (95% confidence interval, 70.8-85.7) while specificity of both the tests was not found to be significantly different. Conclusion: Prayer's sign is not acceptable as a single best bedside test for prediction of difficult intubation. (author)

  4. Utility of a Gum-Elastic Bougie for Difficult Airway Management in Infants: A Simulation-Based Crossover Analysis

    Science.gov (United States)

    Komasawa, Nobuyasu; Hyoda, Akira; Matsunami, Sayuri; Majima, Nozomi; Minami, Toshiaki

    2015-01-01

    Background. Direct laryngoscopy with the Miller laryngoscope (Mil) for infant tracheal intubation is often difficult to use even for skilled professionals. We performed a simulation trial evaluating the utility of a tracheal tube introducer (gum-elastic bougie (GEB)) in a simulated, difficult infant airway model. Methods. Fifteen anesthesiologists performed tracheal intubation on an infant manikin at three different degrees of difficulty (normal [Cormack-Lehane grades (Cormack) 1-2], cervical stabilization [Cormack 2-3], and anteflexion [Cormack 3-4]) with or without a GEB, intubation success rate, and intubation time. Results. In the normal and cervical stabilization trials, all intubation attempts were successful regardless of whether or not the GEB was used. In contrast, only one participant succeeded in tracheal intubation without the GEB in the anteflexion trial; the success rate significantly improved with the GEB (P = 0.005). Intubation time did not significantly change under the normal trial with or without the GEB (without, 12.7 ± 3.8 seconds; with, 13.4 ± 3.6 seconds) but was significantly shorter in the cervical stabilization and anteflexion trials with the GEB. Conclusion. GEB use shortened the intubation time and improved the success rate of difficult infant tracheal intubation by anesthesiologists in simulations.

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

    DEFF Research Database (Denmark)

    Kehlet NØrskov, Anders; Rosenstock, C V

    2015-01-01

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

  6. Sommerfeld radiation condition at threshold

    DEFF Research Database (Denmark)

    Skibsted, Erik

    2011-01-01

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

  7. Association of epilepsy and comorbid conditions

    OpenAIRE

    Seidenberg, Michael; Pulsipher, Dalin T; Hermann, Bruce

    2009-01-01

    Comorbid health conditions are common among people with epilepsy. Proposed explanations for this association include the possibility that first, epilepsy (including its treatment) causes the comorbid condition; second, the comorbid condition (including its treatment) causes epilepsy; or third, a common pathogenic mechanism mediates the co-occurrence of epilepsy and the comorbid condition. It is unlikely that a single explanation will suffice for all of the epilepsy comorbid conditions. Determ...

  8. Power Flow Study Including FACTS Devices

    OpenAIRE

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

    2010-01-01

    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...

  9. Production and exploitation of thermoelectric air conditioning systems for vehicles

    Energy Technology Data Exchange (ETDEWEB)

    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

    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.)

  10. Difficult marketing; Schwierige Vermarktung

    Energy Technology Data Exchange (ETDEWEB)

    Rentzing, Sascha

    2013-02-15

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

  11. Difficult Decisions: Acid Rain.

    Science.gov (United States)

    Miller, John A.; Slesnick, Irwin L.

    1989-01-01

    Discusses some of the contributing factors and chemical reactions involved in the production of acid rain, its effects, and political issues pertaining to who should pay for the clean up. Supplies questions for consideration and discussion. (RT)

  12. Difficult Decisions: Euthanasia.

    Science.gov (United States)

    Parakh, Jal S.; Slesnick, Irwin L.

    1992-01-01

    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)

  13. [Mouthguards: a difficult choice?].

    Science.gov (United States)

    Reukers, H A J; van Damme, P A

    2007-06-01

    It is the dentists' task to advise their patients what type of mouthguard grants the best possible protection. It is generally accepted that off-the-counter mouthguards are not sufficiently protective. These mouthguards are usually ill-fitting and not worn in the mouth but in the sporting shorts' pocket instead. A custom-fabricated mouthguard is proven to offer maximal protection. A mouthguard has to offer adequate protection with high comfort. A composite laminate construction and space between the inner surface of the mouthguard and the labial surface of the upper front teeth are essential for adequate protection. Transitional dentition and/or orthodontic appliances are no limitation to fabricate a custom-formed mouthguard. PMID:17695210

  14. Difficult identification of Haemophilus influenzae, a typical cause of upper respiratory tract infections, in the microbiological diagnostic routine.

    Science.gov (United States)

    Hinz, Rebecca; Zautner, Andreas Erich; Hagen, Ralf Matthias; Frickmann, Hagen

    2015-03-01

    Haemophilus influenzae is a key pathogen of upper respiratory tract infections. Its reliable discrimination from nonpathogenic Haemophilus spp. is necessary because merely colonizing bacteria are frequent at primarily unsterile sites. Due to close phylogenetic relationship, it is not easy to discriminate H. influenzae from the colonizer Haemophilus haemolyticus. The frequency of H. haemolyticus isolations depends on factors like sampling site, patient condition, and geographic region. Biochemical discrimination has been shown to be nonreliable. Multiplex PCR including marker genes like sodC, fucK, and hpd or sequencing of the 16S rRNA gene, the P6 gene, or multilocus-sequence-typing is more promising. For the diagnostic routine, such techniques are too expensive and laborious. If available, matrix-assisted laser-desorption-ionization time-of-flight mass spectrometry is a routine-compatible option and should be used in the first line. However, the used database should contain well-defined reference spectra, and the spectral difference between H. influenzae and H. haemolyticus is small. Fluorescence in-situ hybridization is an option for less well-equipped laboratories, but the available protocol will not lead to conclusive results in all instances. It can be used as a second line approach. Occasional ambiguous results have to be resolved by alternative molecular methods like 16S rRNA gene sequencing. PMID:25883794

  15. 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

  16. Including gauge corrections to thermal leptogenesis

    International Nuclear Information System (INIS)

    This thesis provides the first approach of a systematic inclusion of gauge corrections to leading order to the ansatz of thermal leptogenesis. We have derived a complete expression for the integrated lepton number matrix including all resummations needed. For this purpose, a new class of diagram has been invented, namely the cylindrical diagram, which allows diverse investigations into the topic of leptogenesis such as the case of resonant leptogenesis. After a brief introduction of the topic of the baryon asymmetry in the universe and a discussion of its most promising solutions as well as their advantages and disadvantages, we have presented our framework of thermal leptogenesis. An effective model was described as well as the associated Feynman rules. The basis for using nonequilibrium quantum field theory has been built in chapter 3. At first, the main definitions have been presented for equilibrium thermal field theory, afterwards we have discussed the Kadanoff-Baym equations for systems out of equilibrium using the example of the Majorana neutrino. The equations have also been solved in the context of leptogenesis in chapter 4. Since gauge corrections play a crucial role throughout this thesis, we have also repeated the naive ansatz by replacing the free equilibrium propagator by propagators including thermal damping rates due to the Standard Model damping widths for lepton and Higgs fields. It is shown that this leads to a comparable result to the solutions of the Boltzmann equations for thermal leptogenesis. Thus it becomes obvious that Standard Model corrections are not negligible for thermal leptogenesis and therefore need to be included systematically from first principles. In order to achieve this we have started discussing the calculation of ladder rung diagrams for Majorana neutrinos using the HTL and the CTL approach in chapter 5. All gauge corrections are included in this framework and thus it has become the basis for the following considerations. Furthermore, we have computed the Majorana neutrino production rate itself in chapter 6 to test our numerical procedure. In this context we have calculated the tree-level result as well as the gauge corrected result for the Majorana neutrino production rate. Finally in chapter 7, we have implemented the Majorana neutrino ladder rung diagram into our setup for leptogenesis: As a first consideration, we have collected all gauge corrected diagrams up to three-loop order for the asymmetry-causing two-loop diagrams. However, the results of chap. 5 showed that it is not sufficient to just include diagrams up to three-loop level. Due to the necessity of resumming all n-loop diagrams, we have constructed a cylindrical diagram that fulfils this condition. This diagram is the link between the Majorana neutrino ladder rung diagram calculated before on the one hand and the lepton asymmetry on the other. Therefore we have been able to derive a complete expression for the integrated lepton number matrix including all leading order corrections. The numerical analysis of this lepton number matrix needs a great computational effort since for the resulting eight-dimensional integral two ordinary differential equations have to be computed for each point the routine evaluates. Thus the result remains yet inaccessible. Research perspectives: Summarising, this thesis provides the basis for a systematic inclusion of gauge interactions in thermal leptogenesis scenarios. As a next step, one should evaluate the expression for the integrated lepton number numerically to gain a value, which can be used for comparison to earlier results such as the solutions of the Boltzmann equations as well as the Kadanoff-Baym ansatz with the implemented Standard Model widths. This numerical result would be the first quantitative number, which contains leading order corrections due to all interactions of the Majorana neutrino with the Standard Model particles. Further corrections by means of including washout effects and the Hubble expansion are expected to be reasonably small. Furthermore, it is very in

  17. Physical conditions

    DEFF Research Database (Denmark)

    Nielsen, Birte LindstrØm; Appleby, M.C.

    2011-01-01

    The physical environment of an animal is sometimes altered if it is found to cause problems for animal welfare. These changes are commonly quite specific (making changes to space, food, water, aspects of housing design such as flooring, or to other environmental factors such as air quality) and may be effective in preventing injuries or disease. However, such measures may not be implemented in practice (usually for economic reasons), and where implemented may cause other problems, as when concern for hygiene leads to animals being kept in barren conditions. Numerous ways have also been tried to diversify feeding methods in order to improve animal welfare, but specific changes to the environment such as these often have widespread effects, some of which may be detrimental. For example, inclusion of novel pen structures meant to enrich the environment may lead to increased aggression. A more general approach is therefore appropriate. One area where this is particularly relevant is handling and transport, when animals encounter environments that are wholly new to them. For environments where animals spend more time, several studies have attempted a 'biological approach' in which a biological functioning is considered while avoiding simplistic assumptions of 'natural is best'. We consider as examples systematic tests of environmental enrichment for pigs, novel designs for loose housing of lactating sows and their litters, and furnished cages for laying hens. Stringent tests of every design feature and their interactions are necessary to produce commercial designs from such studies.

  18. Difficult cannulation as defined by a prospective study of the Scandinavian Association for Digestive Endoscopy (SADE) in 907 ERCPs

    DEFF Research Database (Denmark)

    Halttunen, Jorma; Meisner, SØren

    2014-01-01

    BACKGROUND: The definition of a "difficult" cannulation varies considerably in reports of endoscopic retrograde cholangiopancreatography (ERCP). AIMS: To define a difficult cannulation, which translates into higher risk of post-ERCP pancreatitis. PATIENTS AND METHODS: Prospective consecutive recording of 907 cannulations in Scandinavian centers done by experienced endoscopists. Inclusion: indication for biliary access in patients with intact papilla. Exclusion: acute non-biliary and chronic pancreatitis at time of procedure. RESULTS: The primary cannulation succeeded in 74.9%, with median values for time 0.88 min (53 s), with two attempts and with zero pancreatic passages or injections. The overall cannulation success was 97.4% and post-ERCP pancreatitis (PEP) rate was 5.3%. The median time for all successful cannulations was 1.55 min (range 0.02-94.2). If the primary cannulation succeeded, the pancreatitis rate was 2.8%; after secondary methods, it rose to 11.5%. Procedures lasting less than 5 min had a PEP rate of 2.6% versus 11.8% in those lasting longer. With one attempt, the PEP rate was 0.6%, with two 3.1%, with three to four 6.1%, and with five and more 11.9%. With one accidental pancreatic guide-wire passage, the risk of the PEP was 3.7%, and with two passages, it was 13.1%. CONCLUSIONS: If the increasing rate of PEP is taken as defining factor, the wire-guided cannulation of a native papilla can be considered difficult after 5 min, five attempts, and two pancreatic guide-wire passages when any of those limits is exceeded.

  19. A STUDY OF PREDICTION OF DIFFICULT INTUBATION USING MALLAMPATI AND WILSON SCORE CORRELATING WITH CORMACK LEHANE GRADING

    Directory of Open Access Journals (Sweden)

    Vaishali Chandrashekhar

    2015-06-01

    Full Text Available BACKGROUND : This study was carried out to evaluate usefulness of preoperative Mallampati & Wilson’s score grading as a predictor for difficult laryngoscopy & intubation . AIMS : To determine the accuracy of the modified Mallampati test and Wilson score for predicting difficult tracheal intubation and correlation with Cormack Lehane grading . METHODS : This prospective randomized cross sectional Study carried out in 200 patients , posted for surgical procedure under GA with ETT intubation. Preoperative airway assessment using Mallampati grading (MPG & Wilson score done. Conventional anesthesia t echnique followed. Cormack Lehane grading done at laryngoscopy & correlated with previous scores for each patient. RESULTS : A MPG of I/II was found in 140 patients (70% , while 60 patients (30% were class III/IV. 138 patients (69% had a Wilson score of 0 /1 , while 60(30% had a score of 2/3 and 2 patients (1% scored ?4. One hundred & eighty patients (90% were classified as Cormack - Lehane grade I/II , while 20 patients (10% were considered grade III/IV. Of the 60 patients with a Wilson score of 2/3 , 6 cas es (10% two attempts were required and in 2 cases (3.3% in spite of more than two attempts intubation proved impossible with the conventional laryngoscope , articulated McCoy blade was used. Two patients with a Wilson score ?4 were intubated with gum elas tic bougie , using articulated McCoy blade. Overall , out of 200 , in 6 patients (3% two attempts of intubation was required and 4 patients (2% intubation required the use of some kind of gadget other than conventional laryngoscope and more than 2 attempts. The correlation between the Cormack - Lehane classification and the number of endotracheal intubation attempts showed that of the 180 patients with I / II grade , 4 patients (1.3% two attempts were required. Of the 20 patients classified as Cormack - Lehane III/IV , 4 cases (20% intubation proved impossible with conventional technique. This correlation was statistically significant. DISCUSSION : The Wilson score can successfully predict the patients in whom laryngoscopy may prove dif ficult (Wilson 2/3 (p = 0. 01. This reflects the good sensitivity. CONCLUSIONS : Wilson score , despite being seldom used in clinical practice , is a highly sensitive predictor of a difficult airway , although its specificity is low. KEYWORDS : Difficult intubation Prediction , Mallampa ti , Wilson score , Cormack Lehane grading , Specificity & Sensitivity.

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

    OpenAIRE

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

    2011-01-01

    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...

  1. 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.)

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

    OpenAIRE

    Duddridge, M; Powell, R.

    1997-01-01

    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 disease were contro...

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

    Scientific Electronic Library Online (English)

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

    2011-08-01

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

  4. 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)

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

    2014-06-01

    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

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

    DEFF Research Database (Denmark)

    Zank, Wolfgang

    2007-01-01

    In this paper I compare African and European integration. Despite some important progress, so far African integration has not been as deep as the European one. Measured on the terms of intergovernmental versus supranational cooperation, the AU is essentially an intergovernmental arrangement, with a few elements which might have supranational potentialities in the future. In its present form, the AU is more akin to the UN that to the EU. By contrast, the EU is a complex set of arrangements of both intergovernmental and supranational character. In the broad policy fields under "pillar one", the EU resembles already a federal state, with increasing tendencies in this direction. The different degree of integration has been the cause of many factors. I highlight here the importance of two basic conditions for substantial progress at supranational integration. The first one is a consensus on basic constitutional principles. Such a consensus was in place in Western Europe after World War II (democratic rule by law), whereas Africa has exhibited a broad array of incompatible constitutional models after independence. The second condition has been compatible (not identical) socio-economic systems. The Western European countries have been mixed economies with a public sector, but where economic activities were mainly coordinated by market forces. This opened the possibilities to use these market forces, e.g. by removing trade barriers, to strengthen cooperation at ground level and create pressures for further integration. Adherence to such a socio-economic model has also become an explicit criterion for EU membership. By contrast, Africa has seen all kinds of economic systems, centrally-planned socialist ones included. The last ones are incompatible with market economies. The multitude of systems has therefore created additional barriers for African integration. Today there is reason to be moderately optimistic as regards some progress at African integration. Democratic principles are much stronger rooted today than previously, and the time of sweeping social experiments seems to be over. However, in the nearer and mid-term perspective progress is more likely to be achievable on a sub-continental scale; in many cases the first step must be the reconstruction of the "failed state". A further strengthening of cooperation at AU-level is conceivable, but it will hardly acquire supra-national characteristics for many years to come.

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

    Scientific Electronic Library Online (English)

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

    2007-04-01

    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. 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.

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

    Directory of Open Access Journals (Sweden)

    Noemi Grigoletto De Biase

    2007-04-01

    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.

  8. The Megavoltage Radiation Therapy in Treatment of Patients With Advanced or Difficult Giant Cell Tumors of Bone

    International Nuclear Information System (INIS)

    Purpose: To assess the outcomes of radiotherapy, in terms of local control and treatment complications, of advanced or difficult giant cell tumors of bone (GCTB) that could not be treated by surgery. Methods and Materials: Among 122 consecutive patients with confirmed GCTB from 1985 to 2007, 77 patients were treated by megavoltage radiotherapy because they were inappropriate candidates for surgery. We have performed analysis of all data in terms of progression-free survival (PFS) and treatment morbidity. Median follow-up time was 58 months. Results: In the irradiated group, maximal tumor size ranged from 5 to 18 cm (median, 8.5). Anatomic distribution was as follows: femur, 27 cases; tibia, 19; radial/ulnar bone, 12; sacrum, 9; pelvic bones, 5; other, 5. Twenty-one patients (27%) were referred for local recurrence after ?1 other treatment procedures. The radiation doses ranged from 26 to 89 Gy (median, 56; administered 1.8-2.0 Gy/fraction with average total duration of treatment of 5-7 weeks); 8 patients (10%) received 80% at 5 years. Our study confirms that radiotherapy of GCTB offers an alternative to difficult or complex surgery and may be an option of choice in the treatment of inoperable patients.

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

    Energy Technology Data Exchange (ETDEWEB)

    Mathews, Fiona

    2011-07-01

    Full text: Many wind farms in the UK and elsewhere in northern Europe are situated in habitat with dense tall vegetation such as arable fields and upland heaths. This makes surveying for bat fatalities extremely difficult. To facilitate a multi-centre study of the effects of wind turbines on British bats, we have therefore conducted controlled trials of the relative success of trained search dogs and ecologists in retrieving bat carcasses. Although dogs have been used previously in ecological surveys for bats, this is the first time they have been specifically trained for use in 'difficult to survey' habitats. Two ecologists and two Labrador dogs with handlers were each given the opportunity to retrieve up to 45 bat carcasses in a range of habitat types. Their efficiency in terms of overall search time, costs, and retrieval abilities were evaluated. Our results indicate that high rates of retrieval can be achieved by dogs, even in dense vegetation up to 75cm high. Further, a typical 100m2 search area can be surveyed in less than half the time taken by humans. The limitations of using search dogs, and their ability to detect the presence of bats that have been scavenged are also presented (presentation supported with video footage). (Author)

  10. Conditional E-Cash

    Science.gov (United States)

    Shi, Larry; Carbunar, Bogdan; Sion, Radu

    We introduce a novel conditional e-cash protocol allowing future anonymous cashing of bank-issued e-money only upon the satisfaction of an agreed-upon public condition. Payers are able to remunerate payees for services that depend on future, yet to be determined outcomes of events. Once payment complete, any double-spending attempt by the payer will reveal its identity; no double-spending by the payee is possible. Payers can not be linked to payees or to ongoing or past transactions. The flow of cash within the system is thus both correct and anonymous. We discuss several applications of conditional e-cash including online trading of financial securities, prediction markets, and betting systems.

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

    Scientific Electronic Library Online (English)

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

    2007-10-01

    Full Text Available OBJETIVO: Pesquisar a freqüência dos fatores associados à asma de difícil controle. MÉTODOS: Foram selecionados pacientes com diagnóstico de asma grave do ambulatório de asma do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto. Os pacientes foram classificados em dois grupos: asma 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.

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

    Directory of Open Access Journals (Sweden)

    Ana Carla Sousa de Araujo

    2007-10-01

    Full Text Available OBJETIVO: Pesquisar a freqüência dos fatores associados à asma de difícil controle. MÉTODOS: Foram selecionados pacientes com diagnóstico de asma grave do ambulatório de asma do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto. Os pacientes foram classificados em dois grupos: asma grave controlada e asma grave de difícil controle. Após nova tentativa de otimização do tratamento para o grupo de difícil controle, foram aplicados questionário e investigação complementar de fatores associados, como exposição ambiental domiciliar e ocupacional, tabagismo, fatores sociais, rinossinusite, doença do refluxo gastroesofágico (DRGE, apnéia obstrutiva do sono, insuficiência cardíaca congestiva (ICC, embolia pulmonar, fibrose cística, disfunção de cordas vocais, deficiência de alfa-1 antitripsina e vasculite de Churg-Strauss. RESULTADOS: Foram selecionados 77 pacientes com asma grave, dos quais 47 apresentavam asma de difícil controle, sendo 68,1% do sexo feminino, idade média de 44,4 anos (±14,4 e volume expiratório forçado no primeiro segundo de 54,7% (±18,3%. Dos diagnósticos encontrados em associação à asma de difícil controle, o mais freqüente foi a pouca adesão ao tratamento (68%. Outros foram as más condições ambientais (34% e ocupacionais (17%, rinossinusite (57%, DRGE (49%, apnéia obstrutiva do sono (2%, ICC (2% e tabagismo (10%. Em todos os casos, pelo menos um desses fatores concomitantes foi diagnosticado. CONCLUSÕES: O fator mais freqüente associado à asma de difícil controle nos indivíduos estudados é a pouca adesão à medicação prescrita. A investigação de co-morbidades é imperativa na avaliação de pacientes com esta forma da doença.OBJECTIVE: To determine the prevalence of factors associated with difficult-to-control asthma. METHODS: Patients with severe asthma were selected from the outpatient asthma clinic of the Ribeirão Preto School of Medicine Hospital das Clínicas. The patients were divided into two groups: controlled severe asthma and difficult-to-control severe asthma. After new attempts to optimize the severe asthma treatment, a questionnaire was applied, and additional tests for factors associated with difficult-to-control asthma, such as environmental and occupational exposure, smoking history, social factors, rhinitis/sinusitis, gastroesophageal reflux disease (GERD, obstructive sleep apnea, congestive heart failure (CHF, pulmonary embolism, cystic fibrosis, vocal cord dysfunction, alpha-1 antitrypsin deficiency, and Churg-Strauss syndrome, were performed. RESULTS: 77 patients with severe asthma were selected, of which 47 suffered from hard-to-control asthma, being 68.1% female, with mean age of 44.4 years (±14.4, and forced expiratory volume in one second of 54.7% (±18.3. The most factors most often associated with difficult-to-control asthma were noncompliance with treatment (68%, rhinitis/sinusitis (57%, GERD (49%, environmental exposure (34%, occupational exposure (17%, smoking history (10%, obstructive sleep apnea (2%, and CHF (2%. At least one of these factors was identified in every case. CONCLUSIONS: Noncompliance with treatment was the factor most often associated with difficult-to-control asthma, underscoring the need to investigate comorbidities in the evaluation of patients with this form of the disease.

  13. 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

    Scientific Electronic Library Online (English)

    Teresa Maria, Cierco.

    Full Text Available Este artigo explora o papel da União Europeia na proteção, implementação e promoção dos direitos humanos na Sérvia. Torna-se claro que as exigências da União Europeia em matéria de democratização na região dos Balcãs Ocidentais têm sido fundamentais também ao nível dos direitos humanos. Os direitos [...] humanos como parte dos critérios da política de condicionalidade da União Europeia são uma mensagem clara para os Estados que desejam a adesão. Contudo, o progresso da Sérvia nessa área tem se debatido com questões internas. Este paper visa analisar o processo de democratização da Sérvia no seu caminho para a União Europeia, e o seu progresso (ou não) no que se refere à proteção e implementação dos direitos humanos. Abstract in english This article explores the role of the European Union in the human rights protection, implementation and promotion in Serbia. It is clear that the EU demands on democratisation in the region of Western Balkans are crucial to achieve the respect for human rights. The human rights standards as part of [...] the conditionality criteria of the EU is a clear message towards the countries aspiring membership. However, Serbia progress in the field has been difficult due to several internal constraints. This paper aims to uncover the democratisation process of Serbia on its path towards the EU, and its progress (or not) regarding human rights protection and implementation.

  14. Laser surgery for selected small animal soft-tissue conditions

    Science.gov (United States)

    Bartels, Kenneth E.

    1991-05-01

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

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

    Directory of Open Access Journals (Sweden)

    Vera Lo?ckmann

    2013-09-01

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

  16. How FDG-PET helps making decision for surgery in various difficult subgroups of temporal lobe epilepsy?

    International Nuclear Information System (INIS)

    Concordant pre-surgical data are the important predictors of good surgical outcome in patients with localization-related epilepsy. Medically intractable temporal lobe epilepsy with hippocampal sclerosis (HS) and concordant pre-surgical data is straightforward and may not need functional imaging. However, in other instances for example, HS with discordant data (HSD), bilateral HS with discordant data (BHSD), temporal lobe epilepsy with dual pathology (DP), non-lesional temporal lobe epilepsy (NL) are the difficult subgroups. In these groups, functional imaging eg. brain perfusion SPECT or brain PET may play a major role for surgical decision making. To our knowledge, there was no previous data in using FDG-PET in different subgroups as mentioned. Only some previous studies in single subgroup without analyzing impact of PET findings on decision-making have been reported. We thus aim to evaluate the usefulness of FDG-PET in these 4 subgroups

  17. When do chronic differences in self-regulation count? Regulatory focus effects in easy and difficult soccer tasks.

    Science.gov (United States)

    Vogel, Tobias; Genschow, Oliver

    2013-04-01

    Research on regulatory focus theory (Higgins, 1997) suggests that performance increases if instructions fit with sportspersons' dispositions. Sportspersons who chronically focus on wins (i.e., promotion-oriented individuals) perform best if instructions frame the objective as a promotion goal (e.g., "Try to hit!"). By contrast, sportspersons who chronically focus on losses (i.e., prevention-oriented individuals) perform best if instructions frame the objective as a prevention goal (e.g., "Try not to miss!"). Recent theorizing also suggests that regulatory focus interacts with task difficulty. In an experiment, we assessed soccer performance as a function of chronic focus, instructional focus, and task difficulty. Results support that task difficulty moderates the effects of fit on performance; fitting instructions to match the sportsperson's chronic regulatory focus improved performance in the easy rather than the difficult task. Findings are discussed regarding the role of regulatory fit in altering subjective pressure during sports performance. PMID:23535979

  18. A new preparation scheme for a difficult-to-float coking coal by column flotation following grinding

    Scientific Electronic Library Online (English)

    Yinfei, Liaoa; Yijun, Caoa; Zhongbo, Hub; Xiuxiang, Taoc.

    2015-02-01

    Full Text Available A new preparation scheme for a difficult-to-float coking coal from the Kailuan Mine, Tangshan, China was investigated. The results showed that grinding followed by column flotation was beneficial for obtaining products with low ash content. The positive effect of grinding on the coal floatability is [...] attributed to the liberation of intergrowths and coal surface improvement. Tests indicated that 10 minutes was the optimum grinding time, and overgrinding resulted in a deterioration in flotation performance. With a grinding time of 10 minutes, conventional flotation had potential to yield a product with around 12.42% ash content and 69.15% combustible recovery. Column flotation can reduce the product ash content to 11.15% and increase combustible recovery to 74.47%. Consistently better flotation results reveal that column flotation is more efficient than conventional flotation for such fines.

  19. The Experience of Using Ultrasound in Differential Diagnostics of Difficult Cases of Urgent Surgery (Mesenteric Thrombosis and Destructive Pancreatitis

    Directory of Open Access Journals (Sweden)

    Firsova V.G.,

    2011-12-01

    Full Text Available There has been presented the experience of using ultrasound in urgent abdominal surgery. There have been demonstrated the possibilities of US in difficult cases and urgent situations. Differential and diagnostic criteria in acute disorder of the mesenteric circulation and destructive pancreatitis have been given. Revealed ultrasonographic phenomena have been correlated with the data of clinical examination, infrared thermography (CEM ThermoDiagnostic, computer and magnetic resonance tomography, selective angiography, intraoperative review of abdominal cavity organs, as well as verified morphologically (fine needle and intraoperative biopsy and assessed together with the results of surgical interference and conservative treatment. Clinical examples of using additional possibilities of the technique (performing diagnostic fine needle biopsy under US control have been shown.

  20. Weak energy condition violation and superluminal travel

    OpenAIRE

    Lobo, Francisco; Crawford, Paulo

    2002-01-01

    Recent solutions to the Einstein Field Equations involving negative energy densities, i.e., matter violating the weak-energy-condition, have been obtained, namely traversable wormholes, the Alcubierre warp drive and the Krasnikov tube. These solutions are related to superluminal travel, although locally the speed of light is not surpassed. It is difficult to define faster-than-light travel in generic space-times, and one can construct metrics which apparently allow superlumi...

  1. Including fathers in preventing non-accidental head injury.

    Science.gov (United States)

    Coles, Lisa; Collins, Lynne

    2009-04-01

    Health visitors identified fathers as a marginalised, difficult-to-reach group when aiming for universal implementation of a public health programme to prevent non-accidental head injury (NAHI) in babies. Follow-on research with 30 fathers from disadvantaged backgrounds, including some in prison, explored barriers and facilitating factors to preventing NAHI through focus groups and interviews. Fathers expressed both responsibility and helplessness in managing a baby, but many felt excluded from gaining skills and knowledge by healthcare staff. Barriers to implementing a prevention programme included a lack of knowledge about head injuries in babies and poor understanding of prevention as a reduction of risk factors. Fear of blame for a head injury could lead to injury concealment, indicating a taboo subject. Facilitators for fathers to learn about preventing head injuries in babies included concerns of their masculinity being at odds with the frailty of the newborn, recognition of fathers' needs to be valued in their own right, and a need for individualised plans for gaining information and increasing confidence. The modifiable barriers to prevention, from the fathers' perspectives, add to the theoretical and applied evidence base for the prevention of NAHI. PMID:19397079

  2. Field trials of a lifeboat in ice and open water conditions

    Energy Technology Data Exchange (ETDEWEB)

    Veitch, B. [University of Newfoundland, St John' s (Canada); Barker, A; Sudom, D. [Canadian Hydraulics Centre National Research Council of Canada, Ottawa (Canada); Re, Antonio Simoes; Kuczora, A.; Gifford, P. [National Research Council, Institute for Ocean Technology, St John' s (Canada)

    2011-07-01

    Evacuation from offshore installations and marine vessels in Arctic regions is very challenging due to the difficult environmental conditions such as the cold temperatures or the ice-covered sea. Lifeboats have been produced as evacuation vessels from offshore structures for personnel. This paper investigated the performance capability of a 20 person conventional, totally enclosed motor-propelled survival craft (TEMPSC) in sea ice cover. A series of field trials were conducted from 2007 to 2010 under different ice conditions: fresh water ice in a lake, thin level intact ice and broken pack ice in the sea. The paper described in details the different field trials, including a description of the lifeboat, the structural and propulsion changes, the instrumentation and the trial sites. During the test campaign, the propeller and nozzle were redesigned to enhance acceleration capabilities. However the results demonstrated the difficulty of a lifeboat's moving in 7 and 9/10ths ice concentrations.

  3. Predicting indoor temperature and humidity conditions including hygrothermal interactions with the building envelope

    OpenAIRE

    Künzel, H.M.; Zirkelbach, D.; Sedlbauer, K.

    2003-01-01

    The hygrothermal behaviour of the building envelope affects the overall performance of a building. There are numerous tools for the simulation of the heat and moisture transfer in the building enve-lope and also whole building simulation tools for energy calculations. However, working combinations of both models for practical application are just about to be developed. In this paper such a combined model, that takes into account moisture sources and sinks inside a room, input from the envelop...

  4. 76 FR 9283 - Medicaid Program; Payment Adjustment for Provider-Preventable Conditions Including Health Care...

    Science.gov (United States)

    2011-02-17

    ...Compare Internet Web site. The quality measures...Object Retained After Surgery. Air Embolism. ...Infection. Surgical Site Infection Following...Mediastinitis. + Bariatric Surgery. - Laparoscopic Gastric...procedure but on the wrong body part; or...

  5. 76 FR 32815 - Medicaid Program; Payment Adjustment for Provider-Preventable Conditions Including Health Care...

    Science.gov (United States)

    2011-06-06

    ...nonpayment for all PPCs as they pertain to the dual eligible population. This commenter...nonpayment for all PPCs as they pertain to the dual eligible population. This [[Page 32833...payment regulations and has fewer than 100 beds. We are not preparing an analysis...

  6. 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

  7. A Three-Dimensional Thermal Model Including Thermal Boundary Conditions for High Power IGBT Modules

    DEFF Research Database (Denmark)

    Bahman, Amir Sajjad; Ma, Ke; Ghimire, Pramod; Iannuzzo, Francesco; Blaabjerg, Frede

    2016-01-01

    Accurate thermal dynamics of high power IGBT modules is important information for the reliability analysis and thermal design of the power electronics system. However, the existing thermal models have their limits to correctly predict these complicated thermal behaviors in the IGBTs: The typically used thermal model based on one-dimensional RC lumps have limits to provide temperature distributions inside the device, moreover some variable factors in the real-field applications like the cooling a...

  8. FPC conditioning cart at BNL

    Energy Technology Data Exchange (ETDEWEB)

    Xu, W.; Ben-Zvi, I.; Altinbas, F.Z.; Belomestnykh, S.; Burrill, A.; Cole, M.; Deonarine, J.; Jamilkowski, J.; Kayran, D.; Laloudakis, N.; Masi Jr, L.; McIntyre, G.; Pate, D.; Philips, D.; Seda, T.; Steszyn, A.; Tallerico, T.; Todd, R.; Weiss, D.; White, G.; Zaltsman, A.

    2011-03-28

    The 703 MHz superconducting gun for the BNL Energy Recovery Linac (ERL) prototype has two fundamental power couplers (FPCs), and each of them will deliver up to 500 kW of CW RF power. In order to prepare the couplers for high power RF service and process multipacting, the FPCs should be conditioned prior to installation into the gun cryomodule. A conditioning cart based test stand, which includes a vacuum pumping system, controllable bake-out system, diagnostics, interlocks and data log system has been designed, constructed and commissioned by collaboration of BNL and AES. This paper presents FPC conditioning cart systems and the conditioning process.

  9. Endoscopic balloon sphincteroplasty as an adjunct to endoscopic sphincterotomy in removing large and difficult bile duct stones

    International Nuclear Information System (INIS)

    Objective: To evaluate the effectiveness of endoscopic balloon sphincteroplasty as an adjunct to endoscopic sphincterotomy in removing large and difficult bile duct stones. Methods: A prospective non-randomized descriptive study was conducted at the Endoscopic Service of Surgical Unit 4, Civil Hospital Karachi over a period of 2 years from February 2007 to January 2009. A total of 84 patients where the biliary calculus was either greater than 15mm or difficult to remove with standard techniques underwent ERCP with endoscopic sphincterotomy and balloon sphincteroplasty. Patients with diagnosis of cholangitis or pancreatitis were excluded from the study. Endoscopic balloon dilatation was performed after standard sphincterotomy by using standard 15-18mm Controlled Radial Expansion (CRE) balloons. All procedures were done as day case under conscious sedation. Results: There were 18 (21.4%) male and 66 (78.6%) females. Age of the study population ranged from 16-85 years with a mean of 48.38 +- 17.07 years. The size of the stone ranged from 10-32mm with a mean of 14.7 +- 0.44mm. Stones were removed with sphincteroplasty in first session in 52/84 (61.9%) patients, 11/17 (64.4%) patients in the second session and 4/4 (100%) in the third session. Patients who were lost to follow up were 14(16.7%). Surgery was advised for 2 (2.4%) patients because of failure to remove stones by sphincteroplasty. Overall success of endoscopic sphincterotomy and large balloon dilatation in our study was 79.76%. Complications were seen in seven patients (8.3%) while one (1.2%) died. Bleeding was encountered in 3 (3.6%) patients which was controlled by adrenaline injection in 2 patients while one patient died due to severe haemorrhage before any surgical intervention could be undertaken. Moderate pancreatitis necessitating admission was seen in 3 patients (3.6%). None of the patients had severe pancreatitis or perforation secondary to the procedure. Conclusion: Large balloon dilatation along with endoscopic sphincterotomy is a simple, safe and effective technique in removing large bile duct stones, in patients with distal common bile duct narrowing or in whom the size of stone is greater than the size of common bile duct with a complication rate if not less equal to that of endoscopic sphincterotomy alone. (author)

  10. Biomechanical conditions of walking

    CERN Document Server

    Fan, Y F; Luo, L P; Li, Z Y; Han, S Y; Lv, C S; Zhang, B

    2015-01-01

    The development of rehabilitation training program for lower limb injury does not usually include gait pattern design. This paper introduced a gait pattern design by using equations (conditions of walking). Following the requirements of reducing force to the injured side to avoid further injury, we developed a lower limb gait pattern to shorten the stride length so as to reduce walking speed, to delay the stance phase of the uninjured side and to reduce step length of the uninjured side. This gait pattern was then verified by the practice of a rehabilitation training of an Achilles tendon rupture patient, whose two-year rehabilitation training (with 24 tests) has proven that this pattern worked as intended. This indicates that rehabilitation training program for lower limb injury can rest on biomechanical conditions of walking based on experimental evidence.

  11. Article Including Environmental Barrier Coating System

    Science.gov (United States)

    Lee, Kang N. (Inventor)

    2015-01-01

    An enhanced environmental barrier coating for a silicon containing substrate. The enhanced barrier coating may include a bond coat doped with at least one of an alkali metal oxide and an alkali earth metal oxide. The enhanced barrier coating may include a composite mullite bond coat including BSAS and another distinct second phase oxide applied over said surface.

  12. 42 CFR 493.839 - Condition: Chemistry.

    Science.gov (United States)

    2010-10-01

    ...2010-10-01 2010-10-01 false Condition: Chemistry. 493.839 Section 493.839 Public Health...Combination of These Tests § 493.839 Condition: Chemistry. The specialty of chemistry includes for the purposes of proficiency...

  13. 42 CFR 493.821 - Condition: Microbiology.

    Science.gov (United States)

    2010-10-01

    ...2010-10-01 2010-10-01 false Condition: Microbiology. 493.821 Section 493.821 Public...of These Tests § 493.821 Condition: Microbiology. The specialty of microbiology includes, for purposes of proficiency...

  14. Aspects of Oral Language, Speech, and Written Language in Subjects with Temporal Lobe Epilepsy of Difficult Control

    Science.gov (United States)

    Berberian, Ana Paula; Hopker, Christiane; Mazzarotto, Ingrid; Cunha, Jenane; Guarinello, Ana Cristina; Massi, Giselle; Crippa, Ana

    2015-01-01

    Introduction?About 50 million people have epilepsy and 30% of them have epilepsy that does not respond to properly conducted drug treatment. Objective?Verify the incidence of language disorders in oral language, speech, and written language of subjects with difficult to control temporal lobe epilepsy (TLE) and compare the occurrence of these disorders in subjects before and after surgery. Methods?Cross-sectional study with quantitative analysis, exploratory type. A questionnaire for data collection was administered covering the following aspects: oral language, speech complaints, and writing production and comprehension. Criteria for inclusion of subjects were a diagnosis of TLE refractory to drug treatment and at least 4 years of schooling. Results?The sample of 63 patients with TLE was divided into two groups: presurgical (n?=?31) and postsurgical (n?=?32). In the postsurgical group, there was a higher frequency of left lobectomy (75%) than right (25%). Conclusion?Statistical analysis was performed with the chi-square test (significance level of 0.05). Complaints related to speech-language attention were more predominant in postsurgical subjects. Analysis of oral language, speech, and written language in subjects with epilepsy who underwent temporal lobectomy or not showed findings consistent with symptoms related to transient aphasia, with the presence of paraphasias, as well as changes in speech prosody and melody. These symptoms appeared more associated with recurrence after having a temporal lobectomy.

  15. Topic: The Doctor of Nursing Practice; Title: Difficult Professional Choices: Deciding Between the PhD and the DNP

    Directory of Open Access Journals (Sweden)

    Jo A. Loomis

    2007-01-01

    Full Text Available Although the PhD has been the traditional doctoral degree in nursing, nurses now have a choice between that degree and the Doctor of Nursing Practice (DNP degree. An Internet-based exploratory survey of DNP students (n= 69 investigated the motivation of nurses to pursue doctoral education, factors that influenced the decision between the two degrees, rationale for choosing the DNP program, and career plans after graduation. A majority reported considering the PhD but decided the DNP would be more appropriate for their professional and personal goals. Nursing education was ranked as an important career intention for 55% of respondents, dispelling the concern that the DNP will increase the shortage of nursing faculty. The results indicate that the DNP degree is a desirable option for clinically oriented nurses considering doctoral education and provides nurses with a choice of educational pathways for their professional careers. Citation: Loomis, J., Willard, B., Cohen, J., (December 22, 2006. "Difficult Professional Choices: Deciding Between the PhD and the DNP in Nursing". OJIN: The Online Journal of Issues in Nursing. Vol. 12 No. 1. Available: Key words:

  16. Droit de la filiation et procréation médicalisée : une coexistence difficile Law of filiation and medically assisted procreation: difficult coexistence

    Directory of Open Access Journals (Sweden)

    Marie-France Nicolas-Maguin

    2009-04-01

    Full Text Available Les techniques médicales ont le pouvoir de bouleverser le processus de la procréation. Le médecin en devient un acteur essentiel. Cette désincarnation de la procréation atteint les concepts de la filiation plus ou moins largement à travers deux ruptures, la rupture du lien entre procréation et sexualité et la rupture temporelle que permet la congélation des gamètes et de l’embryon. Il appartient à la loi d’intégrer ou d’ignorer ces atteintes. Le droit français a fait le choix de l’intégration sélective puisque la procréation médicalement assistée est considérée comme un remède à la stérilité pathologique et non un mode alternatif de reproduction. Ce choix recèle des contradictions qui illustrent la difficulté de l’exercice.Medical technology has the power drastically impact the procreation process. The doctor becomes a major actor in this process. This disembodiment of procreation more or less affects the filiation concepts through two “kinds of breaking”, breaking the link between procreation and sexuality and breaking the temporal link made possible by freezing gamets and embryo. It is task of the law to incorporate or ignore these gaps. French law has chosen selective integration since medically assisted procreation is considered as a remedy to pathological sterility and not as an alternative mode of reproduction. This choice hides contradictions showing how difficult this exercise is.

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

    Scientific Electronic Library Online (English)

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

    2014-01-01

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

  18. High cell-density expression system: a novel method for extracellular production of difficult-to-express proteins.

    Science.gov (United States)

    Kimata, Koichi; Yamaguchi, Masaya; Saito, Yuta; Hata, Hiroki; Miyake, Kasumi; Yamane, Tsuneo; Nakagawa, Yuko; Yano, Akira; Ito, Keisuke; Kawarasaki, Yasuaki

    2012-02-01

    Yeast's extracellular expression provides a cost-efficient means of producing industrially useful recombinant proteins. However, depending on the protein to be expressed, the production results in a poor yield, which is occasionally accompanied with loss of the expression plasmid and hence hampered growth of the host in the inducing medium. Here we propose an alternative approach, high cell-density expression, to improve the yield of a certain range of so-called difficult-to-express proteins. In this expression system, recombinant yeast cells resting in stationary phase (OD(660)=3-4) are suspended in a small aliquot of inducing medium to form a high cell-density culture (e.g., OD(660)=15). When applied to the yeast strains harboring Lentinula edodes laccase (Lcc1 or Lcc4) expressing plasmids, the high cell-density system allowed the host cells to synthesize elevated amounts of the laccase which resulted in >1000- to 6000-fold higher yield than those synthesized in a classical growth-associated manner. The resting cells required aerobic agitation for the maximum production. The production system also worked for other foreign enzymes but not for beta-galactosidase from Aspergillus oryzae or Escherichia coli, likely suggesting an involvement of chaperons that act on a certain range of secretory proteins. PMID:22079042

  19. Reporte de caso: anestesia espinal multimodal en paciente pediátrico con vía aérea difícil / Case report: Multimodal spinal anesthesia in a pediatric patient with a difficult airway

    Scientific Electronic Library Online (English)

    William, Diaz Herrera; Hector Fidel, Osorio Zambrano; Miguel Francisco, Sandoval Cabrera.

    2013-09-01

    Full Text Available Introducción: La anestesia espinal llevamás de 100 años en la práctica anestésica pediátrica. Actualmente viene aumentando su uso por ser eficaz, eficiente y segura. Se expone un caso exitoso en paciente con vía aérea difícil. Objetivo: Reportar un caso de anestesia espinal y sedación con remifentan [...] ilo, haciendo la revisión de la literatura incluyendo fármacos alfa 2 agonistas, para procedimientos locorregionales pediátricos. Métodos: Búsqueda bibliográfica relevante en las bases bibliográficas PubMed, MD consult y BIREME. Inicialmente se obtienen 306 artículos, seleccionando 23 considerados relevantes por los autores. Resultados: Se presenta el caso de un niño de un año de edad, con vía aérea difícil predicha por un hemangioma cavernoso en labio inferior, programado para corrección quirúrgica de pie chapín bilateral. Se administra anestesia espinal con bupivacaína hiperbárica 0,5% carbonatada 5mg y clonidina 30 1g(1,3 ml total), manteniendo sedoanalgesia 3-4/6 de Ramsay con remifentanilo 0,05-0,075 1g/kg/min, con oxígeno 50% por máscara facial y ventilación espontánea sin efectos adversos hemodinámicos o respiratorios. Conclusiones: La anestesia espinal es una alternativa ante una vía aérea difícil predicha. La clonidina (alfa 2 agonista) prolonga la duración del bloqueo sin complicaciones hemodinámicas o respiratorias. El remifentanilo para sedación en los procedimientos locorregionales pediátricos es de fácil titulación, con resultados predecibles. Abstract in english Introduction: Spinal anesthesia has been part of the pediatric anesthesia practice for more than 100 years. Its use has been increasing in recent years because of its effective-ness.efficiency and safety. We report a successful case in a patient with a difficult airway. Objective: To report a case o [...] f spinal anesthesia and sedation with remifentanil, together with a review of the literature including alpha 2 agonists for locoregional procedures in pediatrics. Methods: Search of relevant references in PubMed, MD consult and BIREME. The search resulted in 306 articles, and 23 considered relevant by the authors were finally selected. Results: We present a case of a 1-year-old boy with an expected difficult airway because of the presence of a cavernous hemangioma of the lower lip, scheduled for surgical correction of bilateral club foot. Spinal anesthesia consisted of 0,5% hyperbaric carbonated bupiva-caine plus 30 g of clonidine (1.3 ml total), maintaining sedation-analgesia at 3^1/6 on the Ramsay scale with remifentanil 0,05-0,075 g/kg/min, 50% oxygen with facial mask, and spontaneous ventilation, with no hemodynamic or respiratory adverse effects. Conclusions: Spinal anesthesia is an option in cases of predicted difficult airway. Clonidine (alpha 2 agonist) prolongs blockade with no hemodynamic or respiratory complications. Remifentanil used for sedation in pediatric locoregional procedures is easy to titrate with-predictable results.

  20. MEASURES OF GENETIC DIVERSITY ARE EFFECTIVE TOOLS FOR EVALUATING ENVIRONMENTAL CONDITION

    Science.gov (United States)

    At their core, ecological risk assessments aim to evaluate the biological integrity and long-term sustainability of natural ecosystems. These are difficult objectives that will ultimately require development of novel indicators of ecological condition that are more accurate and ...

  1. Synthetic Spectra and Colors of Young Giant Planet Atmospheres: Effects of Initial Conditions and Atmospheric Metallicity

    CERN Document Server

    Fortney, Jonathan J; Saumon, Didier; Lodders, Katharina

    2008-01-01

    We examine the spectra and infrared colors of the cool methane-dominated atmospheres at Teff < 1400 K expected for young gas giant planets. We couple these spectral calculations to an updated version of the Marley et al. (2007) giant planet thermal evolution models that include formation by core accretion-gas capture. These relatively cool "young Jupiters" can be 1-6 magnitudes fainter than predicted by standard cooling tracks that include a traditional initial condition, which may provide a diagnostic of formation. If correct, this would make true Jupiter-like planets much more difficult to detect at young ages than previously thought. Since Jupiter and Saturn are of distinctly super-solar composition, we examine emitted spectra for model planets at both solar metallicity and a metallicity of 5 times solar. These metal-enhanced young Jupiters have lower pressure photospheres than field brown dwarfs of the same effective temperatures arising from both lower surface gravities and enhanced atmospheric opacit...

  2. ORGANIZATION OF MANUFACTURE WORK FOR STUDENTS WITH EASY DIFFICULT IN THEIR PSIHIC DEVELOPMENT IN SPECIAL ELEMENTARY SCHOOL “IDNINA”-SKOPJE

    OpenAIRE

    Zlatko PETREVSKI

    2000-01-01

    Some of the students in the special elementary school are unable to continue their education in higher school, because of many objective reasons.Only from that reasons elementary school is the place for their education, working education, where they will have every possible condition for that.

  3. Initial Cladding Condition

    International Nuclear Information System (INIS)

    The purpose of this analysis is to describe the condition of commercial Zircaloy clad fuel as it is received at the Yucca Mountain Project (YMP) site. Most commercial nuclear fuel is encased in Zircaloy cladding. This analysis is developed to describe cladding degradation from the expected failure modes. This includes reactor operation impacts including incipient failures, potential degradation after reactor operation during spent fuel storage in pool and dry storage and impacts due to transportation. Degradation modes include cladding creep, and delayed hydride cracking during dry storage and transportation. Mechanical stresses from fuel handling and transportation vibrations are also included. This Analysis and Model Report (AMR) does not address any potential damage to assemblies that might occur at the YMP surface facilities. Ranges and uncertainties have been defined. This analysis will be the initial boundary condition for the analysis of cladding degradation inside the repository. In accordance with AP-2.13Q, ''Technical Product Development Planning'', a work plan (CRWMS M andO 2000c) was developed, issued, and utilized in the preparation of this document. There are constraints, caveats and limitations to this analysis. This cladding degradation analysis is based on commercial Pressurized Water Reactor (PWR) fuel with Zircaloy cladding but is applicable to Boiling Water Reactor (BWR) fuel. Reactor operating experience for both PWRs and BWRs is used to establish fuel reliability from reactor operation. It is limited to fuel exposed to normal operation and anticipated operational occurrences (i.e. events which are anticipated to occur within a reactor lifetime), and not to fuel that has been exposed to severe accidents. Fuel burnup projections have been limited to the current commercial reactor licensing environment with restrictions on fuel enrichment, oxide coating thickness and rod plenum pressures. The information provided in this analysis will be used in evaluating the post-closure performance of the Monitored Geologic Repository (MGR) in relation to waste form degradation

  4. Composite Pressure Vessel Including Crack Arresting Barrier

    Science.gov (United States)

    DeLay, Thomas K. (Inventor)

    2013-01-01

    A pressure vessel includes a ported fitting having an annular flange formed on an end thereof and a tank that envelopes the annular flange. A crack arresting barrier is bonded to and forming a lining of the tank within the outer surface thereof. The crack arresting barrier includes a cured resin having a post-curing ductility rating of at least approximately 60% through the cured resin, and further includes randomly-oriented fibers positioned in and throughout the cured resin.

  5. Power Flow Study Including FACTS Devices

    Directory of Open Access Journals (Sweden)

    T. Thyagarajan

    2010-01-01

    Full Text Available The electric power industry is undergoing the most profound technical, economic and organizational changes since, its inception some one hundred years ago. This paradigm is the result of the liberalization process, stipulated by politics and followed up by industry. In countries like India with fast growing demand of electric power it is difficult to extend the transmission system in time by either building new lines or by introduction of a new voltage level. Power is therefore transmitted through weak system leading to unsatisfactory quality and reliability of power supply. So, the need for new power flow controllers capable of increasing transmission capacity and controlling power flows through predefined transmission corridors will certainly increase. For this reason, as well known in recent years a new class of controllers, Flexible AC Transmission System (FACTS controllers have rapidly met with favor. Considering the practical application of the FACTS controller, it is of importance to investigate the benefits as well as model these devices for power system steady state operation. We have performed the comprehensive modeling of most popular FACTS devices for power flow study. The effectiveness of modeling and convergence is tested with a five bus study system without any FACTS devices and further analyzed it with different FACTS controllers. The de facto standard Newton-Raphson method is used to solve the nonlinear power flow equation. Also, the study is extended for IEEE 30 bus and IEEE 118 bus system. Programming of the power flow studies stated above is implemented with MATLAB.

  6. Echinoderm phylogeny including Xyloplax, a progenetic asteroid.

    Science.gov (United States)

    Janies, Daniel A; Voight, Janet R; Daly, Marymegan

    2011-07-01

    Reconstruction of the phylogeny of the five extant classes of the phylum Echinodermata has proven difficult. Results concerning higher-level taxonomic relationships among echinoderms are sensitive to the choice of analytical parameters and methods. Moreover, the proposal of a putative sixth class based on a small enigmatic disc-shaped echinoderm, Xyloplax, from the deep seas of the Bahamas and New Zealand in the 1980s further complicated the problem. Although clearly an echinoderm, Xyloplax did not have clear affinity among known groups. Using molecular sequence and developmental data from recently collected Xyloplax adults and embryos, we show that rather than representing an ancient distinct lineage as implied by its status as a class, Xyloplax is simply a starfish that is closely related to the asteroid family Pterasteridae. Many members of the Pterasteridae and all Xyloplax inhabit deep or polar seas and brood young. Brooding pterasterids and Xyloplax hold their young in specialized adult chambers until the young reach an advanced juvenile stage after which they are released as free-living individuals. We hypothesize that the unique morphology of Xyloplax evolved via progenesis--the truncation of somatic growth at a juvenile body plan but with gonadal growth to maturity. Although the overall phylogeny of extant echinoderms remains sensitive to the choice of analytical methods, the placement of Xyloplax as sister to pterasterid asteroids is unequivocal. Based on this, we argue that the proposed class and infraclass status of Xyloplax should be suppressed. PMID:21525529

  7. Methods for estimating the content of transuranium and other difficult to measure nuclides in produced rad waste from BWRs

    International Nuclear Information System (INIS)

    During operation of nuclear power reactors a large number of radionuclides are produced. Some of them are difficult to measure. These are alpha or beta emitting radionuclides with weak or no gamma transition(s). A number of them, for instance some of the transuranium isotopes, may have significant radiological impact. It is of interest to be able to estimate the activity levels of these nuclides in the reactor systems. It is also of significant importance to estimate their content in produced waste packages and their radiological impact. In the report sources and source strengths for uranium and transuranium isotopes as well as for selected activated corrosion products are provided. Models for estimating the activity levels of these nuclides in the reactor systems and in different waste types are proposed. It is shown that the only significant source of uranium and transuranium nuclides is dispersion of fuel during operation of a reactor with defected and degrading fuel. The total amount of uranium on the core surfaces (tramp uranium), for a reactor in which no severe fuel failures have occurred, is about 0.5 g U, containing 2 % fissile material. During operation with defected fuel, up to 400 g U has been dispersed in the reactor water and distributed in the primary system during one single fuel cycle. Models for estimations of the amount of tramp uranium on the core surfaces during operation with no defected rods and the accumulation of uranium during operation with degrading fuel are provided. These models form the basis for consequence analyses of fuel failures and estimations of the amount of alpha emitting nuclides in different types of waste. 19 refs

  8. Application of Digital Imaging for Cytopathology under Conditions of Georgia

    Directory of Open Access Journals (Sweden)

    Ekaterina Kldiashvili

    2015-08-01

    Full Text Available Digital imaging in cytopathology can be defined as a series of procedures, those contributing to the quality of the displayed on the computer monitor final image. The procedures include sample preparation and staining, optical image formation by the microscope and afterwards the digital image sampling by the camera sensor; which means digital image post-processing and compression, transmission across the network and display on the monitor. A large amount of data about digital imaging exist. However, there are existing the problems with standardization and understanding of the digital imaging complete process. The field of digital imaging is rapidly evolving. The new models and protocols of the digital imaging are developed around the world, but in Georgia this field is still at evolving stages and revolves around static telecytology. It has been revealed, that the application of easy available and adaptable technology together with the improvement of infrastructure conditions is the essential basis for digital imaging. This tool is very useful for implementation of second opinion consultations on difficult cases. Digital imaging significantly increases knowledge exchange and thereby ensured a better medical service. The article aims description of digital imaging application for cytopathology under conditions of Georgia.

  9. Pathologic conditions in pregnancy

    International Nuclear Information System (INIS)

    Soma authors suggested that MR imaging could rapresent an effective diagnostic alternative in the study of pathologic conditions of mother and fetus during pregnancy. To verify the actual role of MR imaging, we examined 20 patients in the 2nd and 3rd trimester of gestation, after a preliminary US examination. Fifteen patients presented fetal or placental pathologies; in 4 patients the onset of the pathologic condition occurred during pregnancy; in 1 case of US diagnosis of fetal ascites, MR findings were nornal and the newborn was healty. As for placental pathologies, our series included a case of placental cyst, two hematomas between placenta and uterine wall, and two cases of partial placenta previa. As for fetal malformation, we evaluated a case of omphalocele, one of Prune-Belly syndrome, a case of femoral asimmetry, one of thanatophoric dwarfism, a case of thoracopagus twins with cardiovascular abnormalities, two fetal hydrocephali, and three cases of pyelo-ureteral stenosis. As for maternal pathologies during pregnancy, we observed a case of subserous uterine fibromyoma, one of of right hydronephrosis, one of protrusion of lumbar invertebral disk, and a large ovarian cyst. In our experience, MR imaging exhibited high sensitivity and a large field of view, which were both useful in the investigation of the different conditions occurring during pregnancy. In the evaluation of fetal and placental abnormalities, especially during the 3rd trimester, the diagnostic yieldof MR imaging suggested it as a complementary technique to US for the evaluation of fetal malformation and of intrauterine growth retardation

  10. Cancer of the Soft Tissue including Heart

    Science.gov (United States)

    ... who have died from soft tissue including heart cancer. Green figures represent those who have survived 5 years or ... analysis, rates for new soft tissue including heart cancer cases have been ... below the figure. New Cases, Deaths and 5-Year Relative Survival ...

  11. Reduction of uranium in disposal conditions of spent nuclear fuel

    International Nuclear Information System (INIS)

    This literature study is a summary of publications, in which the reduction of uranium by iron has been investigated in anaerobic groundwater conditions or in aqueous solution in general. The basics of the reduction phenomena and the oxidation states, complexes and solubilities of uranium and iron in groundwaters are discussed as an introduction to the subject, as well as, the Finnish disposal concept of spent nuclear fuel. The spent fuel itself mainly (?96 %) consists of a sparingly soluble uranium(IV) dioxide, UO2(s), which is stable phase in the anticipated reducing disposal conditions. If spent fuel gets in contact with groundwater, oxidizing conditions might be induced by the radiolysis of water, or by the intrusion of oxidizing glacial melting water. Under these conditions, the oxidation and dissolution of uranium dioxide to more soluble U(VI) species could occur. This could lead to the mobilization of uranium and other components of spent fuel matrix including fission products and transuranium elements. The reduction of uranium back to oxidation state U(IV) can be considered as a favourable immobilization mechanism in a long-term, leading to precipitation due to the low solubility of U(IV) species. The cast iron insert of the disposal canister and its anaerobic corrosion products are the most important reductants under disposal conditions, but dissolved ferrous iron may also function as reductant. Other iron sources in the buffer or near-field rock, are also considered as possible reductants. The reduction of uranium is a very challenging phenomenon to investigate. The experimental studies need e.g. well-controlled anoxic conditions and measurements of oxidation states. Reduction and other simultaneous phenomena are difficult to distinghuish. The groundwater conditions (pH, Eh and ions) influence on the prevailing complexes of U and Fe and on forming corrosion products of iron and, thus they determine also the redox chemistry. The partial reduction of sorbed uranium by metallic iron or by its corrosion products (magnetite, green rusts) has been observed in many studies performed under anaerobic solution conditions. A longer reaction time, several months, was needed to observe UO2 crystals. The pyrite in the buffer or pyrite or micas in the near-field rock may reduce uranium to some extent, whereas, hematite, can function as a catalytic surface in the U(VI) reduction by aqueous Fe2+. The surface catalytic reaction seem to outcompete the direct enzymatic U(VI) reduction by bacteria. Some studies suggested the reduction of U(VI) to occur also by aqueous Fe2+ in solution. (orig.)

  12. A deformed medium including a defect field and differential forms

    International Nuclear Information System (INIS)

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

  13. A deformed medium including a defect field and differential forms

    Energy Technology Data Exchange (ETDEWEB)

    Yamasaki, Kazuhito [Department of Earth and Planetary Sciences, Faculty of Science, Kobe University, Kobe (Japan); Nagahama, Hiroyuki [Department of Geoenvironmental Science, Graduate School of Science, Tohoku University, Sendai (Japan)

    2002-04-26

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

  14. Is not the universality of implementation of IAEA rules as difficult to maintain as it was to obtain

    International Nuclear Information System (INIS)

    IAEA recommendations on the safe transport of radioactive materials succeded in their task to uniformize the applicable rules for national and international transport. Problems set up by this carriage evolve with technical progress, nuclear knowledge and implementation development. This report tries to see under what conditions, the harmony obtained at one given date could be maintained and kept with the passing time, through the necessary adaptations in the field of the making up of the general rules, and in the practical applications

  15. MODELING OF PASSENGER TRANSPORTATIONS AND MANAGEMENT BY THE TRANSPORT RESOURCE OF ROUTING TAXI IN DIFFICULT SYSTEM OF THE MEGAPOLICY ????????????? ???????????? ????????? ? ?????????? ???????????? ???????? ?????????? ????? ? ??????? ??????? ??????????

    Directory of Open Access Journals (Sweden)

    Volkov V. S.

    2012-03-01

    Full Text Available The variant of the decision of a task of management of a transport resource of buses is submitted on the basis of the current information on a condition of a route. The real speed of movement of transport, change of number of the passengers is taken into account. The considered task concerns to a class of extreme tasks on networks and is complicated by a set of restrictions

  16. Serotonergic Modulation of Conditioned Fear

    OpenAIRE

    Homberg, Judith R.

    2012-01-01

    Conditioned fear plays a key role in anxiety disorders as well as depression and other neuropsychiatric conditions. Understanding how neuromodulators drive the associated learning and memory processes, including memory consolidation, retrieval/expression, and extinction (recall), is essential in the understanding of (individual differences in vulnerability to) these disorders and their treatment. The human and rodent studies I review here together reveal, amongst others, that acute selective ...

  17. Evaluative conditioning of food technologies

    DEFF Research Database (Denmark)

    Loebnitz, Natascha; Grunert, Klaus G

    2015-01-01

    Consumer attitudes play an important role in the acceptance of new technologies. The success of food innovations depends on understanding how consumers form and change attitudes toward food technologies. Earlier post hoc explanations suggest that evaluative conditioning can change consumer attitudes toward food technologies. The present study tests how evaluative conditioning can affect consumer acceptance of new food technologies. Furthermore, authors investigate whether evaluative conditioning is resistant to extinction after a two-month period and whether the evaluative conditioning effect prevails in a product-related context. Within an evaluative conditioning paradigm including between-subjects control groups in addition to standard within-subjects control conditions, participants were presented with three food technologies (conventional, enzyme, and genetic technology) paired with affectively positive, neutral, and negative pictures. Subsequent evaluative measurements revealed that evaluative conditioning can explain attitude change toward food technologies when affective pictures are used. Furthermore, results indicate that evaluative conditioning is resistant to extinction after two months and acquired evaluative conditioning effect spills over in a product-related context.

  18. Integrated cell and process engineering for improved transient production of a "difficult-to-express" fusion protein by CHO cells.

    Science.gov (United States)

    Johari, Yusuf B; Estes, Scott D; Alves, Christina S; Sinacore, Marty S; James, David C

    2015-12-01

    Based on an optimized electroporation protocol, we designed a rapid, milliliter-scale diagnostic transient production assay to identify limitations in the ability of Chinese hamster ovary (CHO) cells to produce a model "difficult-to-express" homodimeric Fc-fusion protein, Sp35Fc, that exhibited very low volumetric titer and intracellular formation of disulfide-bonded oligomeric aggregates post-transfection. As expression of Sp35Fc induced an unfolded protein response in transfected host cells, we utilized the transient assay to compare, in parallel, multiple functionally diverse strategies to engineer intracellular processing of Sp35Fc in order to increase production and reduce aggregation as two discrete design objectives. Specifically, we compared the effect of (i) co-expression of ER-resident molecular chaperones (BiP, PDI, CypB) or active forms of UPR transactivators (ATF6c, XBP1s) at varying recombinant gene load, (ii) addition of small molecules known to act as chemical chaperones (PBA, DMSO, glycerol, betaine, TMAO) or modulate UPR signaling (PERK inhibitor GSK2606414) at varying concentration, (iii) a reduction in culture temperature to 32°C. Using this information, we designed a biphasic, Sp35Fc-specific transient manufacturing process mediated by lipofection that utilized CypB co-expression at an optimal Sp35Fc:CypB gene ratio of 5:1 to initially maximize transfected cell proliferation, followed by addition of a combination of PBA (0.5?mM) and glycerol (1% v/v) at the onset of stationary phase to maximize cell specific production and eliminate Sp35Fc aggregation. Using this optimal, engineered process transient Sp35Fc production was significantly increased sixfold over a 12 day production process with no evidence of disulfide-bonded aggregates. Finally, transient production in clonally derived sub-populations (derived from parental CHO host) screened for a heritably improved capability to produce Sp35Fc was also significantly improved by the optimized process, showing that protein-specific cell/process engineering can provide a solution that exceeds the limits of genetic/functional diversity within heterogeneous host cell populations. Biotechnol. Bioeng. 2015;112: 2527-2542. © 2015 Wiley Periodicals, Inc. PMID:26126657

  19. Telling Stories: Sustaining Improvement in Schools Operating under Adverse Conditions

    Science.gov (United States)

    Hayes, Debra

    2006-01-01

    We know what good schools look like but experience tells us that it is very difficult to create and maintain them, especially when they are operating under adverse conditions-constant change, limited resources, high staff and student turnover, and a concentration of first time leaders and beginning teachers. The "Changing Schools in Changing Times…

  20. Measuring Science Teachers' Stress Level Triggered by Multiple Stressful Conditions

    Science.gov (United States)

    Halim, Lilia; Samsudin, Mohd Ali; Meerah, T. Subahan M.; Osman, Kamisah

    2006-01-01

    The complexity of science teaching requires science teachers to encounter a range of tasks. Some tasks are perceived as stressful while others are not. This study aims to investigate the extent to which different teaching situations lead to different stress levels. It also aims to identify the easiest and most difficult conditions to be regarded…

  1. Hot conditioning equipment conceptual design report

    Energy Technology Data Exchange (ETDEWEB)

    Bradshaw, F.W., Westinghouse Hanford

    1996-08-06

    This report documents the conceptual design of the Hot Conditioning System Equipment. The Hot conditioning System will consist of two separate designs: the Hot Conditioning System Equipment; and the Hot Conditioning System Annex. The Hot Conditioning System Equipment Design includes the equipment such as ovens, vacuum pumps, inert gas delivery systems, etc.necessary to condition spent nuclear fuel currently in storage in the K Basins of the Hanford Site. The Hot Conditioning System Annex consists of the facility of house the Hot Conditioning System. The Hot Conditioning System will be housed in an annex to the Canister Storage Building. The Hot Conditioning System will consist of pits in the floor which contain ovens in which the spent nuclear will be conditioned prior to interim storage.

  2. Hot conditioning equipment conceptual design report

    International Nuclear Information System (INIS)

    This report documents the conceptual design of the Hot Conditioning System Equipment. The Hot conditioning System will consist of two separate designs: the Hot Conditioning System Equipment; and the Hot Conditioning System Annex. The Hot Conditioning System Equipment Design includes the equipment such as ovens, vacuum pumps, inert gas delivery systems, etc.necessary to condition spent nuclear fuel currently in storage in the K Basins of the Hanford Site. The Hot Conditioning System Annex consists of the facility of house the Hot Conditioning System. The Hot Conditioning System will be housed in an annex to the Canister Storage Building. The Hot Conditioning System will consist of pits in the floor which contain ovens in which the spent nuclear will be conditioned prior to interim storage

  3. Burden of major musculoskeletal conditions

    Directory of Open Access Journals (Sweden)

    Woolf Anthony D.

    2003-01-01

    Full Text Available Musculoskeletal conditions are a major burden on individuals, health systems, and social care systems, with indirect costs being predominant. This burden has been recognized by the United Nations and WHO, by endorsing the Bone and Joint Decade 2000-2010. This paper describes the burden of four major musculoskeletal conditions: osteoarthritis, rheumatoid arthritis, osteoporosis, and low back pain. Osteoarthritis, which is characterized by loss of joint cartilage that leads to pain and loss of function primarily in the knees and hips, affects 9.6% of men and 18% of women aged >60 years. Increases in life expectancy and ageing populations are expected to make osteoarthritis the fourth leading cause of disability by the year 2020. Joint replacement surgery, where available, provides effective relief. Rheumatoid arthritis is an inflammatory condition that usually affects multiple joints. It affects 0.3-1.0% of the general population and is more prevalent among women and in developed countries. Persistent inflammation leads to joint destruction, but the disease can be controlled with drugs. The incidence may be on the decline, but the increase in the number of older people in some regions makes it difficult to estimate future prevalence. Osteoporosis, which is characterized by low bone mass and microarchitectural deterioration, is a major risk factor for fractures of the hip, vertebrae, and distal forearm. Hip fracture is the most detrimental fracture, being associated with 20% mortality and 50% permanent loss in function. Low back pain is the most prevalent of musculoskeletal conditions; it affects nearly everyone at some point in time and about 4-33% of the population at any given point. Cultural factors greatly influence the prevalence and prognosis of low back pain.

  4. What Does Long-Term Care Include?

    Medline Plus

    Full Text Available Video: "What Does Long-Term Care Include?" Long-term care involves a variety of services designed to meet a person's health or personal care needs during a short or long period of ...

  5. Including Indigenous Minorities in Decision-Making

    DEFF Research Database (Denmark)

    Pristed Nielsen, Helene

    2011-01-01

    Based on theories of public sphere participation and deliberative democracy, this book presents empirical results from a study of experiences with including Aboriginal and Maori groups in political decision-making in respectively Western Australia and New Zealand

  6. Births and deaths including fetal deaths

    Data.gov (United States)

    U.S. Department of Health & Human Services — Access to a variety of United States birth and death files including fetal deaths: Birth Files, 1968-2009; 1995-2005; Fetal death file, 1982-2005; Mortality files,...

  7. Gas storage materials, including hydrogen storage materials

    Science.gov (United States)

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

    2014-11-25

    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.

  8. Pacific herring hearing does not include ultrasound

    OpenAIRE

    Mann, David A.; Popper, Arthur N.; Wilson, Ben

    2005-01-01

    Recent studies have shown that some clupeid fishes, including shad and menhaden, can detect ultrasound (sound with frequencies higher than 20?kHz) and actively avoid it. However, other clupeids, including sardines and anchovies, do not detect ultrasound. The hearing abilities of herring are of particular interest because of their commercial importance, our reliance on acoustics to monitor their populations and behavioural evidence of responses to high-frequency sound by some clupeid species. ...

  9. A simple model to evaluate relative urban conditions

    OpenAIRE

    Pareto, Vittorio Emmanuel

    2009-01-01

    The urban development process intends to enhance urban equipment, infrastructure and services to improve urban conditions and reduce inequalities. While planning activities usually demand a sizeable amount of data to assess these conditions, it is hard to find a straightforward procedure to translate these data into a comprehensive and balanced set of projects and programs. Most urban projects have a strong sectorial character and it is difficult to compare parks with roads or sanitation with...

  10. Neuromuscular blockade for improvement of surgical conditions during laparotomy

    DEFF Research Database (Denmark)

    Madsen, Matias Vested; Scheppan, Susanne; Kissmeyer, Peter; Mørk, Emilie; Rosenberg, Jacob; Gätke, Mona Ring

    2015-01-01

    INTRODUCTION: During laparotomy, surgeons frequently experience difficult surgical conditions if the patient's abdominal wall or diaphragm is tense. This issue is particularly pertinent while closing the fascia and placing the intestines into the abdominal cavity. Establishment of a deep neuromuscular blockade (NMB), defined as a post-tetanic-count (PTC) of 0-1, paralyses the abdominal wall muscles and the diaphragm. We hypothesised that deep NMB (PTC 0-1) would improve surgical conditions durin...

  11. Influence of intense neuromuscular blockade on surgical conditions during laparotomy

    DEFF Research Database (Denmark)

    Madsen, Matias Vested; Donatsky, Anders Meller; Jensen, Bente Rona; Rosenberg, Jacob; Hammelev, Karsten Pharao; Gätke, Mona Ring

    2015-01-01

    PURPOSE: Intense neuromuscular block may improve surgical conditions in ileus laparotomies; however, it is difficult to evaluate. The aim of this study was to investigate if neuromuscular block improved surgical conditions in pigs with artificial ileus laparotomy. METHODS: Six pigs were endotracheally intubated, mechanically ventilated, anesthetized with propofol and fentanyl, and randomized into two groups in a cross-over assessor-blinded design. Neuromuscular block was established with rocuron...

  12. Shifting the Culture of Continuing Medical Education: What Needs To Happen and Why Is It So Difficult?

    Science.gov (United States)

    Towle, Angela

    2000-01-01

    The Informed Shared Decision-Making project focused on overcoming physician resistance to continuing education and developing allies for change among stakeholders and opinion leaders. Strategies included substantive incorporation of continuing medical education into the medical education continuum and involvement of patients in planning and…

  13. Imaging of acute neurological conditions in pregnancy and the puerperium

    Energy Technology Data Exchange (ETDEWEB)

    Dineen, R. [Department of Neuroradiology, Queen' s Medical Centre, Nottingham (United Kingdom)]. E-mail: robert.dineen@nhs.net; Banks, A. [Department of Anaesthesia, Queen' s Medical Centre, Nottingham (United Kingdom); Lenthall, R. [Department of Neuroradiology, Queen' s Medical Centre, Nottingham (United Kingdom)

    2005-11-01

    Eclampsia is one of the most common acute neurological events occurring during pregnancy. However, there are many other conditions that can present during pregnancy and the puerperium and that may either mimic eclampsia or produce other acute neurological manifestations. Frequently the symptoms and signs are non-specific, and it can be difficult to differentiate between these conditions on clinical grounds alone. Neuroradiological studies can provide valuable diagnostic information, and interventional radiological procedures may play a part in the subsequent management of these conditions. This review focuses on the imaging of acute neurological conditions which may be associated with, or present during, pregnancy and the puerperium.

  14. Imaging of acute neurological conditions in pregnancy and the puerperium

    International Nuclear Information System (INIS)

    Eclampsia is one of the most common acute neurological events occurring during pregnancy. However, there are many other conditions that can present during pregnancy and the puerperium and that may either mimic eclampsia or produce other acute neurological manifestations. Frequently the symptoms and signs are non-specific, and it can be difficult to differentiate between these conditions on clinical grounds alone. Neuroradiological studies can provide valuable diagnostic information, and interventional radiological procedures may play a part in the subsequent management of these conditions. This review focuses on the imaging of acute neurological conditions which may be associated with, or present during, pregnancy and the puerperium

  15. Terrorism cover in France for property damage including nuclear risks

    International Nuclear Information System (INIS)

    The obligation to include terrorism cover in all Property Damage policies issued on the French Market is ruled by an Act of 1986 and introduced under Section R 126-2 of the French Code of Insurance. This section stipulates that Property Damage policies must provide cover for damage resulting from acts of terrorism, with the same deductible and the same limit than that of the other damage covered in the policy. Soon after the dramatic events of September 11, 2001 in the United States and although reinsurers worldwide restricted their offer of capacities, French insurers recognized that they had to maintain this global cover for the benefit of their insurers. After difficult discussions between insurers, reinsurers, brokers, risk managers and representatives of the State, the creation of a new Pool, backed with a State guarantee, was decided in less than three months. Effective January 1, 2002 and called Gestion d'Assurance et de Reassurance des Risques Attentats et Actes de Terrorisme (GAREAT), the Pool offers a multiple layers stop-loss cover for Property Damage only, i.e. excluding TPL policies. Considering that nuclear risks should be treated in the same way as other industrial risks, it was decided that they would be covered by GAREAT as well. In the meantime, by a Decree of December 28, 2001 modifying Section R 126-2, a special provision, aiming at reducing the limit and thus the price of this cover, was introduced in the Code. The purpose of this paper is to expose the present situation applying through GAREAT and, after two years of operation to discuss future developments, including other sources of capacity for the coverage of acts of terrorism in nuclear risks insurance.(author)

  16. Electric Power Monthly, August 1990. [Glossary included

    Energy Technology Data Exchange (ETDEWEB)

    1990-11-29

    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.

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

    OpenAIRE

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

    2014-01-01

    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 ...

  18. The Controversy Of Homosexuality: A critical look at the issues that make legalizing homosexuality in Malawi difficult

    OpenAIRE

    Malamba, Manuel

    2012-01-01

    Homosexuality still remains to be one of the most controversial issues in the world today. The United Nations and other human rights bodies have postulated that all laws that discriminate against people on the basis of their sexual orientation violate human rights. However, despite this, many countries around the world including Malawi still maintain laws that object to same-sex relationships. In Malawi the issue of homosexuality was not in the public domain until recently after the arrest of...

  19. Micro-dissection testicular sperm extraction as an alternative for sperm acquisition in the most difficult cases of Azoospermia: Technique and preliminary results in India

    Directory of Open Access Journals (Sweden)

    Mohamed C Ashraf

    2013-01-01

    Full Text Available Context: Non-obstructive azoospermia (NOA is an unfavorable prognostic condition for male infertility since spermatogenesis is disrupted. Sperm retrieval (SR coupled with intracytoplasmic sperm injection (ICSI is the only option for men with NOA who seek fertility. Among the SR techniques, microdissection testicular sperm extraction (micro-TESE has been applied with encouraging results. Aims: We describe how we implemented the micro-TESE procedure and present initial micro-TESE experience in a group of men with NOA and poor prognosis for SR. Settings and Design: Case series of men with NOA treated in a tertiary healthcare center. Materials and Methods: An Assisted Reproductive Technology (ART facility was setup to perform SR using microsurgery. Fourteen men with NOA and previous failed retrievals or unfavorable histologic results underwent micro-TESE while their female partners received ovarian stimulation for oocyte pickup (OCP. Micro-TESE was performed the day prior to OCP and testicular sperm were used for sperm injections. We assessed retrieval rates and ICSI outcomes. Statistical Analysis: Outcomes of SR and ICSI were analyzed descriptively. Mann-Whitney and Fisher exact test were used to compare characteristics of men with successful and failed SR. Results: The success of micro-TESE was 50.0% with no major complications. A clear microscopic distinction between enlarged and collapsed seminiferous tubules was seen in 35.7% of the cases, and sperm were retrieved in all but one of these cases. Patients with successful and failed retrieval did not differ with respect to baseline characteristics, use of medical therapy, presence of varicocele, and testicular histology. Sperm injections resulted in normal fertilization and embryo cleavage of 64% and 75%, respectively. A total of five transfers with an average of 1.5 embryos resulted in a cumulative clinical pregnancy rate per ICSI cycle of 28.6%, with an implantation rate of 33.3%. Conclusions: We were successful in integrating the micro-TESE procedures to the in vitro fertilization (IVF laboratory. Our initial experience with micro-TESE applied to the most difficult cases of azoospermia is reassuring.

  20. Reweighting twisted boundary conditions

    CERN Document Server

    Bussone, Andrea; Hansen, Martin; Pica, Claudio

    2015-01-01

    Imposing twisted boundary conditions on the fermionic fields is a procedure extensively used when evaluating, for example, form factors on the lattice. Twisting is usually performed for one flavour and only in the valence, and this causes a breaking of unitarity. In this work we explore the possibility of restoring unitarity through the reweighting method. We first study some properties of the approach at tree level and then we stochastically evaluate ratios of fermionic determinants for different boundary conditions in order to include them in the gauge averages, avoiding in this way the expensive generation of new configurations for each choice of the twisting angle, $\\theta$. As expected the effect of reweighting is negligible in the case of large volumes but it is important when the volumes are small and the twisting angles are large. In particular we find a measurable effect for the plaquette and the pion correlation function in the case of $\\theta=\\pi/2$ in a volume $16\\times 8^3$, and we observe a syst...

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

    Directory of Open Access Journals (Sweden)

    Davide Cattano

    2014-08-01

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

  2. Coherent scattering on deuterium: formula including spins

    International Nuclear Information System (INIS)

    A general formula for coherent scattering on deuterium, including all the complications due to isospin and spin, is derived from Glauber's theory. The advantage of using tensor transition amplitudes instead of the usual amplitudes with two spin projections as indices is stressed. (author)

  3. Including Students with Visual Impairments: Softball

    Science.gov (United States)

    Brian, Ali; Haegele, Justin A.

    2014-01-01

    Research has shown that while students with visual impairments are likely to be included in general physical education programs, they may not be as active as their typically developing peers. This article provides ideas for equipment modifications and game-like progressions for one popular physical education unit, softball. The purpose of these…

  4. Weak energy condition violation and superluminal travel

    CERN Document Server

    Lobo, F; Lobo, Francisco; Crawford, Paulo

    2003-01-01

    Recent solutions to the Einstein Field Equations involving negative energy densities, i.e., matter violating the weak-energy-condition, have been obtained, namely traversable wormholes, the Alcubierre warp drive and the Krasnikov tube. These solutions are related to superluminal travel, although locally the speed of light is not surpassed. It is difficult to define faster-than-light travel in generic space-times, and one can construct metrics which apparently allow superluminal travel, but are in fact flat Minkowski space-times. Therefore, to avoid these difficulties it is important to provide an appropriate definition of superluminal travel.

  5. 77 FR 17009 - Review of Federal Permit Conditions

    Science.gov (United States)

    2012-03-23

    ...terms and conditions early on and...expeditiously. B. Definitions (1) Condition: The agency...Public Law 108-324...of Public Law 108-324...note that the definition includes the...will cover conditions...

  6. 42 CFR 494.80 - Condition: Patient assessment.

    Science.gov (United States)

    2010-10-01

    ...2010-10-01 false Condition: Patient assessment...80 Public Health CENTERS FOR...DEPARTMENT OF HEALTH AND HUMAN SERVICES...CERTIFICATION CONDITIONS FOR COVERAGE...Evaluation of current health status and medical condition, including...

  7. Chinese Conditionals and the Theory of Conditionals.

    Science.gov (United States)

    Chierchia, Gennaro

    2000-01-01

    Summarizes the main features of discourse representation theory, situation-based approaches, and dynamic semantics, and discusses the role the novelty condition plays in each of them, providing the main theoretical coordinates against which to try an assessment of the role of the Chinese conditional and a proposal put forth by Chang and Huang…

  8. Predicting Covariance Matrices with Financial Conditions Indexes

    OpenAIRE

    Opschoor, A.; Dijk, D.J.C. van; Van Der Wel, M.

    2013-01-01

    We model the impact of financial conditions on asset market volatility and correlation. We propose extensions of (factor-)GARCH models for volatility and DCC models for correlation that allow for including indexes that measure financial conditions. In our empirical application we consider daily stock returns of US deposit banks during the period 1994-2011, and proxy financial conditions by the Bloomberg Financial Conditions Index (FCI) which comprises the money, bond, and equity markets. We f...

  9. Photoactive devices including porphyrinoids with coordinating additives

    Energy Technology Data Exchange (ETDEWEB)

    Forrest, Stephen R; Zimmerman, Jeramy; Yu, Eric K; Thompson, Mark E; Trinh, Cong; Whited, Matthew; Diev, Vlacheslav

    2015-05-12

    Coordinating additives are included in porphyrinoid-based materials to promote intermolecular organization and improve one or more photoelectric characteristics of the materials. The coordinating additives are selected from fullerene compounds and organic compounds having free electron pairs. Combinations of different coordinating additives can be used to tailor the characteristic properties of such porphyrinoid-based materials, including porphyrin oligomers. Bidentate ligands are one type of coordinating additive that can form coordination bonds with a central metal ion of two different porphyrinoid compounds to promote porphyrinoid alignment and/or pi-stacking. The coordinating additives can shift the absorption spectrum of a photoactive material toward higher wavelengths, increase the external quantum efficiency of the material, or both.

  10. Including jobs in benefit-cost analysis

    OpenAIRE

    Bartik, Timothy J.

    2011-01-01

    Public policies may affect employment by directly creating jobs, facilitating job creation, or augmenting labor supply. In labor markets with high unemployment, such employment changes may have significant net efficiency benefits, which should be included in benefit-cost analyses. The research literature offers diverse recommendations on measuring employment benefits. Many of the recommendations rely on arbitrary assumptions. The resulting employment benefit estimates vary widely. This paper ...

  11. Electromagnetic transformer modelling including the ferromagnetic core

    OpenAIRE

    Ribbenfjärd, David

    2010-01-01

    In order to design a power transformer it is important to understand its internal electromagnetic behaviour. That can be obtained by measurements on physical transformers, analytical expressions and computer simulations. One benefit with simulations is that the transformer can be studied before it is built physically and that the consequences of changing dimensions and parameters easily can be assessed. In this thesis a time-domain transformer model is presented. The model includes core pheno...

  12. Electric power monthly, September 1990. [Glossary included

    Energy Technology Data Exchange (ETDEWEB)

    1990-12-17

    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)

  13. Contractively included subspaces of Pick spaces

    OpenAIRE

    Benhida, Chafiq; Timotin, Dan

    2013-01-01

    Pick spaces are a class of reproducing kernel Hilbert spaces that generalize the classical Hardy space and the Drury--Arveson reproducing kernel spaces. We give characterizations of certain contractively included subspaces of Pick spaces. These generalize the characterization of closed invariant subspaces of Trent and McCullough, as well as results for the Drury--Arveson space obtained by Ball, Bolotnikov and Fang.

  14. Model for safety reports including descriptive examples

    International Nuclear Information System (INIS)

    Several safety reports will be produced in the process of planning and constructing the system for disposal of high-level radioactive waste in Sweden. The present report gives a model, with detailed examples, of how these reports should be organized and what steps they should include. In the near future safety reports will deal with the encapsulation plant and the repository. Later reports will treat operation of the handling systems and the repository

  15. Difficult diagnosis of brainstem glioblastoma multiforme in a woman: a case report and review of the literature

    Directory of Open Access Journals (Sweden)

    Lakhan Shaheen E

    2009-10-01

    Full Text Available Abstract Introduction Brainstem gliomas are rare in adults. They most commonly occur in the pons and are most likely to be high-grade lesions. The diagnosis of a high-grade brainstem glioma is usually reached due to the presentation of rapidly progressing brainstem, cranial nerve and cerebellar symptoms. These symptoms do, however, overlap with a variety of other central nervous system disorders. Magnetic resonance imaging is the radiographic modality of choice, but can still be misleading. Case presentation A 48-year-old Caucasian woman presented with headache and vomiting followed by cerebellar signs and confusion. Magnetic resonance imaging findings were suggestive of a demyelinating process, but the patient failed to respond to therapy. Her condition rapidly progressed and she died. At autopsy, a high-grade invasive pontine tumor was identified. Histological evaluation revealed glioblastoma multiforme. Conclusion While pontine gliomas are rare in adults, those that do occur tend to be high-grade and rapidly progressive. Progression of symptoms from non-specific findings of headache and vomiting to rapid neurological deterioration, as occurred in our patient, is common in glioblastoma multiforme. While radiographic findings are often suggestive of the underlying pathology, this case represents the possibility of glioblastoma multiforme presenting as a deceptively benign appearing lesion.

  16. Semiclassical energy conditions

    CERN Document Server

    Martin-Moruno, Prado

    2013-01-01

    We present and develop several nonlinear energy conditions suitable for use in the semiclassical regime. In particular, we consider the recently formulated "flux energy condition" (FEC), and the novel "trace-of-square" (TOSEC) and "determinant" (DETEC) energy conditions. As we shall show, these nonlinear energy conditions behave much better than the classical linear energy conditions in the presence of semiclassical quantum effects. Moreover, whereas the quantum extensions of these nonlinear energy conditions seem to be quite widely satisfied as one enters the quantum realm, analogous quantum extensions are generally not useful for the linear classical energy conditions.

  17. Why sentence modality in spontaneous speech is more difficult to classify and why this fact is not too bad for prosody

    OpenAIRE

    Batliner, Anton; Weiand, C.; Kießling, Andreas; Nöth, Elmar

    1994-01-01

    We show in this paper that the labeling of sentence modality in German, esp. of questions vs. non-questions, is more difficult for spontaneous than for read speech and easier for non-elliptic than for elliptic utterances. However, the prosodic marking of sentence modality is more important in elliptic utterances that occur more often in spontaneous speech.

  18. Self-contained co-generation nuclear power plant with integral nuclear reactor designed for remote and difficult-to-access areas

    International Nuclear Information System (INIS)

    The paper gives an overview of the conceptual design of a reactor with enhanced safety intended for small NPPs to provide power supply for difficult-to-access and remote areas. The basic design features and the configuration of an integral nuclear reactor and the plant as a whole, as well as the main technical data are presented. (orig.)

  19. Comparison of the Airtraq and Truview laryngoscopes to the Macintosh laryngoscope for use by Advanced Paramedics in easy and simulated difficult intubation in manikins.

    LENUS (Irish Health Repository)

    Nasim, Sajid

    2009-01-01

    Paramedics are frequently required to perform tracheal intubation, a potentially life-saving manoeuvre in severely ill patients, in the prehospital setting. However, direct laryngoscopy is often more difficult in this environment, and failed tracheal intubation constitutes an important cause of morbidity. Novel indirect laryngoscopes, such as the Airtraq and Truview laryngoscopes may reduce this risk.

  20. CERVICAL EPIDURAL BLOCK AS AN ALTERNATIVE TO GENERAL ANESTHESIA IN A PATIENT WITH ANTICIPATED DIFFICULT AIRWAY AND DERANGED THYROID FUNCTION FOR THYROID SURGERIES

    Directory of Open Access Journals (Sweden)

    Kailash

    2015-05-01

    Full Text Available Choosing safe anesthetic technique is pivotal role for anesthesiologist. It depends Age, preexisting systemic diseases and Type of surgery. In this case report we have chosen Cervical Epidural Block as an alternative to General Anesthesia for a case of Adenoma Thyroid undergoing Hemi thyroidectomy with deranged thyroid function an d difficult Airway.

  1. Neuroendocrine tumors resistant to mammalian target of rapamycin inhibitors: A difficult conversion from biology to the clinic

    Science.gov (United States)

    Fazio, Nicola

    2015-01-01

    Deregulation of the phosphoinositide 3-kinase (PI3K)/protein kinase B (Akt) - mammalian target of rapamycin (mTOR) signaling pathway is one of the most commonly-involved pathways in tumorigenesis. It has also been reported as altered in neuroendocrine tumors (NETs). mTOR inhibitors used in clinical practice are derived from rapamycin, an anti-cancer agent also used as an immunosuppressor after organ transplantation. Everolimus and temsirolimus are the two rapamycin-derived mTOR inhibitors used in NETs. Notably everolimus has been approved in advanced progressive well/moderately-differentiated pancreatic NETs (pNETs). It inhibits specifically the mTORC1 subunit of mTOR, not interacting with mTORC2. Although everolimus produced a significant prolongation of progression-free survival a number of patients with pNETs do not benefit from the drug due to early or late progression. Two supposed mechanisms of resistance to mTOR inhibitors are Akt and PI3K activation, by means of mTORC2 and insulin growth factor (IGF) - IGF receptor signaling, respectively. BEZ235 is a multi-targeted inhibitor binding to PI3K, mTORC1 and mTORC2, therefore potentially turning off all the supposed molecular targets of resistance to everolimus. The two clinical trials designed in pNETs were stopped early due to unmet statistical endpoint and the global clinical development of BEZ235 was also halted. Tolerability of this drug was challenging and conditioned the feasibility of therapy. The BEZ experience is an example of the huge difference between the preclinical and clinical setting and prompts us to pay more attention to the phase?I?step of clinical development and the design of phase II clinical trials. PMID:26677429

  2. Collective atomic recoil lasing including friction and diffusion effects

    International Nuclear Information System (INIS)

    We extend the collective atomic recoil lasing (CARL) model including the effects of friction and diffusion forces acting on the atoms due to the presence of optical molasses fields. The results from this model are consistent with those from a recent experiment by Kruse et al. [ Phys. Rev. Lett. 91, 183601 (2003) ]. In particular, we obtain a threshold condition above which collective backscattering occurs. Using a nonlinear analysis we show that the backscattered field and the bunching evolve to a steady state, in contrast to the nonstationary behavior of the standard CARL model. For a proper choice of the parameters, this steady state can be superfluorescent

  3. Structure analysis including kinematical hardening and creep

    International Nuclear Information System (INIS)

    For a viscoelastic and plastic material or structure, we propose a model, including internal strain parameters and associated transformed parameters, on which experimental identification of the constants can easily be performed. Then we show how to derive easily 'static' and 'dynamic' bounds for a structure under cyclic loading. They are obtained through an elastic calculus without following the whole evolution of the structure. Then, the linear purely viscoelastic response of the structure is calculated through linear differential equations of first order and more precise bounds, depending on the period are established. Moreover, the speed of convergence towards the limiting state can be evaluated. (orig.)

  4. Tracheal intubation with a flexible fibreoptic scope or the McGrath videolaryngoscope in simulated difficult airway scenarios : A randomised controlled manikin study

    DEFF Research Database (Denmark)

    Jepsen, Cecilie H; Gätke, Mona R

    2014-01-01

    BACKGROUND: Flexible fibreoptic endoscopic (FFE) intubation is considered the 'gold-standard' when difficult airway management is anticipated. Several videolaryngoscopes have been developed to facilitate intubation by laryngoscopy. OBJECTIVE: The aim of the study was to compare the performance of the McGrath series 5 videolaryngoscope (McGrath videolaryngoscope) and the FFE for tracheal intubation in manikins with a simulated difficult airway, hypothesizing that the McGrath videolaryngoscope intubation would prove faster than FFE intubation. DESIGN: A randomised controlled study. SETTING: The Danish Institute for medical simulation between December 2009 and June 2010. PARTICIPANTS: Twenty-eight anaesthesia residents participating in the Danish mandatory 3-day airway management course. INTERVENTIONS: All participants received instructions and training in the use of the McGrath videolaryngoscope and FFE. The participants then performed tracheal intubation on a SimMan manikin once with the McGrath videolaryngoscope and once with the FFE in three difficult airway scenarios: (1) pharyngeal obstruction; (2) pharyngeal obstruction and cervical rigidity; (3) tongue oedema. MAIN OUTCOME MEASURES: We measured successful intubations, defined as intubation within 120 ?s, and time to tracheal intubation. RESULTS: The trachea was intubated within 120? s with the McGrath videolaryngoscope in 25 out of 27 (93%), 25 out of 28 (89%) and 18 out of 28 (64%) occasions compared with 11 out of 28 (40%), 11 out of 28 (40%) and 16 out of 28 (57%) with the FFE in scenarios (1), (2) and (3), respectively. Time to tracheal intubation was shorter with the McGrath videolaryngoscope in scenarios (1) and (2) than with the FFE (Wilcoxon signed rank sum test, P?difficult airways. In patients, videolaryngoscopy may have a role in difficult airway algorithms, but the optimal device has yet to be found.

  5. Aerosol simulation including chemical and nuclear reactions

    Energy Technology Data Exchange (ETDEWEB)

    Marwil, E.S.; Lemmon, E.C.

    1985-01-01

    The numerical simulation of aerosol transport, including the effects of chemical and nuclear reactions presents a challenging dynamic accounting problem. Particles of different sizes agglomerate and settle out due to various mechanisms, such as diffusion, diffusiophoresis, thermophoresis, gravitational settling, turbulent acceleration, and centrifugal acceleration. Particles also change size, due to the condensation and evaporation of materials on the particle. Heterogeneous chemical reactions occur at the interface between a particle and the suspending medium, or a surface and the gas in the aerosol. Homogeneous chemical reactions occur within the aersol suspending medium, within a particle, and on a surface. These reactions may include a phase change. Nuclear reactions occur in all locations. These spontaneous transmutations from one element form to another occur at greatly varying rates and may result in phase or chemical changes which complicate the accounting process. This paper presents an approach for inclusion of these effects on the transport of aerosols. The accounting system is very complex and results in a large set of stiff ordinary differential equations (ODEs). The techniques for numerical solution of these ODEs require special attention to achieve their solution in an efficient and affordable manner. 4 refs.

  6. Aerosol simulation including chemical and nuclear reactions

    International Nuclear Information System (INIS)

    The numerical simulation of aerosol transport, including the effects of chemical and nuclear reactions presents a challenging dynamic accounting problem. Particles of different sizes agglomerate and settle out due to various mechanisms, such as diffusion, diffusiophoresis, thermophoresis, gravitational settling, turbulent acceleration, and centrifugal acceleration. Particles also change size, due to the condensation and evaporation of materials on the particle. Heterogeneous chemical reactions occur at the interface between a particle and the suspending medium, or a surface and the gas in the aerosol. Homogeneous chemical reactions occur within the aersol suspending medium, within a particle, and on a surface. These reactions may include a phase change. Nuclear reactions occur in all locations. These spontaneous transmutations from one element form to another occur at greatly varying rates and may result in phase or chemical changes which complicate the accounting process. This paper presents an approach for inclusion of these effects on the transport of aerosols. The accounting system is very complex and results in a large set of stiff ordinary differential equations (ODEs). The techniques for numerical solution of these ODEs require special attention to achieve their solution in an efficient and affordable manner. 4 refs

  7. Most primary care physicians are aware of prescription drug monitoring programs, but many find the data difficult to access.

    Science.gov (United States)

    Rutkow, Lainie; Turner, Lydia; Lucas, Eleanor; Hwang, Catherine; Alexander, G Caleb

    2015-03-01

    State prescription drug monitoring programs are common tools intended to reduce prescription drug abuse and diversion, or the nonmedical use of a prescribed drug. The success of these programs depends largely upon physicians' awareness and use of them. We conducted a nationally representative mail survey of 1,000 practicing primary care physicians in 2014 to characterize their attitudes toward and awareness and use of prescription drug monitoring programs. A total of 420 eligible physicians (adjusted response rate: 58 percent) returned completed surveys. Among all physicians surveyed, 72 percent were aware of their state's prescription drug monitoring program, and 53 percent reported using one of the programs. We identified several barriers that may prevent greater use of the programs, including the time-consuming nature of information retrieval and the lack of an intuitive format for data provided by the programs. These results suggest that the majority of US primary care physicians are aware of and use prescription drug monitoring programs at least on occasion, although many did not access these programs routinely. To increase the use of the programs in clinical practice, states should consider implementing legal mandates, investing in prescriber education and outreach, and taking measures to enhance ease of access to and use of the programs. PMID:25732500

  8. Investing in deliberation: a definition and classification of decision support interventions for people facing difficult health decisions.

    Science.gov (United States)

    Elwyn, Glyn; Frosch, Dominick; Volandes, Angelo E; Edwards, Adrian; Montori, Victor M

    2010-01-01

    This article provides an analysis of 'decision aids', interventions to support patients facing tough decisions. Interest has increased since the concept of shared decision making has become widely considered to be a means of achieving desirable clinical outcomes. We consider the aims of these interventions and examine assumptions about their use. We propose three categories, interventions that are used in face-to-face encounters, those designed for use outside clinical encounters and those which are mediated, using telephone or other communication media. We propose the following definition: decision support interventions help people think about choices they face; they describe where and why choice exists; they provide information about options, including, where reasonable, the option of taking no action. These interventions help people to deliberate, independently or in collaboration with others, about options, by considering relevantattributes; they support people to forecast how they might feel about short, intermediate and long-term outcomes which have relevant consequences, in ways which help the process of constructing preferences and eventual decision making, appropriate to their individual situation. Although quality standards have been published for these interventions, we are also cautious about premature closure and consider that the need for short versions for use inside clinical encounters and long versions for external use requires further research. More work is also needed on the use of narrative formats and the translation of theory into practical designs. The interest in decision support interventions for patients heralds a transformation in clinical practice although many important areas remain unresolved. PMID:21088131

  9. Kinetic gold leach monitoring including cyanide speciation

    Scientific Electronic Library Online (English)

    P.W., Lotz; S., Janse van Rensburg; A., Swarts.

    2009-10-01

    Full Text Available Traditionally, bottle roll tests have been used to optimize the extraction process for best gold extraction and recovery. Such tests typically involve exposing the ore to defined reagent concentrations (lime, cyanide and sufficient oxygen) and balance the gold input with recoveries and losses. With [...] mounting pressures to accommodate sustainability issues during development work, it became apparent that much more information would be required on the interactions and kinetic behaviour of solid and solution species during the entire leach process. This information is vital to enable proactive management of critical issues such as cyanide, arsenic, water and tailings management. Inadequate management of these aspects has led to temporary closures and, in cases of noncompliance, to the dynamically changing regulations. MINTEK's advanced leach facility (ALF) is being developed with the aim of bridging the knowledge gap between the gold leach process and the predictable environmental impacts upon discharge. The facility aims to monitor all parameters of relevance such as pH, Eh, dissolved oxygen, metals, cyanide species, and viscosity during the entire process to enable more informed decisions on practical interventions. The presented set of data reflects first experiences gained from processing a refractory gold ore concentrate. Attempts at optimizing the process were limited due to the developmental nature of the work. Data relating to leaches with differing preoxidation conditions and cyanide staging is presented.

  10. Octonionic Lorenz-like condition

    Indian Academy of Sciences (India)

    Murat Tani?li; Bernard Jancewicz

    2012-02-01

    In this study, the octonion algebra and its general properties are de?ned by the Cayley–Dickson’s multiplication rules for octonion units. The ?eld equations, potential equations and Maxwell equations for electromagnetism are investigated with the octonionic equations and these equations can be compared with their vectorial representations. The potential and wave equations for ?elds with sources are also provided. By using Maxwell equations, a Lorenz-like condition is newly suggested for electromagnetism. The existing equations including the photon mass provide the most acknowledged Lorenz condition for the magnetic monopole and the source.

  11. CERN Technical Training: LABVIEW courses include RADE

    CERN Multimedia

    HR Department

    2009-01-01

    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...

  12. CERN Technical Training: LABVIEW courses include RADE

    CERN Multimedia

    HR Department

    2009-01-01

    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...

  13. CERN Technical Training: LABVIEW courses include RADE

    CERN Multimedia

    HR Department

    2009-01-01

    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...

  14. AMS at the ANU including biomedical applications

    Energy Technology Data Exchange (ETDEWEB)

    Fifield, L.K.; Allan, G.L.; Cresswell, R.G.; Ophel, T.R. [Australian National Univ., Canberra, ACT (Australia); King, S.J.; Day, J.P. [Manchester Univ. (United Kingdom). Dept. of Chemistry

    1993-12-31

    An extensive accelerator mass spectrometry program has been conducted on the 14UD accelerator at the Australian National University since 1986. In the two years since the previous conference, the research program has expanded significantly to include biomedical applications of {sup 26}Al and studies of landform evolution using isotopes produced in situ in surface rocks by cosmic ray bombardment. The system is now used for the measurement of {sup 10}Be, {sup 14}C, {sup 26}Al, {sup 36}Cl, {sup 59}Ni and {sup 129}I, and research is being undertaken in hydrology, environmental geochemistry, archaeology and biomedicine. On the technical side, a new test system has permitted the successful off-line development of a high-intensity ion source. A new injection line to the 14UD has been established and the new source is now in position and providing beams to the accelerator. 4 refs.

  15. Neutrino pair bremsstrahlung including neutral current effects

    International Nuclear Information System (INIS)

    In regions of extreme degeneracy the only process for neutrino pair production which is not suppressed is neutrino bremsstrahlung by a degenerate electron gas interacting with the nuclear Coulomb fields. This process is calculated in a general weak interaction model which includes neutral currents. A static Coulomb potential is assumed and both weak and strong screening are considered. In the limit of extreme degeneracy an analytic approximation for the energy loss rate is given. It is found that neutral currents change the energy loss rate only slightly; for example, in the Weinberg--Salam model the rate is about 1.3 times the rate in the V-A theory. The type of screening does not change the rate by more than a factor of two

  16. Optical panel system including stackable waveguides

    Science.gov (United States)

    DeSanto, Leonard; Veligdan, James T.

    2007-03-06

    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.

  17. Including climate change in energy investment decisions

    International Nuclear Information System (INIS)

    To properly take climate change into account in the analysis of energy investment decisions, it is required to apply decision analysis methods that are capable of considering the specific characteristics of climate change (large uncertainties, long term horizon). Such decision analysis methods do exist. They can explicitly include evolving uncertainties, multi-stage decisions, cumulative effects and risk averse attitudes. Various methods are considered in this report and two of these methods have been selected: hedging calculations and sensitivity analysis. These methods are applied to illustrative examples, and its limitations are discussed. The examples are (1a) space heating and hot water for new houses from a private investor perspective and (1b) as example (1a) but from a government perspective, (2) electricity production with an integrated coal gasification combined cycle (ICGCC) with or without CO2 removal, and (3) national energy strategy to hedge for climate change. 9 figs., 21 tabs., 42 refs., 1 appendix

  18. The surgery of peripheral nerves (including tumors)

    DEFF Research Database (Denmark)

    Fugleholm, Kåre

    2013-01-01

    Surgical pathology of the peripheral nervous system includes traumatic injury, entrapment syndromes, and tumors. The recent significant advances in the understanding of the pathophysiology and cellular biology of peripheral nerve degeneration and regeneration has yet to be translated into improved surgical techniques and better outcome after peripheral nerve injury. Decision making in peripheral nerve surgery continues to be a complex challenge, where the mechanism of injury, repeated clinical evaluation, neuroradiological and neurophysiological examination, and detailed knowledge of the peripheral nervous system response to injury are prerequisite to obtain the best possible outcome. Surgery continues to be the primary treatment modality for peripheral nerve tumors and advances in adjuvant oncological treatment has improved outcome after malignant peripheral nerve tumors. The present chapter provides background knowledge of surgical peripheral nerve disease and some general and practical guidance toward its clinical management.

  19. Models of bovine babesiosis including juvenile cattle.

    Science.gov (United States)

    Saad-Roy, C M; Shuai, Zhisheng; van den Driessche, P

    2015-03-01

    Bovine Babesiosis in cattle is caused by the transmission of protozoa of Babesia spp. by ticks as vectors. Juvenile cattle (Babesiosis, rarely show symptoms, and acquire immunity upon recovery. Susceptibility to the disease varies between breeds of cattle. Models of the dynamics of Bovine Babesiosis transmitted by the cattle tick that include these factors are formulated as systems of ordinary differential equations. Basic reproduction numbers are calculated, and it is proved that if these numbers are below the threshold value of one, then Bovine Babesiosis dies out. However, above the threshold number of one, the disease may approach an endemic state. In this case, control measures are suggested by determining target reproduction numbers. The percentage of a particular population (for example, the adult bovine population) needed to be controlled to eradicate the disease is evaluated numerically using Columbia data from the literature. PMID:25715822

  20. CLIC expands to include the Southern Hemisphere

    CERN Multimedia

    Roberto Cantoni

    2010-01-01

    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...

  1. Integration of cell line and process development to overcome the challenge of a difficult to express protein.

    Science.gov (United States)

    Alves, Christina S; Gilbert, Alan; Dalvi, Swati; Germain, Bryan St; Xie, Wenqi; Estes, Scott; Kshirsagar, Rashmi; Ryll, Thomas

    2015-09-01

    This case study addresses the difficulty in achieving high level expression and production of a small, very positively charged recombinant protein. The novel challenges with this protein include the protein's adherence to the cell surface and its inhibitory effects on Chinese hamster ovary (CHO) cell growth. To overcome these challenges, we utilized a multi-prong approach. We identified dextran sulfate as a way to simultaneously extract the protein from the cell surface and boost cellular productivity. In addition, host cells were adapted to grow in the presence of this protein to improve growth and production characteristics. To achieve an increase in productivity, new cell lines from three different CHO host lines were created and evaluated in parallel with new process development workflows. Instead of a traditional screen of only four to six cell lines in bioreactors, over 130 cell lines were screened by utilization of 15 mL automated bioreactors (AMBR) in an optimal production process specifically developed for this protein. Using the automation, far less manual intervention is required than in traditional bench-top bioreactors, and much more control is achieved than typical plate or shake flask based screens. By utilizing an integrated cell line and process development incorporating medium optimized for this protein, we were able to increase titer more than 10-fold while obtaining desirable product quality. Finally, Monte Carlo simulations were performed to predict the optimal number of cell lines to screen in future cell line development work with the goal of systematically increasing titer through enhanced cell line screening. © 2015 American Institute of Chemical Engineers Biotechnol. Prog., 31:1201-1211, 2015. PMID:25919541

  2. IP-10 predicts viral response and therapeutic outcome in difficult-to-treat patients with HCV genotype 1 infection.

    Science.gov (United States)

    Lagging, Martin; Romero, Ana I; Westin, Johan; Norkrans, Gunnar; Dhillon, Amar P; Pawlotsky, Jean-Michel; Zeuzem, Stefan; von Wagner, Michael; Negro, Francesco; Schalm, Solko W; Haagmans, Bart L; Ferrari, Carlo; Missale, Gabriele; Neumann, Avidan U; Verheij-Hart, Elke; Hellstrand, Kristoffer

    2006-12-01

    Plasma from 173 patients with HCV genotype 1 infection was analyzed for IP-10 levels prior to treatment with pegylated interferon-alpha-2a and ribavirin. Significantly lower IP-10 levels were observed in patients achieving a rapid viral response (RVR) (P index (BMI) > or = 25 kg/m2 (P = .004) and with baseline viral load > or = 2 million IU/mL (P = .001). Similarly, significantly lower IP-10 levels were observed in patients obtaining a sustained viral response (SVR) (P = .0002), including those having higher BMI (P < .05), higher viral load (P = .0005), and both higher BMI and viral load (P < .03). In multivariate logistic regression analyses, a low IP-10 value was independently predictive of both RVR and SVR. A baseline cutoff IP-10 value of 600 pg/mL yielded a negative predictive value (NPV) of 79% (19/24) for all genotype 1-infected patients, which was comparable with that observed using a reduction in HCV-RNA by at least 2 logs after 12 weeks of therapy (NPV 86%; 19/22); by combining the two, 30 of 38 patients (NPV 79%) potentially could have been spared unnecessary therapy. In patients having both higher BMI and viral load, cut-off levels of 150 and 600 pg/mL yielded a positive predictive value (PPV) of 71% and NPV of 100%, respectively. In conclusion, pretreatment IP-10 levels predict RVR and SVR in patients infected with HCV genotype 1, even in those with higher BMI and viral load. A substantial proportion of the latter patients may achieve SVR in spite of unfavorable baseline characteristics if their pretreatment IP-10 level is low. Thus, pretreatment IP-10 analysis may prove helpful in decision-making regarding pharmaceutical intervention. PMID:17133471

  3. Chiropractic care and public health : answering difficult questions about safety, care through the lifespan, and community action

    DEFF Research Database (Denmark)

    Johnson, Claire; Rubinstein, Sidney M

    2012-01-01

    The purpose of this collaborative summary is to document current chiropractic involvement in the public health movement, reflect on social ecological levels of influence as a profession, and summarize the relationship of chiropractic to the current public health topics of: safety, health issues through the lifespan, and effective participation in community health issues. The questions that are addressed include: Is spinal manipulative therapy for neck and low-back pain a public health problem? What is the role of chiropractic care in prevention or reduction of musculoskeletal injuries in children? What ways can doctors of chiropractic stay updated on evidence-based information about vaccines and immunization throughout the lifespan? Can smoking cessation be a prevention strategy for back pain? Does chiropractic have relevance within the VA Health Care System for chronic pain and comorbid disorders? How can chiropractic use cognitive behavioral therapy to address chronic low back pain as a public health problem? What opportunities exist for doctors of chiropractic to more effectively serve the aging population? What is the role of ethics and the contribution of the chiropractic profession to public health? What public health roles can chiropractic interns perform for underserved communities in a collaborative environment? Can the chiropractic profession contribute to community health? What opportunities do doctors of chiropractic have to be involved in health care reform in the areas of prevention and public health? What role do citizen-doctors of chiropractic have in organizing community action on health-related matters? How can our future chiropractic graduates become socially responsible agents of change?

  4. Autonomia e formação humana em situações pedagógicas: um difícil percurso / Autonomy and human development in pedagogical situations: a difficult journey

    Scientific Electronic Library Online (English)

    Maurício, Mogilka.

    1999-07-01

    Full Text Available Este artigo desenvolve uma discussão sobre o processo de estruturação da autonomia da criança em situações pedagógicas. Inicia buscando fazer a distinção entre os conceitos de liberdade e autonomia, posto que freqüentemente tomados como sinônimos. Estabelecer esta distinção é fundamental para explic [...] itar o caráter não inato da autonomia, qualidade do ser que precisa de estruturação. Na abordagem teórica escolhida para esta discussão, de caráter interacionista, a estruturação da autonomia é encarada como um processo que precisa ser construído, entre a liberdade natural, inerente à natureza humana, e a capacidade da criança se auto-regular, na relação com as necessidades de seus semelhantes. Este processo é considerado aqui como resultante de um diálogo entre as potencialidades inatas da criança e os elementos externos ao seu eu: a cultura e as relações sociais. Quando esta interação não é coercitiva e nem permissiva, dar-se-iam as condições necessárias para a estruturação saudável do eu, isto é, o processo de formação humana, entendida no sentido mais rigoroso e pleno de positividade. A reflexão desenvolvida é fundamentada na pedagogia humanista, especialmente no pensamento de Rousseau, Rogers e Dewey. O texto conclui com uma visão positiva sobre as possibilidades de construção da autonomia, mas tenta mostrar, dentro dos seus limites e do seu horizonte teórico, que esta é uma possibilidade problemática. Isto se daria pela dificuldade do agir e do compreender democráticos em uma sociedade simultaneamente diretiva e permissiva. Abstract in english This article discusses the process of structuring the child’s autonomy in pedagogical situations. It starts by attempting to distinguish between the concepts of freedom and autonomy, since these are often taken synonymously. It is fundamental to establish this distinction to reveal the non-innate ch [...] aracter of the autonomy, a quality of the being that needs structuring. In the interactionist theoretical approach chosen for this discussion the structuring of autonomy is seen as a process that needs to be built between the natural freedom - inherent to human nature - and the self-regulating ability of the child in the face of the needs of her/his equals. This process is considered here as resulting from a dialogue between the child’s innate potentials and elements external to his/her self: the culture and the social relations. When such interaction is neither coercive nor lax the necessary conditions would be given to a healthy structuring of the self, that is, the process of human formation understood in its most rigorous sense and full of positiveness. The reflection developed here is rooted in the Humanist pedagogy, especially in the thinking of Rousseau, Rogers, and Dewey. The text concludes with a positive view of the possibilities of constructing autonomy but, within the limits and theoretical boundaries of the work, tries to show that this is a problematical possibility. That would be due to the difficulty of acting and comprehending democratically in a society that is simultaneously conducive and permissive.

  5. Autonomia e formação humana em situações pedagógicas: um difícil percurso Autonomy and human development in pedagogical situations: a difficult journey

    Directory of Open Access Journals (Sweden)

    Maurício Mogilka

    1999-07-01

    Full Text Available Este artigo desenvolve uma discussão sobre o processo de estruturação da autonomia da criança em situações pedagógicas. Inicia buscando fazer a distinção entre os conceitos de liberdade e autonomia, posto que freqüentemente tomados como sinônimos. Estabelecer esta distinção é fundamental para explicitar o caráter não inato da autonomia, qualidade do ser que precisa de estruturação. Na abordagem teórica escolhida para esta discussão, de caráter interacionista, a estruturação da autonomia é encarada como um processo que precisa ser construído, entre a liberdade natural, inerente à natureza humana, e a capacidade da criança se auto-regular, na relação com as necessidades de seus semelhantes. Este processo é considerado aqui como resultante de um diálogo entre as potencialidades inatas da criança e os elementos externos ao seu eu: a cultura e as relações sociais. Quando esta interação não é coercitiva e nem permissiva, dar-se-iam as condições necessárias para a estruturação saudável do eu, isto é, o processo de formação humana, entendida no sentido mais rigoroso e pleno de positividade. A reflexão desenvolvida é fundamentada na pedagogia humanista, especialmente no pensamento de Rousseau, Rogers e Dewey. O texto conclui com uma visão positiva sobre as possibilidades de construção da autonomia, mas tenta mostrar, dentro dos seus limites e do seu horizonte teórico, que esta é uma possibilidade problemática. Isto se daria pela dificuldade do agir e do compreender democráticos em uma sociedade simultaneamente diretiva e permissiva.This article discusses the process of structuring the child’s autonomy in pedagogical situations. It starts by attempting to distinguish between the concepts of freedom and autonomy, since these are often taken synonymously. It is fundamental to establish this distinction to reveal the non-innate character of the autonomy, a quality of the being that needs structuring. In the interactionist theoretical approach chosen for this discussion the structuring of autonomy is seen as a process that needs to be built between the natural freedom - inherent to human nature - and the self-regulating ability of the child in the face of the needs of her/his equals. This process is considered here as resulting from a dialogue between the child’s innate potentials and elements external to his/her self: the culture and the social relations. When such interaction is neither coercive nor lax the necessary conditions would be given to a healthy structuring of the self, that is, the process of human formation understood in its most rigorous sense and full of positiveness. The reflection developed here is rooted in the Humanist pedagogy, especially in the thinking of Rousseau, Rogers, and Dewey. The text concludes with a positive view of the possibilities of constructing autonomy but, within the limits and theoretical boundaries of the work, tries to show that this is a problematical possibility. That would be due to the difficulty of acting and comprehending democratically in a society that is simultaneously conducive and permissive.

  6. Boundary conditions independent diffuse correlation spectroscopy

    Science.gov (United States)

    Diop, Mamadou; St. Lawrence, Keith

    2015-03-01

    Diffuse correlation spectroscopy (DCS) can measure perfusion changes in deep tissue. However, DCS requires solving the diffusion equation with the proper boundary conditions which can be very difficult and even impossible in many cases. We present a DCS approach that is independent of boundary conditions. The approach is based on measuring the probability distribution function (PDF) of the photons' pathlengths by deconvolving the temporal point-spread function and the instrument-response function obtained from time-resolved measurements. The recovered PDF was then used to fit the field correlation function to extract perfusion changes. This approach can be applied to any geometry and is valid for diffusive, single-scattering and multiple-scattering, but non-diffusive media.

  7. Atomic collisions under extreme conditions in space

    International Nuclear Information System (INIS)

    In space, atoms and molecules are often placed under the extreme conditions which are very difficult to be realized on Earth. For instance, extremely hot and dense plasmas are found in and around various stellar objects (e.g., neutron stars) on one hand and extremely cold and diffuse gases prevail in interstellar space on the other. There is so strong a magnetic field that electron clouds in atoms and molecules are distorted. The study of atomic collisions under the extreme conditions is not only helpful in understanding the astrophysical environment but also reveals new aspects of the physics of atoms and molecules. This paper is an invitation to the study. (References are not exhaustive but only provide a clue with which more details can be found.) (author)

  8. Fundamentals for remote condition monitoring of offshore wind turbines

    DEFF Research Database (Denmark)

    McGugan, Malcolm; Larsen, Gunner Chr.

    2008-01-01

    In the future, large wind turbines will be placed offshore in considerable numbers. Since access will be difficult and costly, it is preferable to use monitoring systems to reduce the reliance on manual inspection. The motivation for the effort reported here is to create the fundamental basis necessary for the use of sensors as a structural health monitoring system for wind turbine blades. This includes creating knowledge that will allow sensor signals to be used for remotely identifying the presence and position of any damage, the damage type and severity, and a structural condition assessment of the wind turbine blades that can integrate with existing SCADA tools to improve management of large offshore wind farms, and optimise the manual inspection/maintenance effort. Various sensor types, which have previously been identified as technically (and economically) capable of detecting the early development of significant damage in fibre reinforced composite, are investigated. In each case specific approaches have been proposed, developed and implemented in models or laboratory test specimens. The sensor approaches are based on acoustic emission (various passive and active applications including mobile sensors), fibre optics (including a new microbend transducer design and various Bragg-grating based applications), wireless approaches involving both battery and energy harvesting options, and inertia sensor based system identification approaches able to deal with linear periodic systems. In addition to the sensor investigations, a life-estimate approach for the wind turbines is described based on identifying and characterising critical material failure modes then integrating detailed models of damage progression rates into full scale models of the blade structure under operating loading regimes. The application of sensors is addressed during a full-scale blade test and recommendations are made regarding improvement to the commercial blade certification process of test and inspection, sensor use for monitoring in-service structural response, and the need for dedicated research facilities providing multi-scale and multifunctional testing of structures.

  9. Seepage Model for PA Including Drift Collapse

    International Nuclear Information System (INIS)

    The purpose of this Analysis/Model Report (AMR) is to document the predictions and analysis performed using the Seepage Model for Performance Assessment (PA) and the Disturbed Drift Seepage Submodel for both the Topopah Spring middle nonlithophysal and lower lithophysal lithostratigraphic units at Yucca Mountain. These results will be used by PA to develop the probability distribution of water seepage into waste-emplacement drifts at Yucca Mountain, Nevada, as part of the evaluation of the long term performance of the potential repository. This AMR is in accordance with the ''Technical Work Plan for Unsaturated Zone (UZ) Flow and Transport Process Model Report'' (CRWMS M andO 2000 [153447]). This purpose is accomplished by performing numerical simulations with stochastic representations of hydrological properties, using the Seepage Model for PA, and evaluating the effects of an alternative drift geometry representing a partially collapsed drift using the Disturbed Drift Seepage Submodel. Seepage of water into waste-emplacement drifts is considered one of the principal factors having the greatest impact of long-term safety of the repository system (CRWMS M andO 2000 [153225], Table 4-1). This AMR supports the analysis and simulation that are used by PA to develop the probability distribution of water seepage into drift, and is therefore a model of primary (Level 1) importance (AP-3.15Q, ''Managing Technical Product Inputs''). The intended purpose of the Seepage Model for PA is to support: (1) PA; (2) Abstraction of Drift-Scale Seepage; and (3) Unsaturated Zone (UZ) Flow and Transport Process Model Report (PMR). Seepage into drifts is evaluated by applying numerical models with stochastic representations of hydrological properties and performing flow simulations with multiple realizations of the permeability field around the drift. The Seepage Model for PA uses the distribution of permeabilities derived from air injection testing in niches and in the cross drift to stochastically simulate the 3D flow of water in the fractured host rock (in the vicinity of potential emplacement drifts) under ambient conditions. The Disturbed Drift Seepage Submodel evaluates the impact of the partial collapse of a drift on seepage. Drainage in rock below the emplacement drift is also evaluated

  10. Odontogenic fibroma, including amyloid and ossifying variants.

    Science.gov (United States)

    Eversole, Lewis R

    2011-12-01

    Sixty-five cases of odontogenic fibroma (OdonF) are herein presented having been segregated into peripheral, extra bony tumors (n = 40) and tumors arising in bone or centrally (n = 25). All cases were characterized microscopically by a fibrous proliferation that varied within and between cases in cellularity and collagen fibril diameter, with intermixed odontogenic epithelial islands and cords. All central lesions presented as well demarcated radiolucencies and resorption of contiguous tooth roots was a common finding. These intraosseous lesions were of the WHO type; the so-called nonWHO type was excluded as all lesions with this diagnosis were devoid of an epithelial component and could be reclassified as other soft tissue fibrogenic tumors. Neither the central tumors nor the peripheral lesions recurred following enucleation/curettage, with a mean follow-up of 4 and 3.4 years respectively. Three distinct microscopic variations were encountered in this series: (1) two cases of OdonF with giant cell reaction, (2) two instances of OdonF with ossifying fibroma; and (3) four instances of OdonF with odontogenic ameloblast-associated protein (ODAM), an amyloid-like protein found deposited adjacent to epithelial cords plus CD1a+/S-100+ Langerhans dendritic cells entwined around the epithelial element. A single instance of the odontogenic fibroma-like hamartoma/enamel hypoplasia syndrome has been included in this series. PMID:21751042

  11. Langevin simulations of QCD, including fermions

    International Nuclear Information System (INIS)

    We encounter critical slow down in updating when xi/a -> infinite and in matrix inversion (needed to include fermions) when msub(q)a -> 0. A simulation that purports to solve QCD numerically will encounter these limits, so to face the challenge in the title of this workshop, we must cure the disease of critical slow down. Physically, this critical slow down is due to the reluctance of changes at short distances to propagate to large distances. Numerically, the stability of an algorithm at short wavelengths requires a (moderately) small step size; critical slow down occurs when the effective long wavelength step size becomes tiny. The remedy for this disease is an algorithm that propagates signals quickly throughout the system; i.e. one whose effective step size is not reduced for the long wavelength conponents of the fields. (Here the effective ''step size'' is essentially an inverse decorrelation time.) To do so one must resolve various wavelengths of the system and modify the dynamics (in CPU time) of the simulation so that all modes evolve at roughly the same rate. This can be achieved by introducing Fourier transforms. I show how to implement Fourier acceleration for Langevin updating and for conjugate gradient matrix inversion. The crucial feature of these algorithms that lends them to Fourier acceleration is that they update the lattice globally; hence the Fourier transforms are computed once per sweep rather than once per hit. (orig./HSI)

  12. Antimatter-matter scattering including rearrangement

    Science.gov (United States)

    Kadyrov, Alisher

    2014-10-01

    Two distinct versions of the convergent close coupling (CCC) approach to ion-atom and ion-molecule collisions have been developed in the impact parameter representation. The first method starts from the exact three-body Schrödinger equation for the total scattering wave function and leads to coupled-channel Lippmann-Schwinger type integral equations for the transition amplitudes, with the relative motion of the heavy particles treated fully quantum mechanically. The second approach utilises a traditional semi-classical approximation. It is based on the time-dependent Schrödinger equation for the electronic part of the scattering wave function and leads to a system of coupled differential equations. This allows one to test the quality of approximations used in standard approaches to the problem. Both methods are applied to calculate antiproton collisions with inert gases and simple molecular targets in the energy range from 1 keV to 1 MeV. The methods are also applied to proton collisions including rearrangement channels. Interplay of direct ionisation and electron capture to continuum in target breakup is investigated. The first CCC calculations of the antiproton and proton stopping power in atomic and molecular hydrogen are presented. The work was supported by the Australian Research Council.

  13. Quasilocal energy conditions

    OpenAIRE

    Hayward, Geoff

    1994-01-01

    The classical value of the Hamiltonian for a system with timelike boundary has been interpreted as a quasilocal energy. This quasilocal energy is not positive definite. However, we derive a `quasilocal dominant energy condition' which is the natural consequence of the local dominant energy condition. We discuss some implications of this quasilocal energy condition. In particular, we find that it implies a `quasilocal weak energy condition'.

  14. Developing working conditions

    OpenAIRE

    Bergman, Peter N.

    2011-01-01

    The overall aim of this thesis was to investigate working conditions and organizational strategies providing conditions for job resources with potential for development, positive well-being and health. The aim was formed on the assumption that the organization affects working conditions, working conditions affects employees? development, well-being, health and sickness absence. Both a qualitative case study design and a longitudinal epidemiologic design were used in this thesis. These two dif...

  15. Promoting Social Inclusion Counting with Everyone: Learning Communities and INCLUD-ED

    Science.gov (United States)

    Gatt, Suzanne; Ojala, Mikko; Soler, Marta

    2011-01-01

    The scientific community has provided a wide range of evidence that family and community involvement in schools benefits not only students' learning but also their surrounding community. The INCLUD-ED project has conducted case studies of successful schools around Europe that have strong community participation. Some of them are engaged in the…

  16. Inflation of Conditional Predictions

    Science.gov (United States)

    Koriat, Asher; Fiedler, Klaus; Bjork, Robert A.

    2006-01-01

    The authors report 7 experiments indicating that conditional predictions--the assessed probability that a certain outcome will occur given a certain condition--tend to be markedly inflated. The results suggest that this inflation derives in part from backward activation in which the target outcome highlights aspects of the condition that are…

  17. Wind conditions and resource assessment

    DEFF Research Database (Denmark)

    Lundtang Petersen, Erik; Troen, Ib

    2012-01-01

    The development of wind power as a competitive energy source requires resource assessment of increasing accuracy and detail (including not only the long-term ‘raw’ wind resource, but also turbulence, shear, and extremes), and in areas of increasing complexity. This in turn requires the use of the most advanced large-scale meteorological models and data together with a chain of modeling tools linking the large-scale dynamics via the mesoscales to site-specific wind conditions.These wind conditions (at a given wind turbine site and height) are a complex function of ‘the weather’ statistics and of influence from features at smaller scales such as hills and mountains, surface roughness conditions, surface thermal properties, and specific nearby obstacles such as ‘other’ wind turbines. © 2012 John Wiley & Sons, Ltd.

  18. Use of versapoint to refashion the cervical canal to overcome unusually difficult embryo transfers and improve in-vitro fertilization-embryo transfer outcome: A case series

    Directory of Open Access Journals (Sweden)

    Nalini Mahajan

    2011-01-01

    Full Text Available Background : Smooth atraumatic embryo transfer is paramount for the success of in-vitro fertilization (IVF. In difficult cases, cervical canal manipulation may be required. Aim : To see if surgical correction of the cervical canal or cervical canal refashioning could improve ease of embryo transfer. Setting : Private infertility and IVF hospital. Design : Prospective study. Materials and Methods : Patients: 11 women with failed 1-3 IVF cycles with history of extremely difficult embryo transfers (ETs despite undergoing cervical dilatation in the cycle prior to IVF. Interventions : Operative hysteroscopy using Versapoint for refashioning of the cervical canal. Main Outcome Measures : Ease of ET in the subsequent IVF cycle. Secondary outcome measure was to assess reproductive outcome. Results : Easy and atraumatic ET in the IVF cycle after procedure in 100% patients. PR was 46.5%. Conclusions : Use of Versapoint for refashioning the cervical canal can improve the quality of ET and PR.

  19. SEEPAGE MODEL FOR PA INCLUDING DRIFT COLLAPSE

    Energy Technology Data Exchange (ETDEWEB)

    C. Tsang

    2004-09-22

    The purpose of this report is to document the predictions and analyses performed using the seepage model for performance assessment (SMPA) for both the Topopah Spring middle nonlithophysal (Tptpmn) and lower lithophysal (Tptpll) lithostratigraphic units at Yucca Mountain, Nevada. Look-up tables of seepage flow rates into a drift (and their uncertainty) are generated by performing numerical simulations with the seepage model for many combinations of the three most important seepage-relevant parameters: the fracture permeability, the capillary-strength parameter 1/a, and the percolation flux. The percolation flux values chosen take into account flow focusing effects, which are evaluated based on a flow-focusing model. Moreover, multiple realizations of the underlying stochastic permeability field are conducted. Selected sensitivity studies are performed, including the effects of an alternative drift geometry representing a partially collapsed drift from an independent drift-degradation analysis (BSC 2004 [DIRS 166107]). The intended purpose of the seepage model is to provide results of drift-scale seepage rates under a series of parameters and scenarios in support of the Total System Performance Assessment for License Application (TSPA-LA). The SMPA is intended for the evaluation of drift-scale seepage rates under the full range of parameter values for three parameters found to be key (fracture permeability, the van Genuchten 1/a parameter, and percolation flux) and drift degradation shape scenarios in support of the TSPA-LA during the period of compliance for postclosure performance [Technical Work Plan for: Performance Assessment Unsaturated Zone (BSC 2002 [DIRS 160819], Section I-4-2-1)]. The flow-focusing model in the Topopah Spring welded (TSw) unit is intended to provide an estimate of flow focusing factors (FFFs) that (1) bridge the gap between the mountain-scale and drift-scale models, and (2) account for variability in local percolation flux due to stochastic hydrologic properties and flow processes.

  20. Rayfiles including spectral and colorimetric information.

    Science.gov (United States)

    Jacobs, Valéry Ann; Audenaert, Jan; Bleumers, Johan; Durinck, Guy; Rombauts, Patrick; Hanselaer, Peter

    2015-04-01

    To obtain realistic results in lighting simulation software, realistic models of light sources are needed. A near-field model of a light source is accurate, and can be obtained by a near-field goniophotometer. This type of goniophotometer is conventionally equipped with a V(?)-filter. However, the advent of new light sources with spatial- or angular color variations necessitates the inclusion of spectral information about the source. We demonstrate a method to include spectral information of a light source in ray tracing. We measured the relative angular variation of the spectrum of an OLED using a spectroradiometer mounted on a near-field goniophotometer. Principal component analysis (PCA) is exploited to reduce the amount of data that needs to be stored. Also a photometric ray file of the OLED was obtained. To construct a set of monochromatic ray files, the luminous flux in the original ray file is redistributed over a set of wavelengths and stored in separate ray files. The redistribution depends on the angle of emission and the spectral irradiance measured in that direction. These ray files are then inserted in ray tracing software TracePro. Using the OLED as a test source, the absolute spectral irradiance is calculated at an arbitrary position. The result is validated using a spectroradiometer to obtain the absolute spectral irradiance at that particular point. A good agreement between the simulated and measured absolute spectral irradiance is found. Furthermore, a set of tristimulus ray files is constructed and used in ray tracing software to generate a u'v'-color coordinate distribution on a surface. These values are in agreement with the color coordinate distribution found using the spectral ray files. Whenever spectral or color information is desired at a task area, the proposed method allows for a fast and efficient way to improve the accuracy of simulations using ray tracing. PMID:25968801