WorldWideScience

Sample records for carney complex case

  1. Recurrent right ventricular cardiac myxoma in a patient with Carney complex: a case report.

    Science.gov (United States)

    Sardar, Muhammad Rizwan; Lahoti, Ankush; Khaji, Amanulla; Saeed, Wajeeha; Maqsood, Khawar; Zegel, Harry G; Romanelli, Jeanine E; McGeehin, Frank C

    2014-05-02

    Carney complex is a multiple neoplasia syndrome involving cardiac, endocrine, neural and cutaneous tumors with a variety of pigmented skin lesions. It has an autosomal dominant mode of inheritance. Approximately 7% of cardiac myxomas are related to the Carney complex. Myxomas that occur as part of the Carney complex affect both sexes with equal frequency. Cardiac myxomas with Carney complex are reported mostly in the left side of the heart and are less common on the right side. As per our review, this is the first reported case of Carney complex with right ventricle cardiac myxoma. We present a rare case of recurrent cardiac myxoma in a patient later diagnosed to have Carney complex. A 46-year-old Caucasian man with a history of thyroid hyperplasia came to out-patient cardiology department with new onset atrial fibrillation. A transthoracic echocardiogram revealed a right ventricular mass attached to his interventricular septum, which was later seen on a transesophageal echocardiogram and cardiac magnetic resonance imaging. He underwent resection of the ventricular mass which on pathology revealed myxoma. He later developed skin lesions, pituitary adenoma and Sertoli cell tumor suggesting Carney complex. Two years later he developed a new mass within his right atrium which was later resected. Carney complex is a rare autosomal dominant disease with variable penetrance. Since it involves multiple organs, patients diagnosed with Carney complex should undergo serial endocrine workup, neural assessments, echocardiograms and testicular ultrasounds. Of the total number of cases of Carney complex, 65% are linked to PRKAR1A gene mutation. It is important for clinicians to be cognizant of a link between cardiac myxoma and Carney complex. The use of multi-imaging modalities allows better delineation of the mass before planned resection. Carney complex-related cardiac myxoma comprises 7% of all cardiac myxomas. Right ventricular cardiac myxomas are rare. This case report is

  2. Carney complex (CNC).

    Science.gov (United States)

    Bertherat, Jérôme

    2006-06-06

    The Carney complex (CNC) is a dominantly inherited syndrome characterized by spotty skin pigmentation, endocrine overactivity and myxomas. Skin pigmentation anomalies include lentigines and blue naevi. The most common endocrine gland manifestations are acromegaly, thyroid and testicular tumors, and adrenocorticotropic hormone (ACTH)-independent Cushing's syndrome due to primary pigmented nodular adrenocortical disease (PPNAD). PPNAD, a rare cause of Cushing's syndrome, is due to primary bilateral adrenal defect that can be also observed in some patients without other CNC manifestations or familial history of the disease. Myxomas can be observed in the heart, skin and breast. Cardiac myxomas can develop in any cardiac chamber and may be multiple. One of the putative CNC genes located on 17q22-24, (PRKAR1A), has been identified to encode the regulatory subunit (R1A) of protein kinase A. Heterozygous inactivating mutations of PRKAR1A were reported initially in 45 to 65% of CNC index cases, and may be present in about 80% of the CNC families presenting mainly with Cushing's syndrome. PRKAR1A is a key component of the cAMP signaling pathway that has been implicated in endocrine tumorigenesis and could, at least partly, function as a tumor suppressor gene. Genetic analysis should be proposed to all CNC index cases. Patients with CNC or with a genetic predisposition to CNC should have regular screening for manifestations of the disease. Clinical work-up for all the manifestations of CNC should be performed at least once a year in all patients and should start in infancy. Cardiac myxomas require surgical removal. Treatment of the other manifestations of CNC should be discussed and may include follow-up, surgery, or medical treatment depending on the location of the tumor, its size, the existence of clinical signs of tumor mass or hormonal excess, and the suspicion of malignancy. Bilateral adrenalectomy is the most common treatment for Cushing's syndrome due to PPNAD.

  3. Carney complex (CNC

    Directory of Open Access Journals (Sweden)

    Bertherat Jérôme

    2006-06-01

    Full Text Available Abstract The Carney complex (CNC is a dominantly inherited syndrome characterized by spotty skin pigmentation, endocrine overactivity and myxomas. Skin pigmentation anomalies include lentigines and blue naevi. The most common endocrine gland manifestations are acromegaly, thyroid and testicular tumors, and adrenocorticotropic hormone (ACTH-independent Cushing's syndrome due to primary pigmented nodular adrenocortical disease (PPNAD. PPNAD, a rare cause of Cushing's syndrome, is due to primary bilateral adrenal defect that can be also observed in some patients without other CNC manifestations or familial history of the disease. Myxomas can be observed in the heart, skin and breast. Cardiac myxomas can develop in any cardiac chamber and may be multiple. One of the putative CNC genes located on 17q22-24, (PRKAR1A, has been identified to encode the regulatory subunit (R1A of protein kinase A. Heterozygous inactivating mutations of PRKAR1A were reported initially in 45 to 65 % of CNC index cases, and may be present in about 80 % of the CNC families presenting mainly with Cushing's syndrome. PRKAR1A is a key component of the cAMP signaling pathway that has been implicated in endocrine tumorigenesis and could, at least partly, function as a tumor suppressor gene. Genetic analysis should be proposed to all CNC index cases. Patients with CNC or with a genetic predisposition to CNC should have regular screening for manifestations of the disease. Clinical work-up for all the manifestations of CNC should be performed at least once a year in all patients and should start in infancy. Cardiac myxomas require surgical removal. Treatment of the other manifestations of CNC should be discussed and may include follow-up, surgery, or medical treatment depending on the location of the tumor, its size, the existence of clinical signs of tumor mass or hormonal excess, and the suspicion of malignancy. Bilateral adrenalectomy is the most common treatment for Cushing

  4. Genetics Home Reference: Carney complex

    Science.gov (United States)

    ... National Institute of Diabetes and Digestive and Kidney Diseases: Cushing's Syndrome Educational Resources (5 links) MalaCards: carney complex variant MalaCards: carney complex, type 1 Merck Manual Home ... disease type 1 GABA-transaminase deficiency All New & Updated ...

  5. Cryoglobulinemic vasculitis preceding diagnosis of Carney Complex

    DEFF Research Database (Denmark)

    Glerup, Mia; Stausbøl-Grøn, Brian; Heuck, Carsten

    2014-01-01

    Carney complex (CNC) is a disorder characterized by skin pigmentary abnormalities and benign cardiac, endocrine, skin and neuronal tumors. We present a previously healthy 12-year-old boy with recurrent pain and swelling of the feet. One year later he presented with stiffness of the fingers...

  6. Cryoglobulinemic vasculitis preceding diagnosis of Carney Complex

    DEFF Research Database (Denmark)

    Glerup, Mia; Stausbøl-Grøn, Brian; Heuck, Carsten

    2014-01-01

    Carney complex (CNC) is a disorder characterized by skin pigmentary abnormalities and benign cardiac, endocrine, skin and neuronal tumors. We present a previously healthy 12-year-old boy with recurrent pain and swelling of the feet. One year later he presented with stiffness of the fingers...... and the toes were painful with no swelling. Rheumatoid factor, ANCA and ANA were all negative but cryoglobulins were positive. Unusual lentigines were noted. The monthly attacks with pain and joint swelling were treated sufficiently with prednisolone and azathioprine. Two years later he was admitted....... The lentigines and myxoma led to the suggestion of Carney Complex and the diagnosis was confirmed by a PRKAR1A mutation found in the child as well as the mother....

  7. Fourth Recurrence of Cardiac Myxoma in a Patient with the Carney Complex

    Directory of Open Access Journals (Sweden)

    O Young Kwon

    2016-04-01

    Full Text Available Although cardiac myxoma is the most commonly encountered benign cardiac tumor in cardiac surgery practice, recurrent cardiac myxoma is very rare, is most commonly related to the Carney complex, and usually requires multiple cardiac operations with specific requirements in terms of perioperative management. In this report, we describe a patient who experienced the fourth recurrence of cardiac myxoma and review the diagnostic criteria of the Carney complex. This is the first report of such a case in Korea.

  8. Osteochondromyxoma: Review of a rare carney complex criterion.

    Science.gov (United States)

    Golden, Todd; Siordia, Juan A

    2016-11-01

    Osteochondromyxoma is an extremely rare bone tumor associated with 1% of Carney complex patients and constitutes one of its 11 diagnostic criteria. This narrative review of osteochondromyxoma is based on a search of all references to the topic in PubMed, Web Of Science, SCOPUS, ScienceDirect, and JSTOR databases. Special attention was focused on case reports, leading to a review encompassing the case reports to date, as well as related animal model studies. This review covers the current understanding of osteochondromyxoma, highlighting its variability while providing consensus on the most common clinical presentation, pathological findings, and genetic features of this rare bone tumor.

  9. Harvey Cushing Treated the First Known Patient With Carney Complex.

    Science.gov (United States)

    Tsay, Cynthia J; Stratakis, Constantine A; Faucz, Fabio Rueda; London, Edra; Stathopoulou, Chaido; Allgauer, Michael; Quezado, Martha; Dagradi, Terry; Spencer, Dennis D; Lodish, Maya

    2017-10-01

    Carney complex (CNC) is a syndrome characterized by hyperplasia of endocrine organs and may present with clinical features of Cushing syndrome and acromegaly due to functional adrenal and pituitary gland tumors. CNC has been linked to mutations in the regulatory subunit of protein kinase A type I-alpha ( PRKAR1A ) gene. Tissue samples were taken from the hypothalamus or thalamus or tumors of patients with pituitary adenomas seen and operated on by neurosurgeon Harvey Cushing between 1913 and 1932. Following DNA extraction, sequencing for genes of interest was attempted, including PRKAR1A , AIP , USP8 , GNAS1 , and GPR101 , to explore the possibility that these mutations associated with acromegaly, CNC, and Cushing syndrome have been conserved over time. We report a patient described by Dr. Cushing in 1914 with a clinical presentation and postmortem findings suggestive of CNC. Genetic sequencing of the hypothalamus and pituitary adenoma revealed a germline heterozygous p.Arg74His mutation in the PRKAR1A gene, a codon previously described as mutated in CNC, but with a novel amino acid change. This patient is, to our knowledge, the first molecularly confirmed individual with CNC. This case demonstrates the power of modern genetics in studying archived tissues and the importance of recording detailed clinical notes in the diagnosis of disease.

  10. Failure to Thrive in the Context of Carney Complex.

    Science.gov (United States)

    Tirosh, Amit; Auerbach, Adi; Bonella, Belen; Zavras, Phaedon D; Belyavskaya, Elena; Lyssikatos, Charalampos; Meir, Karen; Weiss, Ram; Daum, Hagit; Lodish, Maya B; Gillis, David; Stratakis, Constantine A

    2018-01-01

    Carney complex (CNC) is a rare syndrome associated with multiple tumors and several other unique manifestations. We describe the clinical, genetic, and laboratory findings in a cohort of patients with CNC and failure to thrive (FTT). A retrospective case series of pediatric patients with CNC presenting with FTT. We describe a patient with infantile Cushing syndrome (CS) who presented with severe FTT and liver disease; the patient was subsequently diagnosed with CNC. This led to the realization that at least 10 other patients with CNC and FTT have been investigated in the last 22 years at the Eunice Kennedy Shriver National Institute of Child Health and Human Development. Four of those had primary pigmented nodular adrenocortical disease (PPNAD), 2 had cardiac myxomas, and 3 had liver disease. Pediatric patients with CNC may present with FTT whose primary cause is variable and includes CS due to PPNAD, hepatic involvement, and other manifestations of CNC. FTT due to liver disease and/or other causes is a unique new presentation of this rare syndrome with which clinicians need to be familiar. © 2017 S. Karger AG, Basel.

  11. PRKAR1A mutation causing pituitary-dependent Cushing disease in a patient with Carney complex.

    Science.gov (United States)

    Kiefer, Florian W; Winhofer, Yvonne; Iacovazzo, Donato; Korbonits, Márta; Wolfsberger, Stefan; Knosp, Engelbert; Trautinger, Franz; Höftberger, Romana; Krebs, Michael; Luger, Anton; Gessl, Alois

    2017-08-01

    Carney complex (CNC) is an autosomal dominant condition caused, in most cases, by an inactivating mutation of the PRKAR1A gene, which encodes for the type 1 alpha regulatory subunit of protein kinase A. CNC is characterized by the occurrence of endocrine overactivity, myxomas and typical skin manifestations. Cushing syndrome due to primary pigmented nodular adrenocortical disease (PPNAD) is the most frequent endocrine disease observed in CNC. Here, we describe the first case of a patient with CNC and adrenocorticotropic hormone (ACTH)-dependent Cushing disease due to a pituitary corticotroph adenoma. Loss-of-heterozygosity analysis of the pituitary tumour revealed loss of the wild-type copy of PRKAR1A , suggesting a role of this gene in the pituitary adenoma development. PRKAR1A loss-of-function mutations can rarely lead to ACTH-secreting pituitary adenomas in CNC patients. Pituitary-dependent disease should be considered in the differential diagnosis of Cushing syndrome in CNC patients. © 2017 European Society of Endocrinology.

  12. Carney's triad

    International Nuclear Information System (INIS)

    Pignatelli, V.; Grassi, L.; Campani, D.; Pingitore, R.

    1988-01-01

    Carney's triad is a rare syndrome characterized by gastric leiomyosarcoma, functioning extraadrenal paraganglioma, and pulmonary chondroma. Twenty-seven cases are reported in literature: the most commonly observed neoplasm is gastric leiomyosarcoma (26/27),followed by lung tumor (22/27), and gastric paraganglioma (15/27). Three patients bearing a gastric leiomysarcoma developed liver metastases, and 6 had a local recurrence after some years. The occurence of paraganglioma makes the prognosis wors: 4 deaths from local infiltration, metastases or severe hypertension. The triad only accured in 9/27 cases, mostly young female patients. A common embryologic origin is difficult to assess. The case of a young female patients. A common embryologic origin is difficult to assess. The case of a young female patient with recurrent gastric leiomyosarcoma (12 years later) and bilateral pulmonary chondroma as described. It is important that patients with any of the tree tumors be periodically examined

  13. Sporadic Carney complex without PRKAR1A mutation in a young patient with ischemic stroke.

    Science.gov (United States)

    Aguiar de Sousa, Diana; Gouveia, Ana Isabel; Wessling, Ana; Geraldes, Ruth; Canhão, Patrícia

    2015-03-01

    We describe a 29-year-old male, with a previous history of testicular tumor, who presented with a posterior circulation ischemic stroke associated to an atrial myxoma. Dermatologic observation disclosed spotty skin and mucosal pigmentation (lentigines), and a cutaneous myxoma was histopathologically confirmed. Although there was no family history of any of the Carney complex (CNC) features and no mutations in the PRKAR1A gene were found, these findings lead to the diagnosis of CNC. We emphasize the importance of recognizing this entity in young patients with stroke. Copyright © 2015 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  14. Carney Complex

    Science.gov (United States)

    ... to Content ASCO.org Conquer Cancer Foundation ASCO Journals Donate eNews Signup f Cancer.net on Facebook t Cancer.net on Twitter q Cancer.net on YouTube g Cancer.net on Google Menu Home Types of Cancer Navigating Cancer Care Coping With Cancer Research and Advocacy Survivorship Blog About ...

  15. Case Report of a Left Atrial Myxoma Associated with Carney%u2019s Syndrome

    Directory of Open Access Journals (Sweden)

    Anil Ozen

    2016-05-01

    Full Text Available Primary cardiac neoplasms are very rare as compared to metastatic tumors. 70% to 80% of them are benign myxomas. Complications of myxomas include cyst and microabscess formation, embolization, syncope and sudden death. Rarely, cardiac myxomas are associated with primary nodular adrenal cortical disease, mammary fibroadenomas, testicular tumors or pitiutary adenomas with gigantism or acromegaly known as Carney%u2019s syndrome. We present a patient with a left atrial myxoma who underwent reoperation associated with Carney%u2019s syndrome.

  16. Identification of a novel mutation of the PRKAR1A gene in a patient with Carney complex with significant osteoporosis and recurrent fractures.

    Science.gov (United States)

    Papanastasiou, Labrini; Fountoulakis, Stelios; Voulgaris, Nikos; Kounadi, Theodora; Choreftaki, Theodosia; Kostopoulou, Akrivi; Zografos, George; Lyssikatos, Charalampos; Stratakis, Constantine A; Piaditis, George

    2016-01-01

    Carney complex (CNC) is a rare autosomal dominant multiple neoplasia syndrome characterized by the presence of endocrine and non-endocrine tumors. More than 125 different germline mutations of the protein Kinase A type 1-α regulatory subunit (PRKAR1A) gene have been reported. We present a novel PRKAR1A gene germline mutation in a patient with severe osteoporosis and recurrent vertebral fractures. Clinical case report. A 53-year-old male with a medical history of surgically removed recurrent cardiac myxomas was evaluated for repeated low-pressure vertebral fractures and severe osteoporosis. Physical examination revealed spotty skin pigmentation of the lower extremities and papules in the nuchal and thoracic region. The presence of hypercortisolism due to micronodular adrenal disease and the history of cardiac myxomas suggested the diagnosis of CNC; the patient underwent detailed imaging investigation and genetic testing. Standard imaging and clinical testing; DNA was sequenced by the Sanger method. Sequence analysis from peripheral lymphocytes DNA revealed a novel heterozygous point mutation at codon 172 of exon 2 (c.172G>T) of the PRKAR1A gene, resulting in early termination of the PRKAR1A transcript [p.Glu58Ter (E58X)]. We report a novel point mutation of the PRKAR1A gene in a patient with CNC who presented with significant osteoporosis and fractures. Low bone mineral density along with recurrent myxomas should point to the diagnosis of CNC.

  17. Frequent phosphodiesterase 11A gene (PDE11A) defects in patients with Carney complex (CNC) caused by PRKAR1A mutations: PDE11A may contribute to adrenal and testicular tumors in CNC as a modifier of the phenotype.

    Science.gov (United States)

    Libé, Rossella; Horvath, Anelia; Vezzosi, Delphine; Fratticci, Amato; Coste, Joel; Perlemoine, Karine; Ragazzon, Bruno; Guillaud-Bataille, Marine; Groussin, Lionel; Clauser, Eric; Raffin-Sanson, Marie-Laure; Siegel, Jennifer; Moran, Jason; Drori-Herishanu, Limor; Faucz, Fabio Rueda; Lodish, Maya; Nesterova, Maria; Bertagna, Xavier; Bertherat, Jerome; Stratakis, Constantine A

    2011-01-01

    Carney complex (CNC) is an autosomal dominant multiple neoplasia, caused mostly by inactivating mutations of the regulatory subunit 1A of the protein kinase A (PRKAR1A). Primary pigmented nodular adrenocortical disease (PPNAD) is the most frequent endocrine manifestation of CNC with a great inter-individual variability. Germline, protein-truncating mutations of phosphodiesterase type 11A (PDE11A) have been described to predispose to a variety of endocrine tumors, including adrenal and testicular tumors. Our objective was to investigate the role of PDE11A as a possible gene modifier of the phenotype in a series of 150 patients with CNC. A higher frequency of PDE11A variants in patients with CNC compared with healthy controls was found (25.3 vs. 6.8%, P CNC patients, those with PPNAD were significantly more frequently carriers of PDE11A variants compared with patients without PPNAD (30.8 vs. 13%, P = 0.025). Furthermore, men with PPNAD were significantly more frequently carriers of PDE11A sequence variants (40.7%) than women with PPNAD (27.3%) (P CNC patients, a high frequency of PDE11A variants, suggesting that PDE11A is a genetic modifying factor for the development of testicular and adrenal tumors in patients with germline PRKAR1A mutation.

  18. Cryoglobulinemic vasculitis preceding diagnosis of Carney Complex

    DEFF Research Database (Denmark)

    Glerup, Mia; Stausbøl-Grøn, Brian; Heuck, Carsten

    2014-01-01

    with classical symptoms of a stroke. MRI revealed small middle cerebral artery infarctions but no signs of schwannomas or vasculitis on the angiography. An echocardiography revealed an obstructive tumor in the left atrium, 5-6 centimeters in diameter, diagnosed as myxoma, which was surgically removed...

  19. A subtle case of tuberous sclerosis complex

    OpenAIRE

    Nakano, Hitoshi; Otsuka, Atsushi; Kinoshita, Masako

    2015-01-01

    Tuberous sclerosis complex (TSC) is known to cause severe intractable epilepsy and mental retardation; however, diagnosis can be delayed in milder cases. We report a 26-year-old right-handed female patient who started having convulsions at age 7. days. She had several focal seizures per year that were intractable to treatment with carbamazepine or phenytoin. Her two sisters had several episodes of suspected epileptic seizures but had no symptoms related to TSC. Seizure semiology of the patien...

  20. [Complex odontoma with dentigerous cyst: a case report].

    Science.gov (United States)

    Qizhang, Xu; Hongliang, Zhang; Xiaoyu, Wang; Zhanji, Wang; Qianqian, Xu; Qiong, Ma

    2014-12-01

    Complex odontoma is a relatively rare dental dysplasia. In particular, a complex odontoma with dentigerous cyst is seldom observed. A case of complex odontoma with dentigerous cyst is reported in this paper.

  1. A subtle case of tuberous sclerosis complex.

    Science.gov (United States)

    Nakano, Hitoshi; Otsuka, Atsushi; Kinoshita, Masako

    2015-01-01

    Tuberous sclerosis complex (TSC) is known to cause severe intractable epilepsy and mental retardation; however, diagnosis can be delayed in milder cases. We report a 26-year-old right-handed female patient who started having convulsions at age 7 days. She had several focal seizures per year that were intractable to treatment with carbamazepine or phenytoin. Her two sisters had several episodes of suspected epileptic seizures but had no symptoms related to TSC. Seizure semiology of the patient comprised of visual hallucination, loss of consciousness, and convulsive movements predominantly on the right. Physical examination revealed several small scattered angiofibromas over the nose that were histologically determined by skin biopsy. Hypomelanotic macules, shagreen patches, or periungual fibromas were not seen. Neurological examination showed mental retardation (MMSE: 23/30, WAIS-III: VIQ63, PIQ59, FIQ58) and decreased vibration sensation in both legs. Interictal EEG showed slow waves and epileptiform discharges broadly over the anterior quadrants bilaterally. Brain imaging showed multiple cortical tubers and malformation of cortical development but no subependymal nodules. Interictal IMP-SPECT showed hypoperfusion in the left frontal lobe. Cardiac rhabdomyoma was not noticed by cardiac echography. Truncal CT showed sclerosis of the bilateral lumbosacral joints. There was no abnormality in the lung, major arteries, liver, or kidneys. No hamartomas or retinal achromic patches were noticed by ophthalmologic evaluation. Administration of lamotrigine was effective for her seizures. This patient fulfilled two major features of diagnostic criteria for TSC and was diagnosed as definite TSC. Patients with mental retardation and epilepsy should be carefully evaluated for the possible diagnosis of TSC.

  2. A subtle case of tuberous sclerosis complex

    Directory of Open Access Journals (Sweden)

    Hitoshi Nakano

    2015-01-01

    Full Text Available Tuberous sclerosis complex (TSC is known to cause severe intractable epilepsy and mental retardation; however, diagnosis can be delayed in milder cases. We report a 26-year-old right-handed female patient who started having convulsions at age 7 days. She had several focal seizures per year that were intractable to treatment with carbamazepine or phenytoin. Her two sisters had several episodes of suspected epileptic seizures but had no symptoms related to TSC. Seizure semiology of the patient comprised of visual hallucination, loss of consciousness, and convulsive movements predominantly on the right. Physical examination revealed several small scattered angiofibromas over the nose that were histologically determined by skin biopsy. Hypomelanotic macules, shagreen patches, or periungual fibromas were not seen. Neurological examination showed mental retardation (MMSE: 23/30, WAIS-III: VIQ63, PIQ59, FIQ58 and decreased vibration sensation in both legs. Interictal EEG showed slow waves and epileptiform discharges broadly over the anterior quadrants bilaterally. Brain imaging showed multiple cortical tubers and malformation of cortical development but no subependymal nodules. Interictal IMP-SPECT showed hypoperfusion in the left frontal lobe. Cardiac rhabdomyoma was not noticed by cardiac echography. Truncal CT showed sclerosis of the bilateral lumbosacral joints. There was no abnormality in the lung, major arteries, liver, or kidneys. No hamartomas or retinal achromic patches were noticed by ophthalmologic evaluation. Administration of lamotrigine was effective for her seizures. This patient fulfilled two major features of diagnostic criteria for TSC and was diagnosed as definite TSC. Patients with mental retardation and epilepsy should be carefully evaluated for the possible diagnosis of TSC.

  3. OEIS complex with major cardiac malformation: a case report.

    Science.gov (United States)

    Batra, Prerna; Saha, Abhijeet; Vilhekar, K Y; Gupta, Anshu

    2007-04-01

    OEIS Complex is a rare congenital multisystem defect that consists of omphalocele, exstrophy, imperforate anus and spinal defects. We report a case of such complex with additional major cardiac and other multisystem anomalies which are rarely described in literature. The authors give a review of literature on this infrequent complex along with a discussion on its pathogenesis, differential diagnosis and prenatal diagnosis.

  4. On the average-case complexity of Shellsort

    NARCIS (Netherlands)

    Vitányi, P.

    We prove a lower bound expressed in the increment sequence on the average-case complexity of the number of inversions of Shellsort. This lower bound is sharp in every case where it could be checked. A special case of this lower bound yields the general Jiang-Li-Vitányi lower bound. We obtain new

  5. The worst case complexity of maximum parsimony.

    Science.gov (United States)

    Carmel, Amir; Musa-Lempel, Noa; Tsur, Dekel; Ziv-Ukelson, Michal

    2014-11-01

    One of the core classical problems in computational biology is that of constructing the most parsimonious phylogenetic tree interpreting an input set of sequences from the genomes of evolutionarily related organisms. We reexamine the classical maximum parsimony (MP) optimization problem for the general (asymmetric) scoring matrix case, where rooted phylogenies are implied, and analyze the worst case bounds of three approaches to MP: The approach of Cavalli-Sforza and Edwards, the approach of Hendy and Penny, and a new agglomerative, "bottom-up" approach we present in this article. We show that the second and third approaches are faster than the first one by a factor of Θ(√n) and Θ(n), respectively, where n is the number of species.

  6. Unusually large erupted complex odontoma: A rare case report

    Science.gov (United States)

    Kukreja, Rahul; Suma, Gundareddy N.; Yadav, Bhawna; Sharma, Havi

    2015-01-01

    Odontomas are nonaggressive, hamartomatous developmental malformations composed of mature tooth substances and may be compound or complex depending on the extent of morphodifferentiation or on their resemblance to normal teeth. Among them, complex odontomas are relatively rare tumors. They are usually asymptomatic in nature. Occasionally, these tumors become large, causing bone expansion followed by facial asymmetry. Odontoma eruptions are uncommon, and thus far, very few cases of erupted complex odontomas have been reported in the literature. Here, we report the case of an unusually large, painless, complex odontoma located in the right posterior mandible. PMID:25793183

  7. Unusually large erupted complex odontoma: A rare case report

    Energy Technology Data Exchange (ETDEWEB)

    Bagewadi, Shivanand B.; Kukreja, Rahul; Suma, Gundareddy N.; Yadav, Bhawn; Sharma, Havi [Dept. of Oral Medicine and Radiology, ITS Centre for Dental Studies and Research, Murad Nagar (India)

    2015-03-15

    Odontomas are nonaggressive, hamartomatous developmental malformations composed of mature tooth substances and may be compound or complex depending on the extent of morphodifferentiation or on their resemblance to normal teeth. Among them, complex odontomas are relatively rare tumors. They are usually asymptomatic in nature. Occasionally, these tumors become large, causing bone expansion followed by facial asymmetry. Odontoma eruptions are uncommon, and thus far, very few cases of erupted complex odontomas have been reported in the literature. Here, we report the case of an unusually large, painless, complex odontoma located in the right posterior mandible.

  8. Unusually large erupted complex odontoma: A rare case report

    International Nuclear Information System (INIS)

    Bagewadi, Shivanand B.; Kukreja, Rahul; Suma, Gundareddy N.; Yadav, Bhawn; Sharma, Havi

    2015-01-01

    Odontomas are nonaggressive, hamartomatous developmental malformations composed of mature tooth substances and may be compound or complex depending on the extent of morphodifferentiation or on their resemblance to normal teeth. Among them, complex odontomas are relatively rare tumors. They are usually asymptomatic in nature. Occasionally, these tumors become large, causing bone expansion followed by facial asymmetry. Odontoma eruptions are uncommon, and thus far, very few cases of erupted complex odontomas have been reported in the literature. Here, we report the case of an unusually large, painless, complex odontoma located in the right posterior mandible.

  9. Pituitary adenoma in monozigotic twins with Cri du Chat syndome: a rare case report

    Directory of Open Access Journals (Sweden)

    Canaz Gokhan

    2016-12-01

    Full Text Available Pituitary adenomas are rare tumours of pediatric population. In etiology, genetic factors are more common than they are in adults. Because of the rarity of the cases, there are only a few large case studies in the literature. Pituitary tumours in children are often related with syndromes like MEN type 1, Carney Complex and Mc Cune Albright, but there is no case in the literature associated with Cri Du Chat syndrome. Statisticlly, it has been reported that, pediatric tumours occur more often in twins, in the pediatric population. Main treatment for prolactinomas is medical intervention with dopamine agonists, as in adults. Surgery is prefered when the tumour is resistant to medical treatment or shows mass effects around sellae. In that situation, as in adults, both transcranial and transsphenoidal approach is possible.

  10. Erupting complex odontoma: Report of a rare case

    Directory of Open Access Journals (Sweden)

    Pinakapani Ramakrishna

    2014-01-01

    Full Text Available Odontomas are the most frequent hamartomatous lesions involving the oral cavity. The complex variant is an agglomerate of all dental tissues characterized by abnormal morphodifferentiation despite normal histodifferentiation. These are usually asymptomatic and are frequently associated with eruption disturbances. We report an unusual case of erupting complex odontoma associated with an impacted maxillary second molar.

  11. A New Look at Worst Case Complexity: A Statistical Approach

    Directory of Open Access Journals (Sweden)

    Niraj Kumar Singh

    2014-01-01

    Full Text Available We present a new and improved worst case complexity model for quick sort as yworst(n,td=b0+b1n2+g(n,td+ɛ, where the LHS gives the worst case time complexity, n is the input size, td is the frequency of sample elements, and g(n,td is a function of both the input size n and the parameter td. The rest of the terms arising due to linear regression have usual meanings. We claim this to be an improvement over the conventional model; namely, yworst(n=b0+b1n+b2n2+ɛ, which stems from the worst case O(n2 complexity for this algorithm.

  12. Erupted complex composite odontoma: Report of two atypical cases

    Directory of Open Access Journals (Sweden)

    Preeti Tomar Bhattacharya

    2015-01-01

    Full Text Available Odontomas are nonaggressive, hamartomatous developmental malformations of odontogenic origin. They are considered one of the most common odontogenic lesions composed by diverse dental tissues. They may interfere with the eruption of an associated tooth and are more prevalent in the posterior mandible. The eruption of a complex odontoma into the oral cavity is rare. Here, we report such two rare cases of gigantic erupted complex composite odontomas.

  13. Tourette's disorder and associated complex behaviors: a case report.

    OpenAIRE

    McDougle, C. J.; Southwick, S. M.; Rohrbaugh, R. M.

    1990-01-01

    A case of a man with Tourette's disorder associated with obsessive-compulsive disorder, multiple sexual paraphilias, and aggressive behavior is described. Treatment with haloperidol led to improvement in the characteristic tics of Tourette's disorder as well as to improvement in these three complex-associated behaviors. After haloperidol was discontinued, an exacerbation of tics and the associated behaviors occurred.

  14. Complex and compound odontomas: Analysis of 69 cases and a ...

    African Journals Online (AJOL)

    2015-02-26

    Feb 26, 2015 ... Material and Methods: The 69 cases were analyzed with regard to the following parameters: age, gender, location, associated unerupted teeth, missing teeth, radiological and ..... Piattelli A, Perfetti G, Carraro A. Complex odontoma as a periapical and interradicular radiopacity in a primary molar. J Endod ...

  15. Simplified Worst-Case Analysis of Complex Systems

    Science.gov (United States)

    Pond, C. L.

    1985-01-01

    Statistical method avoids excessive computer time. Technique involves simplified Monte Carlo simulation of system with randomly chosen parameters and comparison of tolerance extremes of several of worst-case situations found. Resulting combination of tolerance extremes then used in detailed analysis - one that makes use of full complex nonlinear model capable of accurate simulations.

  16. "Understanding Adam" multiple reciprocal translocations: complex case presentation.

    Science.gov (United States)

    Linder, Carie E; Lu, Xianglan; Kim, Young Mi; Li, Shibo; Pineda, Jose

    2009-01-01

    This article presents a case review of a newborn diagnosed with a complex chromosomal rearrangement, as demonstrated through a painted chromosomal analysis. This infant presented with multiple dysmorphology including cutis aplasia, multiple ocular malformations, bilateral cleft lip and palate, and postnatal hydrocephaly. A chromosomal analysis revealed multiple-ways, balanced translocation involving chromosomes 3, 4, 6, 8, and 9. This case study provides a unique opportunity to, in retrospect, trace each malformation exploring the pathophysiology, etiology, and correlating origin with chromosomal variation. Careful review of this case, enhanced by the visually augmented representation of each translocation, will increase understanding of chromosomal anomalies and their implications in embryological development and clinical presentation.

  17. Complex interferometry potential in case of sufficiently stable diagnostic system

    Science.gov (United States)

    Kalal, M.

    2016-06-01

    Classical interferometry is one of the key methods among active optical diagnostics. Its more advanced version, which allows recording and subsequent reconstruction of up to three sets of data using just one data object —a complex interferogram—was developed in the past and became known as complex interferometry. Employing this diagnostics, not only the usual phase shift, but also the amplitude of the probing beam as well as the fringe contrast (leading directly to the phase shift time derivative) can be reconstructed simultaneously from such a complex interferogram. In this paper it will be demonstrated that even in the case of a not particularly good diagnostic beam quality these three quantities can be reconstructed with a high degree of accuracy provided both the diagnostic beam as well as the corresponding optical line feature a reasonable stability. Such stability requirement is important as in an ideal case four shots need to be gradually recorded (one by one): the signal complex interferogram, the reference interferogram as well as the intensity structures of the signal and reference part of the diagnostic beam. Two examples of complex interferograms obtained in experiments will be analyzed: the laser produced plasma (spark in the air) and the high pressure gas jet. A general ray-tracing based iterative algorithm will be outlined in order to increase a precision of the index of refraction spatial profile taking into account refraction effects (omitted in the Abel inversion) and employing the original reconstructed phase shift and amplitude.

  18. Apocrine carcinoma arising in a complex fibroadenoma: a case report.

    Science.gov (United States)

    Mele, Marco; Vahl, Pernille; Funder, Jonas Amstrup; Sorensen, Anne Schmidt; Jensen, Vibeke

    2014-01-01

    A carcinoma arising in a fibroadenoma is a rare event, which often entails a diagnostic challenge. The most common type is the lobular carcinoma and secondary a ductal carcinoma. We present an extremely rare case of malignant development of an invasive apocrine carcinoma in a complex fibroadenoma and underline the importance for clinicians to recognize the possibility of benign and malignant co-existence especially in older women.

  19. Complex odontoma of the nasal cavity: a case report.

    Science.gov (United States)

    Soltan, Michelle; Kacker, Ashutosh

    2008-05-01

    We describe the case of a 76-year-old man who presented with symptoms of chronic nasal obstruction and recurrent sinusitis of many years' duration. The patient's history and radiographic findings established a diagnosis of a complex odontoma of the nasal cavity. The mass was surgically excised, and the diagnosis was confirmed by histopathology. The occurrence of an odontoma in the nasal cavity is extremely rare.

  20. OEIS complex with glomerulocystic kidney disease: a case report.

    Science.gov (United States)

    Hong, Ran; Lim, Sung-Chul; Jang, Jung-Whan; Suh, Chae-Hong; Jeon, Ho-Jong; Lee, Mi-Ja; Kim, Youn-Shin

    2007-01-01

    We present a case of OEIS complex (omphalocele, exstrophy of bladder, imperforated anus, spinal defect) combined with colonic agenesis and glomerulocystic kidney disease (GCKD). The baby was born at 35.2 weeks of gestational age, weighing 2.51 kg. A prenatal ultrasound examination showed spina bifida, hydroureter, and a unilateral polycystic kidney. The postdelivery examination, which included a physical examination, simple X-ray, and pelvic MRI, showed a lower abdominal wall defect through which a small pouch with a segment of bowel protruded, imperforated anus, ambiguous external genitalia, spina bifida with meningomyelocele at the lumbosacral junction, and nonunion of pubic symphysis. The baby underwent surgery, including nephrectomy, colostomy, and repair of the abdominal wall defect. In addition to the abnormalities mentioned, a tailgut as a result of colonic agenesis and 2 appendices were identified in the course of surgery. The result of histopathological examination confirmed the polycystic kidney identified as GCKD. These radiological, surgical, and histopathologic findings are consistent with the OEIS complex. The postoperative course was uneventful during a period of 4 months of follow up. We herein report a case of the very rare OEIS complex in a newborn male baby and review the available literature.

  1. COMPLEXITY OF ECOLOGICAL SYSTEMS (THE CASE OF MARINE CILIATE COMMUNITY

    Directory of Open Access Journals (Sweden)

    I.V. Burkovsky

    2016-03-01

    Full Text Available The paper analyzes the seasonal and long-term dynamics of marine interstitial ciliates communities as a result of the processes of system self-organization (of increasing complexity in constantly fluctuating environment. The traits of simple structure of ciliate community include substantial variability in the composition (even in case of stable environment and the lack of sustainable combinations of species. The mechanism of the current state maintenance is the lack of energy supply in certain periods or in specific loci of space, as well as large amplitude and unpredictable fluctuations of environmental factors. An indication of the community’s complexity is availability of stable combinations of species in time and space. The mechanisms of formation of stable species combinations are a constant flow of external energy, optimal values and stability of environmental factors (including repeatability of seasonal cycles and the use of space resources by species according the principle of complementarity of ecological niches.

  2. Complex and compound odontomas: Analysis of 69 cases and a rare case of erupted compound odontoma.

    Science.gov (United States)

    Bereket, C; Çakır-Özkan, N; Şener, İ; Bulut, E; Tek, M

    2015-01-01

    The purpose of this study was to analyze clinic and radiologic features of the 69 odontoma cases and present a rare case of erupted compound odontoma in the oral cavity. The 69 cases were analyzed with regard to the following parameters: age, gender, location, associated unerupted teeth, missing teeth, radiological and histopathological features and treatment protocols. Of the 69 cases, 49 were compound odontoma and 20 were complex odontoma. There was a female predilection for both compound and complex odontomas. Compound odontoma occurred more often in the anterior region of the jaws; complex lesions occurred more often at the posterior mandible. The most common clinical manifestations were the retention of permanent teeth. Compound odontomas rarely erupt into the mouth. The presented case is the 13 th case of erupted compound odontoma reported in the literature. The treatment of choice is surgical removal of the odontoma. In the case of odontomas associated to impacted teeth, the teeth should be preserved in wait of spontaneous eruption, or alternatively fenestration followed by orthodontic traction is indicated. Regular follow-up period is crucial to evaluate the prognosis of these teeth.

  3. An Unusual Erupted Complex Composite Odontoma: A Rare Case

    Directory of Open Access Journals (Sweden)

    Dawasaz Ali Azhar

    2013-01-01

    Full Text Available Odontomas are malformations of the dental tissues and may interfere with the eruption of the associated tooth. Complex composite odontoma (CO was described as a distinct entity for the first time by Broca in 1866. This lesion takes place due to the developmental disturbances where the dental components are laid down in a disorganized manner, due to failure of normal morphodifferentiation. Very few cases of erupted complex composite odontomas have been reported in the literature. The case reported here is of an odontoma found in the left mandibular body, associated with an impacted second molar of a 17-year-old Saudi male. Under local anesthesia the odontoma was surgically removed. Histopathological examination confirmed the diagnosis of CO. The impacted second molar which was left in the mandibular body erupted clinically after 6 months. Erupted CO is rarely seen in the mandibular left body. The early diagnosis, followed by a proper treatment at the right time, will result in a favorable prognosis.

  4. Economic Value Creation in Metro Complexes: Case Study on Sadr Station Complex in Tehran

    Directory of Open Access Journals (Sweden)

    Nima Jafari

    2017-04-01

    Full Text Available The main objective of this research is economic value creation methods in metro station centers with the case study of Sadr Station complex in Tehran. The research implements a descriptive approach by benefiting from the data of a cross-sectional survey which was collected by the authors. The target population included all scholars of urban development and transport academics, capitalists and directors of the station complex with the total number of 1,100 people. By using a random sampling, 285 people were surveyed with a 25-item questionnaire developed by the researchers. The results suggest priority of value creation respectively in areas of collaborative, competitive, private, governmental, and personal. The test results also showed that among the components of economic value creation (corporate, individual, competitive, governmental and private, the observed correlation was significant. According to the obtained results, development of economic value creation in station centers seems necessary.

  5. Complexities of Medication Management Across Care Transitions: A Case Report.

    Science.gov (United States)

    Knisely, Mitchell R; Bartlett Ellis, Rebecca J; Carpenter, Janet S

    2015-01-01

    The purpose of this article is to identify medication-related considerations for clinical nurse specialist practice by presenting a case report detailing the complexities of medication management, unresolved medication discrepancies, and reconciliation across care transitions. Care transitions are a vulnerable time for medication-related problems to occur. Unresolved medication discrepancies can lead to adverse drug events and other poor health outcomes, including hospital readmissions and increased healthcare costs. Reconciling medication discrepancies during care transitions has been identified as a national patient safety goal to prevent medication-related problems. Clinical nurse specialists are uniquely qualified to lead and manage efforts to mitigate these problems during care transitions. A 72-year-old male patient diagnosed with oral cancer underwent 8 weeks of chemotherapy and radiation treatments. Throughout these 8 weeks, the patient was seen by 4 providers and admitted to the hospital for neutropenia. As a result, a total of 19 new medications were prescribed and 5 medications were discontinued. Medication reconciliation was completed at each visit and at admission and discharge at the hospital. At discharge, the patient's medication regimen was complex, with 38 separate doses of 17 different medications per 24-hour period. Understanding and organizing the daily medication regimen were a consistent challenge for the patient during his illness. This case highlights the complexities of medication regimens and opportunities to improve medication management and reconciliation across care transitions. This case underscores the need for and importance of quality patient-provider communication, assessing and managing medication regimen complexity, evaluating medications against the American Geriatrics Society Beers Criteria, evaluating potential drug-drug or drug-food interactions, and recognizing at-risk behaviors that may lead to medication discrepancies and

  6. [Post-transplant recurrence of glomerulonephritis: a complex clinical case].

    Science.gov (United States)

    Bonucchi, Decenzio; Leonelli, Marco; Damiano, Francesca; Granito, Maria; Ghiandai, Giulia; De Amicis, Sara; Americo, Claudio; Ligabue, Giulia; Albertazzi, Vittorio; Cappelli, Gianni

    2010-01-01

    Lupus nephritis (LN) seldom recurs in a grafted kidney. By contrast, primary membranoproliferative glomerulonephritis (MPGN), which has been included, along with hemolytic uremic syndrome and age-related maculopathy, among the complement dysregulation diseases, has a high recurrence rate and is considered a contraindication to living-donor kidney transplant because of the poor prognosis. We report the case of a young girl with LN-related chronic renal failure who underwent a living donor transplant from her mother. After four months she had a recurrence that did not match the criteria for LN. Graft biopsies and revision of the clinical course pointed to type II MPGN on the basis of a lack of ARA criteria, persistent isolated low C3 levels, and response to plasma therapy. If confirmed by genetic analysis, the patient might benefit from treatment with the monoclonal antibody against the C5-C9 complex, eculizumab.

  7. Adult congenital cardiopathy: percutaneous treatment of a complex case

    International Nuclear Information System (INIS)

    Suarez N, Alberto; Carvajal, Andres; Bustillo, Sabas

    2008-01-01

    Adult congenital cardiopathy is a clinical entity difficult to treat and diagnose. Since 1982 endovascular therapy changed its approach radically (1) and in the last years the design of new appliances and better balloon catheters facilitated the implementation of therapy to a greater number of patients (2). It is the election treatment for entities such as pulmonary valve stenosis (3), atrial septal defect (4) and persistent ductus arteriosus. We present the case of complex adult congenital cardiopathy that consisted of wide atrial septal defect,pulmonary valve stenosis with severe repercussion on the right ventricle, persistent PDA with severe calcification and pulmonary arterial hypertension and systemic essential arterial hypertension that were successfully treated through interventionist endovascular therapy in the Hospital Militar Central, in Bogota.

  8. Understanding Complex Human Ecosystems: The Case of Ecotourism on Bonaire

    Directory of Open Access Journals (Sweden)

    Thomas Abel

    2003-12-01

    Full Text Available It is suggested that ecotourism development on the island of Bonaire can be productively understood as a perturbation of a complex human ecosystem. Inputs associated with ecotourism have fueled transformations of the island ecology and sociocultural system. The results of this study indicate that Bonaire's social and economic hierarchy is approaching a new, stable systems state following a 50-yr transition begun by government and industry that stabilized with the appearance of ecotourism development and population growth. Ecotourism can be understood to have "filled in" the middle of the production hierarchy of Bonaire. Interpreted from this perspective, population growth has completed the transformation by expanding into production niches at smaller scales in the production hierarchy. Both a consequence and a cause, ecotourism has transformed the island's social structure and demography. The theory and methods applied in this case study of interdisciplinary research in the field of human ecosystems are also presented.

  9. Managing a complex case of hypospadias cripple and chordee

    Directory of Open Access Journals (Sweden)

    Costin Gingu

    2017-11-01

    Full Text Available Objectives. Hypospadias is a congenital affliction in which the urethral meatus is located on the underside of the penis. These cases are usually treated during childhood by pediatric surgeons, but more complex forms tend to reoccur, and after several failed attempts end up as hypospadias cripple in the care of urologists at an adult age. The aim of this paper is to present the management of a complex case of hypospadias cripple associated with penile curvature (chordee. Materials and Methods. A 24 year old patient presented in our clinic with hypospadias cripple and ventral penile curvature. At the physical examination we found a penoscrotal urethral meatus, heavy scaring of the distal ventral penis and a ventral chordee of approximately 90 degrees in erect state. A two stage “Bracka” repair technique with buccal mucosa graft was chosen. The first stage of the surgery consisted of removing the scarred and defective distal urethral plate and the fibrotic tissue responsible for the penile curvature, preparing the corpora cavernosa for the graft, clefting the glans, harvesting two buccal mucosa grafts from both inner cheeks, and finally quilting the grafts on the defect. The second stage of the repair was performed after a period of about six months, and consisted in the tubularization of the matured graft and glans plasty. Results and Conclusions. No immediate or late complications occurred after any of the two stages of the surgery; no significant ventral chordee was observed and no urethral fistula occurred till the one year follow-up. A two stage “Bracka” repair technique is best suited for treating these patients, correcting ventral chordee in the first session.

  10. Complex regional pain syndromes (CRPS type 1 validating case histories

    Directory of Open Access Journals (Sweden)

    P. Berger

    2003-01-01

    Full Text Available The treatment of patients with complex regional pain syndrome (CRPS type 1 is challenging and unpredictable as the condition presents with vascular and neuropathic symptoms after nil or even minor injury to a peripheral nerve. The condition is one of a pain and motor dysfunction. The pathophysiology is not well understood and the relief of symptoms may change from being sympathetically mediated to sympathetically independent during  the course of the disease. At any stage physiotherapy has been advocated as the corner stone and most important aspect of treatment in the rehabilitation of these individuals but unfortunately it has been difficult to execute when pain is exacerbated due to allodynia (unbearable to touch or move and hyperalgesia. Best results have been obtained if the patients are recognised and treated in the early or acute phase and it has been found that through careful assessment and analysis these patients can be recognised by previous events that have occurred in their initial case history. The treatment in the acute stage with physiotherapy modalities such as electrical stimulation and acupuncture will produce an early cessation of the symptoms and prevention of the disease developing into the fully blown CRPS type 1 with irreversible and possibly atrophic consequences. Case histories have been presented that illustrate these important aspects and demonstrate  the value of early and the appropriate physiotherapy that may be more successful than other pharmacological and physical interventions in this disease.

  11. Improving the Effectiveness of Professional Education: Learning Managerial Accounting via a Complex Case.

    Science.gov (United States)

    Carter, Melissa; And Others

    To give students more experience with real situations, many professional schools use case studies in their courses. Creating complex cases, case experiences that immerse students in complex problems, rather than mere case studies that require armchair analysis should help students gain better and more integrated knowledge. Designing, implementing,…

  12. Data science and complex networks real case studies with Python

    CERN Document Server

    Caldarelli, Guido

    2016-01-01

    This book provides a comprehensive yet short description of the basic concepts of complex network theory and the code to implement this theory. Differently from other books, we present these concepts starting from real cases of study. The application topics span from food webs, to the Internet, the World Wide Web, and social networks, passing through the international trade web and financial time series. The final part is devoted to definition and implementation of the most important network models. We provide information on the structure of the data and on the quality of available datasets. Furthermore, we provide a series of codes to implement instantly what is described theoretically in the book. People knowing the basis of network theory could learn the art of coding in Python by checking our codes and using the online material. In particular, the interactive Python notebook format is used so that the reader can immediately experiment by themselves with the codes present in the manuscript. To this purpose...

  13. Tríada de Carney incompleta e hipertensión arterial en una mujer joven Incomplete Carney’s triad and arterial hypertension in a young woman

    Directory of Open Access Journals (Sweden)

    Alberto Allievi

    2006-02-01

    Full Text Available Se presenta una el caso de paciente joven, con tríada de Carney incompleta que cursa hipertensión arterial de dos años de evolución y anemia ferropénica grave por pérdida crónica de sangre por tubo digestivo, con tumores gástricos múltiples y paraganglioma pararrenal. No presenta aún desarrollo de condromas pulmonares visibles por tomografía axial computada. En nuestra paciente el paraganglioma no resultó funcionante. Resaltamos que la presencia de tumores gástricos múltiples en un adulto joven debe sugerir la posibilidad de tumores estromales (GIST, cuyo diagnóstico por biopsia endoscópica es difícil debido a su localización profunda, situada en las capas musculares de la pared gástrica. Asimismo queremos remarcar la importancia de las técnicas de marcación descriptas para el diagnóstico preciso. El seguimiento debe ser constante dado el pronóstico incierto de estos tumores. Los condromas pulmonares pueden aparecer años después de la resección del GIST y ser confundidos con metástasis del GIST.The case of young woman with arterial hypertension diagnosed two years before, is here presented; she had a ferropenic anemia caused by digestive loss of blood. Multiple gastric tumors and pararenal non functioning paraganglioma were found. No chondromas were detected. An incomplete Carney’s Triad was diagnosed. We remark that multiple gastric tumors in a young adult suggest the possibility of gastrointestinal stromal tumors (GIST Endoscopic biopsy frequently is not effective because these tumors are deep placed in the muscular gastric layers. The importance of specific techniques for a positive diagnosis are emphasized. Continuous follow up is needed because these tumors have uncertain prognosis. Lung chondromas may appear years later after the GIST was removed and might be confused with GIST metastases.

  14. Complex organizations: the case of the Brazilian nuclear sector

    Energy Technology Data Exchange (ETDEWEB)

    Xavier, Roberto Salles [Comissao Nacional de Energia Nuclear (CNEN), Rio de Janeiro, RJ (Brazil). Coordenacao-Geral de Planejamento e Avaliacao], e-mail: xavier@cnen.gov.br

    2009-07-01

    The resumption of the Brazilian Nuclear Program (BNP), in the proposed size and after 20 years of paralysis, requires profound changes in the current organizational modeling of the national nuclear industry. The effectiveness of any process of organizational change is limited to three factors. The theoretical bottleneck happens when you do not know enough about a phenomenon in order to effect the desired changes. The resource bottleneck occurs when knowledge may be available to change people's behavior but the funds necessary for implementation may be lacking. The organizational bottleneck emerges when there are knowledge and resources to solve a problem, but may not able to organize the resources in order to carry out the problem-solving effort. In the case of resumption of BNP seems clear that there is the knowledge of what is needed to make policy and the intention to allocate the necessary resources. But the question is the following: the current organizational model of the Brazilian nuclear sector is consistent with the goals laid down in the scenario of resumption of BNP? That is, is there organizational ability to leverage a program of the size proposed for the nuclear area? Find answers to these questions is crucial, because the organizational model of the Brazilian nuclear sector consists of elements involving a complex interorganizational system. Thus, this article is to examine the appropriateness of the current organizational modeling of the Brazilian nuclear sector to current demands of society. As a result, the article aims to propose recommendations for a remodeling of the nuclear sector, taking into account the current national and international scenarios of nuclear energy. (author)

  15. COMPLEX MANAGEMENT OF FRAILTY FRACTURES--CASE REPORT.

    Science.gov (United States)

    Costescu, Elena Puin; Dronic, Aliona; Alexa, Loana Dana; Alexa, O

    2016-01-01

    Frailty fractures encompass pelvic ring fractures in the elderly--a condition more frequently encountered in women, usually with pre-existing osteoporosis. The incidence of these fractures is increasing, following the increase in average life expectancy. Most of the times, they are the result of a minor injury, of which the patient has little or no recollection; the clinical signs and symptoms, radiological changes and the degree of fracture stability vary greatly. As such, there is a wide range of therapeutic options and one of the most important decisions for the physician is choosing between surgery and conservative treatment. We present the case of an elderly female patient with multiple pelvic ring fractures, and a medical history of cardiovascular disease and osteoporosis; the orthopedic examination recommended conservative treatment which was carried out in the Geriatric Clinic of the "Dr. C.I. Parhon" Hospital. Following the complete physical examination and through geriatric evaluation, a complex therapeutic plan was devised, which included: recovery through physiotherapy, adequate nutrition, psychological support, treatment of the cardiovascular comorbidities and prevention of the consequences of extended bed rest. The treatment lasted for 60 days and the outcome was favorable: decreased bone frailty, mainly through preserving muscle tone and osteoarticular function, correction of malnutrition, improvement of depression and partial recovery of patient's mobility; the results of our therapy made it possible for the patient to return home, where she leaves alone. She will need help with daily household chores, but she intends to continue the recovery therapy as means of increasing her quality of life and independence.

  16. Complex organizations: the case of the Brazilian nuclear sector

    International Nuclear Information System (INIS)

    Xavier, Roberto Salles

    2009-01-01

    The resumption of the Brazilian Nuclear Program (BNP), in the proposed size and after 20 years of paralysis, requires profound changes in the current organizational modeling of the national nuclear industry. The effectiveness of any process of organizational change is limited to three factors. The theoretical bottleneck happens when you do not know enough about a phenomenon in order to effect the desired changes. The resource bottleneck occurs when knowledge may be available to change people's behavior but the funds necessary for implementation may be lacking. The organizational bottleneck emerges when there are knowledge and resources to solve a problem, but may not able to organize the resources in order to carry out the problem-solving effort. In the case of resumption of BNP seems clear that there is the knowledge of what is needed to make policy and the intention to allocate the necessary resources. But the question is the following: the current organizational model of the Brazilian nuclear sector is consistent with the goals laid down in the scenario of resumption of BNP? That is, is there organizational ability to leverage a program of the size proposed for the nuclear area? Find answers to these questions is crucial, because the organizational model of the Brazilian nuclear sector consists of elements involving a complex interorganizational system. Thus, this article is to examine the appropriateness of the current organizational modeling of the Brazilian nuclear sector to current demands of society. As a result, the article aims to propose recommendations for a remodeling of the nuclear sector, taking into account the current national and international scenarios of nuclear energy. (author)

  17. Complex and Compound Odontomas: Analysis of 69 Cases and a ...

    African Journals Online (AJOL)

    Objective: The purpose of this study was to analyze clinic and radiologic features of the 69 odontoma cases and present a rare case of erupted compound odontoma in the oral cavity. Material and Methods: The 69 cases were analyzed with regard to the following parameters: age, gender, location, associated unerupted ...

  18. Complexity Management - A multiple case study analysis on control and reduction of complexity costs

    DEFF Research Database (Denmark)

    Myrodia, Anna

    Complexity tends to be arguably the biggest challenge of manufacturing companies. The motivation of further studying complexity is a combination between the existing literature and the practical experiences from the industry. Based on the latest trend companies are trying to supply a growing mix...

  19. A practical approach to language complexity: a Wikipedia case study.

    Directory of Open Access Journals (Sweden)

    Taha Yasseri

    Full Text Available In this paper we present statistical analysis of English texts from Wikipedia. We try to address the issue of language complexity empirically by comparing the simple English Wikipedia (Simple to comparable samples of the main English Wikipedia (Main. Simple is supposed to use a more simplified language with a limited vocabulary, and editors are explicitly requested to follow this guideline, yet in practice the vocabulary richness of both samples are at the same level. Detailed analysis of longer units (n-grams of words and part of speech tags shows that the language of Simple is less complex than that of Main primarily due to the use of shorter sentences, as opposed to drastically simplified syntax or vocabulary. Comparing the two language varieties by the Gunning readability index supports this conclusion. We also report on the topical dependence of language complexity, that is, that the language is more advanced in conceptual articles compared to person-based (biographical and object-based articles. Finally, we investigate the relation between conflict and language complexity by analyzing the content of the talk pages associated to controversial and peacefully developing articles, concluding that controversy has the effect of reducing language complexity.

  20. A practical approach to language complexity: a Wikipedia case study.

    Science.gov (United States)

    Yasseri, Taha; Kornai, András; Kertész, János

    2012-01-01

    In this paper we present statistical analysis of English texts from Wikipedia. We try to address the issue of language complexity empirically by comparing the simple English Wikipedia (Simple) to comparable samples of the main English Wikipedia (Main). Simple is supposed to use a more simplified language with a limited vocabulary, and editors are explicitly requested to follow this guideline, yet in practice the vocabulary richness of both samples are at the same level. Detailed analysis of longer units (n-grams of words and part of speech tags) shows that the language of Simple is less complex than that of Main primarily due to the use of shorter sentences, as opposed to drastically simplified syntax or vocabulary. Comparing the two language varieties by the Gunning readability index supports this conclusion. We also report on the topical dependence of language complexity, that is, that the language is more advanced in conceptual articles compared to person-based (biographical) and object-based articles. Finally, we investigate the relation between conflict and language complexity by analyzing the content of the talk pages associated to controversial and peacefully developing articles, concluding that controversy has the effect of reducing language complexity.

  1. Change Management and Complexity: The Case for Narrative Action Research

    Science.gov (United States)

    Boxelaar, Lucia; Paine, Mark; Beilin, Ruth

    2007-01-01

    Post-modern theorists have challenged the totalizing and unifying ambitions of change management practices. This paper explores how a narrative action research approach may be used to combine our modernist commitment to facilitate change and collaboration in the land management context with a post-modern sensitivity to complexity and difference.…

  2. [OEIS complex. Description of a case associated with cardiopathy].

    Science.gov (United States)

    Faranda, F; Zucchinetti, P; Pozzolo, S; Romagnoli, G; Camera, G

    1993-01-01

    We describe a newborn affected by OEIS complex (Omphalocele--Exstrophy of bladder--Imperforate anus--Spinal defect) associated with atrial septal defect. Terminal ileostomy, closure of the abdominal wall defect and suture of the cecal and vesical plates were performed. The patient died at 5 months and four days.

  3. The complexity of language change: The case of Ancient Hebrew ...

    African Journals Online (AJOL)

    This article develops a theory of language change and diffusion in the light of new developments in contemporary linguistics on the themes of language evolution and the rise of linguistic complexity. The core assumptions of this article are, first, the fact that a language inevitably changes and diffuses over time and, second, ...

  4. Data Mining and Complex Problems: Case Study in Composite Materials

    Science.gov (United States)

    Rabelo, Luis; Marin, Mario

    2009-01-01

    Data mining is defined as the discovery of useful, possibly unexpected, patterns and relationships in data using statistical and non-statistical techniques in order to develop schemes for decision and policy making. Data mining can be used to discover the sources and causes of problems in complex systems. In addition, data mining can support simulation strategies by finding the different constants and parameters to be used in the development of simulation models. This paper introduces a framework for data mining and its application to complex problems. To further explain some of the concepts outlined in this paper, the potential application to the NASA Shuttle Reinforced Carbon-Carbon structures and genetic programming is used as an illustration.

  5. Complex regional pain syndromes (CRPS) type 1 validating case histories

    OpenAIRE

    P. Berger

    2003-01-01

    The treatment of patients with complex regional pain syndrome (CRPS) type 1 is challenging and unpredictable as the condition presents with vascular and neuropathic symptoms after nil or even minor injury to a peripheral nerve. The condition is one of a pain and motor dysfunction. The pathophysiology is not well understood and the relief of symptoms may change from being sympathetically mediated to sympathetically independent during  the course of the disease. At any stage physiotherapy has b...

  6. Bladder exstrophy – epispadias complex in a newborn: a case ...

    African Journals Online (AJOL)

    2018-02-15

    Feb 15, 2018 ... prenatal ultrasound scans missed the diagnosis. Medical management was given and the patient was discharged against medical advice 48 hours later upon refusing surgical intervention. CASE PRESENTATION. A new-born male was delivered vaginally at 39 weeks +. 2 days of gestation to a 29 year old ...

  7. The Effect of Client Case Complexity on Clinical Decision Making

    NARCIS (Netherlands)

    Groenier, M.; Pieters, J.M.; Witteman, C.L.M.; Lehmann, S.R.S.

    2014-01-01

    In mental health care, clinicians' treatment decisions are expected to be based on the formulation (i.e., exploration of the causing and maintaining mechanisms) of the client's problems. Previous research showed two things: clinicians' case formulations mainly contain descriptive information instead

  8. The effect of client case complexity on clinical decision making

    NARCIS (Netherlands)

    Groenier, Marleen; Pieters, Julius Marie; Witteman, C.L.M.; Lehmann, Sonja

    2014-01-01

    In mental health care, clinicians’ treatment decisions are expected to be based on the formulation (i.e., exploration of the causing and maintaining mechanisms) of the client’s problems. Previous research showed two things: clinicians’ case formulations mainly contain descriptive information instead

  9. Complex nasal reconstruction after paracoccidioidomycosis infection - Case report*

    Science.gov (United States)

    Ribeiro, Emilie Barreto; de Pochat, Victor Diniz; de Magaldi, Eduarda Nilo; Figueiredo, Bruno Suffredini; Alonso, Nivaldo; Meneses, José Valber de Lima

    2015-01-01

    Paracoccidioidomycosis is an infectious disease whose etiological agent belongs to the Paracoccidioides genus. Although it affects primarily the lungs, it can spread to other tissues, including the skin and mucous membranes. Despite the clinical treatment for this disease, scarring can produce sequelae, manifesting as anatomical and functional deformities of the face. We present a case of extensive, nasal unaesthetic and functional sequelae resulting from paracoccidioidomycosis, reconstructed using the paramedian forehead flap in three stages, through the regional unit principles. PMID:26312717

  10. Complex nasal reconstruction after paracoccidioidomycosis infection--Case report.

    Science.gov (United States)

    Ribeiro, Emilie Barreto; Pochat, Victor Diniz de; Magaldi, Eduarda Nilo de; Figueiredo, Bruno Suffredini; Alonso, Nivaldo; Meneses, José Valber de Lima

    2015-01-01

    Paracoccidioidomycosis is an infectious disease whose etiological agent belongs to the Paracoccidioides genus. Although it affects primarily the lungs, it can spread to other tissues, including the skin and mucous membranes. Despite the clinical treatment for this disease, scarring can produce sequelae, manifesting as anatomical and functional deformities of the face. We present a case of extensive, nasal unaesthetic and functional sequelae resulting from paracoccidioidomycosis, reconstructed using the paramedian forehead flap in three stages, through the regional unit principles.

  11. A Rare Presentation of Conjunctival Myxoma with Pain and Redness: Case Report and Literature Review

    Directory of Open Access Journals (Sweden)

    Yu-Po Chen

    2012-04-01

    Full Text Available Background: Conjunctival myxoma is a type of rare, benign tumor of mesenchymal cells, with fewer than 30 reported cases in the English literature. It is mostly an isolated occurrence but can sometimes be associated with systemic diseases such as Carney complex or Zollinger-Ellison syndrome. It is necessary in clinical practice to differentiate it from other similar lesions, such as amelanotic nevus, lymphangioma, myxoid liposarcoma, spindle-cell lipoma, myxoid neurofibroma, and rhabdomyosarcoma. Case Presentation: The usual presentation of conjunctival myxoma is a translucent, well-circumscribed, and painless conjunctival mass, but in this report we discuss an unusual case of conjunctival myxoma in a 47-year-old Taiwanese woman who presented initially with pain and redness. This atypical presentation complicated the diagnosis and the management at first. Surgical excision of the mass was performed. The mass was found to be a conjunctival myxoma. The patient subsequently underwent extensive evaluation but was found not to have any systemic diseases with known association with conjunctival myxoma. Conclusions: In summary, we present a case of conjunctival myxoma in a 47-year-old Taiwanese woman. The initial presentation with pain and redness was atypical for conjunctival myxoma. The lesion was successfully managed with complete excisional biopsy.

  12. Melanotic schwannoma of the lumbar spine: a case report and literature review

    Directory of Open Access Journals (Sweden)

    João Bernardo Sancio Rocha Rodrigues

    2015-06-01

    Full Text Available Schwannomas are benign tumors, usually solitary, encapsulated, slow-growing, which have their origin in differentiated neoplastic Schwann cells with extramedullary intradural usual development related to nerve roots. The melanotic schwannoma is a variant of these tumors whose location in almost one third of cases is on the posterior spinal nerve root, with a nonspecific clinical presentation. Magnetic resonance imaging is the most widely used test for the diagnosis, revealing hyperintense T1-weighted sequences and hypointense T2-weighted sequences. Diagnostic confirmation is obtained by histological and immunohistochemical studies, in which there is intense cytoplasmatic pigmentation. There are two distinct types of melanotic schwannomas: sporadic and psammomatous, the latter related to the called Carney complex, a form of multiple endocrine neoplasm with familiar character. In literature we found few cases of these neoplasms, the largest series consisting of five cases. The objective of this study is to report a rare case of melanotic schwannoma of the lumbar spine of the sporadic type of extramedullary location. We also present a brief review of the literature containing the main characteristics of the tumor, including its different forms, differential diagnoses, data from histological and immunohistochemical studies as well as the currently recommended approach in order to contribute to a better understanding of this neoplasm.

  13. Operationalization of biopsychosocial case complexity in general health care : the INTERMED project

    NARCIS (Netherlands)

    de Jonge, P; Huyse, FJ; Slaets, JPJ; Sollner, W; Stiefel, FC

    Objective: Lack of operationalization of the biopsychosocial model hinders its effective application to the increasingly prevalent problems of comorbidities in clinical presentations. Here, we describe the INTERMED, an instrument to assess biopsychosocial case complexity in general health care, and

  14. Multiple Dentogerous Cysts With a Complex Odontoma: An Unusual Case Report

    Directory of Open Access Journals (Sweden)

    Sheikhi

    2016-03-01

    Full Text Available Introduction Multiple dentigerous cysts are rare and mostly associated with syndromes. Case Presentation The present case report is unique, as the dentigerous cysts enclosed the lateral incisor, canine, first and second premolars of the mandible and were accompanied by a complex odontoma, instead of first mandibular molar. Conclusions Multiple unilateral nosyndromic dentigerous cysts with complex odontoma are found only rarely. The periapical inflammation of non-vital deciduous teeth and trauma may be considered ethiological factors.

  15. Telemedicine broadening access to care for complex cases.

    Science.gov (United States)

    Jue, Joshua S; Spector, Sydney A; Spector, Seth A

    2017-12-01

    Surgical and nonsurgical specialists are highly centralized, making access to high-quality care difficult for many Americans. We explored the feasibility, benefits, preliminary outcomes, and patient satisfaction with a new type of health visit, in which a surgical oncologist used video telecommunication to manage and treat complex cancer diseases, including patients with severe comorbidities. Patients visited local VA medical centers throughout Florida to engage in video telecommunication visits with a centralized surgical oncologist in Miami, who directed their oncology treatment. The average length of stay and rate of unplanned readmission were calculated within each organ. The total mileage saved was calculated by subtracting the distance between the patient's home address and the local VA from the distance between the patient's home address and the Miami VA. Travel costs were determined by the VA's reimbursement of $0.415/mile for health-related travel and reimbursement of $150.00 for an overnight hotel stay. A Likert scale with both positively and negatively keyed questions was used to assess patient satisfaction. In 24 mo, seven unplanned readmissions occurred among 195 operations. Patients experienced an 80.7% reduction in travel distance and saved a total of 213,007.58 miles by visiting their local VA instead of the Miami VA. Survey results indicate that 86% of patients believed that the telemedicine program made medical care more accessible. The Specialist-Directed Telemedicine Model can save patients substantial time and money by not traveling to centralized areas, while delivering greater continuity of care and patient satisfaction. Copyright © 2017 Elsevier Inc. All rights reserved.

  16. Transforming Industrial Complexes to Innovative Clusters? A Korean Case Study

    Directory of Open Access Journals (Sweden)

    Sang-Chul Park

    2012-01-01

    Full Text Available Global economic environment based on globalization processes caused a severe competition between the nations, and these nations launched various strategic approaches to increase their market shares in the global markets. The economic globalization process stimulates changes of technology environment that is not favor for the technology advanced nations to transfer their strategic technology areas toward developing and newly industrialized nations. Moreover, due to the change of external economic and technological environment national development strategies in all nations are also changing. In order to generate economic growth and gain a better position in severe competition between nations, the advanced nations have already established strong national and regional innovation systems The nations participating in the globalization processes actively tend to close free trade agreements (FTA in order to intensify the movement of their production factors across the national borders as quick as possible. This new trend has cognized the importance of regions and regional competitiveness that are based on regional industries. In line with the new trend of global economies, building innovative local clusters has become one of the core strategies to develop the nations further. This frame shift has affected South Korea to a high extent because the nation cannot develop further without inventing its own core technology that costs a vast capital as well as takes a long time. This paper examines an attempt to restructure existing industrial complexes, turning them into innovative clusters at regional and local level. This contribution also tries to identify the tasks and strategies necessary to build locally embedded innovative clusters and how to best analyze these.

  17. [Causation in the court: the complex case of malignant mesothelioma].

    Science.gov (United States)

    Lageard, Giovanni

    2011-01-01

    established some very clear legal principles of law. Essentially, when ascertaining the causation, a judge should verify whether or not there is a sufficiently well established scientific law covering the question and whether such a law is universal or probabilistic. Should the latter be the case, then it is necessary to establish if the accelerating effect has been determined in the case in question, on the basis of the factual acquisitions. We must now wait for the concrete application of these principles by juridical bodies.

  18. Omphalocele, exstrophy of cloaca, imperforate anus and spinal defect (OEIS Complex: A case report

    Directory of Open Access Journals (Sweden)

    Mete Kaya

    2015-06-01

    Full Text Available Omphalocele, exstrophy of cloaca, imperforate anus and spinal defect (OEIS Complex is an extremely rare combination of serious defects, which was firstly described by Carey and colleagues. Surgical repair of cloacal exctrophy in patients with OEIS complex can be performed at one stage, but it can also be performed safely as staged to minimize the potential complications. In this case report, we aimed to present our early approach to the OEIS complex.

  19. OMPHALOCELE, EXTROPHY OF CLOACA, IMPERFORATE ANUS AND SPINE ABNORMALITIES – OEIS COMPLEX : A RARE CASE REPORT

    OpenAIRE

    Uram Aruna; Ramakrishna; Vandana

    2015-01-01

    OEIS complex is a rare defect with estimated incidence of 1 in 200,000 live births. These defects occur due to improper closure of ventral abdominal wall and constitute a spectrum ranging from simple epispadias to complex association of OEIS. Most cases are sporadic with no obvious etiology. A third gravida with previous normal obstetric history delivered a dead fetus at 18wks of gestation. The anomalies presented are gr ouped under OEIS complex.

  20. Basal Cell Carcinoma of the Nipple-areola Complex: A Case Report

    Directory of Open Access Journals (Sweden)

    Ching-Wen Huang

    2005-10-01

    Full Text Available Basal cell carcinoma (BCC of the nipple-areola complex is very rare. Only 24 cases were reported in the literature and 17 (70.8% of these cases arose in men. Most of the cases were treated with simple excision. We report on a case of BCC of the nipple-areola complex in a 46-year-old woman, treated with partial mastectomy. Metastasis to the axillary lymph nodes had been noted in 3 (12.5% of the 24 reported cases of BCC of the nipple-areola complex. Thus, we applied the concept of the sentinel lymph node to detect possible metastases of axillary lymph nodes, letting us avoid the unnecessary axillary lymph node dissection and possible future morbidity.

  1. Complex transradial carpal dislocation in a Professional Pianist: Case Report.

    Science.gov (United States)

    Pedrazzini, Alessio; Paterlini, Marco; Pompili, Massimo; Tocco, Silvio; Ceccarelli, Francesco

    2014-08-20

    Carpal fracture-dislocation associated to distal radius fractures is an uncommon injury of the wrist. Clinical assessment, instrumental diagnosis and treatment are all challenges for the surgeon. In addition, the prognosis in high-functioning patients is nearly always poor. The authors describe an early diagnosis of scapholunate dissociation and joint capsule tear associated with radial styloid and triquetral fractures in a 39-year-old professional piano player. A dorsal approach was used to reduce and fixate the fracture with k-wires, and to repair soft-tissue injuries with a Titanium micro-anchor. Early controlled mobilization was prescribed post-operatively. No other similar investigations were found because of the various associated fractures in the current case study, which normally excludes subjects from retrospective outcome studies on wrist ligament repair. Early diagnosis and surgical management associated with early controlled mobilization resulted in excellent clinical outcomes, according to radiograph imaging, the Italian version of the DASH score (Disabilities of the Arm, Shoulder and Hand), goniometry and dynamometry.

  2. Perceptions of orthodontic case complexity among orthodontists, general practitioners, orthodontic residents, and dental students.

    Science.gov (United States)

    Heath, Elizabeth M; English, Jeryl D; Johnson, Cleverick D; Swearingen, Elizabeth B; Akyalcin, Sercan

    2017-02-01

    Our aims were to assess the perceptions of orthodontic case complexity among orthodontists, general dentists, orthodontic residents, and dental students and to compare their perceptions with the American Board of Orthodontics Discrepancy Index (DI). Orthodontists, general dentists, orthodontic residents, and dental students (n = 343) participated in a Web-based survey. Pretreatment orthodontic records of 29 cases with varying DI scores were obtained. Respondents were asked to evaluate case complexity on a 100-point visual analog scale. Additional information was collected on participants' orthodontic education and orthodontic treatment preferences. Pearson correlation coefficients were used to assess the relationship between the average complexity score and the DI score. Repeated measures analysis with linear mixed models was used to assess the association between the average complexity score and the DI score and whether the association between the 2 scores varied by level of difficulty or panel group. The level of significance for all analyses was set at P clear aligners. DI score was significantly associated with complexity perceptions (P = 0.0168). Associations between average complexity and DI score varied significantly by provider group (P = 0.0033), with orthodontists and residents showing the strongest associations. When the DI score was greater than 15, orthodontists and residents perceived cases as more complex than did the other provider groups. Orthodontists and orthodontic residents had better judgments for evaluating orthodontic case complexity. The high correlation between orthodontic professionals' perceptions and DI scores suggested that additional orthodontic education and training have an influence on the ability to recognize case complexity. Copyright © 2017 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.

  3. Gingival complex odontoma: a rare case report with a review of the literature

    Science.gov (United States)

    Araujo, Juliane Pirágine; Gallo, Camila de Barros; Trierveiler, Marília

    2018-01-01

    Odontomas are odontogenic tumors composed of a mixture of dental tissues. They are very common hamartomas of the jaws. However, their peripheral or gingival counterparts are extremely uncommon. The objective of this article is to report a rare case of gingival complex odontoma in an 11-year-old patient, and also to review all published cases of this type of lesion. PMID:29515984

  4. A Real-Life Case Study of Audit Interactions--Resolving Messy, Complex Problems

    Science.gov (United States)

    Beattie, Vivien; Fearnley, Stella; Hines, Tony

    2012-01-01

    Real-life accounting and auditing problems are often complex and messy, requiring the synthesis of technical knowledge in addition to the application of generic skills. To help students acquire the necessary skills to deal with these problems effectively, educators have called for the use of case-based methods. Cases based on real situations (such…

  5. Analysis and Perspective from the Complex Aerospace Systems Exchange (CASE) 2013

    Science.gov (United States)

    Jones, Kennie H.; Parker, Peter A.; Detweiler, Kurt N.; McGowan, Anna-Maria R.; Dress, David A.; Kimmel, William M.

    2014-01-01

    NASA Langley Research Center embedded four rapporteurs at the Complex Aerospace Systems Exchange (CASE) held in August 2013 with the objective to capture the essence of the conference presentations and discussions. CASE was established to provide a discussion forum among chief engineers, program managers, and systems engineers on challenges in the engineering of complex aerospace systems. The meeting consists of invited presentations and panels from industry, academia, and government followed by discussions among attendees. This report presents the major and reoccurring themes captured throughout the meeting and provides analysis and insights to further the CASE mission.

  6. Peripheral ameloblastic fibro-odontoma or peripheral developing complex odontoma: report of a case

    DEFF Research Database (Denmark)

    Reibel, Jesper; Grønbæk, Anni Birgitte; Poulsen, Sven

    2011-01-01

    BACKGROUND. Peripheral (extraosseous) odontogenic tumors are rare. CASE REPORT. This report describes a case which illustrates the clinical and histopathological features of a lesion in an 8-year-old, healthy Caucasian girl that on purely morphological grounds would seem to be an ameloblastic fibro-odontoma......, but may represent a case of a peripheral developing complex odontoma. CONCLUSION. Conservative surgical enucleation of the lesion was followed by unbcomplicated healing and no recurrence was seen....

  7. Prenatal ascertainment of OEIS complex/cloacal exstrophy - 15 new cases and literature review.

    Science.gov (United States)

    Keppler-Noreuil, Kim; Gorton, Sue; Foo, Florence; Yankowitz, Jerome; Keegan, Catherine

    2007-09-15

    Omphalocele-exstrophy of the bladder-imperforate anus-spinal defects (OEIS) complex or cloacal exstrophy (EC), describes a rare grouping of more commonly occurring component malformations [Carey et al., 1978]. The etiology is unknown, but likely heterogeneous. While postnatal identification of its associated gastrointestinal, spinal, and genitourinary systems delineates the extent and natural history of OEIS complex, prenatal findings may provide additional information regarding early detection, possible causative factors, and outcome. The purposes of this study were to: (1) present the prenatal ascertainment of OEIS complex in this series of 15 cases identified through several different sources compared to the literature, and (2) discuss the relationship of these prenatal findings to possible abnormal developmental mechanisms causing OEIS complex. These 15 cases indicate that OEIS complex may be difficult to diagnose prenatally, and that the full extent of abnormalities may not be clear until postnatal exam. Confusion with limb-body wall complex (two of our cases) and pentalogy of Cantrell (one of our cases) can occur. Anal/gastrointestinal malformations and genital ambiguity are under-ascertained. Conversely, prenatal defects may resolve postnatally, yet may provide clues for pathogenetic mechanisms. For instance, the finding of nuchal thickening in our three cases (one reported) suggests vascular/hemodynamic compromise early in embryologic development, or intrathoracic compression leading to jugular lymphatic obstruction may play a role. The association of twinning and OEIS complex suggests they may occur as early as blastogenesis. Our three sets of discordant twins also suggest a non-genetic etiology for OEIS complex of uteroplacental insufficiency. This study also indicates that OEIS complex may be more common than previously thought. (c) 2007 Wiley-Liss, Inc.

  8. Succinate dehydrogenase (SDHx) mutations in pituitary tumors: could this be a new role for mitochondrial complex II and/or Krebs cycle defects?

    Science.gov (United States)

    Xekouki, Paraskevi; Stratakis, Constantine A

    2012-12-01

    Succinate dehydrogenase (SDH) or mitochondrial complex II is a multimeric enzyme that is bound to the inner membrane of mitochondria and has a dual role as it serves both as a critical step of the tricarboxylic acid or Krebs cycle and as a member of the respiratory chain that transfers electrons directly to the ubiquinone pool. Mutations in SDH subunits have been implicated in the formation of familial paragangliomas (PGLs) and/or pheochromocytomas (PHEOs) and in Carney-Stratakis syndrome. More recently, SDH defects were associated with predisposition to a Cowden disease phenotype, renal, and thyroid cancer. We recently described a kindred with the coexistence of familial PGLs and an aggressive GH-secreting pituitary adenoma, harboring an SDHD mutation. The pituitary tumor showed loss of heterozygosity at the SDHD locus, indicating the possibility that SDHD's loss was causatively linked to the development of the neoplasm. In total, 29 cases of pituitary adenomas presenting in association with PHEOs and/or extra-adrenal PGLs have been reported in the literature since 1952. Although a number of other genetic defects are possible in these cases, we speculate that the association of PHEOs and/or PGLs with pituitary tumors is a new syndromic association and a novel phenotype for SDH defects.

  9. How Can We Explain Poverty? Case Study of Dee Reveals the Complexities

    Science.gov (United States)

    Seccombe, Karen

    2011-01-01

    Many theories have been offered to explain why people are impoverished. This article by Karen Seccombe uses the case study of "Dee," a newly single mother, to explore four of the most common: individualism, social structuralism, the culture of poverty, and fatalism. She concludes that poverty is a highly complex phenomenon, and it is likely that…

  10. Nurse-led case management for ambulatory complex patients in general health care: A systematic review

    NARCIS (Netherlands)

    Latour-Delfgaauw, C.H.M.; van der Windt, D.A.W.M.; de Jonge, P.; Riphagen, II; Vos, R.; Huyse, F.J.; Stalman, W.A.B.

    2007-01-01

    Objective: The aim of this study was to summarize the available literature on the effectiveness of ambulatory nurse-led case management for complex patients in general health care. Method: We searched MEDLINE, EMBASE, the Cochrane Controlled Trials Register, and Cinahl. We included randomized

  11. A Case of Sheathless Transradial Coronary Intervention for Complex Coronary Lesions with a Standard Guiding Catheter

    Science.gov (United States)

    Choi, Jaehuk; Suh, Jon; Seo, Hye-Sun; Cho, Yoon Haeng

    2013-01-01

    One of the major limitations of transradial coronary intervention is the inability to use large guiding system, which leads to the development of dedicated sheathless guide catheter system. However, these devices are not available in the Republic of Korea. We present a case in which conventional guiding catheter was used for sheathless transradial coronary intervention in the treatment of complex coronary anatomy. PMID:23755083

  12. Peripheral ameloblastic fibro-odontoma or peripheral developing complex odontoma: report of a case.

    Science.gov (United States)

    Reibel, Jesper; Grønbaek, Anni B; Poulsen, Sven

    2011-11-01

    BACKGROUND. Peripheral (extraosseous) odontogenic tumors are rare. CASE REPORT. This report describes a case which illustrates the clinical and histopathological features of a lesion in an 8-year-old, healthy Caucasian girl that on purely morphological grounds would seem to be an ameloblastic fibro-odontoma, but may represent a case of a peripheral developing complex odontoma. CONCLUSION. Conservative surgical enucleation of the lesion was followed by unbcomplicated healing and no recurrence was seen. © 2011 The Authors. International Journal of Paediatric Dentistry © 2011 BSPD, IAPD and Blackwell Publishing Ltd.

  13. A Complex Facial Trauma Case with Multiple Mandibular Fractures and Dentoalveolar Injuries

    Science.gov (United States)

    Zorlu, Sevgi; Cankaya, Abdulkadir Burak; Aktoren, Oya; Gencay, Koray

    2015-01-01

    The principles of management of mandibular fractures differ in children when compared to adults and depend on the specific age-related status of the growing mandible and the developing dentition. This paper presents a case report with a complex facial trauma affecting the mandibular body and condyle region and dentoalveolar complex. Clinical examination revealed soft tissue injuries, limited mouth opening, lateral deviation of the mandible, an avulsed incisor, a subluxated incisor, and a fractured crown. CBCT examination revealed a nondisplaced fracture and an oblique greenstick fracture of the mandibular body and unilateral fracture of the condyle. Closed reduction technique was chosen to manage fractures of the mandible. Favorable healing outcomes on multiple fractures of the mandible throughout the 6-year follow-up period proved the success of the conservative treatment. This case report is important since it presents a variety of pathological sequelae to trauma within one case. PMID:26339511

  14. A Rare Cause of Prepubertal Gynecomastia: Sertoli Cell Tumor

    Directory of Open Access Journals (Sweden)

    Fatma Dursun

    2015-01-01

    Full Text Available Prepubertal gynecomastia due to testis tumors is a very rare condition. Nearly 5% of the patients with testicular mass present with gynecomastia. Sertoli cell tumors are sporadic in 60% of the reported cases, while the remaining is a component of multiple neoplasia syndromes such as Peutz-Jeghers syndrome and Carney complex. We present a 4-year-old boy with gynecomastia due to Sertoli cell tumor with no evidence of Peutz-Jeghers syndrome or Carney complex.

  15. Complex Frontal Pneumosinus Dilatans Associated with Meningioma: A Report of Two Cases and Associated Literature Review

    Science.gov (United States)

    Timms, Sara; Lakhani, Raj; Connor, Steve; Hopkins, Claire

    2017-01-01

    Introduction  Pneumosinus dilatans (PSD) is a rare phenomenon involving the expansion of the paranasal sinuses, without bony destruction or a mass. Previously documented cases have demonstrated simple expansion of a solitary air cell. We present two unique cases of PSD in the presence of meningioma, in which complex new cells developed within the frontal sinus. One of the two patients developed associated sinus disease. Case 1  A 28-year-old man presented with facial pain. A computed tomography scan showed an abnormally enlarged, septated right frontal sinus, not present on childhood scans. He underwent a modified endoscopic Lothrop approach to divide the septations, and his symptoms resolved. Case 2  A 72-year-old woman presented with a 3-month history of headaches. Scans revealed a left frontal meningioma and multiple enlarged, dilated left frontal air cells. She had no clinical sinusitis and therefore was managed conservatively. Conclusions  PSD has been widely documented in association with fibrous dysplasia and meningioma. The most prevalent theory of the mechanism of PSD is of obstruction of the sinus ostium causing sinus expansion through a “ball-valve” effect. Our cases, which demonstrate septated PSD, suggest a more complex process involving local mediators and highlight the need to consider underlying meningioma in pneumosinus dilatans. PMID:28752019

  16. [Refusal of care faced by case manager from elderly persons in complex situation: cross perspectives].

    Science.gov (United States)

    Corvol, A; Balard, F; Moutel, G; Somme, D

    2014-01-01

    Case management is a new professional field in France. It is addressed to elderly persons living in community whose situation is regarded as particularly complex. Case managers have to assess needs and coordinate necessary services. One common criteria of complexity is refusal of care. The objective of this study is to compare the words of users with those of case managers about refusal of care, in order to understand its meaning, professionals' attitudes and ethical challenges. Two researchers have cooperated on this qualitative research: the first one, anthropologist, interviewed 19 individuals, and 11 of their caregivers. The second one, geriatrician and researcher in medical ethics, lead four focus groups gathering a total of 18 case managers. Refusal of care often is the result of the will of preserving one's identity, compromised by illness. Individuals seek control on their life. Facing this behaviour, case managers try to secure the individual, by establishing a personal relationship that respects their choices, even if care has to be delayed. Refusal of care may sometimes disclose a desire to vanish, in front of which professionals meet their own limits. To recognise an elderly person that refuses care as a unique individual who can make choices secure his identity, and allow him to change. Copyright © 2013 Société nationale française de médecine interne (SNFMI). Published by Elsevier SAS. All rights reserved.

  17. Bladder exstrophy – epispadias complex in a newborn: a case report and review of literature

    Directory of Open Access Journals (Sweden)

    Paul N. Tolefac

    2018-02-01

    Full Text Available Background: Bladder exstrophy-epispadias complex (BEEC is a rare congenital malformation of the genitourinary system usually associated with other malformations. Case summary: We report the case of a new born delivered vaginally at 39 weeks and 2 days of gestation with BEEC. Three prenatal ultrasound scans missed the diagnosis. Medical management was provided and the patient was discharged against medical advice 48 hours later upon refusing surgical intervention. Conclusion: The diagnosis and management of BEEC is a challenge in sub-Sahara Africa. Radiologists doing prenatal ultrasounds should check routinely to exclude foetal anomalies.

  18. Xanthogranulomatous Pyelonephritis Can Simulate a Complex Cyst: Case Description and Review of Literature

    Directory of Open Access Journals (Sweden)

    Salvatore Butticè

    2014-05-01

    Full Text Available Xanthogranulomatous pyelonephritis is a rare and peculiar form of chronic pyelonephritis and is generally associated with renal lithiasis. Its incidence is higher in females. The peculiarity of this disease is that it requires a differential diagnosis, because it can often simulate dramatic pathologic conditions. In fact, in the literature are also described cases in association with squamous cell carcinoma of the kidney The radiologic clinical findings simulate renal masses, sometimes in association with caval thrombus. We describe a case of xanthogranulomatous pyelonephritis with radiologic aspects of a complex cyst of Bosniak class III in a man 40-year old.

  19. Circle of Willis variation in a complex stroke presentation: a case report

    Directory of Open Access Journals (Sweden)

    Young Carolyn A

    2006-03-01

    Full Text Available Abstract Background The impact of circle of Willis anatomical variation upon the presentation of stroke is probably underrecognised. Case presentation A 63-year-old right-handed woman developed a left hemiparesis and right leg weakness sequentially following a road traffic accident (RTA. Despite initial concern about the possibility of cervical spinal cord injury, the final diagnosis was bilateral artery-to-artery embolic cerebral infarction with dominant right internal carotid artery. Conclusion The case illustrates the complex presentation of stroke as a pseudo-cervical cord lesion and the impact of circle of Willis anatomical variation upon the expression of large vessel cerebrovascular disease.

  20. Complex Suicide by Self-stabbing and Drowning: A Case Report and a Review of Literature.

    Science.gov (United States)

    Peyron, Pierre-Antoine; Casper, Thierry; Mathieu, Olivier; Musizzano, Yuri; Baccino, Eric

    2018-03-01

    Sharp force injuries and drowning are methods exceptionally combined in complex suicides. We report a challenging case of complex suicide by self-stabbing and drowning that illustrates the difficulty in discriminating between homicide and suicide in such circumstances of death. The corpse of a young man was found submerged in a river, stabbed nine times with two wounds that had penetrated the thorax and had caused lung injuries and a hemopneumothorax. The postmortem and histological examinations were consistent with a death caused by drowning, but the manner of death still remained undetermined. Police investigation finally concluded to a suicide, although no suicide note had been left and the victim had no underlying diagnosed mental disorder. The parameters that may help distinguish suicide from homicide at the autopsy should be interpreted in light of a thorough forensic investigation to determine the exact manner of death in such a case. © 2017 American Academy of Forensic Sciences.

  1. Dependent personality features in a complex case of borderline personality disorder.

    Science.gov (United States)

    Nirestean, Tudor; Lukacs, Emese; Nirestean, Aurel; Gabos Grecu, Iosif

    2016-11-01

    Borderline personality disorder is a complex disease model as it encompasses a diversity of pathological personality traits and psychopathological symptoms. It is not surprising, therefore, that it is often manifested by personality disorders across all three clusters and accompanied by other mental (Axis I) disorders. This melange makes both psychological treatment and pharmacotherapy especially challenging, and this paper describes the case of a particularly complex case of a 33-year-old Romanian patient, who has a history of severe deprivation in childhood, mood and substance use disorder in association with borderline pathology. In the course of treatment from many sources and interventions, it has become clear that dependence is a key component of the pathology and has been rewarded with a degree of success in management. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

  2. Omphalocele-Exstrophy-Imperforate Anus-Spinal Defects Complex: Associated Malformations in 12 New Cases.

    Science.gov (United States)

    Mallmann, Michael Rudolf; Reutter, Heiko; Müller, Annette Margarete; Geipel, Annegret; Berg, Christoph; Gembruch, Ulrich

    2017-01-01

    The omphalocele-exstrophy-imperforate anus-spinal defects (OEIS) complex is a rare variant of the bladder exstrophy epispadias complex with in most cases unknown etiology. Due to the rarity of the disease, no large series exist that describe the prenatal spectrum of disease or additional malformations. In this study, we present the prenatal findings in a series of 12 cases. All fetuses showed exstrophy of the bladder, 9/12 omphalocele, 9/12 anal atresia, 10/12 neural tube defects, 4/12 vertebral defects, 5/12 lower extremity defects including clubfeet, and 4/12 a single umbilical artery. Additional malformations included hydrocephalus, hypertelorism, aplasia of the gall bladder, heart defects and kidney malformations. All karyotyped fetuses (11/11) showed a normal karyotype. These findings illustrate the spectrum of disease in prenatal diagnosis. © 2016 S. Karger AG, Basel.

  3. Compound-complex odontoma: A case report of a rare variant

    Directory of Open Access Journals (Sweden)

    Nishath Khanum

    2014-01-01

    Full Text Available The odontoma is a benign tumor containing all the various component tissues of the teeth. It is the most common odontogenic tumor representing 67% of all odontogenic tumors. Odontomas are considered to be developmental anomalies (hamartomas rather than true neoplasms. Based on the degree of morphodifferentiation or on the basis of their resemblance to normal teeth, they are divided into compound and complex odontomas. The compound odontoma is composed of multiple, small tooth-like structures. The complex odontoma consists of a conglomerate mass of enamel and dentin, which bears no anatomic resemblance to a tooth. They are usually diagnosed on routine radiological examinations in the second decade of life and are often slow growing and non-aggressive in nature. Here, we report a case of rare, unusually large, compound-complex odontoma, located in the left anterior maxilla of a 13-year-old male patient.

  4. Complex Regional Pain Syndrome (CRPS Type II After Carpal Tunnel Release Surgery: Case Report

    Directory of Open Access Journals (Sweden)

    Hakan Tunç

    2010-08-01

    Full Text Available Summary Complex regional pain syndrome is a chronic syndrome characterised with dystrophic changes and neurovascular disordes of bone and skin of extremities. The most common etiological factors are trauma, ischemic heart disease, cerebral lesions, servical region disorders, infections, and surgical treatments. Carpal tunnel syndrome is the most common compressive neuropaty of the upper extremity. There are various surgical and conservative alternatives in the treatment of carpal tunnel syndrome. Complex regional pain syndrome has been reported as a complication of surgical carpal tunnel release in 2-5% of patients. In this case report clinical characteristics and rehabilitation outcomes of a patient with complex regional pain syndrome after carpal tunnel release surgery is presented. (Osteoporoz Dünyasından 2010;16:41-3

  5. Surgical treatment of extensive complex odontoma in the mandible by corticotomy. A case report.

    Science.gov (United States)

    Nogueira, A S; Gonçales, E S; Gonçales, A G B; Thiegui-Neto, V; Nogueira, C B P; Nogueira, A; Medeiros, R

    2013-09-01

    Odontomas represent the most prevalent odontogenic tumors in the jaw. The treatment of choice is surgical removal, usually performed by conventional techniques involving ostectomies to expose the tumor. In this paper, the authors describe, through the report of a case of complex odontoma located in the mandibular angle, a more conservative surgical technique called corticotomy, in which the bone removed for access to the tumor (buccal cortical) is repositioned and fixed by titanium plates of 1.5 mm.

  6. Complex Regional Pain Syndrome following an Episode of Herpes Zoster: A Case Report

    OpenAIRE

    Marrero, Christopher E; Mclean, Neuyen; Varnado, Keyana

    2017-01-01

    Introduction: Complex regional pain syndrome (CRPS) is characterized by searing pain, hyperalgesia, edema, allodynia, and skin changes. CRPS may be difficult to diagnose and to treat given poorly understood mechanisms as well as its presentation of symptoms that may mimic common conditions such as joint stiffness in this condition as well as rheumatoid arthritis. Case Report: A 71-year-old female presented to our clinic post shingles of the right upper extremity. We diagnosed her with CRPS ba...

  7. [Case management and complex chronic diseases: concepts, models, evidence and uncertainties].

    Science.gov (United States)

    Morales-Asencio, José Miguel

    2014-01-01

    Chronic diseases are the greatest challenge for Health Care, but the conventional health care models have failed noticeably. Nurses are one of the main providers of the services developed to tackle this challenge, with special emphasis on case management, as one of the most common forms. But, one of the key problems is that case management is poorly conceptualized, and with the diversity of experience available, make its development and comparative evaluation difficult. An in-depth review on case management definition and concepts is presented in this article, with a description of the models, ingredients and the effectiveness reported in various studies. The remaining uncertainties in case management, such as the heterogeneity of designs and target populations, the weak description of the components, and the scarce use of research models for complex interventions, are also discussed. Finally, some key factors for a successful implementation of case management are detailed, such as a clear definition of accountability and roles, the existence of support to guarantee the competence of case managers, the use of valid mechanisms for case finding, adjusted caseload, accessible and team-shared record systems, or the integration of health and social services. Copyright © 2013 Elsevier España, S.L. All rights reserved.

  8. A suspected case of rocuronium-sugammadex complex-induced anaphylactic shock after cesarean section.

    Science.gov (United States)

    Yamaoka, Masakazu; Deguchi, Miki; Ninomiya, Kiichiro; Kurasako, Toshiaki; Matsumoto, Mutsuko

    2017-02-01

    An anaphylactic reaction during a cesarean section occurs rarely, and rocuronium is thought to be one of the common agents causing perioperative anaphylaxis. Here we report an anaphylactic shock after cesarean section that is suggested to be induced by the rocuronium-sugammadex complex. A 36-year-old primigravida underwent an elective cesarean section under general anesthesia due to placenta previa. While the operation was completed uneventfully, she developed anaphylactic shock following sugammadex administration. She was successfully managed with rapid treatments. Serum tryptase level was significantly elevated. Although sugammadex was first suspected to be the causative agent, the result of intradermal skin tests with sugammadex were negative. Surprisingly, a subsequent intradermal test with undiluted rocuronium caused the patient to fall into a state of shock. Furthermore, a later skin-prick test with pre-mixed rocuronium-sugammadex complex also revealed a strong positive reaction, and a test with only rocuronium showed negative. We finally concluded that the rocuronium-sugammadex complex is the causative agent in this case. To the best of our knowledge, this is the first report suggesting anaphylaxis caused by the rocuronium-sugammadex complex. This case highlights the importance of appropriate examinations to determinate the pathogenesis of anaphylaxis in order to establish risk reduction strategies.

  9. OEIS complex (omphalocele-exstrophy-imperforate anus-spinal defects): a review of 14 cases.

    Science.gov (United States)

    Keppler-Noreuil, K M

    2001-04-01

    OEIS complex refers to a combination of defects consisting of omphalocele, exstrophy of the cloaca, imperforate anus, and spinal defects. Possible embryologic mechanisms proposed for these findings have included: a single defect of early blastogenesis or a defect of mesodermal migration during the primitive streak period. Fourteen cases with OEIS complex and related malformations were reviewed for demographic features, prenatal and family histories, and clinical, radiological and pathological findings including the frequency and types of associated anomalies. The pathogenetic mechanisms causing OEIS complex and related malformations, such as anorectal and spinal defects, are discussed. The findings in these cases illustrate the spectrum of defects that can occur in the embryologic development of the cloaca and the urorectal septum. Differences in the timing and extent of mesenchymal ingrowth as well as cloacal membrane rupture may account for these variable findings. A developmental field defect involving the intraembryonic mesoderm suggests a possible etiologic role for homeobox genes, such as HLXB9 with mutations, resulting in anorectal and spine abnormalities, or retinoic acid receptors. OEIS complex with its mostly sporadic occurrence suggests etiologic heterogeneity with a possible role for environmental and genetic causes. Copyright 2001 Wiley-Liss, Inc.

  10. OEIS complex associated with chromosome 1p36 deletion: a case report and review.

    Science.gov (United States)

    El-Hattab, Ayman W; Skorupski, Josh C; Hsieh, Michael H; Breman, Amy M; Patel, Ankita; Cheung, Sau Wai; Craigen, William J

    2010-02-01

    OEIS complex (Omphalocele, Exstrophy of the cloaca, Imperforate anus, and Spine abnormalities) is a rare defect with estimated incidence of 1 in 200,000 live births. Most cases are sporadic, with no obvious cause. However, it has been rarely reported in patients with family members having similar malformations or with chromosomal anomalies. In addition, OEIS complex has been observed in association with environmental exposures, twinning, and in vitro fertilization. Monosomy 1p36 is the most common terminal deletion syndrome, with a prevalence of 1 in 5,000 newborns. It is characterized by specific facial features, developmental delay, and heart, skeletal, genitourinary, and neurological defects. We describe an infant with OEIS complex and 1p36 deletion who had features of both disorders, including omphalocele, cloacal exstrophy, imperforate anus, sacral multiple segmentation, renal malposition and malrotation, genital anomalies, diastasis of the symphysis pubis, microbrachycephaly, large anterior fontanel, cardiac septal defects, rib fusion, a limb deformity, developmental delay, and typical facial features. Chromosomal microarray analysis detected a 2.4 Mb terminal deletion of chromosome 1p. This is the first reported case with OEIS complex in association with a chromosome 1p36 deletion. Copyright 2010 Wiley-Liss, Inc.

  11. Conjunctival myxoma - atypical presentation of a rare tumour: case report and review of literature.

    Science.gov (United States)

    Sharma, Neharika; O'Hagan, Stephen; Phillips, Gael

    2016-05-13

    presentation. Conjunctival myxomas can occur in association with the Carney Complex, which is an autosomal dominant syndrome associated with benign tumours, spotty mucocutaneous pigmentation, and endocrine overactivity (Ophthalmic Surg Lasers Imaging 39(6):514-6, 2008). Ophthalmic manifestations of the Carney Complex have been found to precede vascular embolic events secondary to cardiac myxoma, thus early diagnosis of conjunctival myxoma can prevent potentially devastating consequences (Ophthalmic Surg Lasers Imaging 39(6):514-6, 2008). The different presentations of this rare tumour emphasise the importance of excisional biopsies in diagnosing indeterminate conjunctival lesions; and its association with cardiac myxoma, highlights the need for cardiac investigations in all patients who present with conjunctival myxoma (J Ophthalmol (1);1-5, 2014; Ophthalmic Surg Lasers Imaging 39(6):514-6, 2008).

  12. Knowledge to action for solving complex problems: insights from a review of nine international cases.

    Science.gov (United States)

    Riley, B L; Robinson, K L; Gamble, J; Finegood, D T; Sheppard, D; Penney, T L; Best, A

    2015-05-01

    Solving complex problems such as preventing chronic diseases introduces unique challenges for the creation and application of knowledge, or knowledge to action (KTA). KTA approaches that apply principles of systems thinking are thought to hold promise, but practical strategies for their application are not well understood. In this paper we report the results of a scan of systems approaches to KTA with a goal to identify how to optimize their implementation and impact. A 5-person advisory group purposefully selected 9 initiatives to achieve diversity on issues addressed and organizational forms. Information on each case was gathered from documents and through telephone interviews with primary contacts within each organization. Following verification of case descriptions, an inductive analysis was conducted within and across cases. The cases revealed 5 guidelines for moving from conceiving KTA systems to implementing them: (1) establish and nurture relationships, (2) co-produce and curate knowledge, (3) create feedback loops, (4) frame as systems interventions rather than projects, and (5) consider variations across time and place. Results from the environmental scan are a modest start to translating systems concepts for KTA into practice. Use of the strategies revealed in the scan may improve KTA for solving complex public health problems. The strategies themselves will benefit from the development of a science that aims to understand adaptation and ongoing learning from policy and practice interventions, strengthens enduring relationships, and fills system gaps in addition to evidence gaps. Systems approaches to KTA will also benefit from robust evaluations.

  13. Complex odontoma: report of a five-year follow-up case.

    Science.gov (United States)

    Barros, Luciana D'azevedo; Pedron, Irineu Gregnanin; Utumi, Estevam Rubens; Zambon, Camila Eduarda; Rocha, Andre Caroli

    2010-01-01

    Odontomas are odontogenic tumors that usually present as benign lesions. They are easily diagnosed and affect individuals in their first and second decades of life. In most cases, odontomas are asymptomatic and the presence could be suspected due to the delay in tooth eruption or via routine radiographic examinations. Treatment of choice has been surgical removal of the lesion, and prognosis is usually favorable because of its benign characteristics and rare recurrence. The purpose of this study is to report the case of a complex odontoma in a child impacting a permanent molar and preventing its eruption. The lesion was surgically removed, and the eruption of the permanent mandibular left second molar tooth occurred after 5 months. Clinical, radiographic, and histopathological characteristics were studied in this case.

  14. An Unusual Case of Heteropagus: Autosite With a Complex Cardiac Malformation

    Directory of Open Access Journals (Sweden)

    Hulya Ozkan-Ulu

    2011-12-01

    Full Text Available Asymmetrical form of conjoined twinning (heteropagus is an extremely rare event with an incidence of 1–2 million live births. The incomplete component of heteropagus, namely, parasite, usually consists of rudimentary organs. Therefore, the autosite component of heteropagus can be separated successfully. A wide spectrum of associated congenital cardiac malformations, which are usually minor, has been described in autosites. However, a single-ventricle heart anomaly in the autosite has been reported in a very few cases. We report an unusual case of heteropagus with a complex cardiac malformation. To the best of our knowledge, this is the third heteropagus case in the literature with a single-ventricle heart in the autosite.

  15. A case for Sandia investment in complex adaptive systems science and technology.

    Energy Technology Data Exchange (ETDEWEB)

    Colbaugh, Richard; Tsao, Jeffrey Yeenien; Johnson, Curtis Martin; Backus, George A.; Brown, Theresa Jean; Jones, Katherine A.

    2012-05-01

    This white paper makes a case for Sandia National Laboratories investments in complex adaptive systems science and technology (S&T) -- investments that could enable higher-value-added and more-robustly-engineered solutions to challenges of importance to Sandia's national security mission and to the nation. Complex adaptive systems are ubiquitous in Sandia's national security mission areas. We often ignore the adaptive complexity of these systems by narrowing our 'aperture of concern' to systems or subsystems with a limited range of function exposed to a limited range of environments over limited periods of time. But by widening our aperture of concern we could increase our impact considerably. To do so, the science and technology of complex adaptive systems must mature considerably. Despite an explosion of interest outside of Sandia, however, that science and technology is still in its youth. What has been missing is contact with real (rather than model) systems and real domain-area detail. With its center-of-gravity as an engineering laboratory, Sandia's has made considerable progress applying existing science and technology to real complex adaptive systems. It has focused much less, however, on advancing the science and technology itself. But its close contact with real systems and real domain-area detail represents a powerful strength with which to help complex adaptive systems science and technology mature. Sandia is thus both a prime beneficiary of, as well as potentially a prime contributor to, complex adaptive systems science and technology. Building a productive program in complex adaptive systems science and technology at Sandia will not be trivial, but a credible path can be envisioned: in the short run, continue to apply existing science and technology to real domain-area complex adaptive systems; in the medium run, jump-start the creation of new science and technology capability through Sandia's Laboratory Directed Research

  16. Does model performance improve with complexity? A case study with three hydrological models

    Science.gov (United States)

    Orth, Rene; Staudinger, Maria; Seneviratne, Sonia I.; Seibert, Jan; Zappa, Massimiliano

    2015-04-01

    In recent decades considerable progress has been made in climate model development. Following the massive increase in computational power, models became more sophisticated. At the same time also simple conceptual models have advanced. In this study we validate and compare three hydrological models of different complexity to investigate whether their performance varies accordingly. For this purpose we use runoff and also soil moisture measurements, which allow a truly independent validation, from several sites across Switzerland. The models are calibrated in similar ways with the same runoff data. Our results show that the more complex models HBV and PREVAH outperform the simple water balance model (SWBM) in case of runoff but not for soil moisture. Furthermore the most sophisticated PREVAH model shows an added value compared to the HBV model only in case of soil moisture. Focusing on extreme events we find generally improved performance of the SWBM during drought conditions and degraded agreement with observations during wet extremes. For the more complex models we find the opposite behavior, probably because they were primarily developed for prediction of runoff extremes. As expected given their complexity, HBV and PREVAH have more problems with over-fitting. All models show a tendency towards better performance in lower altitudes as opposed to (pre-) alpine sites. The results vary considerably across the investigated sites. In contrast, the different metrics we consider to estimate the agreement between models and observations lead to similar conclusions, indicating that the performance of the considered models is similar at different time scales as well as for anomalies and long-term means. We conclude that added complexity does not necessarily lead to improved performance of hydrological models, and that performance can vary greatly depending on the considered hydrological variable (e.g. runoff vs. soil moisture) or hydrological conditions (floods vs. droughts).

  17. Comparative Study of Elastic Network Model and Protein Contact Network for Protein Complexes: The Hemoglobin Case

    Directory of Open Access Journals (Sweden)

    Guang Hu

    2017-01-01

    Full Text Available The overall topology and interfacial interactions play key roles in understanding structural and functional principles of protein complexes. Elastic Network Model (ENM and Protein Contact Network (PCN are two widely used methods for high throughput investigation of structures and interactions within protein complexes. In this work, the comparative analysis of ENM and PCN relative to hemoglobin (Hb was taken as case study. We examine four types of structural and dynamical paradigms, namely, conformational change between different states of Hbs, modular analysis, allosteric mechanisms studies, and interface characterization of an Hb. The comparative study shows that ENM has an advantage in studying dynamical properties and protein-protein interfaces, while PCN is better for describing protein structures quantitatively both from local and from global levels. We suggest that the integration of ENM and PCN would give a potential but powerful tool in structural systems biology.

  18. Giant complex odontoma of the anterior mandible: report of case with long follow up.

    Science.gov (United States)

    Spini, Pedro Henrique Rezende; Spini, Túlio Humberto; Servato, João Paulo Silva; Faria, Paulo Rogério de; Cardoso, Sérgio Vitorino; Loyola, Adriano Mota

    2012-01-01

    This paper describes an exceptional case of an enormous complex odontoma affecting the mandibular symphysis of a 9-year-old boy. Because of its dimensions, the lesion produced cortical bone expansion, dental displacement and impactation, which are clinical signs very seldom described for odontomas. The lesion was surgically excised in a conservative way using an intraoral approach with local anesthesia. After 7 years of follow up, all teeth had erupted and the mandibular bone healed totally. Because of its radiographic mixed radiolucent and radiopaque appearance and its expansive growth, it is imperative to make the differential diagnosis of giant complex odontoma for other more aggressive mixed odontogenic tumors, such as ameloblastic fibro-odontoma, odotoameloblastoma and cystic calcified odontogenic tumor. Conservative approach appears to be indicated in the treatment of such lesions.

  19. Synchronization in complex systems following a decision based queuing process: rhythmic applause as a test case

    Science.gov (United States)

    Xenides, D.; Vlachos, D. S.; Simos, T. E.

    2008-07-01

    Living communities can be considered as complex systems, and are thus fertile grounds for studies related to statistics and dynamics. In this study we revisit the case of rhythmic applause by utilizing the model proposed by Vázquez et al (2006 Phys. Rev. E 73 036127) augmented with two opposing driving forces, namely the desires for individuality and companionship. To that end, after performing computer simulations with a large number of oscillators we propose an explanation on the following open questions: (a) Why does synchronization occur suddenly? (b) Why is synchronization observed when the clapping period (Tc) is 1.5 × Tstime? Moreover, on the basis of the model, a weak preferential attachment principle is proposed which can produce complex networks obeying a power law in the distribution of the number of edges per node with exponent greater than 3.

  20. Viability and resilience of complex systems concepts, methods and case studies from ecology and society

    CERN Document Server

    Deffuant, Guillaume

    2011-01-01

    One common characteristic of a complex system is its ability to withstand major disturbances and the capacity to rebuild itself. Understanding how such systems demonstrate resilience by absorbing or recovering from major external perturbations requires both quantitative foundations and a multidisciplinary view of the topic. This book demonstrates how new methods can be used to identify the actions favouring the recovery from perturbations on a variety of examples including the dynamics of bacterial biofilms, grassland savannahs, language competition and Internet social networking sites. The reader is taken through an introduction to the idea of resilience and viability and shown the mathematical basis of the techniques used to analyse systems. The idea of individual or agent-based modelling of complex systems is introduced and related to analytically tractable approximations of such models. A set of case studies illustrates the use of the techniques in real applications, and the final section describes how on...

  1. Synchronization in complex systems following a decision based queuing process: rhythmic applause as a test case

    International Nuclear Information System (INIS)

    Xenides, D; Vlachos, D S; Simos, T E

    2008-01-01

    Living communities can be considered as complex systems, and are thus fertile grounds for studies related to statistics and dynamics. In this study we revisit the case of rhythmic applause by utilizing the model proposed by Vázquez et al (2006 Phys. Rev. E 73 036127) augmented with two opposing driving forces, namely the desires for individuality and companionship. To that end, after performing computer simulations with a large number of oscillators we propose an explanation on the following open questions: (a) Why does synchronization occur suddenly? (b) Why is synchronization observed when the clapping period (T c ) is 1.5 × T s c s (T s is the mean self-period for the spectators) and lost after a time? Moreover, on the basis of the model, a weak preferential attachment principle is proposed which can produce complex networks obeying a power law in the distribution of the number of edges per node with exponent greater than 3

  2. The evaluation of complex interventions in palliative care: an exploration of the potential of case study research strategies.

    Science.gov (United States)

    Walshe, Catherine

    2011-12-01

    Complex, incrementally changing, context dependent and variable palliative care services are difficult to evaluate. Case study research strategies may have potential to contribute to evaluating such complex interventions, and to develop this field of evaluation research. This paper explores definitions of case study (as a unit of study, a process, and a product) and examines the features of case study research strategies which are thought to confer benefits for the evaluation of complex interventions in palliative care settings. Ten features of case study that are thought to be beneficial in evaluating complex interventions in palliative care are discussed, drawing from exemplars of research in this field. Important features are related to a longitudinal approach, triangulation, purposive instance selection, comprehensive approach, multiple data sources, flexibility, concurrent data collection and analysis, search for proving-disproving evidence, pattern matching techniques and an engaging narrative. The limitations of case study approaches are discussed including the potential for subjectivity and their complex, time consuming and potentially expensive nature. Case study research strategies have great potential in evaluating complex interventions in palliative care settings. Three key features need to be exploited to develop this field: case selection, longitudinal designs, and the use of rival hypotheses. In particular, case study should be used in situations where there is interplay and interdependency between the intervention and its context, such that it is difficult to define or find relevant comparisons.

  3. Complex Regional Pain Syndrom Due to Cat Bite: A Case Report

    Directory of Open Access Journals (Sweden)

    Tuncay Cakir

    2014-04-01

    Full Text Available Complex regional pain syndrome (CPRS, is a painful and disabling disorder that can effect one or more extremities, characterized by a combination of vasomotor, sudomoto rand dystrophic alterations and may cause restriction in movements. The pain of this condition out of proportion to the severity of the initial injury. There are many aetiologic factors such as soft tissue injury, surgery, immobilization or myocardial ischemia. The pathophysiology of CPRS is not clear but peripheral and central sensitization resulting in neurogenic inflammation has been held responsible. This case report discribes the clinical condition of CPRS due to cat bite, and is presented to emphasize rare etiologic factors that may cause CPRS.

  4. Complex Evaluation of Light Sources in Case of Electric Power Cost Increase

    Directory of Open Access Journals (Sweden)

    Y. N. Kolesnik

    2008-01-01

    Full Text Available The paper gives complex evaluation of efficiency of incandescent lamps, luminescent and light-emitting-diode (LED light sources in case of electric power price increase. On the basis of experimental table lamp electric power indices of light-emitting-diode (LED light sources with equivalent luminous flux have been determined. Dependences of main indices of economic efficiency of various light sources on their operational regimes have been obtained and rate of influence on these indices of electric power price increase have been determined. Economically justified variants and conditions for application of various light sources have been substantiated.

  5. Complex Variant t(9;22 Chromosome Translocations in Five Cases of Chronic Myeloid Leukemia

    Directory of Open Access Journals (Sweden)

    Ana Valencia

    2009-01-01

    Full Text Available The Philadelphia (Ph1 chromosome arising from the reciprocal t(9;22 translocation is found in more than 90% of chronic myeloid leukemia (CML patients and results in the formation of the chimeric fusion gene BCR-ABL. However, a small proportion of patients with CML have simple or complex variants of this translocation, involving various breakpoints in addition to 9q34 and 22q11. We report five CML cases carrying variant Ph translocations involving both chromosomes 9 and 22 as well as chromosomes 3, 5, 7, 8, or 10. G-banding showed a reciprocal three-way translocation involving 3q21, 5q31, 7q32, 8q24, and 10q22 bands. BCR-ABL fusion signal on der(22 was found in all of the cases by FISH.

  6. [Complex prosthetic rehabilitation of a patient with temporomandibular dysfunction. Case report].

    Science.gov (United States)

    Nagy, Zsanett; Schmidt, Péter; Hermann, Péter

    2013-03-01

    There are varying opinions regarding the contribution of occlusal interferences to the development and progression of temporomandibular dysfunction (TMD). Several studies have demonstrated that the use of occlusal adjustment might prevent the development of TMD and the exacerbation of its symptoms. Since the aetiology of TMD is multiple, the prosthodontic treatment cannot always be sufficient, but tends to be effective in some cases. The present article describes a case of a complex prosthetic rehabilitation of a patient with TMD that originates from her previous prosthesis, resulting in reduced vertical dimension. Treatment included the registration of vertical and horizontal dimensions of occlusion by gothic arch (arrow-point) tracing. Degrees of the mandibular movement were recorded by digital axiograph (ARCUSdigma-KaVo) and transferred to a semi-adjustable articulator (KaVo Protar 5B). Appropriate vertical and horizontal occlusal dimensions and individual mandibular movements were then transferred to the final prosthesis.

  7. Complex endodontic treatment of an immature type III dens invaginatus. A case report.

    Science.gov (United States)

    Fregnani, E R; Spinola, L F B; Sônego, J R O; Bueno, C E S; De Martin, A S

    2008-10-01

    To report the endodontic treatment of an immature maxillary central incisor with dens invaginatus. Dens invaginatus is a rare malformation of teeth, probably resulting from an infolding of the dental papilla during tooth development. The present case describes the complex endodontic treatment of a type III dens invaginatus in an immature maxillary central incisor with a necrotic pulp and abscess formation. The initial treatment goal was to achieve apexification of the pseudocanal root and conservative root canal treatment in the main canal. Following 1-year of treatment with calcium hydroxide dressings, radiography revealed a healing response, but no sign of a hard tissue barrier at the apex. Periapical surgery with the placement of a zinc oxide cement (IRM) root-end filling was considered successful at the 4-year follow-up. The complexity of the canal system and open apex in dens invaginatus present a challenge to endodontic treatment. Correct diagnosis and treatment planning are fundamental to treatment of dens invaginatus. Periapical surgery is indicated in cases of unsuccessful apexification in immature teeth with dens invaginatus and nonvital pulp.

  8. COMPLEX TREATMENT IN A PATIENT WITH SEVERE CHRONIC PERIODONTITIS (Case Report.

    Directory of Open Access Journals (Sweden)

    Kamen Kotsilkov

    2015-02-01

    Full Text Available INTRODUCTION: Periodontitis is characterized by progressive destruction of periodontium, caused by relatively small group of microorganisms. The treatment aims to create proper environment which hampers the colonization of pathogens. The mechanical cleaning of the root surfaces combined with meticulous oral hygiene is the consensus treatment. In advanced cases the progression of the disease could lead to different problems - gingival recessions, insufficiency of attached gingiva, mobility and tooth loss which require complex treatment. OBJECTIVE: This presentation demonstrates the multidisciplinary treatment approach in a patient with a severe chronic periodontitis. METHODS: S.S. (42 with severe chronic periodontitis, insufficient mandibular vestibule depth, lack of keratinized gingiva, class III recessions and central incisors with grade III mobility. The #12 is missing and a crossbite is present on #32. The anti-infective therapy led to stable periodontal status. The corrective phase included the creation of vestibule depth with an autogenous gingival graft, dental implant placement with immediate provisional loading for #12, extraction of #31 and #41 due to attachment loss to the apex and immediate placement of provisionals with crossbite correction. RESULT: The reevaluation demonstrated good control of the gingival inflammation and stable periodontal status. The subsequent implant and prosthetic treatment led to the restoration of a functional dentition. CONCLUSION: The long term success of the treatment of the complex cases with severe chronic periodontitis depends significantly upon the proper control of the periodontal infection and the achievement of a stable periodontal status. These are the major prerequisites for successful further implant and prosthetic rehabilitation.

  9. [A complex diagnostic approach in lymphomas: practical aspect in short case reports].

    Science.gov (United States)

    Kalinová, Markéta; Mrhalová, Marcela; Krsková, Lenka; Jungbauerová, Helena; Kalfusová, Alena; Manďáková, Petra; Candová, Jarmila; Soukup, Jan; Campr, Vít; Kodet, Roman

    2014-07-01

    Complex laboratory investigation is necessary for the diagnosis and relevant classification of lymphomas. The classical histopathological morphology and cytology investigation is essential, but further investigations such as immunohistochemistry and fluorescence in situ hybridization are necessary. It is also important to employ flow cytometry as a method of investigation running synchronously or preceding the histopathological approach. Last but not least, the investigation of nucleic acids in lymphoma by molecular approaches is necessary and has become an everyday practice. Communication between pathologists and clinical colleagues (oncologists, hematologists, internal medicine specialists and radiologists) is very important. We demonstrate the necessity of a complex diagnostic approach to lymphomas and an appropriate interpretation of all laboratory investigations giving examples of eight patients with various types of lymphomas. In some cases, it is impossible to properly diagnose a lymphoma without molecular investigation. Occasionally, the results of the molecular investigation may be misleading and/or may be inaccurately interpreted, leading to an incorrect conclusion. For that reason, it is very important to incorporate all specialized laboratories and their teams under one roof (preferably that of pathology departments), enabling tight and daily cooperation between the specialists. This is the way to reach a precise diagnosis in a majority of cases, as well as how to comply with clinical expectations of properly classified lymphomas for a targeted therapy of patients.

  10. Idealized tropical cyclone simulations of intermediate complexity: A test case for AGCMs

    Directory of Open Access Journals (Sweden)

    Kevin Reed

    2012-04-01

    Full Text Available The paper introduces a moist, deterministic test case of intermediate complexity for Atmospheric General Circulation Models (AGCMs. We suggest pairing an AGCM dynamical core with simple physical parameterizations to test the evolution of a single, idealized, initially weak vortex into a tropical cyclone. The initial conditions are based on an initial vortex seed that is in gradient-wind and hydrostatic balance. The suggested ``simple-physics'' package consists of parameterizations of bulk aerodynamic surface fluxes for moisture, sensible heat and momentum, boundary layer diffusion, and large-scale condensation. Such a configuration includes the important driving mechanisms for tropical cyclones, and leads to a rapid intensification of the initial vortex over a forecast period of ten days. The simple-physics test paradigm is not limited to tropical cyclones, and can be universally applied to other flow fields. The physical parameterizations are described in detail to foster model intercomparisons.The characteristics of the intermediate-complexity test case are demonstrated with the help of four hydrostatic dynamical cores that are part of the Community Atmosphere Model version 5 (CAM 5 developed at the National Center for Atmospheric Research (NCAR. In particular, these are the Finite-Volume, Spectral Element, and spectral transform Eulerian and semi-Lagrangian dynamical cores that are coupled to the simple-physics suite. The simulations show that despite the simplicity of the physics forcings the models develop the tropical cyclone at horizontal grid spacings of about 55 km and finer. The simple-physics simulations reveal essential differences in the storm's structure and strength due to the choice of the dynamical core. Similar differences are also seen in complex full-physics aqua-planet experiments with CAM 5 which serve as a motivator for this work. The results suggest that differences in complex full-physics simulations can be, at least

  11. Analysis of agro industries dissolution: The case of Fars Industrial Meat Complex in Iran

    Directory of Open Access Journals (Sweden)

    Ashkan Khatir

    2014-06-01

    Full Text Available After the formation of various production and utilization systems in Iran, the most advanced utilization units entitled “Agro-Industry” were established in 1968 according to the constitutional law of sub-dam land utilization companies. After several years of the activity of these units, they were dissolved one after the another. Fars Industrial Meat Complex was one of the agro-industries dissolved several decades after its activity. Since agro-industries were one of the most important production and utilization systems, awareness of the reasons for their dissolution is vital. The purpose of the study is to analyze the reasons for dissolution of the Fars Industrial Meat Complex. Qualitative research using a case study was conducted by applying a semi-structured interview technique and archive documents. To this end, in addition to the production units of this agro-industry, management issues and the related balance sheet have been also analyzed. The findings indicated that the production rate in the units of this agro-industry has been remarkably low. Besides the presence of limitations and problems in agricultural, animal breeding, animal feed factory, slaughterhouse and food industries, ill-managerial system in Fars Industrial Meat Complex, have had a significant role in the dissolution of this agro-industry.

  12. Isolated tear of the cord-like middle glenohumeral ligament in Buford complex: A case report.

    Science.gov (United States)

    Lee, Byung-Ill; Kim, Yong Beom; Won, Sung Hun; Hwang, Shu Chiang; Choi, Sung-Woo; Nho, Jae-Hwi; Chun, Dong-Il

    2017-11-01

    We describe a rare case of the isolated tear in the cord-like middle glenohumeral ligament (MGHL) in Buford complex. To the best of our knowledge, this is the first report in the English literature about the isolated tear of cord-like MGHL in Buford complex. The present report describes in detail our experience with the diagnosis of isolated tear of the cord-like MGHL in Buford complex and management. A 50-year-old female patient visited our hospital with pain and stiffness in the right shoulder that lasted for 9 months. The clinical impression was frozen shoulder by primary impingement syndrome of right shoulder and the magnetic resonance (MR) images showed tear of cord-like MGHL. We repaired the torn MGHL with the arthroscopic technique. Positive outcome by arthroscopic repair demonstrates that this disease entity is one of spectrum of pathologic condition in shoulder joint. Isolated tear of cord-like MGHL should be restored to the original anatomy for positive outcome.

  13. Analysis Thermal Comfort Condition in Complex Residential Building, Case Study: Chiangmai, Thailand

    Science.gov (United States)

    Juangjandee, Warangkana

    2017-10-01

    Due to the increasing need for complex residential buildings, it appears that people migrate into the high-density urban areas because the infrastructural facilities can be easily found in the modern metropolitan areas. Such rapid growth of urbanization creates congested residential buildings obstructing solar radiation and wind flow, whereas most urban residents spend 80-90% of their time indoor. Furthermore, the buildings were mostly built with average materials and construction detail. This causes high humidity condition for tenants that could promote mould growth. This study aims to analyse thermal comfort condition in complex residential building, Thailand for finding the passive solution to improve indoor air quality and respond to local conditions. The research methodology will be in two folds: 1) surveying on case study 2) analysis for finding the passive solution of reducing humidity indoor air The result of the survey indicated that the building need to find passive solution for solving humidity problem, that can be divided into two ways which raising ventilation and indoor temperature including increasing wind-flow ventilation and adjusting thermal temperature, for example; improving building design and stack driven ventilation. For raising indoor temperature or increasing mean radiant temperature, daylight can be passive solution for complex residential design for reducing humidity and enhance illumination indoor space simultaneous.

  14. An Orchestrating Evaluation of Complex Educational Technologies: a Case Study of a CSCL System

    Directory of Open Access Journals (Sweden)

    Luis P. Prieto

    2014-06-01

    Full Text Available As digital technologies permeate every aspect of our lives, the complexity of the educational settings, and of the technological support we use within them, unceasingly rises. This increased complexity, along with the need for educational practitioners to apply such technologies within multi-constraint authentic settings, has given rise to the notion of technology-enhanced learning practice as “orchestration of learning”. However, at the same time, the complexity involved in evaluating the benefits of such educational technologies has also increased, prompting questions about the way evaluators can cope with the different places, technologies, informants and issues involved in their evaluation activity. By proposing the notion of “orchestrating evaluation”, this paper tries to reconcile the often disparate “front office accounts” of research publications and the “shop floor practice” of evaluation of educational technology, through the case study of evaluating a system to help teachers in coordinating computer-supported collaborative learning (CSCL scenarios. We reuse an internationally-evaluated conceptual framework of “orchestration aspects” (design, management, adaptation, pragmatism, etc. to structure the case‟s narrative, showing how the original evaluation questions and methods were modulated in the face of the multiple (authentic evaluation setting constraints.

  15. Mobile education in autopsy conferences of pathology: presentation of complex cases

    Directory of Open Access Journals (Sweden)

    Kayser Klaus

    2006-11-01

    Full Text Available Abstract Background MeduMobile was a project to develop and evaluate learning scenarios for medical students and teachers by use of video communication and notebooks. Its core part was assigned to various medical routines, conferences or meetings such as doctor-patient bedside conversation. These were filmed by video teams and broadcasted live via the WLAN of the Charité campus to course participating students. One type of the learning arrangements was the autopsy conference as an on-call scenario. Materials and methods The MeduMobile project consisted of two main compartments: the regular seminar event which took place every week or month, and the on-call event. For an on-call event the students were informed two hours before the lesson's start. A mobile video team organised the video conference via a specific MeduMobile seminar system. This software offered the students to log. The MeduMobile seminar system is based on the Windows operating system and realises an extended video communication via WLAN. Thirteen access points were implemented at the Charité Campus Virchow Klinikum and Campus Mitte. A questionnaire was developed to investigate in the response and learning effect of the mobile seminar system. Results During the MeduMobile project 42 video conferences with (cumulative 145 participating students took place. Four autopsy conferences could be organised as on-call scenarios within this project. A prospective, not randomised follow-up study was included 25 students of the 1st – 6th clinical semester. According to the answers, professional reasoning, professional performance, sustainability, and the complexity were broadly accepted by the students. Discussion In principle, the MeduMobile realised an interdisciplinary case presentation using video conference and web page. The evaluation indicates a high acception of such complex case presentation with multidisciplinary settings. The use of the notebooks in mobile learning enables an

  16. Planned Complex Occupation-related Suicide by Sulfuric Acid Ingestion and Thorax Stab Wound: Case Report

    Directory of Open Access Journals (Sweden)

    Pasquale Beltempo

    2015-12-01

    Full Text Available Sulfuric acid is a colourless, odorless liquid, which causes typical injury patterns such as cutaneous and ocular burns, respiratory complications from inhalation, and ingestion injuries (coagulative necrosis of the mucosa, gastric and intestinal perforations with significant dermal and mucosal injury because of its corrosive action. Most injuries caused by sulfuric acid ingestion are accidental, especially in the paediatric population. Intentional cases of ingestion have rarely been reported in adults as a method of suicide following a major depressive disorder. In this paper, we report the case of a 44-year-old woman who was found dead outside her home with a retained fillet knife embedded in her left chest wall and cutaneous chemical burns extending from her mouth down her chin and anterior torso. During the crime scene investigation, a half empty bottle of chemical drain cleaner containing concentrated sulfuric acid was found next to her body. An autopsy revealed chemical burns to the tongue, trachea, larynx, pharynx and oesophagus along with a blackish fluid in the peritoneal cavity. Histological analyses showed extensive corrosive changes in the gastrointestinal tract. Toxicological screening of blood and urine samples was negative; gastric contents contained a high quantity of concentrated (≈ 96% sulfuric acid with a pH value of < 1.0. Death was attributed to shock following sulfuric acid ingestion. Circumstantial evidence and autopsy findings proved that the manner of death was suicidal. Complex suicides can be challenging for the forensic pathologist because of the plurality of methods used. The authors highlight the importance of systematical exhaustive postmortem investigation in order to ascertain the cause and manner of death in cases of planned complex suicide.

  17. Tsunami landslide source models as a tool for analyzing complex case studies

    Science.gov (United States)

    Grilli, S. T.; Watts, P.; Kirby, J. T.

    2003-12-01

    In tsunami generation, coseismic displacement sources can essentially be considered as having negligible duration (i.e., of a few to a few dozen seconds), as compared to characteristic times of tsunami propagation (i.e., period of at least several minutes). By contrast, submarine landslides, when they occur in or near very deep water areas, may last for a much longer time and thus produce tsunami sources of significant duration as compared to tsunami period. In analyzing data from landslide tsunami case studies, and in particular wave data, it is therefore very important to be able to understand the full history of both landslide and tsunami generation, in order to accurately estimate landslide time of failure based on such data. Recent three-dimensional (3D) hydrodynamic models developed to simulate tsunami generation by complex landslide scenarios offer such possibilities. Using these models, together with field data, the authors were able to identify both likely types and times of failure in specific case studies, in order to reproduce at best the observations in both the near and far field. To obtain far field results, the modeled 3D tsunami source is used as initial condition in a two-dimensional long wave propagation model. The cases of Skagway, PNG, and Unimak 1946 will be specifically discussed.

  18. Complex functional and epithetic rehabilitation after ablation of recurrent retroauricular basal cell carcinoma - a case study.

    Science.gov (United States)

    Reich, Waldemar; Exner, Anika; Winter, Eileen; Al-Nawas, Bilal; Eckert, Alexander Walter

    2017-01-01

    The reconstruction of extended defects of the concha poses a complex challenge for plastic surgeons. In cases of subtotal ablation, an alternative method designed especially for elderly oncological patients consists of epithetic rehabilitation. However, inserting an implant-retained concha epithesis proves challenging in patients with antecedents of deep resections involving the mastoid process. In the present case study, we report on the long-term treatment course (2009-2017) of a 79-year-old male patient suffering from a recurrent basal cell carcinoma of the retroauricular region. Following tumor resection, along with lateral mastoidectomy, reconstruction, and adjuvant radiotherapy, functional and esthetic deficits primarily due to peripheral facial nerve palsy were successfully managed using a multistep procedure. The procedure was completed by inserting an implant-retained concha epithesis, resulting in improved quality of life. Due to prior lateral mastoidectomy, ultra-short implants (4 mm) were inserted, partially at atypical positions. For maintaining healthy periimplant soft tissue, aftercare comprised cold plasma treatment. This oncologic case demonstrates the therapeutic necessity of using a broad spectrum of reconstructive procedures, along with their limitations, in a critical anatomic region. Specific features include the presentation of a workflow using ultra-short implants in a compromised mastoid region. Surgeons should consider alternative implant positions in the event of any compromised mastoid process. A particular emphasis has been put on meticulous aftercare to preserve healthy periimplant soft tissues.

  19. Case Study of a Complex Informing System: Joint Interagency Field Experimentation (JIFX

    Directory of Open Access Journals (Sweden)

    Grandon Gill

    2015-08-01

    The present paper describes an exploratory case research study that was conducted over a one year period and involved both direct observation of the event and follow-up interviews with 49 past participants in the event. The goal of the research was to assess the nature of participant-impact resulting from attending JIFX and to consider the consistency of the findings with the predictions of various theoretical frameworks used in informing science. The results suggest that participants perceived that the event provided significant value from three principal sources: discovery, interaction with potential clients (users of the technologies involved, and networking with other participants. These findings were largely consistent with what could be expected from informing under conditions of high complexity; because value generally derives from combinations of attributes rather than from the sum of individual attributes, we would expect that overall value from informing activities will be perceived even though estimates of the incremental value of that informing cannot be made.

  20. Using virtual humans and computer animations to learn complex motor skills: a case study in karate

    Directory of Open Access Journals (Sweden)

    Spanlang Bernhard

    2011-12-01

    Full Text Available Learning motor skills is a complex task involving a lot of cognitive issues. One of the main issues consists in retrieving the relevant information from the learning environment. In a traditional learning situation, a teacher gives oral explanations and performs actions to provide the learner with visual examples. Using virtual reality (VR as a tool for learning motor tasks is promising. However, it raises questions about the type of information this kind of environments can offer. In this paper, we propose to analyze the impact of virtual humans on the perception of the learners. As a case study, we propose to apply this research problem to karate gestures. The results of this study show no significant difference on the after training performance of learners confronted to three different learning environments (traditional group, video and VR.

  1. The application of method supplier’s complex evaluation. Case study

    Directory of Open Access Journals (Sweden)

    Ekaterina Chytilová

    2012-01-01

    Full Text Available The main goal of this article includes the illustration of selecting bidders evaluation with help Method of complex evaluation of suppliers (MCE. Nowadays the evaluation of suppliers has more importance is in the supply chain management. For SMEs with discontinuous custom manufacturing supplier evaluation at first stage becomes a priority to maintain and enhance the competitiveness of farm output and overall competitiveness. This article presents results of control MCE. The results of this article are results of suppliers’ evaluation conditions and eliminations of MCE application on the base of real enterprise data. MCE is oriented to small and medium-sized enterprises with discontinue manufacturing to order. Research is oriented to selecting procedure of existing suppliers at the first stage of supply chain. Nationality and geographic location haven’t importance to MCE application. Illustrative case study presents the evaluation process to the specific conditions and subsequently demonstrated viability of MCE.

  2. Familial Atrial Myxoma: Three Related Cases at an Australian Tertiary Institution.

    Science.gov (United States)

    Schmidt, Campbell; Doi, Atsuo; Ura, Masashi; Cole, Chris; Mundy, Julie

    2017-08-20

    Carney complex accounts for up to two-thirds of familial cardiac myxoma. It is a rare autosomal dominant syndrome, which is also characterized by multiple mucocutaneous lesions and endocrine tumors. We report on three first-degree relatives who underwent surgical resection at the same Australian tertiary institution. One patient re-presented with a recurrent tumor at an interval of 6 years. In this context, the role of interval surveillance, family screening, and genetic testing is explored. We recommend interval echocardiographic surveillance for affected individuals and first-degree relatives given the high risk of recurrence and the morbidity and mortality associated with cardiac tumors in any location.

  3. Navigating the complexities of qualitative comparative analysis: case numbers, necessity relations, and model ambiguities.

    Science.gov (United States)

    Thiem, Alrik

    2014-12-01

    In recent years, the method of Qualitative Comparative Analysis (QCA) has been enjoying increasing levels of popularity in evaluation and directly neighboring fields. Its holistic approach to causal data analysis resonates with researchers whose theories posit complex conjunctions of conditions and events. However, due to QCA's relative immaturity, some of its technicalities and objectives have not yet been well understood. In this article, I seek to raise awareness of six pitfalls of employing QCA with regard to the following three central aspects: case numbers, necessity relations, and model ambiguities. Most importantly, I argue that case numbers are irrelevant to the methodological choice of QCA or any of its variants, that necessity is not as simple a concept as it has been suggested by many methodologists, and that doubt must be cast on the determinacy of virtually all results presented in past QCA research. By means of empirical examples from published articles, I explain the background of these pitfalls and introduce appropriate procedures, partly with reference to current software, that help avoid them. QCA carries great potential for scholars in evaluation and directly neighboring areas interested in the analysis of complex dependencies in configurational data. If users beware of the pitfalls introduced in this article, and if they avoid mechanistic adherence to doubtful "standards of good practice" at this stage of development, then research with QCA will gain in quality, as a result of which a more solid foundation for cumulative knowledge generation and well-informed policy decisions will also be created. © The Author(s) 2014.

  4. Impact of Business Interoperability on the Performance of Complex Cooperative Supply Chain Networks: A Case Study

    Directory of Open Access Journals (Sweden)

    Izunildo Cabral

    2018-01-01

    Full Text Available This paper proposes an agent-based model for evaluating the effect of business interoperability on the performance of cooperative supply chain networks. The model is based on insights from the Industrial Marketing and Purchasing network approach and the complex systems theory perspective. To demonstrate its applicability, an explanatory case study regarding a Portuguese reverse logistics cooperative supply chain network is presented. Face-to-face interviews and forms were used to collect data. The findings show that the establishment of appropriate levels of business interoperability has helped to reduce several non-value-added interaction processes and consequently improve the operational performance of the Valorpneu network. Regarding the research implications, this paper extends the current knowledge on business interoperability and an important problem in business: how business interoperability gaps in dyadic organizational relationships affect the network of companies that the two companies belong to—network effect. In terms of practical implications, managers can use the proposed model as a starting point to simulate complex interactions between supply chain network partners and understand better how the performance of their networks emerges from these interactions and from the adoption of different levels of business interoperability.

  5. DIMENSIONS OF EXPERT REPORT COMPLEXITY IN INTELLECTUAL/INDUSTRIAL PROPERTY. CASE STUDY

    Directory of Open Access Journals (Sweden)

    Raul Sorin Fântână

    2016-11-01

    Full Text Available The growing number of complex processes with the specific intellectual / industrial property demonstrated the need for highly qualified experts called in solving technical problems in the court files. The expertise in such field obliges to detailed knowledge of domestic and international law. However, those processes have as conjugate subjects: counterfeiting inventions, trademarks, industrial design; unfair competition; calculating damage that leads to highlighting the economic benefits, the latter requiring economic assessment of an intangible asset using in formula,in addition to economic data, micro - and macro-economic risk factors. Conflicts arise in a specific space. It is therefore necessary detailed knowledge of company law, competition law, that relating to interest, insolvency and bankruptcy in their developments. It should be considered domestic and European legal practice, as well as the rapid evolution of the meaning of legal terms and concepts. Experts have to understand solutions given in the prior complaints for correct interpretation of the provisions of the agreements, laws and regulations derived. The paper refersto one of the most complex expertise reports, which forced expert to integrated legislation acquaintances on patents, on insolvency and interest - in their evolution. But fundamentally, the expert had to understand the phenomenon of engineering and how to measure economic efficiency in the case of a divided invention.

  6. Rapid spread of complex change: a case study in inpatient palliative care

    Directory of Open Access Journals (Sweden)

    Filipski Marta I

    2009-12-01

    Full Text Available Abstract Background Based on positive findings from a randomized controlled trial, Kaiser Permanente's national executive leadership group set an expectation that all Kaiser Permanente and partner hospitals would implement a consultative model of interdisciplinary, inpatient-based palliative care (IPC. Within one year, the number of IPC consultations program-wide increased almost tenfold from baseline, and the number of teams nearly doubled. We report here results from a qualitative evaluation of the IPC initiative after a year of implementation; our purpose was to understand factors supporting or impeding the rapid and consistent spread of a complex program. Methods Quality improvement study using a case study design and qualitative analysis of in-depth semi-structured interviews with 36 national, regional, and local leaders. Results Compelling evidence of impacts on patient satisfaction and quality of care generated 'pull' among adopters, expressed as a remarkably high degree of conviction about the value of the model. Broad leadership agreement gave rise to sponsorship and support that permeated the organization. A robust social network promoted knowledge exchange and built on an existing network with a strong interest in palliative care. Resource constraints, pre-existing programs of a different model, and ambiguous accountability for implementation impeded spread. Conclusions A complex, hospital-based, interdisciplinary intervention in a large health care organization spread rapidly due to a synergy between organizational 'push' strategies and grassroots-level pull. The combination of push and pull may be especially important when the organizational context or the practice to be spread is complex.

  7. [Violent outburst from teenagers in the pediatric emergency room: Complex cases].

    Science.gov (United States)

    Cohen, L; Gras-Le Guen, C; Fleury, J; Caldagues, E; Dreno, L; Picherot, G; Vabres, N

    2017-12-01

    Teenagers admitted to the emergency room for a violent attacks episode are increasingly numerous. The source of agitation is multifactorial for these teenagers, often with a complex course. They jeopardize hospital wards, which are often ill-suited for and overwhelmed during these outbursts. This study aims to identify and describe all the teenagers admitted to the hospital over 1 year for a violent outburst and discuss their management. Retrospective and descriptive study of teenagers admitted to the pediatric emergency department of the Nantes University Hospital for a violent outburst in 2015. During this 1-year study, 99 teenagers out of a total of 182 consultations were admitted for a violent outburst. We noted that 85% of them had a previous history of a violent outburst, 70% of them were seeing a psychologist, and 56% were followed by the child welfare services. Most of the outbursts took place at home and were hetero-aggressive. Upon arrival at the pediatric emergency ward, 90% of the teenagers had calmed down. The mean time spent in the emergency ward was 3h42min. Finally, 31% of the teenagers were hospitalized in the general pediatric unit, 14% in the children's psychiatric department, and 8% in the adult psychiatry ward. We observed a high proportion of complex cases in the teenagers admitted to our emergency department for a violent outburst. These teenagers in distress, with a complex previous history, illustrated the relation between violence against themselves and their own violent behavior toward others. Developing short-stay units for a temporary isolation could be an advantageous multidisciplinary approach to allow somatic, psychological, and social evaluation of these vulnerable patients. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  8. Single ventricle, bicuspid aorta and interatrial wall aneurysm as a rare complex adult congenital heart disease: a case report

    OpenAIRE

    Berisha, Blerim; Krasniqi, Xhevdet; Thaqi, Agim; Gashi, Masar; Ko?inaj, Dardan

    2009-01-01

    Background Single ventricle, bicuspid aortic valve and interatrial wall aneurysm in adulthood are a rare and unique case in medical literature. This presented case with congenital heart disease has never been treated surgically and clinical consequences seriously presented in adulthood. Case presentation A 27 year old man with complex congenital heart disease presented. At the age of six, the single ventricle was ultrasonographly diagnosed, but at age 27 clinical consequences started to be se...

  9. Discordant Anomalies with Combined Features of Pentalogy of Cantrell and OEIS Complex: A Case Report in Monochorionic Twins.

    Science.gov (United States)

    Kunapinun, Nique; Treetipsatit, Jitsupa

    2017-10-01

    Ventral body wall defects have various manifestations. Among others, pentalogy of Cantrell (PC) and omphalocele exstrophy imperforate anus spinal abnormalities (OEIS) complex are defects that involve upper and lower anterior midline of body wall, respectively. Although both entities are in a spectrum of ventral body wall defects, the combination of PC and OEIS complex has not been described. In this report, we describe an unusual case of congenital ventral body wall defect with combined features of PC and OEIS complex, which discordantly occurred in monochorionic monoamniotic twins. PC and OEIS complex may be related regarding their embryologic origins. The combination may represent the most severe manifestation of ventral body wall defects.

  10. Intrathecal management of complex regional pain syndrome: A case report and literature.

    Science.gov (United States)

    Hagedorn, Jonathan M; Atallah, George

    2017-01-01

    Complex regional pain syndrome (CRPS) is a painful condition typically resulting from a traumatic event. Pain control in these patients is often difficult and requires a multimodal approach. Our objectives are to present a single intrathecal pain management regimen for CRPS and provide a literature review of intrathecal pain management options in CRPS. Case report from an academic pain management clinic. We present the case of a 29-year-old female with a past medical history of multiple lumbar spine surgeries and lumbar post-laminectomy syndrome who presented to clinic with CRPS type II of the bilateral lower extremities. After failing conservative measures, she underwent placement of a successful intrathecal drug delivery system. The use of intrathecal medications is useful for pain control in CRPS patients. We provide a framework for treatment of CRPS, which could be useful for practitioners dealing with this difficult and painful condition. Copyright © 2016 Scandinavian Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

  11. Complex regional pain syndrome type i. An analysis of 7 cases in children.

    Science.gov (United States)

    Pedemonte Stalla, V; Medici Olaso, C; Kanopa Almada, V; Gonzalez Rabelino, G

    2015-01-01

    Complex regional pain syndrome (CRPS) is characterised by the presence of pain accompanied by sensory, autonomic and motor symptoms, usually preceded by a lesion or immobilisation. The clinical course is disproportionate to the initial injury in intensity and in duration. Its distribution is regional, predominantly in limbs. It is classified as type I and type II according to the absence or presence of nerve injury. We present the cases of seven children, 6 girls and 1 boy, aged 7 to 15 years. Three had a history of previous trauma. In 5 cases, the symptoms were located in the lower limbs. Time to diagnosis was between 4 and 90 days. Three patients had clinical features of anxiety and depression. Imaging and immunological studies were performed to rule out differential diagnoses in all the children. Interdisciplinary treatment was performed with physiotherapy, psychotherapy, and gabapentin or pregabalin. All patients had a good clinical outcome, with no relapses in the follow-up period (between 4 and 30 months). CRPS is frequently unrecognised in children, leading to family anxiety and unnecessary para-clinical costs. Paediatricians and paediatric neurologists should be aware of this syndrome in order to avoid delay in diagnosis, unnecessary studies, and multiple visits to specialists, with a view to providing effective treatment. Copyright © 2013 Sociedad Española de Neurología. Published by Elsevier España, S.L.U. All rights reserved.

  12. The influence of vertical disparity gradient and cue conflict on EEG omega complexity in Panum's limiting case.

    Science.gov (United States)

    Li, Huayun; Jia, Huibin; Yu, Dongchuan

    2018-03-01

    Using behavioral measures and ERP technique, researchers discovered at least two factors could influence the final perception of depth in Panum's limiting case, which are the vertical disparity gradient and the degree of cue conflict between two- and three-dimensional shapes. Although certain event-related potential components have been proved to be sensitive to the different levels of these two factors, some methodological limitations existed in this technique. In this study, we proposed that the omega complexity of EEG signal may serve as an important supplement of the traditional event-related potential technique. We found that the trials with lower vertical gradient disparity have lower omega complexity (i.e., higher global functional connectivity) of the occipital region, especially that of the right-occipital hemisphere. Moreover, for occipital omega complexity, the trials with low-cue conflict have significantly larger omega complexity than those with medium- and high-cue conflict. It is also found that the electrodes located in the middle line of the occipital region (i.e., POz and Oz) are more crucial to the impact of different levels of cue conflict on omega complexity than the other electrodes located in the left- and right-occipital hemispheres. These evidences demonstrated that the EEG omega complexity could reflect distinct neural activities evoked by Panum's limiting case configurations, with different levels of vertical disparity gradient and cue conflict. Besides, the influence of vertical disparity gradient and cue conflict on omega complexity may be regional dependent. NEW & NOTEWORTHY The EEG omega complexity could reflect distinct neural activities evoked by Panum's limiting case configurations with different levels of vertical disparity gradient and cue conflict. The influence of vertical disparity gradient and cue conflict on omega complexity is regional dependent. The omega complexity of EEG signal can serve as an important supplement of the

  13. Venipuncture-induced complex regional pain syndrome: a case report and review of the literature.

    Science.gov (United States)

    Elahi, Foad; Reddy, Chandan G

    2014-01-01

    Venipuncture, the most frequently performed invasive medical procedure, is usually benign. Generally it produces only transitory mild discomfort. Venipuncture-induced neuropathic pain is hard to recognize at an early stage. Medical literature reviews show that there is not adequate medical knowledge about this important subject. The inciting incident in complex regional pain syndrome (CRPS) can often seem far too trivial to result in a condition with such severe pathophysiologic effects. The practicing physician has little information available to enable early recognition of the condition, initiation of multidisciplinary treatment modalities, and proper referral to pain specialists. We encountered a unique case of venipuncture-induced complex regional pain syndrome (CRPS). The patient is a 52-year-old school teacher with no significant past medical history, who presented initially to the Center of Pain Medicine with left upper extremity pain. The pain started while phlebotomy was performed in the patient's left antecubital area for routine blood check. The patient's pain did not improve with multiple medications, physical therapy, or several nerve blocks. The patient demonstrated all the signs and symptoms of chronic neuropathic pain of CRPS in the upper extremity with minimal response to the continuous pain management. We decided to proceed with cervical spinal cord nerve stimulation along with continuing other modalities. The patient responded to this combination. During the follow-up, we noticed that the patient's pain course was complicated by extension of the CRPS to her lower extremity. We will describe the course of treatment for the patient in this paper. In this paper we will discuss the electrical neuromodulation as an important modality in addition to the multidisciplinary pain management for a patient with venipuncture-induced chronic neuropathic pain.

  14. Modeling a Complex Biological Network with Temporal Heterogeneity: Cardiac Myocyte Plasticity as a Case Study

    Science.gov (United States)

    Mazloom, Amin R.; Basu, Kalyan; Mandal, Subhrangsu S.; Das, Sajal K.

    Complex biological systems often characterize nonlinear dynamics. Employing traditional deterministic or stochastic approaches to quantify these dynamics either fail to capture their existing deviant effects or lead to combinatorial explosion. In this work we devised a novel approach that projects the biological functions within a pathway to a network of stochastic events that are random in time and space. By applying this approach recursively to the object system we build the event network of the entire system. The dynamics of the system evolves through the execution of the event network by a simulation engine which comprised of a time prioritized event queue. As a case study we utilized the current method and conducted an in-silico experiment on the metabolic plasticity of a cardiac myocyete. We aimed to quantify the down stream effects of insulin signaling that predominantly controls the plasticity in myocardium. Intriguingly, our in-silico results on transcription regulatory effect of insulin showed a good agreement with experimental data. Meanwhile we were able to characterize the flux change across major metabolic pathways over 48 hours of the in-silico experiment. Our simulation performed a remarkable efficiency by conducting 48 hours of simulation-time in less that 2 hours of processor time.

  15. Neuroscience, neuropolitics and neuroethics: the complex case of crime, deception and FMRI.

    Science.gov (United States)

    Henry, Stuart; Plemmons, Dena

    2012-09-01

    Scientific developments take place in a socio-political context but scientists often ignore the ways their innovations will be both interpreted by the media and used by policy makers. In the rush to neuroscientific discovery important questions are overlooked, such as the ways: (1) the brain, environment and behavior are related; (2) biological changes are mediated by social organization; (3) institutional bias in the application of technical procedures ignores race, class and gender dimensions of society; (4) knowledge is used to the advantage of the powerful; and (5) its applications may reinforce existing structures of power that pose ethical questions about distributive justice. The case of crime, deception and functional Magnetic Resonance Imaging (fMRI) shows the complexity, and the political and ethical challenges that confront those who seek to use neuroscience to explain the etiology of crime, and who base policy on its findings. An ethically grounded neuroscience needs to take account of existing structures of power and difference, and to develop a public neuropolitical consciousness that ensures that those subject to risk by the application of science and technology are participants in the decision-making processes involving the implementation of policies that affect them.

  16. Complex Odontoma: A Case Report with Micro-Computed Tomography Findings

    Science.gov (United States)

    Santos, L. A. N.; Roque-Torres, G. D.; Oliveira, V. F.; Freitas, D. Q.

    2016-01-01

    Odontomas are the most common benign tumors of odontogenic origin. They are normally diagnosed on routine radiographs, due to the absence of symptoms. Histopathologic evaluation confirms the diagnosis especially in cases of complex odontoma, which may be confused during radiographic examination with an osteoma or other highly calcified bone lesions. The micro-CT is a new technology that enables three-dimensional analysis with better spatial resolution compared with cone beam computed tomography. Another great advantage of this technology is that the sample does not need special preparation or destruction in the sectioned area as in histopathologic evaluation. An odontoma with CBCT and microtomography images is presented in a 26-year-old man. It was first observed on panoramic radiographs and then by CBCT. The lesion and the impacted third molar were surgically excised using a modified Neumann approach. After removal, it was evaluated by histopathology and microtomography to confirm the diagnostic hypothesis. According to the results, micro-CT enabled the assessment of the sample similar to histopathology, without destruction of the sample. With further development, micro-CT could be a powerful diagnostic tool in future research. PMID:27293913

  17. Complex Ebstein's Anomaly in an 86-Year-Old Iranian Man: A Case Report

    Directory of Open Access Journals (Sweden)

    Bahieh Moradi

    2017-03-01

    Full Text Available Ebstein's anomaly is defined as the significant apical displacement of the tricuspid valve causing tricuspid regurgitation. Although a variety of concomitant lesions have been previously described, we herein introduce an unusual presentation.  Our patient was an 86-year-old man with a primary presentation of typical chest pain in the setting of recently diagnosed coronary artery disease with concomitant Ebstein’s anomaly. We found mild-to-moderate tricuspid regurgitation, bicuspid aortic valve, persistent left superior vena cava, and patent foramen ovale. The patient had suffered from chest discomfort on exertion for 2 months with good functional capacity prior to diagnosis. Coronary angiography revealed two-vessel disease. The patient refused surgery. He was treated with medical anti-ischemic therapy. He had good exercise tolerance with relief of chest pain at the latest follow-up. The features demonstrated in this case report suggest that there may be several adult survivors of complex congenital heart diseases requiring individualized surgical treatment plans.

  18. Complex young lives: a collective qualitative case study analysis of young fatherhood and breastfeeding.

    Science.gov (United States)

    Ayton, Jennifer; Hansen, Emily

    2016-01-01

    Of all births in Australia, 10 % are to young fathers aged less than 24 years. How young fathers experience any breastfeeding and how this is shaped by their social context is poorly understood. Our aim is to increase understanding of the lived experience of young fathers (aged less than 24 years) and to explore the way they speak about breastfeeding in the context of their lives and parenting. This collective case study analysis uses qualitative data from interviews and focus groups with young fathers (aged less than 24 years) and community support staff. The research was undertaken in Tasmania, Australia, March to December 2013. Young fathers in our study had complex social and emotional circumstances that meant breastfeeding was not a high priority despite them valuing the health benefits of breastfeeding for their babies. If supported by peers and their community they appear to have a more positive parenting experience. Breastfeeding although understood by the young fathers in our study as healthy and desirable is not a priority in their lives. Learning to be a parent and support their partners to breastfeed may be more effectively gained through mentoring and father-to-father localized community based support services.

  19. Mycobacterium avium complex-associated cholecystitis in AIDS patient: a case description and review of literature.

    Science.gov (United States)

    El Chaer, Firas; Harris, Nadine; El Sahly, Hana; Hemmige, Vagish; Martinez Blanco, Elvia; Woc-Colburn, Laila

    2016-11-01

    AIDS-related cholangiopathy was common in patients with AIDS prior to the advent of highly active antiretroviral therapy. Mycobacterium avium complex (MAC) is the most common opportunistic bacterial infection seen in AIDS patients and one of many opportunistic pathogens implicated in AIDS cholangiopathy. We describe a case of acute cholecystitis secondary to MAC in a patient with likely AIDS cholangiopathy. The patient, a 37-year-old Hispanic woman with CD4 + cell count of 10 cells/mm 3 who was previously diagnosed with disseminated MAC, presented with a eight days of diffuse abdominal pain and anorexia. Radiologic imaging suggested acute cholecystitis, so the patient underwent open cholecystectomy. Pathology staining of the gall bladder wall revealed acid-fast bacilli consistent with MAC. The patient had been receiving appropriate therapy as an outpatient for MAC with presumed reliable adherence, but we suggest her burden of disease was high due to her severe immunosuppressive state. A thorough review of the literature showed that there are many infectious and non-infectious aetiologies for AIDS-associated cholangiopathy. Acute cholecystitis can develop in the setting of AIDS cholangiopathy, potentially secondary to the opportunistic infection that initially caused the cholangiopathy. MAC-related gallbladder disease needs to be considered in patients with advanced AIDS who present with evidence of acute cholecystitis. © The Author(s) 2015.

  20. Complex Odontoma: A Case Report with Micro-Computed Tomography Findings

    Directory of Open Access Journals (Sweden)

    L. A. N. Santos

    2016-01-01

    Full Text Available Odontomas are the most common benign tumors of odontogenic origin. They are normally diagnosed on routine radiographs, due to the absence of symptoms. Histopathologic evaluation confirms the diagnosis especially in cases of complex odontoma, which may be confused during radiographic examination with an osteoma or other highly calcified bone lesions. The micro-CT is a new technology that enables three-dimensional analysis with better spatial resolution compared with cone beam computed tomography. Another great advantage of this technology is that the sample does not need special preparation or destruction in the sectioned area as in histopathologic evaluation. An odontoma with CBCT and microtomography images is presented in a 26-year-old man. It was first observed on panoramic radiographs and then by CBCT. The lesion and the impacted third molar were surgically excised using a modified Neumann approach. After removal, it was evaluated by histopathology and microtomography to confirm the diagnostic hypothesis. According to the results, micro-CT enabled the assessment of the sample similar to histopathology, without destruction of the sample. With further development, micro-CT could be a powerful diagnostic tool in future research.

  1. Return to work program efficacy with Self-Regulation Therapy (SRT®): Case study with complex trauma and concurrent disorders.

    Science.gov (United States)

    Miller, Tara

    2017-06-16

    Background This study shows the efficacy of treating complex cases neurobiologically using Self-Regulation Therapy (SRT®) within the context of return to work goals. Case presentation This is a single case study of a 32-year-old white female. This case study follows a client with concurrent diagnoses of post-traumatic stress disorder (PTSD), bipolar disorder I and substance abuse over the course of 2 years of treatment with SRT®. Using SRT® as primary modality and Likert Scale self-report on the Zettl Scale of Dysregulation, psychiatric medication monitoring and pharmaceutical tracking, this study shows session summaries and progress. Results After six sessions the client was cleared by her psychiatrist for return to work. Her medications were reduced and her post-traumatic symptoms abated. She no longer met diagnostic criteria for PTSD or substance abuse after nine sessions. She returned to work successfully and maintained sobriety and continued symptom reduction. Follow up over a 2-year time period showed consistency and continued improvements in both her professional and her personal life. Conclusions Clients with complex traumatic history with concurrent diagnosis are typically difficult to treat in traditional psychotherapy with limited long-term success. This creates challenges in therapy because the traumas occur during key developmental periods of life. This study shows the efficacy of treating complex cases neurobiologically using SRT®. Using SRT®, clinicians are able to address both developmental and complex trauma to reduce sympathetic arousal in the nervous system providing symptom reduction and even resolution of previous clinical diagnoses.

  2. Isolated bilateral zygomatic complex and zygomatic arch fractures with oral submucous fibrosis: An unusual and rare case report

    Directory of Open Access Journals (Sweden)

    Alagappan Meyyappan

    2014-01-01

    Full Text Available Zygomatic bone forms major buttress of the facial skeleton and plays an important role in facial contour. Fractures of zygomatic complex are second most common only next to nasal bone fractures. Motor vehicle accidents and interpersonal violence are common causes. Bilateral fractures of zygomatic complex and zygomatic arch are very rare. We present a case report of isolated fractures involving bilateral zygomatic complex and zygomatic arch with oral submucous fibrosis, which is unique and first of its kind to be reported.

  3. Negotiated plea agreements in cases of serious and complex fraud in England and Wales: a new conceptualisation of plea bargaining?

    OpenAIRE

    Alge, Daniele

    2013-01-01

    This article examines negotiated plea agreements introduced by the Attorney General in 2009 for cases of serious or complex fraud, and the degree to which these differ from plea agreements reached through informal plea bargaining in other types of criminal case. It first considers whether the formally negotiated agreements are a result of coercion being brought to bear on defendants, or of defendants ‘playing the system’ (the two most common criticisms of ordinary plea bargains). It is then a...

  4. Elements of complexity in subsurface modeling, exemplified with three case studies

    Energy Technology Data Exchange (ETDEWEB)

    Freedman, Vicky L. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Truex, Michael J. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Rockhold, Mark [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Bacon, Diana H. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Freshley, Mark D. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Wellman, Dawn M. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2017-04-03

    There are complexity elements to consider when applying subsurface flow and transport models to support environmental analyses. Modelers balance the benefits and costs of modeling along the spectrum of complexity, taking into account the attributes of more simple models (e.g., lower cost, faster execution, easier to explain, less mechanistic) and the attributes of more complex models (higher cost, slower execution, harder to explain, more mechanistic and technically defensible). In this paper, modeling complexity is examined with respect to considering this balance. The discussion of modeling complexity is organized into three primary elements: 1) modeling approach, 2) description of process, and 3) description of heterogeneity. Three examples are used to examine these complexity elements. Two of the examples use simulations generated from a complex model to develop simpler models for efficient use in model applications. The first example is designed to support performance evaluation of soil vapor extraction remediation in terms of groundwater protection. The second example investigates the importance of simulating different categories of geochemical reactions for carbon sequestration and selecting appropriate simplifications for use in evaluating sequestration scenarios. In the third example, the modeling history for a uranium-contaminated site demonstrates that conservative parameter estimates were inadequate surrogates for complex, critical processes and there is discussion on the selection of more appropriate model complexity for this application. All three examples highlight how complexity considerations are essential to create scientifically defensible models that achieve a balance between model simplification and complexity.

  5. Thresholds of Knowledge Development in Complex Problem Solving: A Multiple-Case Study of Advanced Learners' Cognitive Processes

    Science.gov (United States)

    Bogard, Treavor; Liu, Min; Chiang, Yueh-hui Vanessa

    2013-01-01

    This multiple-case study examined how advanced learners solved a complex problem, focusing on how their frequency and application of cognitive processes contributed to differences in performance outcomes, and developing a mental model of a problem. Fifteen graduate students with backgrounds related to the problem context participated in the study.…

  6. Peripheral Complex Odontoma in the Gingiva: A Case Report of an 11 Year Old Boy and Review of Literature

    DEFF Research Database (Denmark)

    Jóhannsson, Gunnar Ingi; Bærentzen, Steen; Blomlöf, Johan

    2017-01-01

    and often associated with delayed eruption of teeth. However, they can be extraosseous and are then referred to as either peripheral complex or compound odontoma. Peripheral odontomas are rare entities. We report a case of an 11 year old boy referred to the Department of Oral and Maxillofacial Surgery...

  7. Dynamic Patterns in Development of Accuracy and Complexity : A Longitudinal Case Study in the Acquisition of Finnish

    NARCIS (Netherlands)

    Spoelman, Marianne; Verspoor, Marjolijn

    Within a Dynamic System Theory (DST) approach, it is assumed that language is in a constant flux, but that differences in the degree of variability can give insight into the developmental process. This longitudinal case study focuses on intra-individual variability in accuracy rates and complexity

  8. On the worst-case complexity of the gradient method with exact line search for smooth strongly convex functions

    OpenAIRE

    de Klerk, Etienne; Glineur, François; Taylor, Adrien B.

    2016-01-01

    We consider the gradient (or steepest) descent method with exact line search applied to a strongly convex function with Lipschitz continuous gradient. We establish the exact worst-case rate of convergence of this scheme, and show that this worst-case behavior is exhibited by a certain convex quadratic function. We also give the tight worst-case complexity bound for a noisy variant of gradient descent method, where exact line-search is performed in a search direction that differs from negative...

  9. From survey to high definition representations of a continuous architectonical space. The case study of the Pomposa Abbey complex

    Directory of Open Access Journals (Sweden)

    Anna Maria Manferdini

    2015-01-01

    Full Text Available The aim of this paper is to show the main results about high resolution 3D digital survey and representations of Santa Maria di Pomposa complex.The project has been developed in order to compare different methodologies, evaluating their effectiveness in the survey and representation of a huge architectural complex. This digitizationcampaign was planned for reproducing different multi-scalar representations, analyzing the digital replica of the site from different points of view and for different communication purposes. The paper presents some exemplifications of graphic representations extracted from a complex and multi-scalar 3D digital model. The adopted approach and the methodology has been developed and tested on field about a specific case study, but it can be extended to other examples which will present similar characteristics in critical and potential terms, common in several Cultural Heritage case studies.

  10. Complex Regional Pain Syndrome following an Episode of Herpes Zoster: A Case Report.

    Science.gov (United States)

    Marrero, Christopher E; Mclean, Neuyen; Varnado, Keyana

    2017-01-01

    Complex regional pain syndrome (CRPS) is characterized by searing pain, hyperalgesia, edema, allodynia, and skin changes. CRPS may be difficult to diagnose and to treat given poorly understood mechanisms as well as its presentation of symptoms that may mimic common conditions such as joint stiffness in this condition as well as rheumatoid arthritis. A 71-year-old female presented to our clinic post shingles of the right upper extremity. We diagnosed her with CRPS based on the Budapest diagnostic criteria and the clinical findings of pain and decreased the range of motion along with edema, hypersensitivity, discoloration and allodynia of the right thumb and index finger. She was treated with vitamin C as well as gabapentin and physical therapy. The patient was unable to go consistently to physical therapy due to insurance limitations, and we found no clinical benefit of vitamin C in reducing her symptoms. She was lost to follow-up during her treatment but re-emerged at 21 months. At that time she reported, she was largely unchanged in regards to her right-hand symptoms but did believe the gabapentin was helpful and still continued to take 300 mg daily. This case report highlights the usefulness of the Budapest diagnostic criteria to make the diagnosis of CRPS when associated with shingles, which can cause long-term pain and mimic some findings. Prompt diagnosis is important, as recovery typically extends beyond 6 months; our patient still reported continued symptoms at 21 months post initial presentation. Our primary treatment plan was physical therapy, which she discontinued due to insurance limitations. We recommend that patients, physicians, and third-party payers work together to extend access to physical therapy. More investigation is warranted regarding symptomatic treatment, as we found limited clinical benefit of gabapentin and vitamin C.

  11. Localization of the epileptogenic foci in tuberous sclerosis complex: a pediatric case report

    Directory of Open Access Journals (Sweden)

    Alexander eHunold

    2014-03-01

    Full Text Available Tuberous sclerosis complex (TSC is a rare disorder of tissue growth and differentiation, characterized by benign hamartomas in the brain and other organs. Up to 90% of TSC patients develop epilepsy and 50% become medically intractable requiring resective surgery. The surgical outcome of TSC patients depends on the accurate identification of the epileptogenic zone consisting of tubers and the surrounding epileptogenic tissue. There is conflicting evidence whether the epileptogenic zone is in the tuber itself or in abnormally developed surrounding cortex. Here, we report the localization of the epileptiform activity among the many cortical tubers in a four-year old patient with TSC-related refractory epilepsy undergoing magnetoencephalography (MEG, electroencephalography (EEG, and diffusion tensor imaging (DTI. For MEG, we used a prototype system that offers higher spatial resolution and sensitivity compared to the conventional adult systems. The generators of interictal activity were localized using both EEG and MEG with equivalent current dipole (ECD and minimum norm estimation (MNE methods according to the current clinical standards. For DTI, we calculated four diffusion scalar parameters for the fibers passing through four ROIs defined: (i at a large cortical tuber identified at the right quadrant, (ii at the normal appearing tissue contralateral to the tuber, (iii at the cluster formed by ECDs fitted at the peak of interictal spikes, and (iv at the normal appearing tissue contralateral to the cluster. ECDs were consistently clustered at the vicinity of the large calcified cortical tuber. MNE and ECDs indicated epileptiform activity in the same areas. DTI analysis showed differences between the scalar values of the tracks passing through the tuber and the ECD cluster. In this illustrative case, we provide evidence supporting the view that epileptiform activity may derive from abnormally developed tissue surrounding the tuber rather than the

  12. Music therapy applied to complex blast injury in interdisciplinary care: a case report.

    Science.gov (United States)

    Vaudreuil, Rebecca; Avila, Luis; Bradt, Joke; Pasquina, Paul

    2018-04-24

    Music therapy has a long history of treating the physiological, psychological, and neurological injuries of war. Recently, there has been an increase in the use of music therapy and other creative arts therapies in the care of combat injured service members returning to the United States from Iraq and Afghanistan, especially those with complex blast-related injuries. This case report describes the role of music therapy in the interdisciplinary rehabilitation of a severely injured service member. Music therapy was provided as stand-alone treatment and in co-treatment with speech language pathology, physical therapy, and occupational therapy. The report is based on clinical notes, self-reports by the patient and his wife, and interviews with rehabilitation team members. In collaboration with other treatment disciplines, music therapy contributed to improvements in range of motion, functional use of bilateral upper extremities, strength endurance, breath support, articulation, task-attention, compensatory strategies, social integration, quality of life, and overall motivation in the recovery process. The inclusion of music therapy in rehabilitation was highly valued by the patient, his family, and the treatment team. Music therapy has optimized the rehabilitation of a service member through assisting the recovery process on a continuum from clinic to community. Implications for Rehabilitation Music therapy in stand-alone sessions and in co-treatment with traditional disciplines can enhance treatment outcomes in functional domains of motor, speech, cognition, social integration, and quality of life for military populations. Music therapists can help ease discomfort and difficulty associated with rehabilitation activities, thereby enhancing patient motivation and participation in interdisciplinary care. Music therapy assists treatment processes from clinic to community, making it highly valued by the patient, family, and interdisciplinary team members in military

  13. Case Management for Patients with Complex Multimorbidity: Development and Validation of a Coordinated Intervention between Primary and Hospital Care

    Directory of Open Access Journals (Sweden)

    Salvador Tortajada

    2017-06-01

    Full Text Available In the past few years, healthcare systems have been facing a growing demand related to the high prevalence of chronic diseases. Case management programs have emerged as an integrated care approach for the management of chronic disease. Nevertheless, there is little scientific evidence on the impact of using a case management program for patients with complex multimorbidity regarding hospital resource utilisation.  We evaluated an integrated case management intervention set up by community-based care at outpatient clinics with nurse case managers from a telemedicine unit. The hypothesis to be tested was whether improved continuity of care resulting from the integration of community-based and hospital services reduced the use of hospital resources amongst patients with complex multimorbidity.  A retrospective cohort study was performed using a sample of 714 adult patients admitted to the program between January 2012 and January 2015. We found a significant decrease in the number of emergency room visits, unplanned hospitalizations, and length of stay, and an expected increase in the home care hospital-based episodes. These results support the hypothesis that case management interventions can reduce the use of unplanned hospital admissions when applied to patients with complex multimorbidity.

  14. New definition of complexity for self-gravitating fluid distributions: The spherically symmetric, static case

    Science.gov (United States)

    Herrera, L.

    2018-02-01

    We put forward a new definition of complexity, for static and spherically symmetric self-gravitating systems, based on a quantity, hereafter referred to as complexity factor, that appears in the orthogonal splitting of the Riemann tensor, in the context of general relativity. We start by assuming that the homogeneous (in the energy density) fluid, with isotropic pressure is endowed with minimal complexity. For this kind of fluid distribution, the value of complexity factor is zero. So, the rationale behind our proposal for the definition of complexity factor stems from the fact that it measures the departure, in the value of the active gravitational mass (Tolman mass), with respect to its value for a zero complexity system. Such departure is produced by a specific combination of energy density inhomogeneity and pressure anisotropy. Thus, zero complexity factor may also be found in self-gravitating systems with inhomogeneous energy density and anisotropic pressure, provided the effects of these two factors, on the complexity factor, cancel each other. Some exact interior solutions to the Einstein equations satisfying the zero complexity criterium are found, and prospective applications of this newly defined concept, to the study of the structure and evolution of compact objects, are discussed.

  15. Sporadic and genetic forms of paediatric somatotropinoma: a retrospective analysis of seven cases and a review of the literature

    Directory of Open Access Journals (Sweden)

    Nozières Cécile

    2011-10-01

    Full Text Available Abstract Background Somatotropinoma, a pituitary adenoma characterised by excessive production of growth hormone (GH, is extremely rare in childhood. A genetic defect is evident in some cases; known genetic changes include: multiple endocrine neoplasia type 1 (MEN1; Carney complex; McCune-Albright syndrome; and, more recently identified, aryl hydrocarbon receptor-interacting protein (AIP. We describe seven children with somatotropinoma with a special focus on the differences between genetic and sporadic forms. Methods Seven children who presented in our regional network between 1992 and 2008 were included in this retrospective analysis. First-type therapy was somatostatin (SMS analogues or transsphenoidal surgery. Control was defined as when insulin-like growth factor-1 (IGF-1 levels were within the normal range for the patient's age at 6 months after therapy, associated with decreasing tumour volume. Results Patients were aged 5-17 years and the majority (n = 6 were male. Four patients had an identified genetic mutation (McCune-Albright syndrome: n = 1; MEN1: n = 1; AIP: n = 2; the remaining three cases were sporadic. Accelerated growth rate was reported as the first clinical sign in four patients. Five patients presented with macroadenoma; invasion was noted in four of them (sporadic: n = 1; genetic: n = 3. Six patients were treated with SMS analogues; normalisation of IGF-1 occurred in one patient who had a sporadic intrasellar macroadenoma. Multiple types of therapy were necessary in all patients with an identified genetic mutation (4 types: n = 1; 3 types: n = 2; 2 types: n = 1, whereas two of the three patients with sporadic somatotropinoma required only one type of therapy. Conclusions This is the first series that analyzes the therapeutic response of somatotropinoma in paediatric patients with identified genetic defects. We found that, in children, genetic somatotropinomas are more invasive than sporadic somatotropinomas. Furthermore

  16. Disease: H01820 [KEGG MEDICUS

    Lifescience Database Archive (English)

    Full Text Available H01820 Carney complex Carney complex (CNC) is a rare multiple neoplasia syndrome characterized by pigmente... endocrine tumors. Further manifestations include primary pigmented nodular adrenocortical disease (PPNAD) [

  17. Dynamic Development of Complexity and Accuracy: A Case Study in Second Language Academic Writing

    Science.gov (United States)

    Rosmawati

    2014-01-01

    This paper reports on the development of complexity and accuracy in English as a Second Language (ESL) academic writing. Although research into complexity and accuracy development in second language (L2) writing has been well established, few studies have assumed the multidimensionality of these two constructs (Norris & Ortega, 2009) or…

  18. The Stryker Mobile Gun System: A Case Study on Managing Complexity

    Science.gov (United States)

    2009-06-01

    element of success. Robert W. Rykroft and Don E. Kash (1999) discuss complexity in product development in their book The Complexity Challenge...Although the pursuit of absolute certainty is a quixotic program objective, a more pragmatic objective for program managers is the management of

  19. Characteristics of Urban Sustainability in the Cases of Multi Commercial Complexes from the Perspective of the “Ground”

    Directory of Open Access Journals (Sweden)

    Soomi Kim

    2016-05-01

    Full Text Available In the diverse research on Multi Commercial Complexes, rather than a technical and statistical approach, it is now time to focus on the quality of urban sustainability based on the daily experience of urban residents. Therefore, this research proposes a mechanism for making a sophisticated adjustment to the “Ground”, defined as the empty space of a designated site under the existing urban conditions, towards planning the sustainability of a Multi-Commercial Complex. For the first step, the elements of urban sustainability were extracted from the Figure-Ground Theory and the urban theory of Aldo Rossi and Kevin Lynch, respectively. The relationship between the methodology, which deals with the concept of “Ground” and its sustainable urban status, is analyzed using five selected multi-commercial complex cases. We derived the characteristics of “Ground” represented in each case, including “Responding”, “Contextual”, “Historical”, “Co-existing”, and “Hybrid” sustainability. In each case, the “Ground” was treated as a crucial common issue. In this paper, we suggest that preferential consideration and sensitive design of the “Ground” are crucial for maintaining urban sustainability in the planning of Multi Commercial Complexes. This paper can thus contribute to the body of research on urban sustainability along with existing technical studies.

  20. The complexities of anti-doping violations: a case study of sanctioned cases in all performance levels of USA cycling.

    Science.gov (United States)

    Henning, April D; Dimeo, Paul

    2014-01-01

    The use of banned substances and techniques in sport is regulated by anti-doping rules co-ordinated by the World Anti-Doping Agency. The purposes of these rules are to protect the health of the athlete, the level playing field and what WADA refers to as the spirit of sport. In this article, we review the known cases of sanctions in USA cycling since 2001. We show that the diversity of cases expands upon the simplistic, one-dimensional understanding of doping as risky and cheating. Contrary to this paradigm, we establish a typology of cases that challenges the one size fits all approach and, more specifically, we argue that WADA should develop new policies with independent standards for amateur and masters athletes.

  1. Time Series Analysis OF SAR Image Fractal Maps: The Somma-Vesuvio Volcanic Complex Case Study

    Science.gov (United States)

    Pepe, Antonio; De Luca, Claudio; Di Martino, Gerardo; Iodice, Antonio; Manzo, Mariarosaria; Pepe, Susi; Riccio, Daniele; Ruello, Giuseppe; Sansosti, Eugenio; Zinno, Ivana

    2016-04-01

    The fractal dimension is a significant geophysical parameter describing natural surfaces representing the distribution of the roughness over different spatial scale; in case of volcanic structures, it has been related to the specific nature of materials and to the effects of active geodynamic processes. In this work, we present the analysis of the temporal behavior of the fractal dimension estimates generated from multi-pass SAR images relevant to the Somma-Vesuvio volcanic complex (South Italy). To this aim, we consider a Cosmo-SkyMed data-set of 42 stripmap images acquired from ascending orbits between October 2009 and December 2012. Starting from these images, we generate a three-dimensional stack composed by the corresponding fractal maps (ordered according to the acquisition dates), after a proper co-registration. The time-series of the pixel-by-pixel estimated fractal dimension values show that, over invariant natural areas, the fractal dimension values do not reveal significant changes; on the contrary, over urban areas, it correctly assumes values outside the natural surfaces fractality range and show strong fluctuations. As a final result of our analysis, we generate a fractal map that includes only the areas where the fractal dimension is considered reliable and stable (i.e., whose standard deviation computed over the time series is reasonably small). The so-obtained fractal dimension map is then used to identify areas that are homogeneous from a fractal viewpoint. Indeed, the analysis of this map reveals the presence of two distinctive landscape units corresponding to the Mt. Vesuvio and Gran Cono. The comparison with the (simplified) geological map clearly shows the presence in these two areas of volcanic products of different age. The presented fractal dimension map analysis demonstrates the ability to get a figure about the evolution degree of the monitored volcanic edifice and can be profitably extended in the future to other volcanic systems with

  2. A Case Study on the Application of a Structured Experimental Method for Optimal Parameter Design of a Complex Control System

    Science.gov (United States)

    Torres-Pomales, Wilfredo

    2015-01-01

    This report documents a case study on the application of Reliability Engineering techniques to achieve an optimal balance between performance and robustness by tuning the functional parameters of a complex non-linear control system. For complex systems with intricate and non-linear patterns of interaction between system components, analytical derivation of a mathematical model of system performance and robustness in terms of functional parameters may not be feasible or cost-effective. The demonstrated approach is simple, structured, effective, repeatable, and cost and time efficient. This general approach is suitable for a wide range of systems.

  3. Optimized implementations of rational approximations—a case study on the Voigt and complex error function

    Science.gov (United States)

    Schreier, Franz; Kohlert, Dieter

    2008-10-01

    Rational functions are frequently used as efficient yet accurate numerical approximations for real and complex valued special functions. For the complex error function w(x+iy), whose real part is the Voigt function K(x,y), the rational approximation developed by Hui, Armstrong, and Wray [Rapid computation of the Voigt and complex error functions, J. Quant. Spectrosc. Radiat. Transfer 19 (1978) 509-516] is investigated. Various optimizations for the algorithm are discussed. In many applications, where these functions have to be calculated for a large x grid with constant y, an implementation using real arithmetic and factorization of invariant terms is especially efficient.

  4. Creutzfeldt-Jakob Disease-Like Periodic Sharp Wave Complexes in Voltage-Gated Potassium Channel-Complex Antibodies Encephalitis: A Case Report.

    Science.gov (United States)

    Savard, Martin; Irani, Sarosh R; Guillemette, Annie; Gosselin-Lefebvre, Stéphanie; Geschwind, Michael; Jansen, Gerard H; Gould, Peter V; Laforce, Robert

    2016-02-01

    Voltage-gated potassium channel-complex antibodies (VGKC-cAbs) encephalitis, a treatable autoantibody encephalopathy, has been previously reported to clinically mimic sporadic Creutzfeldt-Jakob disease. Among available clinical clues to distinguish them, periodic sharp wave complexes, a typical finding in sporadic Creutzfeldt-Jakob disease, have never been reported in association with VGKC-cAbs encephalitis. A 76-year-old man was transferred to a tertiary neurology center with a clinical history of 6-month weight loss, cognitive disturbance, and nonspecific generalized weakness. He had two seizures the month before transfer and then evolved to severe encephalopathy, requiring mechanical ventilation. Periodic sharp wave complexes every 1 to 2 seconds over slowed background were found on EEG, and MRI showed cerebellar and bifrontal cortical T2/FLAIR/DWI hypersignal without restricted diffusion on ADC mapping. Pancorporal positron emission tomography scan was negative. An immunotherapy trial did not improve the patient condition. Therefore, he died after life support withdrawal. Brain autopsy revealed mononuclear neocortex infiltrate without significant spongiosis, and the anti-VGKC test showed a seropositivity of 336 pmol/L (normal, 0-31), 3 month after the patient deceased. This is the first reported case of VGKC-cAbs encephalitis associated with periodic sharp wave complexes on EEG, which further confuse the differential diagnosis with sporadic Creutzfeldt-Jakob disease. However, the cortical DWI hypersignal without restriction seems to remain a way to discriminate these two entities appropriately, when present. These clues are of paramount importance because VGKC-cAbs encephalitis is a treatable disease.

  5. Environmental management on the basis of Complex Regional Indicators Concept: case of the Murmansk region

    Science.gov (United States)

    Kozlov, A.; Gutman, S.; Zaychenko, I.; Rytova, E.; Nijinskaya, P.

    2015-09-01

    The article presents an approach to sustainable environmental development of the Murmansk region of the Russian Federation based on the complex regional indicators as a transformation of a balance scorecard method. The peculiarities of Murmansk region connected with sustainable environmental development are described. The complex regional indicators approach allows to elaborate the general concept of complex regional development taking into consideration economic and non-economic factors with the focus on environmental aspects, accumulated environmental damage in particular. General strategic chart of sustainable environmental development of the Murmansk region worked out on the basis of complex regional indicators concept is composed. The key target indicators of sustainable ecological development of the Murmansk region are presented for the following strategic chart components: regional finance; society and market; industry and entrepreneurship; training, development and innovations. These charts are to be integrated with international environmental monitoring systems.

  6. A case of complex odontoma in a horse - clinical signs, radiography, ultrasonography and computer tomography

    International Nuclear Information System (INIS)

    Heufelder, B.; Mettenleiter, E.; Tietje, S.; Traenckner, C.M.

    1994-01-01

    The clinical signs, diagnosis and pathology of an adult horse with a complex odontoma are described. Computer tomography was shown to be a new diagnostic technique with outstanding potential in the investigation of diseases of the equine head

  7. Analysis of Engineered Nanomaterials in Complex Matricies (Environment and Biota): General Considerations and Conceptual Case Studies

    Science.gov (United States)

    Advances in the study of the environmental fate, transport, and ecotoxicological effects of engineered nanomaterials (ENMs) have been hampered by a lack of adequate techniques for the detection and quantification of ENMs at environmentally relevant concentrations in complex media...

  8. A Rare Case of Genital Malformation with Omphalocele, Exstrophy of Bladder, Imperforate Anus and Spinal Defect Complex-Autopsy Findings.

    Science.gov (United States)

    Mamatha, K; Yelikar, B R; Deshpande, Varsha R; Disha, B S

    2017-07-01

    Omphalocele, Exstrophy of cloaca, Imperforate anus and Spinal defects (OEIS) is a severe manifestation of exstrophy-epispadias sequence with a combination of defects including OEIS. It results from improper closure of anterior abdominal wall and defective development of cloaca and urogenital septum due to defect in blastogenesis during the 4 th week of gestation. Identification of this complex is important through foetal autopsy as this condition can recur in siblings. Prenatal diagnosis also helps to prevent foetal death with appropriate management in the less severe cases. In severe cases, termination of pregnancy is considered. A primigravida with 28 weeks of gestation had delivered a live baby with multiple congenital anomalies; baby died after 10 minutes. These anomalies were grouped under OEIS complex.

  9. Bringing content understanding into usability testing in complex application domains—a case study in eHealth

    DEFF Research Database (Denmark)

    Andersen, Simon Bruntse; Rasmussen, Claire Kirchert; Frøkjær, Erik

    2017-01-01

    A usability evaluation technique, Cooperative Usability Testing with Questions of Understanding (CUT with QU) intended to illuminate users’ ability to understand the content information of an application is proposed. In complex application domains as for instance the eHealth domain, this issue...... of users’ content understanding is sometimes crucial, and thus should be carefully evaluated. Unfortunately, conventional usability evaluation techniques do not address challenges of content understanding. In a case study within eHealth, specifically the setting of a rehabilitation clinic involving...... the participation of four physiotherapists and four clients in a period of 3.5 months, it was demonstrated how CUT with QU can complement conventional usability testing and provide insight into users’ challenges with understanding of a new complex eHealth application. More experiments in other complex application...

  10. Case study method and problem-based learning: utilizing the pedagogical model of progressive complexity in nursing education.

    Science.gov (United States)

    McMahon, Michelle A; Christopher, Kimberly A

    2011-08-19

    As the complexity of health care delivery continues to increase, educators are challenged to determine educational best practices to prepare BSN students for the ambiguous clinical practice setting. Integrative, active, and student-centered curricular methods are encouraged to foster student ability to use clinical judgment for problem solving and informed clinical decision making. The proposed pedagogical model of progressive complexity in nursing education suggests gradually introducing students to complex and multi-contextual clinical scenarios through the utilization of case studies and problem-based learning activities, with the intention to transition nursing students into autonomous learners and well-prepared practitioners at the culmination of a nursing program. Exemplar curricular activities are suggested to potentiate student development of a transferable problem solving skill set and a flexible knowledge base to better prepare students for practice in future novel clinical experiences, which is a mutual goal for both educators and students.

  11. Binding abilities of a chiral calix[4]resorcinarene: a polarimetric investigation on a complex case of study

    Directory of Open Access Journals (Sweden)

    Marco Russo

    2017-12-01

    Full Text Available Polarimetry was used to investigate the binding abilities of a chiral calix[4]resorcinarene derivative, bearing L-proline subunits, towards a set of suitably selected organic guests. The simultaneous formation of 1:1 and 2:1 host–guest inclusion complexes was observed in several cases, depending on both the charge status of the host and the structure of the guest. Thus, the use of the polarimetric method was thoroughly revisited, in order to keep into account the occurrence of multiple equilibria. Our data indicate that the stability of the host–guest complexes is affected by an interplay between Coulomb interactions, π–π interactions, desolvation effects and entropy-unfavorable conformational dynamic restraints. Polarimetry is confirmed as a very useful and versatile tool for the investigation of supramolecular interactions with chiral hosts, even in complex systems involving multiple equilibria.

  12. A New Approach for Complex Upper Limb Revisions Utilizing the Clavicula Pro Humero Technique: A Case Report.

    Science.gov (United States)

    Clayer, Mark

    2015-01-01

    A complex case is described involving limb salvage using a combination of the clavicula pro humero technique with a free vascularized fibular graft to span the defect following a failed megaprosthetic reconstruction. This is believed to be the first description of this approach for a very difficult problem. In the setting of infection and minimal bone stock, conventional reconstruction options for the proximal aspect of the humerus were unsatisfactory. This new technique provides a biologic, immunocompetent option for limb salvage.

  13. Making System Dynamics Cool II : New Hot Teaching and Testing Cases of Increasing Complexity

    NARCIS (Netherlands)

    Pruyt, E.

    2010-01-01

    This follow-up paper presents several actual cases for testing and teaching System Dynamics. The cases were developed between April 2009 and January 2010 for the Introductory System Dynamics courses at Delft University of Technology in the Netherlands. They can be used for teaching and testing

  14. The complexities in system building strategies — The case of personalized cancer medicines in England

    NARCIS (Netherlands)

    Kukk, P.; Moors, E.H.M.; Hekkert, M.P.

    Abstract Novel technologies often face difficulties in market uptake, especially when they differ significantly from already established technologies. In some cases, like personalized medicine, new technologies are composed of a number of parallel emerging technologies – in our case therapeutics and

  15. Complex rearranged small supernumerary marker chromosomes (sSMC, three new cases; evidence for an underestimated entity?

    Directory of Open Access Journals (Sweden)

    Mkrtchyan Hasmik

    2008-04-01

    Full Text Available Abstract Background Small supernumerary marker chromosomes (sSMC are present ~2.6 × 106 human worldwide. sSMC are a heterogeneous group of derivative chromosomes concerning their clinical consequences as well as their chromosomal origin and shape. Besides the sSMC present in Emanuel syndrome, i.e. der(22t(11;22(q23;q11, only few so-called complex sSMC are reported. Results Here we report three new cases of unique complex sSMC. One was a de novo case with a dic(13 or 21;22 and two were maternally derived: a der(18t(8;18 and a der(13 or 21t(13 or 21;18. Thus, in summary, now 22 cases of unique complex sSMC are available in the literature. However, this special kind of sSMC might be under-diagnosed among sSMC-carriers. Conclusion More comprehensive characterization of sSMC and approaches like reverse fluorescence in situ hybridization (FISH or array based comparative genomic hybridization (array-CGH might identify them to be more frequent than only ~0.9% among all sSMC.

  16. Case management for the elderly with complex needs: cross-linking the views of their role held by elderly people, their informal caregivers and the case managers

    Directory of Open Access Journals (Sweden)

    Frédéric Balard

    2016-11-01

    Full Text Available Abstract Background In 2009, case management interventions were a new social service in France implemented within the framework of the PRISMA-France program (2006–2010. People who had benefitted from case management intervention were individuals, over 60 years old living at home in situations deemed complex by professionals. Their informal caregivers were also considered as users of the service. This research accompanied the interventions during the implementation of PRISMA-France attempting to explore the users’ (old people and their informal caregivers and case managers’ first experiences of case management. Its aim is to provide a thorough knowledge of the dispositive in order to reveal any initial failings and to ensure optimum conditions for the onset of full implementation. Methods The study had a qualitative explorative design. Cross-linked representations of case-management were obtained through opened-ended and guided interviews with three types of informants: old people (19, their informal caregivers (11 and the case managers (5 who participated in the program during the first 6 months. Thematic analysis of the data was carried out. Results The analysis revealed that each group of people generated its own representations of the case manager’s role, even though the three groups of informants shared the idea that the case manager is first and foremost a helper. The case managers insisted on their proximity to the old people and their role as coordinators. The informal caregivers saw the professional as a partner and potential provider of assistance in accompanying old people. The old people focused on the personal connections established with the case manager. Conclusion The innovative and experimental dimension of case management in France and the flexible nature of the role generated a broad spectrum of representations by those involved. These different representations are, in part, the fruit of each individual’s projected

  17. Case management for the elderly with complex needs: cross-linking the views of their role held by elderly people, their informal caregivers and the case managers.

    Science.gov (United States)

    Balard, Frédéric; Gely-Nargeot, Marie-Christine; Corvol, Aline; Saint-Jean, Olivier; Somme, Dominique

    2016-11-08

    In 2009, case management interventions were a new social service in France implemented within the framework of the PRISMA-France program (2006-2010). People who had benefitted from case management intervention were individuals, over 60 years old living at home in situations deemed complex by professionals. Their informal caregivers were also considered as users of the service. This research accompanied the interventions during the implementation of PRISMA-France attempting to explore the users' (old people and their informal caregivers) and case managers' first experiences of case management. Its aim is to provide a thorough knowledge of the dispositive in order to reveal any initial failings and to ensure optimum conditions for the onset of full implementation. The study had a qualitative explorative design. Cross-linked representations of case-management were obtained through opened-ended and guided interviews with three types of informants: old people (19), their informal caregivers (11) and the case managers (5) who participated in the program during the first 6 months. Thematic analysis of the data was carried out. The analysis revealed that each group of people generated its own representations of the case manager's role, even though the three groups of informants shared the idea that the case manager is first and foremost a helper. The case managers insisted on their proximity to the old people and their role as coordinators. The informal caregivers saw the professional as a partner and potential provider of assistance in accompanying old people. The old people focused on the personal connections established with the case manager. The innovative and experimental dimension of case management in France and the flexible nature of the role generated a broad spectrum of representations by those involved. These different representations are, in part, the fruit of each individual's projected expectations of this social service. Analyzing the first representations

  18. Discovering complex interrelationships between socioeconomic status and health in Europe: A case study applying Bayesian Networks.

    Science.gov (United States)

    Alvarez-Galvez, Javier

    2016-03-01

    Studies assume that socioeconomic status determines individuals' states of health, but how does health determine socioeconomic status? And how does this association vary depending on contextual differences? To answer this question, our study uses an additive Bayesian Networks model to explain the interrelationships between health and socioeconomic determinants using complex and messy data. This model has been used to find the most probable structure in a network to describe the interdependence of these factors in five European welfare state regimes. The advantage of this study is that it offers a specific picture to describe the complex interrelationship between socioeconomic determinants and health, producing a network that is controlled by socio-demographic factors such as gender and age. The present work provides a general framework to describe and understand the complex association between socioeconomic determinants and health. Copyright © 2016 Elsevier Inc. All rights reserved.

  19. Prediction in complex systems: The case of the international trade network

    Science.gov (United States)

    Vidmer, Alexandre; Zeng, An; Medo, Matúš; Zhang, Yi-Cheng

    2015-10-01

    Predicting the future evolution of complex systems is one of the main challenges in complexity science. Based on a current snapshot of a network, link prediction algorithms aim to predict its future evolution. We apply here link prediction algorithms to data on the international trade between countries. This data can be represented as a complex network where links connect countries with the products that they export. Link prediction techniques based on heat and mass diffusion processes are employed to obtain predictions for products exported in the future. These baseline predictions are improved using a recent metric of country fitness and product similarity. The overall best results are achieved with a newly developed metric of product similarity which takes advantage of causality in the network evolution.

  20. Positioning matrix of economic efficiency and complexity: a case study in a university hospital.

    Science.gov (United States)

    Ippolito, Adelaide; Viggiani, Vincenzo

    2014-01-01

    At the end of 2010, the Federico II University Hospital in Naples, Italy, initiated a series of discussions aimed at designing and applying a positioning matrix to its departments. This analysis was developed to create a tool able to extract meaningful information both to increase knowledge about individual departments and to inform the choices of general management during strategic planning. The name given to this tool was the positioning matrix of economic efficiency and complexity. In the matrix, the x-axis measures the ratio between revenues and costs, whereas the y-axis measures the index of complexity, thus showing "profitability" while bearing in mind the complexity of activities. By using the positioning matrix, it was possible to conduct a critical analysis of the characteristics of the Federico II University Hospital and to extract useful information for general management to use during strategic planning at the end of 2010 when defining medium-term objectives. Copyright © 2013 John Wiley & Sons, Ltd.

  1. Electrocardiogram artifact caused by rigors mimicking narrow complex tachycardia: a case report.

    Science.gov (United States)

    Matthias, Anne Thushara; Indrakumar, Jegarajah

    2014-02-04

    The electrocardiogram (ECG) is useful in the diagnosis of cardiac and non-cardiac conditions. Rigors due to shivering can cause electrocardiogram artifacts mimicking various cardiac rhythm abnormalities. We describe an 80-year-old Sri Lankan man with an abnormal electrocardiogram mimicking narrow complex tachycardia during the immediate post-operative period. Electrocardiogram changes caused by muscle tremor during rigors could mimic a narrow complex tachycardia. Identification of muscle tremor as a cause of electrocardiogram artifact can avoid unnecessary pharmacological and non-pharmacological intervention to prevent arrhythmias.

  2. Using the MRC Framework for Complex Interventions to Develop Clinical Decision Support: A Case Study.

    Science.gov (United States)

    Dowding, Dawn; Lichtner, Valentina; Closs, S José

    2017-01-01

    The Medical Research Council (MRC) framework for complex interventions provides useful guidance to assist with the development and evaluation of health technology interventions such as decision support. In this paper we briefly summarise a project that focused on designing a decision support intervention to assist with the recognition, assessment and management of pain in patients with dementia in an acute hospital setting. We reflect on our experience of using the MRC framework to guide our study design, and highlight the importance of considering decision support interventions as complex interventions.

  3. The OEIS complex: two case reports that illustrate the spectrum of abnormalities and a review of the literature.

    Science.gov (United States)

    Vasudevan, Pradeep C; Cohen, Marta C; Whitby, Elspeth H; Anumba, Dilly O C; Quarrell, Oliver W J

    2006-03-01

    We present two cases of OEIS (omphalocele, exstrophy, imperforate anus, spinal defects) complex -MIM 258040 and a review of the literature. Case 1 was a 14-year-old girl who presented at 30 weeks' gestation. An ultrasound examination showed an omphalocele and spina bifida; the bladder was not visualised. She went into spontaneous labour two weeks later and the baby died shortly after birth. A full post-mortem examination was refused, but the mother did agree to an external examination, skin biopsy for fibroblast culture, X rays and MR imaging. The MR imaging showed a pelvic kidney, a large omphalocele containing the other kidney, liver, bowel and a fluid filled structure thought to represent an exstrophy of the bladder (EB). Case 2 was a 30-year-old woman who had an ultrasound examination at 20 weeks' gestation; this showed an omphalocele, but the bladder was not visualised. The pregnancy was subsequently terminated and a post-mortem examination showed a low set umbilical cord associated with a small omphalocele; there was an imperforate anus; a blind ending rectum terminated in the omphalocele. We conclude that these two cases illustrate the variability of the OEIS complex. 2006 John Wiley & Sons, Ltd.

  4. Infantile myofibroma of the zygomatoco-maxillo-orbital complex: Case report with spontaneous regression

    Directory of Open Access Journals (Sweden)

    K. Arab

    2016-12-01

    Conclusion: Radiologically aggressive infantile myofibroma has been previously treated by surgical intervention. In this case report there was a significant spontaneous regression. Conservative treatment and follow-up may be an appropriate alternative.

  5. Complexities in building innovation systems : the case of radical medical technologies

    NARCIS (Netherlands)

    Kukk, P.

    2016-01-01

    The main goal of this thesis is to facilitate a further understanding of how firms behind innovative technologies deal with different complexities in system-building strategies and the co-dependencies among different technologies, actors and system-building activities, while contributing to the

  6. 'Cold Case': Vascular dysregulation in the chronic Complex Regional Pain Syndrome

    NARCIS (Netherlands)

    J.G. Groeneweg (George)

    2009-01-01

    textabstractThe aim of this thesis was to study the nature of the vascular alterations in patients with cold chronic Complex Regional Pain Syndrome. CRPS usually develops as a disproportionate consequence of trauma and is characterised by spontaneous pain, movement disorders and abnormal regulation

  7. Case Study: Skinny Genes? An Interdisciplinary Look at a Complex Behavioral Disorder

    Science.gov (United States)

    Gow, Joan-Beth; Carpino, Lisa A.

    2018-01-01

    Anorexia nervosa is a complex behavioral disorder with the highest risk of death of any psychological disorder. Between 15% and 20% of those suffering from anorexia die from complications that are attributed either directly or indirectly to self-starvation. Heritability for anorexia is around 0.5, meaning about 50% of the risk for anorexia is…

  8. Modernization at the Y-12 National Security Complex: A Case for Additional Experimental Benchmarks

    Energy Technology Data Exchange (ETDEWEB)

    Thornbury, Matthew [Y-12 National Security Complex, Oak Ridge, TN (United States)

    2017-10-25

    Electrorefining (ER) is a major part of efforts at the Y-12 National Security Complex to revolutionize the reprocessing and purification of enriched uranium (EU). Successful implementation of ER could drastically reduce the operational costs and footprint, hazardous materials use, and waste generation.

  9. Co-managing complex social-ecological systems in Tanzania : the case of Lake Jipe wetland

    NARCIS (Netherlands)

    Mahonge, C.P.I.

    2010-01-01

    It has been conventional among co-management scientists to view social-ecological systems and actors and institutions found in these systems monolithically. Such a view is simplistic and conceals the complex nature of social-ecological systems and associated institutions and actors. In essence, a

  10. Multilevel Integration Entropies: The Case of Reconstruction of Structural Quasi-Stability in Building Complex Datasets

    Directory of Open Access Journals (Sweden)

    Slobodan Maletić

    2017-04-01

    Full Text Available The emergence of complex datasets permeates versatile research disciplines leading to the necessity to develop methods for tackling complexity through finding the patterns inherent in datasets. The challenge lies in transforming the extracted patterns into pragmatic knowledge. In this paper, new information entropy measures for the characterization of the multidimensional structure extracted from complex datasets are proposed, complementing the conventionally-applied algebraic topology methods. Derived from topological relationships embedded in datasets, multilevel entropy measures are used to track transitions in building the high dimensional structure of datasets captured by the stratified partition of a simplicial complex. The proposed entropies are found suitable for defining and operationalizing the intuitive notions of structural relationships in a cumulative experience of a taxi driver’s cognitive map formed by origins and destinations. The comparison of multilevel integration entropies calculated after each new added ride to the data structure indicates slowing the pace of change over time in the origin-destination structure. The repetitiveness in taxi driver rides, and the stability of origin-destination structure, exhibits the relative invariance of rides in space and time. These results shed light on taxi driver’s ride habits, as well as on the commuting of persons whom he/she drove.

  11. Assisted reproductive techniques and risk of exstrophy-epispadias complex: a German case-control study.

    Science.gov (United States)

    Zwink, Nadine; Jenetzky, Ekkehart; Hirsch, Karin; Reifferscheid, Peter; Schmiedeke, Eberhard; Schmidt, Dominik; Reckin, Sabrina; Obermayr, Florian; Boemers, Thomas M; Stein, Raimund; Reutter, Heiko; Rösch, Wolfgang H; Brenner, Hermann; Ebert, Anne-Karoline

    2013-04-01

    We assessed the risk of exstrophy-epispadias complex in children conceived by in vitro fertilization or intracytoplasmic sperm injection. Data from the German Network for Congenital Uro-REctal malformations were compared to nationwide data from the German In Vitro Fertilization Register and the German Federal Statistical Office. Odds ratios (95% CI) were determined to quantify associations using logistic regression. A total of 123 patients with exstrophy-epispadias complex born in Germany between 1997 and 2011 were recruited through participating departments of pediatric urology and pediatric surgery throughout the country as well as the German self-help organizations Blasenekstrophie/Epispadie e.V. and Kloakenekstrophie. All German live births (10,069,986) between 1997 and 2010 comprised the controls. Overall, 12 subjects (10%) and 129,982 controls (1%) were conceived by in vitro fertilization or intracytoplasmic sperm injection. Conception by assisted reproductive technique was associated with a more than eightfold increased risk of exstrophy-epispadias complex compared to spontaneous conception (OR 8.3, 95% CI 4.6-15.0, p assisted reproductive techniques such as in vitro fertilization and intracytoplasmic sperm injection are associated with a markedly increased risk of having a child born with exstrophy-epispadias complex. However, it remains unclear whether this finding may be due to assisted reproduction per se and/or underlying infertility/subfertility etiology or parent characteristics. Copyright © 2013 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  12. L2 Grammatical Gender in a Complex Morphological System: The Case of German

    Science.gov (United States)

    Spinner, Patti; Juffs, Alan

    2008-01-01

    In order to determine the nature of naturalistic learners' difficulty with grammatical gender in a complex morphological system, the longitudinal production data of an early naturalistic L1-Italian and L1-Turkish learner who are acquiring German are examined in light of current theories of gender within Chomsky's (1995) Minimalist Program. After…

  13. The inter-Korean economic cooperation: the case of Kaesong Industrial Complex

    Directory of Open Access Journals (Sweden)

    Ángel Licona Michel

    2012-06-01

    Full Text Available The inter-Korean economic cooperation materialized with the development of Kaesong Industrial Complex shows that the governments of South Korea and North Korea despite having unstable political relations need to agree to enhance trade and increase productivity of industries seeking thereby to have more competitive economies to detonate the creation of more infrastructure.

  14. Diffusion of interstitials in metallic systems, illustration of a complex study case: aluminum.

    Science.gov (United States)

    David, Matthieu; Connétable, Damien

    2017-10-19

    While diffusion mechanisms of interstitial elements in fcc systems are generally well-known, especially in the case of H atoms, we show in this work that even in the case of a simple metallic system (aluminum), the diffusion of interstitials exhibits a wide variety of paths and mechanisms that depend on the specie. We used an approach based on first-principles calculations associated with kinetic Monte-Carlo simulations and a multi-state diffusion formalism to compute the diffusion coefficients of five interstitial elements: hydrogen, boron, carbon, nitrogen and oxygen. For instance, at the atomic scale, whilst we find that C atoms prefer to be located in octahedral sites (labeled o) rather than in tetrahedral positions (labeled t), we find one additional stable position in the lattice (M). The diffusion through these three stable positions are thus studied in detail. In the case of B atoms, for which the tetrahedral site is found unstable, the diffusion path is between o-o sites. Similarly, in the case of oxygen, t positions are found to be the only stable positions (o are unstable) and the path of migration, along t-t direction, is found through a twice degenerated asymmetric transition state. In the case of H and N atoms for which t and o sites are stable, we explain why the only path is along the t-o direction. Finally, we discuss explicit formulas to compute coefficients of diffusion of interstitials in fcc structures.

  15. Diffusion of interstitials in metallic systems, illustration of a complex study case: aluminum

    Science.gov (United States)

    David, Matthieu; Connétable, Damien

    2017-11-01

    While diffusion mechanisms of interstitial elements in fcc systems are generally well-known, especially in the case of H atoms, we show in this work that even in the case of a simple metallic system (aluminum), the diffusion of interstitials exhibits a wide variety of paths and mechanisms that depend on the specie. We used an approach based on first-principles calculations associated with kinetic Monte-Carlo simulations and a multi-state diffusion formalism to compute the diffusion coefficients of five interstitial elements: hydrogen, boron, carbon, nitrogen and oxygen. For instance, at the atomic scale, whilst we find that C atoms prefer to be located in octahedral sites (labeled o) rather than in tetrahedral positions (labeled t), we find one additional stable position in the lattice (M). The diffusion through these three stable positions are thus studied in detail. In the case of B atoms, for which the tetrahedral site is found unstable, the diffusion path is between o-o sites. Similarly, in the case of oxygen, t positions are found to be the only stable positions (o are unstable) and the path of migration, along t-t direction, is found through a twice degenerated asymmetric transition state. In the case of H and N atoms for which t and o sites are stable, we explain why the only path is along the t-o direction. Finally, we discuss explicit formulas to compute coefficients of diffusion of interstitials in fcc structures.

  16. A possibility to identify the vehicle driver through complex forensic and criminalistic expertise--case report.

    Science.gov (United States)

    Păduraru, G; Knieling, A; Scripcaru, C; Iliescu, Diana Bulgaru

    2014-01-01

    Traffic accidents can have more or less dramatic consequences that involve penal and civil responsibility with amplitude extending over long periods of time. In many cases, substitution of the driver with the passenger in order to avoid criminal responsibility is often remarked. The substitution takes place with the passenger's agreement or, in cases with dramatic consequences (coma or death), without his/her consent. These situations are encountered in civil cases regarding insurance fraud. In addition to forensic medical expertise, to aid the experts, mathematical modeling and computer simulation of the dynamics of vehicle passengers is a tool that completes the criminal expertise of traffic accidents. This paper presents the method of identification of the person driving the vehicle based on the computer simulation of vehicle occupants' dynamics.

  17. Digital documentation of complex architectures by integration of multiple techniques: the case study of Valer Castle

    Science.gov (United States)

    Voltolini, Francesca; El-Hakim, Sabry; Remondino, Fabio; Girardi, Stefano; Rizzi, Alessandro; Pontin, Marco; Gonzo, Lorenzo

    2007-01-01

    The digital documentation of monuments and architectures is an important field of application of the 3D modeling where both visual quality and precise 3D measurement are important. This paper proposes an integrated approach based upon the combination of different 3D modeling techniques for the virtual reconstruction of complex architectures like those found in medieval castles. The need of combining multiple techniques, like terrestrial laser scanning, photogrammetry and digital surveying comes from the complexity of some structures and by the lack of a single technique capable of giving satisfactory results in all measuring conditions. This paper will address modeling issues related to the automation of photogrammetric methods and to the fusion of 3D models acquired with different techniques, at different point densities and measurement accuracies. The test bench is a medieval castle placed in Trentino A.A., a tiny region in Northern Italy.

  18. Complex networks for data-driven medicine: the case of Class III dentoskeletal disharmony

    International Nuclear Information System (INIS)

    Scala, A; Auconi, P; Scazzocchio, M; Caldarelli, G; McNamara, JA; Franchi, L

    2014-01-01

    In the last decade, the availability of innovative algorithms derived from complexity theory has inspired the development of highly detailed models in various fields, including physics, biology, ecology, economy, and medicine. Due to the availability of novel and ever more sophisticated diagnostic procedures, all biomedical disciplines face the problem of using the increasing amount of information concerning each patient to improve diagnosis and prevention. In particular, in the discipline of orthodontics the current diagnostic approach based on clinical and radiographic data is problematic due to the complexity of craniofacial features and to the numerous interacting co-dependent skeletal and dentoalveolar components. In this study, we demonstrate the capability of computational methods such as network analysis and module detection to extract organizing principles in 70 patients with excessive mandibular skeletal protrusion with underbite, a condition known in orthodontics as Class III malocclusion. Our results could possibly constitute a template framework for organising the increasing amount of medical data available for patients’ diagnosis. (paper)

  19. Conservation of vibrational coherence in ultrafast electronic relaxation: The case of diplatinum complexes in solution

    Czech Academy of Sciences Publication Activity Database

    Monni, R.; Auböck, G.; Kinschel, D.; Aziz-Lange, K. M.; Gray, H. B.; Vlček, Antonín; Chergui, M.

    2017-01-01

    Roč. 683, SEP 2017 (2017), s. 112-120 ISSN 0009-2614 R&D Projects: GA MŠk LD14129; GA ČR GA17-01137S Grant - others:COST(XE) CM1201 Institutional support: RVO:61388955 Keywords : vibrational energy * electronic energy * diplatinum complexes Subject RIV: CG - Electrochemistry OBOR OECD: Electrochemistry (dry cells, batteries, fuel cells, corrosion metals, electrolysis) Impact factor: 1.815, year: 2016

  20. School Bus Routing: A Case Study of Wood Bridge School Complex, Sekondi-Takoradi, Ghana

    Directory of Open Access Journals (Sweden)

    John Awuah Addor

    2013-12-01

    Full Text Available This research article presents a School Bus Routing Problem of Wood Bridge School Complex,Sekondi-Takoradi, Ghana. The problem was formulated as an Integer Programming Model and an Ant Colony Based Meta-heuristic for the Travelling Salesman Problem was used to solve the problem. Data on distances were collected and coded usingMatlab. Our proposed model revealed a tremendous improvement in the total route length by approximately 32%.

  1. Citizen Data Science for Social Good in Complex Systems: Case Studies and Vignettes from Recent Projects

    OpenAIRE

    Banerjee, Soumya

    2017-01-01

    The confluence of massive amounts of openly available data, sophisticated machine learning algorithms and an enlightened citizenry willing to engage in data science presents novel opportunities for crowd sourced data science for social good. In this submission, I present vignettes of data science projects that I have been involved in and which have impact in various spheres of life and on social good. Complex systems are all around us: from social networks to transportation sys...

  2. Complex Mixture-Associated Hormesis and Toxicity: The Case of Leather Tanning Industry

    OpenAIRE

    Pagano, Giovanni; Castello, Giuseppe; Gallo, Marialuisa; Borriello, Ilaria; Guida, Marco

    2008-01-01

    A series of studies investigated the toxicities of tannery-derived complex mixtures, i.e. vegetable tannin (VT) from Acacia sp. or phenol-based synthetic tannin (ST), and waste-water from tannin-based vs. chromium-based tanneries. Toxicity was evaluated by multiple bioassays including developmental defects and loss of fertilization rate in sea urchin embryos and sperm (Paracentrotus lividus and Sphaerechinus granularis), and algal growth inhibition (Dunaliella tertiolecta and Selenastrum capr...

  3. Conservation of vibrational coherence in ultrafast electronic relaxation: The case of diplatinum complexes in solution

    Czech Academy of Sciences Publication Activity Database

    Monni, R.; Auböck, G.; Kinschel, D.; Aziz-Lange, K. M.; Gray, H. B.; Vlček, Antonín; Chergui, M.

    2017-01-01

    Roč. 683, SEP 2017 (2017), s. 112-120 ISSN 0009-2614 R&D Projects: GA MŠk LD14129; GA ČR GA17-01137S Grant - others: COST (XE) CM1201 Institutional support: RVO:61388955 Keywords : vibrational energy * electronic energy * diplatinum complexes Subject RIV: CG - Electrochemistry OBOR OECD: Electrochemistry (dry cells, batteries, fuel cells, corrosion metals, electrolysis) Impact factor: 1.815, year: 2016

  4. Collaboration, communication and categorical complexity: A case study in collaboratory evaluation

    DEFF Research Database (Denmark)

    Cleal, B.R.; Andersen, H.H.K.; Albrechtsen, H.

    2004-01-01

    This article presents findings from an empirical evaluation of a collaboratory supporting film research. Few collaboratories have been formally evaluated. The article makes a case for looking at wider work-based contexts users engage in. Focussing on key features of the prototype system, it is sh......This article presents findings from an empirical evaluation of a collaboratory supporting film research. Few collaboratories have been formally evaluated. The article makes a case for looking at wider work-based contexts users engage in. Focussing on key features of the prototype system...

  5. Boundary-spanning actors in complex adaptive governance systems: The case of multisectoral nutrition.

    Science.gov (United States)

    Pelletier, David; Gervais, Suzanne; Hafeez-Ur-Rehman, Hajra; Sanou, Dia; Tumwine, Jackson

    2017-10-10

    A growing literature highlights complexity of policy implementation and governance in global health and argues that the processes and outcomes of policies could be improved by explicitly taking this complexity into account. Yet there is a paucity of studies exploring how this can be achieved in everyday practice. This study documents the strategies, tactics, and challenges of boundary-spanning actors working in 4 Sub-Saharan Africa countries who supported the implementation of multisectoral nutrition as part of the African Nutrition Security Partnership in Burkina Faso, Mali, Ethiopia, and Uganda. Three action researchers were posted to these countries during the final 2 years of the project to help the government and its partners implement multisectoral nutrition and document the lessons. Prospective data were collected through participant observation, end-line semistructured interviews, and document analysis. All 4 countries made significant progress despite a wide range of challenges at the individual, organizational, and system levels. The boundary-spanning actors and their collaborators deployed a wide range of strategies but faced significant challenges in playing these unconventional roles. The study concludes that, under the right conditions, intentional boundary spanning can be a feasible and acceptable practice within a multisectoral, complex adaptive system in low- and middle-income countries. © 2017 The Authors. The International Journal of Health Planning and Management Published by John Wiley & Sons Ltd.

  6. Spontaneous Partitioning of Californium from Curium: Curious Cases from the Crystallization of Curium Coordination Complexes.

    Science.gov (United States)

    Cary, Samantha K; Silver, Mark A; Liu, Guokui; Wang, Jamie C; Bogart, Justin A; Stritzinger, Jared T; Arico, Alexandra A; Hanson, Kenneth; Schelter, Eric J; Albrecht-Schmitt, Thomas E

    2015-12-07

    The reaction of (248)CmCl3 with excess 2,6-pyridinedicarboxylic acid (DPA) under mild solvothermal conditions results in crystallization of the tris-chelate complex Cm(HDPA)3 · H2O. Approximately half of the curium remains in solution at the end of this process, and evaporation of the mother liquor results in crystallization of the bis-chelate complex [Cm(HDPA)(H2DPA)(H2O)2Cl]Cl·2H2O. (248)Cm is the daughter of the α decay of (252)Cf and is extracted in high purity from this parent. However, trace amounts of (249,250,251)Cf are still present in all samples of (248)Cm. During the crystallization of Cm(HDPA)3 · H2O and [Cm(HDPA)(H2DPA)(H2O)2Cl]Cl · 2H2O, californium(III) spontaneously separates itself from the curium complexes and is found doped within crystals of DPA in the form of Cf(HDPA)3. These results add to the growing body of evidence that the chemistry of californium is fundamentally different from that of earlier actinides.

  7. Concept of Complex Environmental Monitoring Network - Vardzia Rock Cut City Case Study

    Science.gov (United States)

    Elashvili, Mikheil; Vacheishvili, Nikoloz; Margottini, Claudio; Basilaia, Giorgi; Chkhaidze, Davit; Kvavadze, Davit; Spizzichino, Daniele; Boscagli, Franceso; Kirkitadze, Giorgi; Adikashvili, Luka; Navrozashvili, Levan

    2016-04-01

    Vardzia represents an unique cultural heritage monument - rock cut city, which unites architectural monument and Natural-Geological complex. Such monuments are particularly vulnerable and their restoration and conservation requires complex approach. It is curved in various layers of volcanic tuffs and covers several hectares of area, with chronologically different segments of construction. This monument, as many similar monuments worldwide, is subjected to slow but permanent process of destruction, expressed in following factors: surface weathering of rock, active tectonics (aseismic displacement along the active faults and earthquakes), interaction between lithologically different rock layers, existence of major cracks and associated complex block structure, surface rainwater runoff and infiltrated ground water, temperature variations, etc. During its lifetime, Vardzia was heavily damaged by Historical Earthquake of 1283 and only partly restored afterwards. The technological progress together with the increased knowledge about ongoing environmental processes, established the common understanding that the complex monitoring of the environment represents the essential component for resolving such a principal issues, as: Proper management and prevention of natural disasters; Modeling of environmental processes, their short and long term prognosis; Monitoring of macro and micro climate; Safe functioning and preservation of important constructions. Research Center of Cultural Heritage and Environment of Ilia State University in cooperation with Experts from ISPRA, with the funding from the State agency of Cultural Heritage, has developed a concept of Vardzia complex monitoring network. Concept of the network includes: monitoring local meteorological conditions (meteorological station), monitoring microclimate in caves (temperature and humidity in the air and rock), monitoring microtremors and ambient seismic noise in Vardzia (local strong motion network), monitoring

  8. Containing Pedagogical Complexity through the Assignment of Photography: Two Case Presentations

    Science.gov (United States)

    Garrett, H. James; Matthews, Sara

    2014-01-01

    This article investigates the use of photography as a narrative approach to learning in the context of postsecondary education. Two cases are presented: a social studies methods course in a teacher education program in the South of the United States; and a senior undergraduate seminar on global violence at a university in southern Ontario, Canada.…

  9. Story-Making on the iPad When Children Have Complex Needs: Two Case Studies

    Science.gov (United States)

    Kucirkova, Natalia; Messer, David; Critten, Val; Harwood, Jane

    2014-01-01

    The two case studies reported in this clinical exchange describe the way in which iPads can foster children's motivation to engage in communication and literacy-related activities such as story-sharing and story-creation. A detailed description of a particular iPad app (Our Story) is provided, along with observations of the implementation of this…

  10. A case of horseshoe lung and complex congenital heart disease in a term newborn

    Energy Technology Data Exchange (ETDEWEB)

    Jeewa, Aamir [British Columbia Children' s Hospital and University of British Columbia, Department of Pediatrics, Division of Cardiology, Vancouver (Canada); Culham, J.A.G. [British Columbia Children' s Hospital, Department of Radiology, Vancouver (Canada); Human, Derek G. [British Columbia Children' s Hospital and University of British Columbia, Department of Pediatrics, Division of Cardiology, Vancouver (Canada); B.C. Children' s Hospital, Children' s Heart Centre, Vancouver (Canada)

    2010-02-15

    We describe and illustrate a rare association of hypoplastic left heart syndrome, absent hilar left pulmonary artery, and an unusual bronchopulmonary malformation. This case highlights the utility of combination imaging of echocardiography and CT angiography in diagnosing a cyanotic newborn with a chest radiograph that is suspicious for lung hypoplasia. (orig.)

  11. A Rare Case Report of Bilateral Complex Macrocystic Adrenal Hemorrhage Mimicking Fetal Neuroblastoma

    OpenAIRE

    Sindhwani, Geetika; Patel, Viral; Jain, Abhinav

    2018-01-01

    Fetal and neonatal adrenal glands are large vascular organs, which make them vulnerable to frequent bleeding. Although neonatal adrenal hemorrhage is commonly reported, it is rarely diagnosed on antenatal sonography. We present a rare case of prenatally diagnosed bilateral adrenal hemorrhage, which mimicked antenatal neuroblastoma.

  12. Utility of 3D printed temporal bones in pre-surgical planning for complex BoneBridge cases.

    Science.gov (United States)

    Mukherjee, Payal; Cheng, Kai; Flanagan, Sean; Greenberg, Simon

    2017-08-01

    With the advent of single-sided hearing loss increasingly being treated with cochlear implantation, bone conduction implants are reserved for cases of conductive and mixed hearing loss with greater complexity. The BoneBridge (BB, MED-EL, Innsbruck, Austria) is an active fully implantable device with no attenuation of sound energy through soft tissue. However, the floating mass transducer (FMT) part of the device is very bulky, which limits insertion in complicated ears. In this study, 3D printed temporal bones of patients were used to study its utility in preoperative planning on complicated cases. Computed tomography (CT) scans of 16 ears were used to 3D print their temporal bones. Three otologists graded the use of routine preoperative planning provided by MED-EL and that of operating on the 3D printed bone of the patient. Data were collated to assess the advantage and disadvantage of the technology. There was a statistically significant benefit in using 3D printed temporal bones to plan surgery for difficult cases of BoneBridge surgery compared to the current standard. Surgeons preferred to have the printed bones in theatre to plan their drill sites and make the transition of the planning to the patient's operation more precise. 3D printing is an innovative use of technology in the use of preoperative planning for complex ear surgery. Surgical planning can be done on the patient's own anatomy which may help to decrease operating time, reduce cost, increase surgical precision and thus reduce complications.

  13. How partnership accelerates Open Science: High Energy Physics and INSPIRE, a case study of a complex repository ecosystem

    CERN Document Server

    AUTHOR|(CDS)2079501; Hecker, Bernard Louis; Holtkamp, Annette; Mele, Salvatore; O'Connell, Heath; Sachs, Kirsten; Simko, Tibor; Schwander, Thorsten

    2013-01-01

    Public calls, agency mandates and scientist demand for Open Science are by now a reality with different nuances across diverse research communities. A complex “ecosystem” of services and tools, mostly communityDdriven, will underpin this revolution in science. Repositories stand to accelerate this process, as “openness” evolves beyond text, in lockstep with scholarly communication. We present a case study of a global discipline, HighDEnergy Physics (HEP), where most of these transitions have already taken place in a “social laboratory” of multiple global information services interlinked in a complex, but successful, ecosystem at the service of scientists. We discuss our firstDhand experience, at a technical and organizational level, of leveraging partnership across repositories and with the user community in support of Open Science, along threads relevant to the OR2013 community.

  14. Molecular diagnostic development for begomovirus-betasatellite complexes undergoing diversification: A case study.

    Science.gov (United States)

    Brown, Judith K; Ur-Rehman, Muhammad Zia; Avelar, Sofia; Chingandu, N; Hameed, Usman; Haider, Saleem; Ilyas, Muhammad

    2017-09-15

    At least five begomoviral species that cause leaf curl disease of cotton have emerged recently in Asia and Africa, reducing fiber quality and yield. The potential for the spread of these viruses to other cotton-vegetable growing regions throughout the world is extensive, owing to routine, global transport of alternative hosts of the leaf curl viruses, especially ornamentals. The research reported here describes the design and validation of polymerase chain reaction (PCR) primers undertaken to facilitate molecular detection of the two most-prevalent leaf curl-associated begomovirus-betasatellite complexes in the Indian Subcontinent and Africa, the Cotton leaf curl Kokhran virus-Burewala strain and Cotton leaf curl Gezira virus, endemic to Asia and Africa, respectively. Ongoing genomic diversification of these begomoviral-satellite complexes was evident based on nucleotide sequence alignments, and analysis of single nucleotide polymorphisms, both factors that created new challenges for primer design. The additional requirement for species and strain-specific, and betasatellite-specific primer design, imposes further constraints on primer design and validation due to the large number of related species and strains extant in 'core leaf curl virus complex', now with expanded distribution in south Asia, the Pacific region, and Africa-Arabian Peninsula that have relatively highly conserved coding and non-coding regions, which precludes much of the genome-betasatellite sequence when selecting primer 'targets'. Here, PCR primers were successfully designed and validated for detection of cloned viral genomes and betasatellites for representative 'core leaf curl' strains and species, distant relatives, and total DNA isolated from selected plant species. The application of molecular diagnostics to screen plant imports prior to export or release from ports of entry is expected to greatly reduce the likelihood of exotic leaf curl virus introductions that could dramatically affect

  15. Modeling complex aquifer systems: a case study in Baton Rouge, Louisiana (USA)

    Science.gov (United States)

    Pham, Hai V.; Tsai, Frank T.-C.

    2017-05-01

    This study targets two challenges in groundwater model development: grid generation and model calibration for aquifer systems that are fluvial in origin. Realistic hydrostratigraphy can be developed using a large quantity of well log data to capture the complexity of an aquifer system. However, generating valid groundwater model grids to be consistent with the complex hydrostratigraphy is non-trivial. Model calibration can also become intractable for groundwater models that intend to match the complex hydrostratigraphy. This study uses the Baton Rouge aquifer system, Louisiana (USA), to illustrate a technical need to cope with grid generation and model calibration issues. A grid generation technique is introduced based on indicator kriging to interpolate 583 wireline well logs in the Baton Rouge area to derive a hydrostratigraphic architecture with fine vertical discretization. Then, an upscaling procedure is developed to determine a groundwater model structure with 162 layers that captures facies geometry in the hydrostratigraphic architecture. To handle model calibration for such a large model, this study utilizes a derivative-free optimization method in parallel computing to complete parameter estimation in a few months. The constructed hydrostratigraphy indicates the Baton Rouge aquifer system is fluvial in origin. The calibration result indicates hydraulic conductivity for Miocene sands is higher than that for Pliocene to Holocene sands and indicates the Baton Rouge fault and the Denham Springs-Scotlandville fault to be low-permeability leaky aquifers. The modeling result shows significantly low groundwater level in the "2,000-foot" sand due to heavy pumping, indicating potential groundwater upward flow from the "2,400-foot" sand.

  16. Amphotericin B lipid complex in the treatment of severe paracoccidioidomycosis: a case series.

    Science.gov (United States)

    Peçanha, Paulo Mendes; de Souza, Stella; Falqueto, Aloísio; Grão-Veloso, Tânia Regina; Lírio, Ludmila Ventura; Ferreira, Carlos Urbano Gonçalves; Santos, Aline Rocha; Costa, Hélbia Garcia; de Souza, Lúcia Renata Meirelles; Tuon, Felipe Francisco

    2016-10-01

    Amphotericin B deoxycholate is the main option for intravenous (i.v.) treatment of severe paracoccidioidomycosis (PCM). This is the first report of amphotericin B lipid complex (ABLC) in the treatment of PCM. Among 28 patients, cure was achieved in all patients (100%) using ABLC. Mean and median daily doses of ABLC were 3.39 mg/kg/day and 3.35 mg/kg/day, respectively. ABLC may be a choice in the treatment of severe forms of PCM or when i.v. options are required. Copyright © 2016 Elsevier B.V. and International Society of Chemotherapy. All rights reserved.

  17. Complex Analysis of 700-Year-Old Skeletal Remains found in an Unusual Grave: Case Report

    Czech Academy of Sciences Publication Activity Database

    Vaněk, D.; Brzobohatá, Hana; Šilerová, M.; Horák, Z.; Nývltová Fišáková, Miriam; Vašinová Galiová, M.; Zedníková Malá, P.; Urbanová, V.; Dobisíková, M.; Beran, M.; Brestovanský, P.

    2015-01-01

    Roč. 2, č. 5 (2015) ISSN 2332-0915 R&D Projects: GA ČR GB14-36938G Grant - others:GA MŠk(CZ) ED1.1.00/02.0068 Program:ED Institutional support: RVO:67985912 ; RVO:68081758 Keywords : mass spectrometry * genealogical * physical anomalies * anthropological Subject RIV: AC - Archeology, Anthropology, Ethnology http://www.omicsonline.org/ open - access /complex-analysis-of-700yearold-skeletal-remains-found-in-an-unusualgravecase-report-2332-0915-1000138.pdf

  18. No evidence for a genetic blueprint: The case of the "complex" mammalian photoreceptor

    Directory of Open Access Journals (Sweden)

    G Kumaramanickavel

    2015-01-01

    Full Text Available Despite the intensity of the search for genes causing inherited retinal degenerations over the past 3 decades, of the approximately 200 disease genes identified to date, all appear to be ordinary housekeeping genes specifying proteins playing basic structural and functional roles in the mature photoreceptor cells. No genes or genetic elements have been identified which can be construed as having a specific morphogenic role, directing the development of the cytoarchitecture of any particular retinal cell. The evidence suggests that the cytoarchitecture of the retinal photoreceptors, although enormously complex, arises from the self-organization of the cells constituents without any regulation or direction from an external genetic blueprint.

  19. How to handle activity coefficients of weak complexes in thermodynamic databases. A case study

    Energy Technology Data Exchange (ETDEWEB)

    Jordan, Norbert [Helmholtz-Zentrum Dresden-Rossendorf e.V., Dresden (Germany). Div. Surface Processes; Spahiu, K. [Swedish Nuclear Fuel and Waste Management Co, Stockholm (Sweden)

    2016-07-01

    A procedure to handle the log β of weak complexes in thermodynamic databases (TDB) is described here. It consists in extrapolating data obtained at constant ionic strength and in mixed electrolytes (e.g. HClO{sub 4} and HNO{sub 3}) to the pure background electrolyte media (perchlorate), i.e. at trace ligand (NO{sub 3}{sup -}) concentration. The obtained equilibrium constants can subsequently be extrapolated to zero ionic strength using, e.g., the Specific Ion Interaction Theory (SIT) approach.

  20. Healthcare improvement as planned system change or complex responsive processes? a longitudinal case study in general practice.

    Science.gov (United States)

    Booth, Barbara J; Zwar, Nicholas; Harris, Mark F

    2013-04-23

    Interest in how to implement evidence-based practices into routine health care has never been greater. Primary care faces challenges in managing the increasing burden of chronic disease in an ageing population. Reliable prescriptions for translating knowledge into practice, however, remain elusive, despite intense research and publication activity. This study seeks to explore this dilemma in general practice by challenging the current way of thinking about healthcare improvement and asking what can be learned by looking at change through a complexity lens. This paper reports the local level of an embedded case study of organisational change for better chronic illness care over more than a decade. We used interviews, document review and direct observation to explore how improved chronic illness care developed in one practice. This formed a critical case to compare, using pattern matching logic, to the common prescription for local implementation of best evidence and a rival explanation drawn from complexity sciences interpreted through modern sociology and psychology. The practice changed continuously over more than a decade to deliver better chronic illness care in line with research findings and policy initiatives--re-designing care processes, developing community linkages, supporting patient self-management, using guidelines and clinical information systems, and integrating nurses into the practice team. None of these improvements was designed and implemented according to an explicit plan in response to a documented gap in chronic disease care. The process that led to high quality chronic illness care exhibited clear complexity elements of co-evolution, non-linearity, self-organisation, emergence and edge of chaos dynamics in a network of agents and relationships where a stable yet evolving way of organizing emerged from local level communicative interaction, power relating and values based choices. The current discourse of implementation science as planned

  1. A case of black hairy tongue responding to oral nystatin and vitamin B complex treatment

    Directory of Open Access Journals (Sweden)

    Ömer Kutlu

    2015-12-01

    Full Text Available Black hairy tongue, also known as lingua villosa nigra, is characterized by desquamation defects on the dorsal side of the tongue with reactive hypertrophy of the filiform papillae. Although the etiology of the disease is unknown, conditions such as smoking, alcohol and candidal infection are accused. In this study, a case of black hairy tongue which is considered to occur due to poor oral hygiene and candidal infection is presented.

  2. Cor triatriatum dexter associated with atrial septal defect: Management in a complex clinical case.

    Science.gov (United States)

    Sozzi, Fabiola B; Montanaro, Claudia; Bacà, Laura; Viani, Giacomo M; Zilocchi, Massimo; Canetta, Ciro; Meazza, Roberto; Pavone, Laura; Lombardi, Federico

    2017-11-01

    The coexistence of an atrial septal defect and a prominent eustachian valve is a rare congenital anomaly, rarely reported in literature. Differentiation between a giant eustachian valve and cor triatriatum dexter can be difficult. A case of a large atrial septal defect associated with cor triatriatum dexter diagnosed by echocardiography in an asymptomatic woman is reported. A watchful waiting strategy was adopted. © 2017, Wiley Periodicals, Inc.

  3. COMPLEX TREATMENT IN A PATIENT WITH SEVERE CHRONIC PERIODONTITIS (Case Report).

    OpenAIRE

    Kamen Kotsilkov; Radoi Dimitrov

    2015-01-01

    INTRODUCTION: Periodontitis is characterized by progressive destruction of periodontium, caused by relatively small group of microorganisms. The treatment aims to create proper environment which hampers the colonization of pathogens. The mechanical cleaning of the root surfaces combined with meticulous oral hygiene is the consensus treatment. In advanced cases the progression of the disease could lead to different problems - gingival recessions, insufficiency of attached gingiva, mobility an...

  4. Endeavor research into evolving paradigms around ophiolites: the case of the oceanic igneous complexes of Costa Rica

    International Nuclear Information System (INIS)

    Alvarado, Guillermo E.; Denyer, Perci; Gazel, Esteban

    2009-01-01

    , like Santa Elena Peninsula, Tortugal, Herradura and Quepos, the picture on these oceanic complexes are more or less clear. In the case of Osa-Golfito-Burica area, more studies are necessary. In general, the detailed field mapping is a powerful tool in combination with the modern techniques. The similarity in age, petrology, geochemistry and tectonic context for other oceanic complexes in Guatemala, Antilles and the northern part of South America, is more than a coincidence, they have a similar evolution. Therefore, a multidisciplinary study of the chrono- and bio-stratigraphic relations, together with modern petrology, geochemical and micropaleontology approach is necessary to provide a solid base for a robust plate tectonic reconstruction and geologic history. (author)

  5. Iterated real-time path integral evaluation using a distributed approximating functional propagator and average-case complexity integration

    International Nuclear Information System (INIS)

    Kouri, D.J.; Huang, Y.; Hoffman, D.K.

    1995-01-01

    The distributed approximating functional-path integral is formulated as an iterated sequence of d-dimensional integrals, where d is the intrinsic number of degrees of freedom for the system under consideration. This is made practical for larger values of d by evaluating these integrals using average-case complexity integration techniques, based on deterministic ''low discrepancy sequences,'' as opposed to products of one-dimensional quadratures or basis functions. The integration converges as (logP) d-1 /P, where P is the number of sample points used, and the dimensionality of the integral does not increase with the number of time slices required

  6. Construction of a Blow-Up Solution for the Complex Ginzburg-Landau Equation in a Critical Case

    Science.gov (United States)

    Nouaili, Nejla; Zaag, Hatem

    2017-12-01

    We construct a solution for the Complex Ginzburg-Landau equation in a critical case which blows up in finite time T only at one blow-up point. We also give a sharp description of its profile. The proof relies on the reduction of the problem to a finite dimensional one, and the use of index theory to conclude. The interpretation of the parameters of the finite dimension problem in terms of the blow-up point and time allows us to prove the stability of the constructed solution.

  7. Solitary Metastasis to the Facial/Vestibulocochlear Nerve Complex: Case Report and Review of the Literature.

    Science.gov (United States)

    Ariai, M Shafie; Eggers, Scott D; Giannini, Caterina; Driscoll, Colin L W; Link, Michael J

    2015-10-01

    Distant metastasis of mucinous adenocarcinoma from the gastrointestinal tract, ovaries, pancreas, lungs, breast, or urogenital system is a well-described entity. Mucinous adenocarcinomas from different primary sites are histologically identical with gland cells producing a copious amount of mucin. This report describes a very rare solitary metastasis of a mucinous adenocarcinoma of unknown origin to the facial/vestibulocochlear nerve complex in the cerebellopontine angle. A 71-year-old woman presented with several month history of progressive neurological decline and a negative extensive workup performed elsewhere. She presented to our institution with complete left facial weakness, left-sided deafness, gait unsteadiness, headache and anorexia. A repeat magnetic resonance imaging scan of the head revealed a cystic, enhancing abnormality involving the left cerebellopontine angle and internal auditory canal. A left retrosigmoid craniotomy was performed and the lesion was completely resected. The final pathology was a mucinous adenocarcinoma of indeterminate origin. Postoperatively, the patient continued with her preoperative deficits and subsequently died of her systemic disease 6 weeks after discharge. The facial/vestibulocochlear nerve complex is an unusual location for metastatic disease in the central nervous system. Clinicians should consider metastatic tumor as the possible etiology of an unusual appearing mass in this location causing profound neurological deficits. The prognosis after metastatic mucinous adenocarcinoma to the cranial nerves in the cerebellopontine angle may be poor. Copyright © 2015 Elsevier Inc. All rights reserved.

  8. A Naturally Occurring Antioxidant Complex from Unripe Grapes: The Case of Sangiovese (v. Vitis vinifera

    Directory of Open Access Journals (Sweden)

    Giovanna Fia

    2018-02-01

    Full Text Available The wine industry is well known for its production of a large amount of wastes and by-products. Among them, unripe grapes from thinning operations are an undervalued by-product. Grapes are an interesting source of natural antioxidants such as flavonoids, non-flavonoids and stilbenes. A potential strategy to exploit unripe grapes was investigated in this study. Juice from unripe grapes, v. Sangiovese, was obtained by an innovative technique of solid-liquid extraction without the use of solvents. The juice was dried by a spray-drying technique with the addition of arabic gum as support to obtain powder; juice and powder were characterized for antioxidant activity, phenolic concentration and profile. Phenolic acids, flavonols, flava-3-ols, procyanidins and resveratrol were detected in the juice and powder. The powder was used as anti-browning additive in white wine to test the potential re-use of the unripe grapes in the wine industry. The results indicated that the antioxidant complex from unripe grapes contributed to increasing the anti-browning capacity of white wine. Other applications, such as food and nutraceutical products development, can be considered for the antioxidant complex extracted from unripe grapes. In conclusion, the method proposed in this study may contribute to the exploitation of unripe grapes as a by-product of the winemaking process.

  9. Young children’s number sense development: Age related complexity across cases of three children

    Directory of Open Access Journals (Sweden)

    Zuhal Yılmaz

    2017-06-01

    Full Text Available Children start to develop number sense even well before they start the school. Developing number sense serves as an intermediate tool for learning conventional mathematics taught in schools. This number sense has three key areas: number knowledge, counting and arithmetic operations. As a result, the aim of this study was to examine aged related complexity of number sense development of young children’s aged four, six and seven under two key areas: number knowledge and counting. Semi structured task based clinical interviews were employed to examine number sense development. Five different assessment tasks were employed with three children. Children’s responses were analysed to identify their level of number sense understanding and difficulties with developing number sense. Findings were reported under two categories: first children’s ability to understand number concept and their ability to accomplish number word sequences and second counting. Findings of the study indicated a significant age related complexity and improvement in both two aspects of number sense. Older children with more experience developed better number sense than the younger children.

  10. Young Children’s Number Sense Development: Age Related Complexity across Cases of Three Children

    Directory of Open Access Journals (Sweden)

    Zuhal YILMAZ

    2017-06-01

    Full Text Available Children start to develop number sense even well before they start the school. Developing number sense serves as an intermediate tool for learning conventional mathematics taught in schools. This number sense has three key areas: number knowledge, counting and arithmetic operations. As a result, the aim of this study was to examine aged related complexity of number sense development of young children’s aged four, six and seven under two key areas: number knowledge and counting. Semi structured task based clinical interviews were employed to examine number sense development. Five different assessment tasks were employed with three children. Children’s responses were analysed to identify their level of number sense understanding and difficulties with developing number sense. Findings were reported under two categories: first children’s ability to understand number concept and their ability to accomplish number word sequences and second counting. Findings of the study indicated a significant age related complexity and improvement in both two aspects of number sense. Older children with more experience developed better number sense than the younger children.

  11. Entangling the complexity of protected area management: the case of Wolong Biosphere Reserve, southwestern China.

    Science.gov (United States)

    Fu, Bojie; Wang, Kelin; Lu, Yihe; Liu, Shiliang; Keming, Ma; Chen, Liding; Liu, Guohua

    2004-06-01

    Protected Area (PA) management is a complex issue that requires the consideration of many factors and relationships. A conceptual framework for the analysis of biodiversity change, local human communities, and PA management was put forward, accordingly. Under the framework, we investigated the economic status, livelihood activities, biodiversity use and perceptions of local communities, and the land use history in Wolong Biosphere Reserve, southwestern China through household survey and document review in order to gain a better understanding of the complexity of PA management. According to the land use history, the preservation of agro-biodiversity, and the raising of productivity, ecological rehabilitation and the regulation of the human pressures are indispensable in the management of the reserve. Livelihood activities and the perceptions of local communities were largely determined by the socioeconomic background, which has important implications in solving the conflicts or incompatibilities in the reserve. In Wolong Biosphere Reserve, it is beneficial to support local farmers in solving their socioeconomic problems such as the overabundance of labor force and the lack of livelihood alternatives. Without this, there will be scarcely any effective biodiversity conservation and successful reserve management in the long term.

  12. Proteins with complex architecture as potential targets for drug design: a case study of Mycobacterium tuberculosis.

    Directory of Open Access Journals (Sweden)

    Bálint Mészáros

    2011-07-01

    Full Text Available Lengthy co-evolution of Homo sapiens and Mycobacterium tuberculosis, the main causative agent of tuberculosis, resulted in a dramatically successful pathogen species that presents considerable challenge for modern medicine. The continuous and ever increasing appearance of multi-drug resistant mycobacteria necessitates the identification of novel drug targets and drugs with new mechanisms of action. However, further insights are needed to establish automated protocols for target selection based on the available complete genome sequences. In the present study, we perform complete proteome level comparisons between M. tuberculosis, mycobacteria, other prokaryotes and available eukaryotes based on protein domains, local sequence similarities and protein disorder. We show that the enrichment of certain domains in the genome can indicate an important function specific to M. tuberculosis. We identified two families, termed pkn and PE/PPE that stand out in this respect. The common property of these two protein families is a complex domain organization that combines species-specific regions, commonly occurring domains and disordered segments. Besides highlighting promising novel drug target candidates in M. tuberculosis, the presented analysis can also be viewed as a general protocol to identify proteins involved in species-specific functions in a given organism. We conclude that target selection protocols should be extended to include proteins with complex domain architectures instead of focusing on sequentially unique and essential proteins only.

  13. Renal angiomyolipoma in Birt-Hogg-Dube syndrome: A case study supporting overlap with tuberous sclerosis complex.

    Science.gov (United States)

    Dow, Eryn; Winship, Ingrid

    2016-12-01

    Birt-Hogg-Dube syndrome (BHD) is an autosomal dominant disease characterised by benign cutaneous lesions, pulmonary cysts, and an increased risk of renal tumors. This rare condition is due to a mutation in the folliculin (FLCN) gene on chromosome 17q11.2, which has a role in the mechanistic/mammalian target of rapamycin (mTOR) signaling pathway of tumorigenesis. This case illustrates a patient with BHD and a renal angiomyolipoma, a neoplastic lesion not usually associated with BHD but common in Tuberous Sclerosis Complex (TSC). There is both clinical and molecular overlap between BHD and TSC, which may arise from similarities in function of the TSC and FLCN proteins in the mTOR pathway; this case further demonstrates this potential correlation. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

  14. Global sensitivity analysis for complex ecological models: a case study of riparian cottonwood population dynamics.

    Science.gov (United States)

    Harper, Elizabeth B; Stella, John C; Fremier, Alexander K

    2011-06-01

    Mechanism-based ecological models are a valuable tool for understanding the drivers of complex ecological systems and for making informed resource-management decisions. However, inaccurate conclusions can be drawn from models with a large degree of uncertainty around multiple parameter estimates if uncertainty is ignored. This is especially true in nonlinear systems with multiple interacting variables. We addressed these issues for a mechanism-based, demographic model of Populus fremontii (Fremont cottonwood), the dominant riparian tree species along southwestern U.S. rivers. Many cottonwood populations have declined following widespread floodplain conversion and flow regulation. As a result, accurate predictive models are needed to analyze effects of future climate change and water management decisions. To quantify effects of parameter uncertainty, we developed an analytical approach that combines global sensitivity analysis (GSA) with classification and regression trees (CART) and Random Forest, a bootstrapping CART method. We used GSA to quantify the interacting effects of the full range of uncertainty around all parameter estimates, Random Forest to rank parameters according to their total effect on model predictions, and CART to identify higher-order interactions. GSA simulations yielded a wide range of predictions, including annual germination frequency of 10-100%, annual first-year survival frequency of 0-50%, and patch occupancy of 0-100%. This variance was explained primarily by complex interactions among abiotic parameters including capillary fringe height, stage-discharge relationship, and floodplain accretion rate, which interacted with biotic factors to affect survival. Model precision was primarily influenced by well-studied parameter estimates with minimal associated uncertainty and was virtually unaffected by parameter estimates for which there are no available empirical data and thus a large degree of uncertainty. Therefore, research to improve

  15. Multiple dimensions of transitions in complex socio-ecological systems - A case from China

    Science.gov (United States)

    Liu, Wei; Yang, Wu; Vina, Andres; Schröter, Dagmar; Liu, Jianguo

    2013-04-01

    Transitions in complex socio-ecological systems are intermediate phases between two successive and more stable periods or states and involve various societal, ecological, and biophysical changes that are often non-linear and inter-related. Understanding transitions is challenging but important for managing socio-ecological systems for achieving environmental sustainability and improving human well-being. Long-term and intensive research is warranted to disclose common patterns and mechanisms of socio-ecological transitions and to develop ideas and methods for studying and planning sustainable transitions. Based on a long-term research on human-nature relationships in Wolong Nature Reserve in China, we studied multiple concurrent social, economic, and ecological transitions during the last 15 years. As a UNESCO biosphere reserve, Wolong lies within a global biodiversity hotspot and a World Heritage site. It contains the largest populations of the world-famous endangered giant pandas and several thousand other animal and plant species. Like most nature reserves in China and many other developing countries, Wolong is also home to many local residents who undertake a variety of activities that involve interaction with ecosystem. For the majority of the 20th century, local people in Wolong lived under poverty line in a closed subsistence-based agricultural economy. Their demands on for wood (as fuel and raw materials) from the natural forests were high and resulted in severe deforestation, habitat degradation, and landslides. Since late 1990s, a series of major economic (e.g., tourism development) and environmental (e.g., payment for ecosystem services programs) policies have been implemented in the reserve as adaptive strategies to cope with poverty and ecological degradation. Within a decade, we have observed major transitions in land use (i.e., from extractive use to non-consumptive use), economic structure (i.e., from a subsistence-based agricultural economy to an

  16. Traumatic complex wounds, multidisciplinary approach: our experience in a case series.

    Science.gov (United States)

    Assenza, M; Valesini, L; Monacelli, G; Simonelli, L; Antoniozzi, A; Ferrazza, G C; Usai, V; Romeo, V; Modini, C

    2010-01-01

    "Limb-salvage" is a social problem that is rapidly increasing, both in Italy and in the rest of world. Today, as in earlier times, the main causes of open wounds are traumas and such injuries are mainly of II and III stage of Gustilo's classification. Nowadays, the use of modern techniques determined a further dramatic reduction in the infection rates and, above all, in the risk of limb amputation. The most important techniques include: V.A.C. therapy (vacuum assisted closure); PRP gel (platelet-rich plasma gel); hyperbaric oxygen therapy. We treated 4 patients with high energy acute trauma through the combined and innovative use of advanced dressings. The authors report their experience and a brief review of the literature as contribution in regards to treatment of complex wounds of the limbs.

  17. Familial clustering of congenital deafness, patent ductus arteriosus, Eisenmenger complex, and differential cyanosis: A case report.

    Science.gov (United States)

    Lin, Ting-Wei; Tseng, Chih-Wei; Huang, Chi-Yao; Wang, Kuo-Yang; Liang, Kae-Woei

    2017-06-01

    Few studies had reported syndromes that include patent ductus arteriosus (PDA) with Eisenmenger syndrome and congenital deafness clustered in male siblings without facial, skeletal, or mental abnormalities. Two brothers, who were deaf and had PDA with Eisenmenger complex, were first seen at our Cardiology clinic at the ages of 25 and 41, respectively. They presented with progressive dyspnea on exertion. Upon physical examination, both brothers had clubbing and/or cyanotic toes, normal fingers, and without facial, skeletal, ophthalmological, or mental abnormalities. Echocardiography and multidetector computed tomography revealed large PDAs in both brothers. Cardiac catheterization showed bidirectional shunting via the PDA. Familial clustering of Eisenmenger PDA and congenital deafness is rare. Further studies are warranted to define possible genetic links.

  18. Double lumbosacral lipomas of the dorsal and filar types associated with OEIS complex: case report.

    Science.gov (United States)

    Tokunaga, So; Morioka, Takato; Hashiguchi, Kimiaki; Samura, Kazuhiro; Yoshida, Fumiaki; Miyagi, Yasushi; Yoshiura, Takashi; Yamanouchi, Takeshi; Sasaki, Tomio

    2009-10-01

    A female baby was born at 37 weeks and 6 days gestation by vaginal delivery with omphalocele, exstrophy of the cloaca, and imperforate anus, indicating the presence of OEIS complex, a rare combination of defects consisting of omphalocele (O), exstrophy of the cloaca (E), imperforate anus (I), and spinal deformity (S), associated with lumbosacral lipoma. The most common associated spinal deformity is terminal myelocystocele, and spinal lipoma is rare. Constructive interference in steady-state magnetic resonance imaging clearly revealed double lipomas, a dorsal-type lipoma, located dorsal to the low-lying conus medullaris, and a filar-type lipoma, revealed by a thickened and fatty filum terminale. After recovery from abdominogenital repairs, debulking of the dorsal-type lipoma and untethering of the spinal cord by sectioning of the filar-type lipoma were performed at the age of 14 months. Neurosurgical treatment for occult spinal dysraphism should be undertaken after recovery from the initial series of major abdominogenital procedures.

  19. A case report of complex auricular neuralgia treated with the great auricular nerve and facet blocks

    Directory of Open Access Journals (Sweden)

    Eghtesadi M

    2017-02-01

    Full Text Available Marzieh Eghtesadi,1 Elizabeth Leroux,2 Grisell Vargas-Schaffer3 1Department of Pain Clinic, Headache Management, Centre Hospitalier de l’Université de Montréal (CHUM, Centre de Recherche de l’Université de Montréal (CRCHUM, 2Department of General Neurology, Headache Management, Centre Hospitalier de l’Université de Montréal (CHUM, Centre de Recherche de l’Université de Montréal (CRCHUM, 3Department of Anesthesiology, Pain Clinic, Centre Hospitalier de l’Université de Montréal (CHUM, Centre de Recherche de l’Université de Montréal (CRCHUM, Montreal, QC, Canada Background: The great auricular nerve is a cutaneous branch of the cervical plexus originating from the C2 and C3 spinal nerves. It innervates the skin over the external ear, the angle of the mandible and the parotid gland. It communicates with the ansa cervicalis. Great auricular neuralgia is rarely diagnosed in clinical practice and can be refractory. We present a new approach using ultrasound-guided nerve blocks.Case: We present a case of a 41-year-old female with paroxysmal ear pain accompanied by dysautonomia, tingling in the tongue, dysphagia, dysarthria and abdominal symptoms. No significant findings were found on cervical and brain imaging. The patient responded partially to a great auricular nerve block. A combined approach using this block with facet block of C2 and C3 induced a more pronounced and prolonged benefit.Conclusion: Great auricular neuralgia is not often encountered in practice and can be accompanied by symptoms originating from the ansa cervicalis network. A combined approach of nerve blocks can be considered in refractory cases. Keywords: ansa cervicalis, neuropathic pain, facet block, red ear syndrome, great auricular nerve

  20. A possible new syndrome with growth-hormone secreting pituitary adenoma, colonic polyposis, lipomatosis, lentigines and renal carcinoma in association with familial testicular germ cell malignancy: A case report

    Directory of Open Access Journals (Sweden)

    Mai Phuong L

    2007-03-01

    Full Text Available Abstract Background Germ-cell testicular cancer has not been definitively linked to any known hereditary cancer susceptibility disorder. Familial testicular cancer in the presence of other findings in affected and unaffected family members might indicate a previously-unidentified hereditary cancer syndrome. Case presentation The patient was diagnosed with a left testicular seminoma at age 28, and treated with left orchiectomy followed by adjuvant cobalt radiation. His family history is significant for testicular seminoma in his son, bladder cancer in his sister, and lipomatosis in his father. His evaluation as part of an etiologic study of familial testicular cancer revealed multiple colon polyps (adenomatous, hyperplastic, and hamartomatous first found in his 50 s, multiple lipomas, multiple hyperpigmented skin lesions, left kidney cancer diagnosed at age 64, and a growth-hormone producing pituitary adenoma with associated acromegaly diagnosed at age 64. The patient underwent genetic testing for Cowden syndrome (PTEN gene, Carney complex (PRKAR1A gene, and multiple endocrine neoplasia syndrome type 1 (MEN1 gene; no deleterious mutations were identified. Discussion The constellation of benign and malignant neoplasms in the context of this patient's familial testicular cancer raised the possibility that these might be manifestations of a known hereditary susceptibility cancer syndrome; however, genetic testing for the three syndromes that were most likely to explain these findings did not show any mutation. Alternatively, this family's phenotype might represent a novel neoplasm susceptibility disorder. This possibility cannot be evaluated definitively on the basis of a single case report; additional observations and studies are necessary to investigate this hypothesis further.

  1. Epidermal Grafting for Chronic Complex Wounds in India: A Case Series

    Science.gov (United States)

    Chaudhary, Dr. Ajay; Purushothaman, Shyam; K.V., Smitha; Arvind K., Varada

    2016-01-01

    Background  In India, the high cost of medical treatments and limited resources can deter patients from receiving available care, leading to the development of chronic wounds. We evaluated the use of epidermal grafting in patients with complex, long-term chronic wounds. Methods Eighteen patients with complex wounds were treated with epidermal micrografts between September 2014 and March 2015 at a state-run, community health center in Mahe, Puducherry, India. Wound re-epithelialization was monitored for up to 14 weeks. Results  Comorbidities in the patient group (nine females and nine males; mean age 54.1 ± 10.8 years, range 32–70 years) included diabetes mellitus, hypertension, obesity (body mass index (BMI) >30 kg/m2), and peripheral vascular disease. The wound types included diabetic and nondiabetic foot, pressure, and venous leg ulcers. The average wound age prior to treatment was 36.8 ± 48.5 months (range 2–180 months) in the majority of patients. All wounds measured less than 7 cm × 7 cm. The mean time to wound epithelialization was 3.7 ± 1.8 weeks (range 2–9 weeks). The majority of wounds healed following epidermal grafting (n=16, 88.9%). One patient developed infection following removal of the dressing under non-sterile conditions against the advice of the healthcare providers. Another patient developed wound hypergranulation after grafting. Both wounds healed completely after treatment with antibiotic therapy and tissue resection, respectively. All donor sites healed without complications. Conclusion  In patients with small- to medium-sized chronic wounds, epidermal grafting offered a viable wound closure option for wounds requiring only the epidermal layer. Additionally, epidermal grafting was performed in the clinic without anesthesia or a surgeon, making the procedure more accessible in resource-challenged regions. PMID:27054051

  2. 3D Inversion of complex resistivity data: Case study on Mineral Exploration Site.

    Science.gov (United States)

    Son, Jeong-Sul; Kim, Jung-ho; Park, Sam-gyu; Park, My-Kyung

    2016-04-01

    Complex resistivity (CR) method is a frequency domain induced polarization (IP) method. It is also known as Spectral IP (SIP) method, if wider frequencies are used in data acquisition and interpretation. Although it takes more times than conventional time domain IP method, its data quality is more stable because its data acquisition which measures amplitude and phase is done when the source current is being injected. Our research group has been studying the modeling and inversion algorithms of complex resistivity (CR) method since several years ago and recently applied developed algorithms to various real field application. Due to tough terrain in our country, Profile survey and 2D interpretation were generally used. But to get more precise interpretation, three dimensional modeling and inversion algorithm is required. We developed three dimensional inversion algorithm for this purpose. In the inversion, we adopt the method of adaptive lagraingian multiplier which is automatically set based on the size of error misfit and model regularization norm. It was applied on the real data acquired for mineral exploration sites. CR data was acquired with the Zeta system, manufactured by Zonge Co. In the inversion, only the lower frequency data is used considering its quality and developed 3D inversion algorithm was applied to the acquired data set. Its results were compared to those of time domain IP data conducted at the same site. Resistivity image sections of CR and conventional resistivity method were almost identical. Phase anomalies were well matched with chargeability anomalies and the mining history of the test site. Each anomalies were well discriminated in 3D interpretation than those of 2D. From those experiments, we know that CR method was very effective for the mineral exploration.

  3. Particle image velocimetry measurement of complex flow structures in the diffuser and spherical casing of a reactor coolant pump

    Directory of Open Access Journals (Sweden)

    Yongchao Zhang

    2018-04-01

    Full Text Available Understanding of turbulent flow in the reactor coolant pump (RCP is a premise of the optimal design of the RCP. Flow structures in the RCP, in view of the specially devised spherical casing, are more complicated than those associated with conventional pumps. Hitherto, knowledge of the flow characteristics of the RCP has been far from sufficient. Research into the nonintrusive measurement of the internal flow of the RCP has rarely been reported. In the present study, flow measurement using particle image velocimetry is implemented to reveal flow features of the RCP model. Velocity and vorticity distributions in the diffuser and spherical casing are obtained. The results illuminate the complexity of the flows in the RCP. Near the lower end of the discharge nozzle, three-dimensional swirling flows and flow separation are evident. In the diffuser, the imparity of the velocity profile with respect to different axial cross sections is verified, and the velocity increases gradually from the shroud to the hub. In the casing, velocity distribution is nonuniform over the circumferential direction. Vortices shed consistently from the diffuser blade trailing edge. The experimental results lend sound support for the optimal design of the RCP and provide validation of relevant numerical algorithms. Keywords: Diffuser, Flow Structures, Particle Image Velocimetry, Reactor Coolant Pump, Spherical Casing, Velocity Distribution

  4. Collaboration, communication and categorical complexity: A case study in collaboratory evaluation

    DEFF Research Database (Denmark)

    Cleal, B.R.; Andersen, H.H.K.; Albrechtsen, H.

    2004-01-01

    This article presents findings from an empirical evaluation of a collaboratory supporting film research. Few collaboratories have been formally evaluated. The article makes a case for looking at wider work-based contexts users engage in. Focussing on key features of the prototype system......, it is shown that the design, while providing adequate functionality, fails to support the way users currently work. The relative advantages and disadvantages of this outcome are then assessed. Acknowledging the need for consistency in design, the article concludes that this should not be at the expense...

  5. Complex-network analysis of combinatorial spaces: the NK landscape case.

    Science.gov (United States)

    Tomassini, Marco; Vérel, Sébastien; Ochoa, Gabriela

    2008-12-01

    We propose a network characterization of combinatorial fitness landscapes by adapting the notion of inherent networks proposed for energy surfaces. We use the well-known family of NK landscapes as an example. In our case the inherent network is the graph whose vertices represent the local maxima in the landscape, and the edges account for the transition probabilities between their corresponding basins of attraction. We exhaustively extracted such networks on representative NK landscape instances, and performed a statistical characterization of their properties. We found that most of these network properties are related to the search difficulty on the underlying NK landscapes with varying values of K .

  6. Management of Complex Industrial Supplier Relations - a Case of Customer Attractiveness

    DEFF Research Database (Denmark)

    Ellegaard, Chris

    of supplier relationships of the company Danfoss Drives, an alternative understanding of the supplier relationship management task is proposed. The case study methodology forms the basis for the applied research design. The alternative understanding sees the management task as one of influencing suppliers...... relationship management is proposed – the concept of Customer Attractiveness. Customer Attractiveness is founded on the revised understanding of the supplier relationship management task and focuses on influencing suppliers by being an attractive customer, hereby motivating the necessary commitment to long...

  7. Stream computing for biomedical signal processing: A QRS complex detection case-study.

    Science.gov (United States)

    Murphy, B M; O'Driscoll, C; Boylan, G B; Lightbody, G; Marnane, W P

    2015-01-01

    Recent developments in "Big Data" have brought significant gains in the ability to process large amounts of data on commodity server hardware. Stream computing is a relatively new paradigm in this area, addressing the need to process data in real time with very low latency. While this approach has been developed for dealing with large scale data from the world of business, security and finance, there is a natural overlap with clinical needs for physiological signal processing. In this work we present a case study of streams processing applied to a typical physiological signal processing problem: QRS detection from ECG data.

  8. Case report 483: Discoid lateral meniscus (DLM), medially displaced, with complex tear

    International Nuclear Information System (INIS)

    Howe, M.A.; Buckwalter, K.A.; Braunstein, E.M.; Wojtys, E.M.

    1988-01-01

    A case of a 9-year-old girl who presented with persistent pain in the left knee was demonstrated to have a discoid lateral meniscus (DLM). The sagittal MR images demonstrated the oval shape of the meniscus, consistent with the typical arthrographic appearance. The coronal images showed that the main substance of the meniscus was displaced medially, with overgrowth of the articular cartilage at the lateral aspect of the joint. The medial aspect of the lateral femoral condyle was concave to accommodate the abnormal meniscus. These findings are consistent with long-standing, medial displacement of the torn meniscus. The literature concerning DLM, an uncommon variant, was reviewed and discussed. (orig.)

  9. A Complex Case of Cholestasis in a Patient with ABCB4 and ABCB11 Mutations

    Directory of Open Access Journals (Sweden)

    Mariana Ferreira Cardoso

    2017-11-01

    Full Text Available The low-phospholipid-associated cholelithiasis (LPAC syndrome is a form of symptomatic cholelithiasis occurring in young adults, characterized by recurrence of symptoms after cholecystectomy and presence of hepatolithiasis. The case refers to a healthy 39-year-old Caucasian male who presented with abdominal pain and jaundice. His blood tests showed conjugated hyperbilirubinemia and elevated liver enzymes (total bilirubin 6.65 mg/dL, γ-glutamyltransferase 699 IU/L and abdominal computed tomography revealed dilation of common bile duct and left intrahepatic ducts. Magnetic resonance cholangiopancreatography identified choledocholithiasis, retrieved by endoscopic retrograde cholangiopancreatography, after which there was a worsening of jaundice (total bilirubin 23 mg/dL, which persisted for several weeks, possibly due to ciprofloxacin toxicity. After an extensive workup including liver biopsy, the identification of two foci of hepatolithiasis on reevaluation abdominal ultrasound raised the hypothesis of LPAC syndrome and the patient was started on ursodeoxycholic acid, with remarkable improvement. Genetic testing identified the mutation c.1954A>G (p.Arg652Gly in ABCB4 gene (homozygous and c.1331T>C (p.Val444Ala in ABCB11 gene (heterozygous. In conclusion, we describe the unique case of an adult male with choledocholithiasis, hepatolithiasis, and persistent conjugated hyperbilirubinemia after retrieval of stones, fulfilling the criteria for LPAC syndrome and with possible superimposed drug-induced liver injury, in whom ABCB4 and ABCB11 mutations were found, both of which had not been previously described in association with LPAC.

  10. A case study of infant physiologic response to skin-to-skin contact following surgery for complex congenital heart disease

    Science.gov (United States)

    Harrison, Tondi M.; Ludington-Hoe, Susan

    2014-01-01

    Background Infants with complex congenital heart disease requiring surgical intervention within the first days or weeks of life may be the most seriously ill infants needing intensive nursing and medical care immediately after birth. Skin to skin contact (SSC) is well-accepted and practiced as a positive therapeutic intervention in premature infants, but is not routinely offered to infants in cardiac intensive care units. Physiologic effects of SSC in the congenital heart disease population must be examined before recommending incorporation of SSC into standard care routines. Objective The purpose of this case study was to describe the physiologic response to a single session of SSC in an 18-day-old infant with hypoplastic left heart syndrome. Methods Repeated measures of heart rate, respiratory rate, oxygen saturation, blood pressure, and temperature were recorded 30 minutes prior to SSC, during SSC (including interruptions for bottle and breast feedings), and 10 minutes after SSC was completed. Results All physiologic parameters were clinically acceptable throughout the 135-minute observation. Conclusion This case study provides beginning evidence that SSC is safe in full-term infants following surgery for complex congenital heart disease. Further research with a larger sample is needed to examine effects of SSC on infant physiology before surgery and earlier in the postoperative time period as well as on additional outcomes such as length of stay, maternal-infant interaction, and neurodevelopment. PMID:25325374

  11. Critical analysis of the data on complexation of lanthanides and actinides by natural organic matter: particular case of humic substances

    International Nuclear Information System (INIS)

    Reiller, P.

    2010-01-01

    This document proposes a critical analysis of the models that describe the actinides and lanthanides complexation by natural organic matter in general and by humic substances in particular. In order to better delimit the particular properties of these substances the most influent physical and chemical properties on complexation are recalled as a preamble. Models as well as data that has been used are reviewed, compiled, and eventually compared to independent data in order to identify (i) their application domain, (ii) the possible simplifications which permit to obtain operational models, (iii) the conditions in which simplifications cannot be ascertained yet, and (iv) the data or fields of knowledge which are still too uncertain. A comparison between the different models is proposed in order to adapt parameters from one model to another minimising the experimental acquisitions, or at least to focus on missing data. Usually, data on the complexation of free ions M z+ are reliable; as soon as hydrolysis, or competition with another ligand in general, in at stake data are much less reliable. Predictions from models are much more uncertain: formation of mixed complexes with hydroxide or carbonate anions is not univocal whatever the modelling strategy. Hints for transfer functions between models which are believed to be incompatible could be explored in order to justify necessary simplifications for using operational modelling. Influence on the solubility of oxides could be quantified, but it is difficult to clearly separate it from colloidal particles stabilisation. The account of the competition between cations by the models has also been tested. In view of the small number of available experimental data there still lie some uncertainties especially for the media that are close to neutrality and in the case of competition with magnesium, but overall in the case of the competition with aluminium and iron. The influence of redox activity of humic substances is also

  12. Emergent nested systems a theory of understanding and influencing complex systems as well as case studies in urban systems

    CERN Document Server

    Walloth, Christian

    2016-01-01

    This book presents a theory as well as methods to understand and to purposively influence complex systems. It suggests a theory of complex systems as nested systems, i. e. systems that enclose other systems and that are simultaneously enclosed by even other systems. According to the theory presented, each enclosing system emerges through time from the generative activities of the systems they enclose. Systems are nested and often emerge unplanned, and every system of high dynamics is enclosed by a system of slower dynamics. An understanding of systems with faster dynamics, which are always guided by systems of slower dynamics, opens up not only new ways to understanding systems, but also to effectively influence them. The aim and subject of this book is to lay out these thoughts and explain their relevance to the purposive development of complex systems, which are exemplified in case studies from an urban system. The interested reader, who is not required to be familiar with system-theoretical concepts or wit...

  13. The Design Features of Complex Vessels of Malyshev Neolithic Culture of Lower Priamurye (case study: Malyshevo 1 Settlement

    Directory of Open Access Journals (Sweden)

    Inga V. Filatova

    2015-03-01

    Full Text Available According to the author’s opinion, the solution for cultural genesis issues can be tackled through the analysis of structural peculiarities of hollow bodies of vessels of different ceramic complexes. The ceramics of the Malyshev Culture of the Lower Amur is no exception. The article traces the evolution of researchers’ views in regard to Neolithic culture in inner periodization of the region as well as cultural relevance of early complex ceramics by a well known Soviet archeologist academic A.P. Okladnykov – stage of Lower Amur Neolithic culture. Case study: visualization of ceramic collection of one-layer Neolithic settlement Malyshevo-1 (“At the craftsmen”. Here we identify two vessel groups, which differ through their morphological and decorative features. On the ground of technological assessments of manufacturing techniques by I. G. Glushkov (1996, including methodological developments by A. A. Bobrinsky (1978, the program of hollow body design is researched. The manufacturing techniques are identified (methods of fixing, build-up, straps oiling, types of molding, filling program, cutting and bottom fixing. The mixed programs of hollow body vessels are identified and locations of two pottery traditions are found. A competitive analysis for identifying the peculiarities of Malyshev ceramics and Neolithic materials of the Lower Amur and bordering seaside territories. There are similarities are drawn out between ceramic complexes of Osipov culture of early Neolithic (Lower Amur and Rudninsky culture (Rudninsky type, Sergeev type of early Neolithic (seaside territories.

  14. Management of Complex Knee Deformities in Asian Population: Our Experience of 11 Cases

    Directory of Open Access Journals (Sweden)

    Syed Shahid Noor

    2015-01-01

    Total Knee Arthroplasty (TKA is a life changing procedure for such patients. Great improvements in quality of life and outcome measure scores have been observed in patients undergone TKA. Our patients are challenging further as compared to western population because they present late for consultation when the disease and deformity is advanced. Their expectations are high, as they wish to resume their ground base activities such as kneeling for prayers. Furthermore with financial constraints present with most of the patients, one has to be careful in choosing the type of implant and keep in consideration other alternative available options. This case series encompasses our experience of TKA on patients with variety of challenging deformities, their short term outcome and a review of the literature.

  15. The Complexities of Implementing Cluster Supply Chain - Case Study of JCH

    Science.gov (United States)

    Xue, Xiao; Zhang, Jibiao; Wang, Yang

    As a new type of management pattern, "cluster supply chain" (CSC) can help SMEs to face the global challenges through all kinds of collaboration. However, a major challenge in implementing CSC is the gap between theory and practice in the field. In an effort to provide a better understanding of this emerging phenomenon, this paper presents the implementation process of CSC in the context of JingCheng Mechanical & Electrical Holding co., ltd.(JCH) as a case study. The cast study of JCH suggests that the key problems in the practice of cluster supply chain: How do small firms use cluster supply chain? Only after we clarify the problem, the actual construction and operation of cluster supply chain does show successful results as it should be.

  16. Exposing the key functions of a complex intervention for shared care in mental health: case study of a process evaluation

    Directory of Open Access Journals (Sweden)

    Redfern Sally

    2008-12-01

    Full Text Available Abstract Background Complex interventions have components which can vary in different contexts. Using the Realistic Evaluation framework, this study investigates how a complex health services intervention led to developments in shared care for people with long-term mental illness. Methods A retrospective qualitative interview study was carried out alongside a randomised controlled trial. The multi-faceted intervention supported by facilitators aimed to develop systems for shared care. The study was set in London. Participants included 46 practitioners and managers from 12 participating primary health care teams and their associated community mental health teams. Interviews focussed on how and why out comes were achieved, and were analysed using a framework incorporating context and intervening mechanisms. Results Thirty-one interviews were completed to create 12 case studies. The enquiry highlighted the importance of the catalysing, doing and reviewing functions of the facilitation process. Other facets of the intervention were less dominant. The intervention catalysed the allocation of link workers and liaison arrangements in nearly all practices. Case discussions between link workers and GPs improved individual care as well as helping link workers become part of the primary care team; but sustained integration into the team depended both on flexibility and experience of the link worker, and upon selection of relevant patients for the case discussions. The doing function of facilitators included advice and, at times, manpower, to help introduce successful systems for reviewing care, however time spent developing IT systems was rarely productive. The reviewing function of the intervention was weak and sometimes failed to solve problems in the development of liaison or recall. Conclusion Case discussions and improved liaison at times of crisis, rather than for proactive recall, were the key functions of shared care contributing to the success of

  17. Optimizing Treatment for Complex Cases of Childhood Obsessive Compulsive Disorder: A Preliminary Trial

    Science.gov (United States)

    Peris, Tara S.; Piacentini, John

    2012-01-01

    Objective Family factors such as conflict, blame, and poor cohesion have been found to attenuate response to cognitive behavior therapy (CBT) for pediatric obsessive compulsive disorder (OCD). This study examined the feasibility and acceptability of a brief, personalized intervention for cases of pediatric OCD complicated by these family features. Method Twenty youth with a primary DSM-IV diagnosis of OCD (mean age = 12.50 years; 55% male; 60% Caucasian) and their families participated. To be included in the study, families were required to evidence poor functioning on measures of blame, conflict, and/or cohesion. Eligible families were randomly assigned to either standard treatment (ST) with 12 weeks of individual child CBT that included weekly parent check ins and psychoeducation or to Positive Family Interaction Therapy (PFIT), which consisted of 12 weeks of individual child CBT plus an additional six sessions of family treatment aimed at shifting family dynamics. Clinical outcomes were determined by blind independent evaluators using the Clinician's Global Impressions-Improvement (CGI-I) scale. Results All families completed the study. High levels of satisfaction were reported among participants in both arms of the study, despite the added burden of attending the PFIT sessions. Both mothers and fathers attended 95% of the PFIT family sessions. Families in the ST condition demonstrated a 40% response rate on the CGI-I; families in the PFIT condition demonstrated a 70% response rate. Treatment gains were maintained in both conditions at 3-month follow-up. Conclusions Preliminary data suggest that PFIT is acceptable and feasible. Further testing and treatment development are needed to optimize outcomes for complicated cases of pediatric OCD. PMID:22548378

  18. Methodology for designing and manufacturing complex biologically inspired soft robotic fluidic actuators: prosthetic hand case study.

    Science.gov (United States)

    Thompson-Bean, E; Das, R; McDaid, A

    2016-10-31

    We present a novel methodology for the design and manufacture of complex biologically inspired soft robotic fluidic actuators. The methodology is applied to the design and manufacture of a prosthetic for the hand. Real human hands are scanned to produce a 3D model of a finger, and pneumatic networks are implemented within it to produce a biomimetic bending motion. The finger is then partitioned into material sections, and a genetic algorithm based optimization, using finite element analysis, is employed to discover the optimal material for each section. This is based on two biomimetic performance criteria. Two sets of optimizations using two material sets are performed. Promising optimized material arrangements are fabricated using two techniques to validate the optimization routine, and the fabricated and simulated results are compared. We find that the optimization is successful in producing biomimetic soft robotic fingers and that fabrication of the fingers is possible. Limitations and paths for development are discussed. This methodology can be applied for other fluidic soft robotic devices.

  19. Hiding phase-quantized biometrics: a case of steganography for reduced-complexity correlation filter classifiers

    Science.gov (United States)

    Hennings, Pablo; Savvides, Marios; Vijaya Kumar, B. V. K.

    2005-03-01

    This paper introduces an application of steganography for hiding cancelable biometric data based on quad-phase correlation filter classification. The proposed technique can perform two tasks: (1) embed an encrypted (cancelable) template for biometric recognition into a host image or (2) embed the biometric data required for remote (or later) classification, such as embedding a transformed face image into the host image, so that it can be transmitted for remote authentication or stored for later use. The novel approach is that we will encode quantized Fourier domain information of the template (or biometric) in the spatial representation of the host image. More importantly we show that we only need 2 bits per pixel in the frequency domain to represent the filter and biometric, making it compact and ideal for application of data hiding. To preserve the template (or biometric) from vulnerabilities to successful attacks, we encrypt the filter or biometric image by convolving it with a random kernel which essentially produces an image in the spatial domain which looks like white noise, so essentially both the frequency and spatial representations will have no visible exploitable structure. We also present results on reduced complexity correlation filter classification performance when using biometric images recovered from stego-images.

  20. Complex analysis of energy efficiency in operated high-rise residential building: Case study

    Directory of Open Access Journals (Sweden)

    Korniyenko Sergey

    2018-01-01

    Full Text Available Energy conservation and human thermal comfort enhancement in buildings is a topical issue of modern architecture and construction. The innovative solution of this problem makes it possible to enhance building ecological and maintenance safety, to reduce hydrocarbon fuel consumption, and to improve life standard of people. The requirements to increase of energy efficiency in buildings should be provided at all the stages of building's life cycle that is at the stage of design, construction and maintenance of buildings. The research purpose is complex analysis of energy efficiency in operated high-rise residential building. Many actions for building energy efficiency are realized according to the project; mainly it is the effective building envelope and engineering systems. Based on results of measurements the energy indicators of the building during annual period have been calculated. The main reason of increase in heat losses consists in the raised infiltration of external air in the building through a building envelope owing to the increased air permeability of windows and balcony doors (construction defects. Thermorenovation of the building based on ventilating and infiltration heat losses reduction through a building envelope allows reducing annual energy consumption. Energy efficiency assessment based on the total annual energy consumption of building, including energy indices for heating and a ventilation, hot water supply and electricity supply, in comparison with heating is more complete. The account of various components in building energy balance completely corresponds to modern direction of researches on energy conservation and thermal comfort enhancement in buildings.

  1. Is the NIMBY syndrome real and remediable? A case of complex decision-making

    International Nuclear Information System (INIS)

    Tanaka, Yasumasa

    2003-01-01

    What is commonly termed the NIMBY syndrome is a complex psychological process. It is related to risk perception and anticipation; utility value judgment; and the approach-avoidance stimulus formation and the reward-punishment learning. The first section of the present paper briefly discusses these psychological aspects of the NIMBY reactions. The second section of this paper deals with the issues associated with risk perception and communication. Importance of factors relevant to risk-benefit trade-off is discussed. On the basis of both the theoretical model of communication and the result obtained from a number of empirical research, salient factors affecting the effectiveness of risk communication will be discussed. The last section presents a rational model of entire risk communication process. It is concluded that public acceptance of the siting of nuclear power plants is susceptible to a number of socio-psychological factors. Four most important factors in the risk communication process are the source (the sender), the message, the destination (the receiver) and the channel, which affect the effectiveness of communication. Dominant socio-political values, such as an equal opportunity to participate in decision-making, the openness and transparency of information, also seems to influence the process of enhancing public acceptance of nuclear energy. (author)

  2. Detecting outliers and learning complex structures with large spectroscopic surveys - a case study with APOGEE stars

    Science.gov (United States)

    Reis, Itamar; Poznanski, Dovi; Baron, Dalya; Zasowski, Gail; Shahaf, Sahar

    2018-02-01

    In this work we apply and expand on a recently introduced outlier detection algorithm that is based on an unsupervised random forest. We use the algorithm to calculate a similarity measure for stellar spectra from the Apache Point Observatory Galactic Evolution Experiment (APOGEE). We show that the similarity measure traces non-trivial physical properties and contains information about complex structures in the data. We use it for visualization and clustering of the dataset, and discuss its ability to find groups of highly similar objects, including spectroscopic twins. Using the similarity matrix to search the dataset for objects allows us to find objects that are impossible to find using their best fitting model parameters. This includes extreme objects for which the models fail, and rare objects that are outside the scope of the model. We use the similarity measure to detect outliers in the dataset, and find a number of previously unknown Be-type stars, spectroscopic binaries, carbon rich stars, young stars, and a few that we cannot interpret. Our work further demonstrates the potential for scientific discovery when combining machine learning methods with modern survey data.

  3. Difficult Geotechnical Conditions Under the Palace Complex, Case Study from Cianowice, Near Krakow, Poland

    Science.gov (United States)

    Gil-Mastalerczyk, Joanna; Gil, Regina

    2016-10-01

    The palace complex in Cianowice near Krakow (Lesser Poland, Poland) built around 1890, after 1945 ceased to function as a residential, so the whole building underwent successive devastation. Military activities, ad hoc repairs and long-term shortage of funds in Poland, led to the destruction of the magnificent assumptions. Since 2006. Palace remained completely unsecured and unattended. Performed in 2012-2015 modernization of the historic palace with the expansion of the basement (for residential building multigenerational) has become the occasion for a thorough diagnosis of the prevailing geotechnical conditions and the state of preservation of threads stone and brick walls and vaults chambers basement. Difficult ground conditions, water penetration, lack of insulation of horizontal and vertical has become one of the main causes of the destruction of the foundations and walls of basements. Moisture from the ground, rising damp in the walls (with dissolved salts in it), evaporate causing erosion of the walls. The result it led to the weakening of the structural and breakout layers of walls. The phenomenon has become particularly clear after the geotechnical surveys, excavations and complete discovery of the basement walls. The conducted works related to general technical renovation and restoration, included foundations (lining and insulation), walls, floors and roof. The assumption palace in Cianowice, through appropriate interference with the use of modern and introduction of a new substance, in any manner that emphasizes value and historical monument became possible to restore the important significance of the object and place.

  4. Unravelling the complex antimicrobial interactions of essential oils--the case of Thymus vulgaris (thyme).

    Science.gov (United States)

    Ahmad, Aijaz; van Vuuren, Sandy; Viljoen, Alvaro

    2014-03-06

    Thymus vulgaris has gained tremendous popularity as an ornamental, culinary herb and its use in phytotherapy is well established and supported in the literature. The objective of this study was to explore possible interactions between selected molecules within Thymus vulgaris essential oil (TvEO) to gain a better understanding of how this complex essential oil exerts its antimicrobial activity. Evaluation of the antimicrobial efficacy and interactions were assessed on the essential oil and volatile constituents against various pathogens. Interactions between molecules at various ratios were graphically observed through the construction of isobolograms. Gas chromatography-mass spectrometry (GC-MS) analysis revealed 22 compounds which collectively represent >95% of the oil composition. Based on their minimum inhibitory concentration (MIC) values, they were categorised into weak (≥4 mg mL⁻¹), moderate (2-4 mg mL⁻¹) and noteworthy active (≤2 mg mL⁻¹) compounds. For the combination study, 21% synergistic, 42% additive, 36% indifferent and 1% antagonistic interactions were observed. Most of the interactions were observed between the weak and highly active molecules, and interestingly, no synergistic interaction was observed between the highly active compounds. Synergistic and additive interactions between the strong and weaker antimicrobial constituents present in TvEO enhance the antimicrobial efficacy of this commercially important essential oil.

  5. Complex mixture-associated hormesis and toxicity: the case of leather tanning industry.

    Science.gov (United States)

    Pagano, Giovanni; Castello, Giuseppe; Gallo, Marialuisa; Borriello, Ilaria; Guida, Marco

    2008-01-01

    A series of studies investigated the toxicities of tannery-derived complex mixtures, i.e. vegetable tannin (VT) from Acacia sp. or phenol-based synthetic tannin (ST), and waste-water from tannin-based vs. chromium-based tanneries. Toxicity was evaluated by multiple bioassays including developmental defects and loss of fertilization rate in sea urchin embryos and sperm (Paracentrotus lividus and Sphaerechinus granularis), and algal growth inhibition (Dunaliella tertiolecta and Selenastrum capricornutum). Both VT and ST water extracts resulted in hormetic effects at concentrations ranging 0.1 to 0.3%, and toxicity at levels > or =1%, both in sea urchin embryo and sperm, and in algal growth bioassays. When comparing tannin-based tannery wastewater (TTW) vs. chromium-based tannery effluent (CTE), a hormesis to toxicity trend was observed for TTW both in terms of developmental and fertilization toxicity in sea urchins, and in algal growth inhibition, with hormetic effects at 0.1 to 0.2% TTW, and toxicity at TTW levels > or =1%. Unlike TTW, CTE showed a monotonic toxicity increase from the lowest tested level (0.1%) and CTE toxicity at higher levels was significantly more severe than TTW-induced toxicity. The results support the view that leather production utilizing tannins might be regarded as a more environmentally friendly procedure than chromium-based tanning process.

  6. Complex regional pain syndrome in pediatric sports: a case series of three young athletes.

    Science.gov (United States)

    Martínez-Silvestrini, Julio A; Micheo, William F

    2006-01-01

    Outpatient Sports Medicine Clinic. Three adolescent young female athletes who developed clinical findings compatible with complex regional pain syndrome (CRPS) after lower extremity trauma. Based on the clinical picture, the patients were identified and treated with physical therapy, which included desensitization techniques, stress loading, edema control, early mobilization and electrical stimulation. It was combined with pharmacotherapeutic measures such as non-steroidal anti-inflamatories, oral corticosteroids and gabapentin. One of the patients required serotonin selective reuptake inhibitors, opioid analgesics and acupuncture as an adjunctive treatment. All three patients had involvement of the lower extremities, with a degree of pain and edema exceeding the expected for the nature of their injury. They exhibited a good response to conservative treatment, with physical therapy playing a significant role on the treatment plan. One of the patients, whose diagnosis and treatment was delayed due to late referral, had a more severe presentation and protracted recovery. CRPS is a challenging disease that may affect young active and athletic patients. In this population, early clinical suspicion and aggressive treatment may lead to excellent clinical results and the avoidance of invasive procedures or long-term disability. Laboratory and imaging studies should be used to discard other conditions with clinical presentations similar to CRPS.

  7. The Challenges of Dysphagia Management and Rehabilitation in Two Complex Cases Post Chemical Ingestion Injury.

    Science.gov (United States)

    Rumbach, Anna F; Cremer, Rebecca; Chatwood, Astra; Fink, Sari; Haider, Sadaf; Yee, Michelle

    2016-11-01

    Dysphagia is common sequelae of chemical ingestion injury, resulting from damage to critical swallowing structures. From a speech-language pathology perspective, this study outlines the physiological deficits in 2 individuals with severe injury (1 woman, acid; 1 man, alkali) and the pattern of dysphagia rehabilitation and recovery. A retrospective chart review of clinical and instrumental assessments was conducted to examine swallow characteristics and speech-language pathology management (compensatory and rehabilitation strategies) at multiple time points. Chemical ingestion injury resulted in severe pharyngeal dysphagia for both participants, warranting speech-language pathology management. Dysphagia was characterized by poor base of tongue mobility and reduced laryngeal excursion. Decreased airway patency and protection, secondary to mucosal sloughing, widespread edema, and structural deficits necessitated tracheostomy. Recovery was complicated by physical alterations of pharyngeal and laryngeal structures (e.g., interarytenoid adhesions) and esophageal strictures. Participant 1 was discharged (Day 135) consuming a texture-modified diet; Participant 2 remained nil by mouth (Day 329). Dysphagia recovery subsequent to chemical ingestion is protracted and complex. Clinical outcomes may be improved through individualized and intensive rehabilitation by speech-language pathologists.

  8. Modernization at the Y-12 National Security Complex: A Case for Additional Experimental Benchmarks

    Energy Technology Data Exchange (ETDEWEB)

    Thornbury, M. L. [Y-12 National Security Complex, Oak Ridge, TN (United States); Juarez, C. [Y-12 National Security Complex, Oak Ridge, TN (United States); Krass, A. W. [Y-12 National Security Complex, Oak Ridge, TN (United States)

    2017-08-14

    Efforts are underway at the Y-12 National Security Complex (Y-12) to modernize the recovery, purification, and consolidation of un-irradiated, highly enriched uranium metal. Successful integration of advanced technology such as Electrorefining (ER) eliminates many of the intermediate chemistry systems and processes that are the current and historical basis of the nuclear fuel cycle at Y-12. The cost of operations, the inventory of hazardous chemicals, and the volume of waste are significantly reduced by ER. It also introduces unique material forms and compositions related to the chemistry of chloride salts for further consideration in safety analysis and engineering. The work herein briefly describes recent investigations of nuclear criticality for 235UO2Cl2 (uranyl chloride) and 6LiCl (lithium chloride) in aqueous solution. Of particular interest is the minimum critical mass of highly enriched uranium as a function of the molar ratio of 6Li to 235U. The work herein also briefly describes recent investigations of nuclear criticality for 235U metal reflected by salt mixtures of 6LiCl or 7LiCl (lithium chloride), KCl (potassium chloride), and 235UCl3 or 238UCl3 (uranium tri-chloride). Computational methods for analysis of nuclear criticality safety and published nuclear data are employed in the absence of directly relevant experimental criticality benchmarks.

  9. Forgotten CBD stent (102 months) with stone-stent complex: A case report.

    Science.gov (United States)

    Barai, Varsha; Hedawoo, Jagadish; Changole, Sanjay

    2017-01-01

    Choledocholithiasis is presence of stone in Common bile duct (CBD) which can be treated by endoscopy or surgery [1]. Retained foreign bodies like stents forms a nidus for stone formation resulting in pain, fever, jaundice. 60 years female patient admitted in surgery ward with features of cholangitis with computed tomography showing cholangitic abscess with dilated common bile duct and sludge around stent in situ. Stone was found at proximal end of stent during surgery. Stents may remain without complications or may migrate, and rarely form nidus for stone formation. If kept for long time they lead to bacterial proliferation, biofilm formation and precipitation of calcium bilirubinate presenting as fever, pain, jaundice. Stent-stone complex can be treated endoscopically and surgically [6,7]. As stent can cause stone formation, infection and other complications, timely removal of stent should advised. III-effects of stent in-situ should be explained, record should be maintained [8] and patient should be advised regular follow up and stent removal after 6 weeks. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

  10. Complex analysis of energy efficiency in operated high-rise residential building: Case study

    Science.gov (United States)

    Korniyenko, Sergey

    2018-03-01

    Energy conservation and human thermal comfort enhancement in buildings is a topical issue of modern architecture and construction. The innovative solution of this problem makes it possible to enhance building ecological and maintenance safety, to reduce hydrocarbon fuel consumption, and to improve life standard of people. The requirements to increase of energy efficiency in buildings should be provided at all the stages of building's life cycle that is at the stage of design, construction and maintenance of buildings. The research purpose is complex analysis of energy efficiency in operated high-rise residential building. Many actions for building energy efficiency are realized according to the project; mainly it is the effective building envelope and engineering systems. Based on results of measurements the energy indicators of the building during annual period have been calculated. The main reason of increase in heat losses consists in the raised infiltration of external air in the building through a building envelope owing to the increased air permeability of windows and balcony doors (construction defects). Thermorenovation of the building based on ventilating and infiltration heat losses reduction through a building envelope allows reducing annual energy consumption. Energy efficiency assessment based on the total annual energy consumption of building, including energy indices for heating and a ventilation, hot water supply and electricity supply, in comparison with heating is more complete. The account of various components in building energy balance completely corresponds to modern direction of researches on energy conservation and thermal comfort enhancement in buildings.

  11. Impaired perception of harmonic complexity in congenital amusia: a case study.

    Science.gov (United States)

    Reed, Catherine L; Cahn, Steven J; Cory, Christopher; Szaflarski, Jerzy P

    2011-07-01

    This study investigates whether congenital amusia (an inability to perceive music from birth) also impairs the perception of musical qualities that do not rely on fine-grained pitch discrimination. We established that G.G. (64-year-old male, age-typical hearing) met the criteria of congenital amusia and demonstrated music-specific deficits (e.g., language processing, intonation, prosody, fine-grained pitch processing, pitch discrimination, identification of discrepant tones and direction of pitch for tones in a series, pitch discrimination within scale segments, predictability of tone sequences, recognition versus knowing memory for melodies, and short-term memory for melodies). Next, we conducted tests of tonal fusion, harmonic complexity, and affect perception: recognizing timbre, assessing consonance and dissonance, and recognizing musical affect from harmony. G.G. displayed relatively unimpaired perception and production of environmental sounds, prosody, and emotion conveyed by speech compared with impaired fine-grained pitch perception, tonal sequence discrimination, and melody recognition. Importantly, G.G. could not perform tests of tonal fusion that do not rely on pitch discrimination: He could not distinguish concurrent notes, timbre, consonance/dissonance, simultaneous notes, and musical affect. Results indicate at least three distinct problems-one with pitch discrimination, one with harmonic simultaneity, and one with musical affect-and each has distinct consequences for music perception.

  12. Safety culture of complex risky systems: the Nuclear Engineering Institute case study

    International Nuclear Information System (INIS)

    Obadia, Isaac Jose; Vidal, Mario Cesar Rodriguez; Melo, Paulo Fernando F. Frutuoso e

    2002-01-01

    Analysis of industrial accidents have demonstrated that safe and reliable operation of complex industrial processes that use risky technology and/or hazard material depends not only on technical factors but on human and organizational factors as well. After the Chernobyl nuclear accident in 1986, the International Atomic Energy Agency established the safety culture concept and started a safety culture enhancement program within nuclear organizations worldwide. The Nuclear Engineering Institute, IEN, is a research and technological development unit of the Brazilian Nuclear Energy Commission, CNEN, characterized as a nuclear and radioactive installation where processes presenting risks to operators and to the environment are executed. In 1999, IEN started a management change program, aiming to achieve excellence of performance, based on the Model of Excellence of the National Quality Award. IEN's safety culture project is based on IAEA methodology and has been incorporated to the organizational management process. This work presents IEN's safety culture project; the results obtained on the initial safety culture assessment and the following project actions. (author)

  13. Detecting outliers and learning complex structures with large spectroscopic surveys - a case study with APOGEE stars

    Science.gov (United States)

    Reis, Itamar; Poznanski, Dovi; Baron, Dalya; Zasowski, Gail; Shahaf, Sahar

    2018-05-01

    In this work, we apply and expand on a recently introduced outlier detection algorithm that is based on an unsupervised random forest. We use the algorithm to calculate a similarity measure for stellar spectra from the Apache Point Observatory Galactic Evolution Experiment (APOGEE). We show that the similarity measure traces non-trivial physical properties and contains information about complex structures in the data. We use it for visualization and clustering of the data set, and discuss its ability to find groups of highly similar objects, including spectroscopic twins. Using the similarity matrix to search the data set for objects allows us to find objects that are impossible to find using their best-fitting model parameters. This includes extreme objects for which the models fail, and rare objects that are outside the scope of the model. We use the similarity measure to detect outliers in the data set, and find a number of previously unknown Be-type stars, spectroscopic binaries, carbon rich stars, young stars, and a few that we cannot interpret. Our work further demonstrates the potential for scientific discovery when combining machine learning methods with modern survey data.

  14. Unravelling the Complex Antimicrobial Interactions of Essential Oils — The Case of Thymus vulgaris (Thyme

    Directory of Open Access Journals (Sweden)

    Aijaz Ahmad

    2014-03-01

    Full Text Available Thymus vulgaris has gained tremendous popularity as an ornamental, culinary herb and its use in phytotherapy is well established and supported in the literature. The objective of this study was to explore possible interactions between selected molecules within Thymus vulgaris essential oil (TvEO to gain a better understanding of how this complex essential oil exerts its antimicrobial activity. Evaluation of the antimicrobial efficacy and interactions were assessed on the essential oil and volatile constituents against various pathogens. Interactions between molecules at various ratios were graphically observed through the construction of isobolograms. Gas chromatography-mass spectrometry (GC-MS analysis revealed 22 compounds which collectively represent >95% of the oil composition. Based on their minimum inhibitory concentration (MIC values, they were categorised into weak (≥4 mg mL−1, moderate (2–4 mg mL−1 and noteworthy active (≤2 mg mL−1 compounds. For the combination study, 21% synergistic, 42% additive, 36% indifferent and 1% antagonistic interactions were observed. Most of the interactions were observed between the weak and highly active molecules, and interestingly, no synergistic interaction was observed between the highly active compounds. Synergistic and additive interactions between the strong and weaker antimicrobial constituents present in TvEO enhance the antimicrobial efficacy of this commercially important essential oil.

  15. [Pediatric complex regional pain syndrome affecting an upper limb: 7 cases and a brief review of the literature].

    Science.gov (United States)

    Cebrián, J; Sánchez, P

    2009-03-01

    To review the clinical, psychiatric, and social characteristics of complex regional pain syndrome in children and adolescents treated in the last 4 years at our pediatric pain clinic. We analyzed the specialty of the initial treating physician, age, sex, initial diagnosis, pain intensity, degree of disability, fear of movement, clinical stage, history of trauma, time between onset and diagnosis, psychiatric illness, family support and behavior, chronic pain in near relatives, school grades and attendance, treatment given at the pediatric pain clinic, recurrences, and course of disease. The cases of 7 patients (4 female, 3 male) between the ages of 8 and 15 years were analyzed. Four had been referred by the child psychiatry department. The initial diagnosis was erroneous in all but 1 case. Pain intensity and associated disability were severe in 5 patients and 4 expressed intense fear of moving the limb. Five patients had initial stage I disease, 5 had a history of trauma, and 5 had been previously treated by immobilization of the limb and prescription of nonsteroidal anti-inflammatory drugs. The time between onset and diagnosis ranged from 2 to 18 months (mean [SD], 6.4 [3.5] months). In most cases psychiatric disease and concomitant social disability were present. Treatment prescribed at the pediatric pain clinic consisted of a combination of oral medication, psychologic and psychiatric counseling, and intensive physiotherapy for all but 2 children, who required regional nerve blocks. The clinical course was satisfactory for all but 1 patient, who developed severe disability. Complex regional pain syndrome affecting an upper limb is uncommon in children but not rare.

  16. Data mining for better material synthesis: The case of pulsed laser deposition of complex oxides

    Science.gov (United States)

    Young, Steven R.; Maksov, Artem; Ziatdinov, Maxim; Cao, Ye; Burch, Matthew; Balachandran, Janakiraman; Li, Linglong; Somnath, Suhas; Patton, Robert M.; Kalinin, Sergei V.; Vasudevan, Rama K.

    2018-03-01

    The pursuit of more advanced electronics, and finding solutions to energy needs often hinges upon the discovery and optimization of new functional materials. However, the discovery rate of these materials is alarmingly low. Much of the information that could drive this rate higher is scattered across tens of thousands of papers in the extant literature published over several decades but is not in an indexed form, and cannot be used in entirety without substantial effort. Many of these limitations can be circumvented if the experimentalist has access to systematized collections of prior experimental procedures and results. Here, we investigate the property-processing relationship during growth of oxide films by pulsed laser deposition. To do so, we develop an enabling software tool to (1) mine the literature of relevant papers for synthesis parameters and functional properties of previously studied materials, (2) enhance the accuracy of this mining through crowd sourcing approaches, (3) create a searchable repository that will be a community-wide resource enabling material scientists to leverage this information, and (4) provide through the Jupyter notebook platform, simple machine-learning-based analysis to learn the complex interactions between growth parameters and functional properties (all data/codes available on https://github.com/ORNL-DataMatls). The results allow visualization of growth windows, trends and outliers, which can serve as a template for analyzing the distribution of growth conditions, provide starting points for related compounds and act as a feedback for first-principles calculations. Such tools will comprise an integral part of the materials design schema in the coming decade.

  17. Biomonitoring of complex occupational exposures to carcinogens: The case of sewage workers in Paris

    Directory of Open Access Journals (Sweden)

    Tiberguent Aziz

    2008-03-01

    Full Text Available Abstract Background Sewage workers provide an essential service in the protection of public and environmental health. However, they are exposed to varied mixtures of chemicals; some are known or suspected to be genotoxics or carcinogens. Thus, trying to relate adverse outcomes to single toxicant is inappropriate. We aim to investigate if sewage workers are at increased carcinogenic risk as evaluated by biomarkers of exposure and early biological effects. Methods/design This cross sectional study will compare exposed sewage workers to non-exposed office workers. Both are voluntaries from Paris municipality, males, aged (20–60 years, non-smokers since at least six months, with no history of chronic or recent illness, and have similar socioeconomic status. After at least 3 days of consecutive work, blood sample and a 24-hour urine will be collected. A caffeine test will be performed, by administering coffee and collecting urines three hours after. Subjects will fill in self-administered questionnaires; one covering the professional and lifestyle habits while the a second one is alimentary. The blood sample will be used to assess DNA adducts in peripheral lymphocytes. The 24-hour urine to assess urinary 8-oxo-7, 8-dihydro-2'-deoxy-Guanosine (8-oxo-dG, and the in vitro genotoxicity tests (comet and micronucleus using HeLa S3 or HepG2 cells. In parallel, occupational air sampling will be conducted for some Polycyclic Aromatic Hydrocarbons and Volatile Organic Compounds. A weekly sampling chronology at the offices of occupational medicine in Paris city during the regular medical visits will be followed. This protocol has been accepted by the French Est III Ethical Comitee with the number 2007-A00685-48. Discussion Biomarkers of exposure and of early biological effects may help overcome the limitations of environmental exposure assessment in very complex occupational or environmental settings.

  18. Biomonitoring of complex occupational exposures to carcinogens: The case of sewage workers in Paris

    International Nuclear Information System (INIS)

    Al Zabadi, Hamzeh; Ferrari, Luc; Laurent, Anne-Marie; Tiberguent, Aziz; Paris, Christophe; Zmirou-Navier, Denis

    2008-01-01

    Sewage workers provide an essential service in the protection of public and environmental health. However, they are exposed to varied mixtures of chemicals; some are known or suspected to be genotoxics or carcinogens. Thus, trying to relate adverse outcomes to single toxicant is inappropriate. We aim to investigate if sewage workers are at increased carcinogenic risk as evaluated by biomarkers of exposure and early biological effects. This cross sectional study will compare exposed sewage workers to non-exposed office workers. Both are voluntaries from Paris municipality, males, aged (20–60) years, non-smokers since at least six months, with no history of chronic or recent illness, and have similar socioeconomic status. After at least 3 days of consecutive work, blood sample and a 24-hour urine will be collected. A caffeine test will be performed, by administering coffee and collecting urines three hours after. Subjects will fill in self-administered questionnaires; one covering the professional and lifestyle habits while the a second one is alimentary. The blood sample will be used to assess DNA adducts in peripheral lymphocytes. The 24-hour urine to assess urinary 8-oxo-7, 8-dihydro-2'-deoxy-Guanosine (8-oxo-dG), and the in vitro genotoxicity tests (comet and micronucleus) using HeLa S3 or HepG2 cells. In parallel, occupational air sampling will be conducted for some Polycyclic Aromatic Hydrocarbons and Volatile Organic Compounds. A weekly sampling chronology at the offices of occupational medicine in Paris city during the regular medical visits will be followed. This protocol has been accepted by the French Est III Ethical Comitee with the number 2007-A00685-48. Biomarkers of exposure and of early biological effects may help overcome the limitations of environmental exposure assessment in very complex occupational or environmental settings

  19. TDPAC study of complex structure semiconductor compounds; The case of niobium pentoxide

    Energy Technology Data Exchange (ETDEWEB)

    Shitu, J.; Renteria, M.; Massolo, C.P.; Bibiloni, A.G.; Desimonni, J. (Departamento de Fisica, Facultad de Ciencias Exactas, Universidad Nacional de La Plata, C.C. No. 67, 1900 La Plata (AR))

    1992-07-20

    In this paper, a new method for analyzing Time-Differential Perturbed Angular Correlation spectra is presented and applied to study the hyperfine interaction of {sup 100}Rh in the high temperature modification of niobium pentoxide. The measured quadrupole interactions are assigned to about 80% of the radioactive probes replacing niobium atoms in the lattice and about 20% located in perturbed sites. The origin of this perturbation, producing a high frequency component in the measured spectra is discussed and temptatively assigned to remaining radiation damage in the compound. The hyperfine interaction of {sup 111}Cd probes, introduced through thermal diffusion into niobium pentoxide, is also presented. The temperature dependence of the hyperfine parameters in this case is studied in the temperature range RT-800{degrees} C. The spectral analyzing method employed allows a direct comparison of experimental data with point charge model calculations and a simultaneous evaluation of the antishielding factor {beta}. The obtained values (27 for {sup 100}Rh and 15 for {sup 111}Cd) are discussed in terms of the compound and probe's characteristics.

  20. TDPAC study of complex structure semiconductor compounds; The case niobium pentoxide

    Energy Technology Data Exchange (ETDEWEB)

    Shitu, J.; Renteria, M.; Massolo, C.P.; Bibiloni, A.G.; Desimoni, J. (Dept. de Fisica, Facultad de Ciencias Exactas, Univ. Nacional de La Plata, C.C. No. 67, 1900 La Plata (AR))

    1992-07-10

    In this paper, a new method for analyzing Time-Differential Perturbed Angular Correlation spectra is presented and applied to study the hyperfine interaction of {sup 100}Rh in the high temperature modification of niobium pentoxide. The measured quadrupole interactions are assigned to about 80% of the radioactive probes replacing niobium atoms in the lattice and about 20% located in perturbed sites. The origin of this perturbation, producing a high frequency component in the measured spectra is discussed and temptatively assigned to remaining radiation damage in the compound. The hyperfine interaction of {sup 111}Cd probes, introduced through thermal diffusion into niobium pentoxide, is also presented. The temperature dependence of the hyperfine parameters in this case is studied in the temperature range RT-800{degrees}C. The spectral analyzing method employed allows a direct comparison of experimental data with point charge model calculations and a simultaneous evaluation of the anti-shielding factor {beta}. The obtained values (27 for {sup 100}Rh and 15 for {sup 111}Cd) are discussed in terms of the compound and probe's characteristics.

  1. THE SIGNIFICANCE OF USER PARTICIPATION IN ARCHITECTURAL DESIGN: THE CASE OF NICOSIA SOCIAL HOUSING COMPLEX

    Directory of Open Access Journals (Sweden)

    Rafooneh Mokhtarshahi Sani

    2011-11-01

    Full Text Available In both primitive and traditional societies, the user was directly involved in design and construction process of his dwelling, progressively being part of the whole process. However, together with the need to develop for masses of people; and the materialization of architecture as a professional act, the close tie between the individual and his own environment has weakened, creating a ground for little or no user participation, mainly leading to the emergence of passive users. However, in architecture it is extremely important that the end product satisfy the needs of users so that a sense of belonging can be created at long run. Otherwise, the consequences will lead to various problems at cultural, psychological and physical levels leading to a series of changes in the built environment and/or abandonment of building on a permanent basis. The article focuses on a selected case study multi-story social housing schemes delivered by the government of Northern Cyprus, in the capital city, Nicosia where transformation of user profile led to a series of changes in the built environment, causing the area lose its attraction over the years. Through environment-behavior research tools -focused interviews and observations of physical traces, the study analyses the utilization of openspaces within the context of existing community texture to reach various arguments for the elucidation of the research problem. The article concludes with recommendations regarding the effect of user participation on place making at large scale social housing schemes.

  2. A rare case of massive carpal osteoblastoma requiring complex reconstructive surgery.

    Science.gov (United States)

    Dunda, S E; Kauczok, J; Demir, E; Braunschweig, T; Pallua, N

    2013-07-01

    An osteoblastoma is a rare, commonly benign, osteoid-producing neoplasm of the bone with an incidence of 2% of all primary bone tumours. We present a case of a 54-year-old patient with persisting carpal pain and massive swelling of the hand for a period of 4 years. Incision biopsies revealed the histopathological finding of a carpal osteoblastoma. After complete tumour excision, including the carpal and, in parts, metacarpal bones, reconstructive surgery was performed with a free osteocutaneous iliac crest flap to obtain a natural hand contour and the best possible hand function. Follow-up revealed improvement of the hand function in terms of flexion, extension and strength without discomfort or further pain. Thus, ongoing carpal pain should lead to an intensive search with further diagnostic measures such as magnetic resonance imaging (MRI) scan as well as biopsies, if necessary, to obtain the correct diagnosis. Copyright © 2013 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  3. Promoting employee acceptance of a consumer bill of rights in a complex medical care organization: a case study.

    Science.gov (United States)

    Mullen, P D; Leifer, B H

    1982-01-01

    To develop strong health education programs, health educators working in complex medical care organizations must often secure professional cooperation across disciplines, coordination of services, and orientation of policies, procedures, and personnel toward patient preferences and needs. Frequently, they undertake these tasks against the tide, within a problematic organizational structure. The present case study illustrates the difficulties posed by introducing change in medical care organizations in the context of an education program to acquaint employees of a large HMO with a consumer bill of rights mandated by the consumer Board of Trustees. The underlying assumption was that in a bureaucratic institution, an employee-centered and modest system reform strategy would be effective in bringing about client-centered outcomes-in this case, increased recognition of client rights. The case analysis and results of a post-intervention, cross-sectional survey suggest that in units where a threshold level of participation was reached, there were improvements in knowledge about the Bill and employee attitudes. The program was less successful with hospital nurses whose feelings about physicians were not taken into account fully, and with physicians whose relative lack of integration into the policy and managerial domains made them harder to reach.

  4. Complex functional and epithetic rehabilitation after ablation of recurrent retroauricular basal cell carcinoma – a case study

    Directory of Open Access Journals (Sweden)

    Reich, Waldemar

    2017-12-01

    Full Text Available The reconstruction of extended defects of the concha poses a complex challenge for plastic surgeons. In cases of subtotal ablation, an rn method designed especially for elderly oncological patients consists of epithetic rehabilitation. However, inserting an implant-retained concha epithesis proves challenging in patients with antecedents of deep resections involving the mastoid process.In the present case study, we report on the long-term treatment course (2009–2017 of a 79-year-old male patient suffering from a recurrent basal cell carcinoma of the retroauricular region. Following tumor resection, along with lateral mastoidectomy, reconstruction, and adjuvant radiotherapy, functional and esthetic deficits primarily due to peripheral facial nerve palsy were successfully managed using a multistep ed The procedure was completed by inserting an implant-retained concha epithesis, resulting in improved quality of life. Due to prior lateral mastoidectomy, ultra-short implants (4 mm were inserted, partially at atypical positions. For maintaining healthy periimplant soft tissue, aftercare comprised cold plasma treatment.This oncologic case demonstrates the therapeutic necessity of using a broad spectrum of reconstructive procedures, along with their limitations, in a critical anatomic region. Specific features include the presentation of a workflow using ultra-short implants in a compromised mastoid region. Surgeons should consider alternative implant positions in the event of any compromised mastoid process. A particular emphasis has been put on meticulous aftercare to preserve healthy periimplant soft tissues.

  5. Anatomy of a Complex Fault Zone: Land Seismic Reflection Imaging of the Tacoma Fault Zone, Washington State

    Science.gov (United States)

    Pape, K.; Liberty, L. M.; Pratt, T. L.

    2005-12-01

    Preliminary interpretations of new land-based seismic reflection images across the Tacoma fault zone in western Washington State document a complex pattern of faulting and folding. The Tacoma fault zone bounds gravity and aeromagnetic anomalies for 50 km across the central Puget Lowland west of the city of Tacoma, and tomography data suggest there is as much as 6 km of post-Eocene uplift of the hanging wall relative to Tacoma basin sediments to the south. We acquired four north-south seismic reflection profiles to define the character and tectonic history of the Tacoma fault zone. The 6-km long Powerline Road profile, located west of Case Inlet, perpendicularly crosses the 4-km-long Catfish Lake scarp discerned from Lidar data and trenching. The profile shows flat-lying strata on the south, but the north part of the profile is dominated by south-dipping Tertiary and older strata that appear to form the limb of an anticline. There appears to be at least one, and likely two faults in the Tertiary and older strata, although it is not clear these faults penetrate the shallowest Pleistocene strata. The 8.5-km long Carney Lake profile is located east of Case Inlet and spans two scarps imaged on Lidar data. This profile shows a similar geometry to the Powerline Road profile, folded and faulted Tertiary and older strata adjacent to flat-lying marine sediments of the Tacoma Basin. The 9-km long Bethel-Burley profile across the east portion of the Tacoma fault near Gig Harbor shows a significantly different reflector geometry than the profiles to the west. The Bethel-Burley profile is dominated by a strong, south-dipping reflection that becomes a prominent arch near the north end of the section. The strength of the reflector suggests that it marks the top of the Eocene basement rocks. South-dipping strata on this profile match those imaged on marine profiles from Carr Inlet. The new seismic reflection data support an interpretation in which the north edge of the Tacoma basin

  6. Case report

    African Journals Online (AJOL)

    abp

    25 août 2015 ... abdominal note une cicatrice de laparotomie médiane à cheval sur l'ombilic et la présence d'une masse allant de l'hypochondre droit à la fosse iliaque droite .... Les formes rétropéritonéales sont le plus souvent isolées [3,4]. Ils sont associés parfois à d'autres pathologies , notamment la triade de Carney [6] ...

  7. Complex integrated method of dynamic meditation with Buddhists’ breathing in case of neurotic reactions

    Directory of Open Access Journals (Sweden)

    V.I. Omelyanenko

    2014-02-01

    Full Text Available Purpose: to elaborate complex integrated method of psychological influence upon sport dancers in time of training on base of Buddhists’ meditation “conscious breathing” for neurotic reactions elimination, professional skill improvement and psycho emotional stability advance. Material : twenty dancers at the age of 40-50 with neurotic reactions participated in the research. At the first stage of the research all the subjects’ ability to focus attention at breathing during sports dancing performance was examined. At the second stage training in method of dynamic meditation applied for martial arts of the experimental group of 10 subjects was conducted. Both individual and group training sessions were held. At the third stage the experimental group joined dynamic meditation and breathing at dance performance. At the fourth stage the experimental group’s results were compared with the control group’s results. Results : at the first stage of the research all the subjects noted difficulties in focusing attention on Buddhists’ nasal breathing and dance technique come-down. 3-5 sessions of training in method of dynamic meditation were necessary for the subjects of the experimental group at the second stage of the research. At the third stage of the research all the subjects of the experimental group could control their nasal breathing at dance performance without dance technique come-down. At the fourth stage the comparative evaluation of the results of the experimental and control groups revealed that it was necessary 3-7 sport dance practice sessions for elimination of the neurotic reactions. No such effect was observed in the control group. Conclusions : The results of the research prove that Buddhists’ meditation “conscious breathing” may be joined with dynamic meditation successfully. It’s impossible to focus attention continuously on breathing at time of sport dance performance. The elaborated technique of the integration of

  8. A Case Study of the Annual Evolution of the Cape Bathurst Polynya Complex in Western Amundsen Gulf, 2003-2004

    Science.gov (United States)

    Galley, R. J.; Barber, D. G.; Key, E.; Prinsenberg, S.

    2008-12-01

    A case study focused on the spatial and temporal interaction of dynamic and thermodynamic sea ice processes in the southern Beaufort Sea (SBS) and Amundsen Gulf (AG) was conducted to determine the mechanisms which form the Cape Bathurst flaw lead polynya complex over an annual cycle. This study is motivated by the need to further understand the complex interaction of the Beaufort Sea perennial sea ice pack and a seasonal sea ice zone of the SBS and AG as it is manifested in the operation of the Cape Bathurst flaw lead polynya complex. Understanding the present interplay of thermodynamic and dynamic forcing in the polynya is vital should we hope to determine how it will operate in a future Arctic dominated by seasonal sea ice. The study area has been the subject of the Canadian Arctic Shelf Exchange Study and the International Polar Year - Circumpolar Flaw Lead Study. The case study presented here further attempts to provide context in terms the physical operation of the polynya and associated flaw lead system for the biological and oceanographic measurements that were made in the course of those studies. We first describe the regional scale evolution of sea ice in western AG between fall 2003 and summer 2004 representing sea ice formation through both dynamics and thermodynamics. We investigate fine scale sea ice thickness in western AG to determine the relative contribution of leads, ridges and level sea ice in spring 2004 prior to the formation of the polynya proper. The region's potential thermodynamic sea ice growth is modeled between freeze-up in 2003 and break-up in 2004. Finally, sea ice motion in the region between freeze-up and break- up in 2004 was used to help determine the relative contribution and timing of dynamic processes on the sea ice in our case study region. It is concluded that the formation of the Cape Bathurst polynya in spring results from the interaction of the Beaufort Sea perennial pack with seasonal sea ice in AG, beginning in fall.

  9. The Effect of a Complex Multi-modality Ayurvedic Treatment in a Case of Unknown Female Infertility.

    Science.gov (United States)

    Kessler, Christian; Stapelfeldt, Elmar; Michalsen, Andreas; Kowalcek, Ingrid; Kronpaß, Ludwig; Dhruva, Anand

    2015-01-01

    Treatment of female infertility has been growing globally in recent years. In spite of improvements in medical strategies and the improved outcomes for infertile couples, treatment attempts remain largely unsuccessful. A growing number of patients pursue complementary and alternative medicine treatment options like Ayurveda that offers a variety of inpatient and outpatient treatments for infertility. A case of a 38 year-old woman with infertility of unknown origin is presented. She received 18 conventional fertility treatments in 5 different fertility centers and 3 different countries. After several complications, the patient quitted conventional treatment and admitted to an Ayurvedic outpatient clinic where she received a complex Ayurvedic treatment, which included botanicals, dietary and lifestyle advice, manual therapy, yoga, and spiritual elements. The patient then became pregnant and gave birth to a healthy boy in 2012. Ayurveda may be a useful complementary option in the case of futile conventional treatment attempts in female infertility. Nevertheless, the evidence base for Ayurvedic interventions remains weak and requires well-designed clinical trials. This case raises some questions, such as whether the exposure to a large number of assisted reproduction procedures can lead to more health problems than health benefits. The Ayurvedic approach to fertility strives first to improve the health of the patient leading to a higher likelihood of pregnancy. As this is a case report, we are not able to exclude temporal factors stimulating the pregnancy. However, the chronology suggests that this approach might have been an important factor in the eventual pregnancy. © 2015 S. Karger GmbH, Freiburg.

  10. Dynamics for the complex Ginzburg-Landau equation on non-cylindrical domains II: The monotone case

    Science.gov (United States)

    Zhou, Feng; Sun, Chunyou; Cheng, Jiaqi

    2018-02-01

    In this article, we continue the study of the dynamics of the following complex Ginzburg-Landau equation ∂tu - (λ + iα)Δu + (κ + iβ)|u|p-2u - γu = f(t) on non-cylindrical domains. We assume that the spatial domains are bounded and increase with time, which is different from the diffeomorphism case presented in Zhou and Sun [Discrete Contin. Dyn. Syst., Ser. B 21, 3767-3792 (2016)]. We develop a new penalty function to establish the existence and uniqueness of a variational solution satisfying energy equality as well as some energy inequalities and prove the existence of a D -pullback attractor for the non-autonomous dynamical system generated by this class of solutions.

  11. Inter-organisational communication in civil-military cooperation during complex emergencies: a case study in Afghanistan.

    Science.gov (United States)

    Rietjens, Sebastiaan J H; Verlaan, Kirsten; Zaalberg, Thijs W Brocades; de Boer, Sirp J

    2009-07-01

    This paper seeks to contribute to an improved information management and exchange between humanitarian organisations and military agents in complex emergencies. To do so, a theoretical information management process model was developed and applied to the case of information management between International Security Assistance Force troops and humanitarian organisations such as Cordaid, DACAAR and the International Office for Migration in Kabul, Afghanistan. Based on this analysis the main shortcomings and problems in each stage of the information management process were identified. These include a lack of structured information databases, the absence of identification of information needs, and an over-classification of documents by the military. Using a logical framework analysis, six major improvement tactics were developed, including the creation of more overlap in rotations of personnel, the specification of aims and tasks regarding information management, the improvement of skills and competences of personnel involved, and the introduction of regular joint civil-military evaluations.

  12. Coexistence of Autism Spectrum Disorders Among Three Children with Tuberous Sclerosis Complex; Case reports and review of literature

    Directory of Open Access Journals (Sweden)

    Amna Al-Futaisi

    2016-11-01

    Full Text Available Tuberous sclerosis complex (TSC is a multisystem neurocutaneous disorder inherited in an autosomal dominant manner and characterised by benign tumours in the brain and other vital organs such as the heart, eyes, kidneys, skin and lungs. Links between autism spectrum disorder (ASD and TSC have been postulated for many decades, with TSC considered to be one of the main syndromic causes of ASD; however, precise confirmation of a relationship between these two disorders required validated diagnostic tools. Fortunately, accurate evaluation of this relationship is now possible with standardised criteria for ASD diagnosis. We report three children who presented to the Sultan Qaboos University Hospital, Muscat, Oman, between 2014 and 2015 with ASD and TSC. These cases demonstrate the spectrum of neuropsychiatric involvement in TSC and highlight the importance of screening children with TSC for ASD features in order to encourage the early enrolment of these children in educational and rehabilitation programmes.

  13. BAC-FISH assays delineate complex chromosomal rearrangements in a case of post-Chernobyl childhood thyroid cancer.

    Directory of Open Access Journals (Sweden)

    Horst F Zitzelsberger

    2009-12-01

    Full Text Available Structural chromosome aberrations are known hallmarks of many solid tumors. In the papillary form of thyroid cancer (PTC, for example, activation of the receptor tyrosine kinase (RTK genes, RET and neurotrophic tyrosine kinase receptor type I (NTRK1 by intra- and interchromosomal rearrangements has been suggested as a cause of the disease. However, many phenotypically similar tumors do not carry an activated RET or NTRK-1 gene or express abnormal ret or NTRK-1 transcripts. Thus, we hypothesize that other cellular RTK-type genes are aberrantly expressed in these tumors. Using fluorescence in situ hybridization-based methods, we are studying karyotype changes in a relatively rare subgroup of PTCs, i.e., tumors that arose in children following the 1986 nuclear accident in Chernobyl, Ukraine. Here, we report our technical developments and progress in deciphering complex chromosome aberrations in case S48TK, an aggressively growing PTC cell line, which shows an unusual high number of unbalanced translocations.

  14. BAC-FISH assays delineate complex chromosomal rearrangements in a case of post-Chernobyl childhood thyroid cancer

    Energy Technology Data Exchange (ETDEWEB)

    Kwan, Johnson; Baumgartner, Adolf; Lu, Chun-Mei; Wang, Mei; Weier, Jingly F.; Zitzelsberger, Horst F.; Weier, Heinz-Ulrich G.

    2009-03-09

    Structural chromosome aberrations are known hallmarks of many solid tumors. In the papillary form of thyroid cancer (PTC), for example, activation of the receptor tyrosine kinase (RTK) genes, RET and neurotrophic tyrosine kinase receptor type I (NTRK1) by intra- and interchromosomal rearrangements has been suggested as a cause of the disease. However, many phenotypically similar tumors do not carry an activated RET or NTRK-1 gene or express abnormal ret or NTRK-1 transcripts. Thus, we hypothesize that other cellular RTK-type genes are aberrantly expressed in these tumors. Using fluorescence in situ hybridization-based methods, we are studying karyotype changes in a relatively rare subgroup of PTCs, i.e., tumors that arose in children following the 1986 nuclear accident in Chernobyl, Ukraine. Here, we report our technical developments and progress in deciphering complex chromosome aberrations in case S48TK, an aggressively growing PTC cell line, which shows an unusual high number of unbalanced translocations.

  15. Colonization of a Central Venous Catheter by the Hyaline Fungus Fusarium solani Species Complex: A Case Report and SEM Imaging

    Directory of Open Access Journals (Sweden)

    Alberto Colombo

    2013-01-01

    Full Text Available The incidence of opportunistic infections by filamentous fungi is increasing partly due to the widespread use of central venous catheters (CVC, indwelling medical devices, and antineoplastic/immunosuppressive drugs. The case of a 13-year-old boy under treatment for acute lymphoblastic leukemia is presented. The boy was readmitted to the Pediatric Ward for intermittent fever of unknown origin. Results of blood cultures drawn from peripheral venous sites or through the CVC were compared. CVC-derived bottles (but not those from peripheral veins yielded hyaline fungi that, based on morphology, were identified as belonging to the Fusarium solani species complex. Gene amplification and direct sequencing of the fungal ITS1 rRNA region and the EF-1alpha gene confirmed the isolate as belonging to the Fusarium solani species complex. Portions of the CVC were analyzed by scanning electron microscopy. Fungi mycelia with long protruding hyphae were seen into the lumen. The firm adhesion of the fungal formation to the inner surface of the catheter was evident. In the absence of systemic infection, catheter removal and prophylactic voriconazole therapy were followed by disappearance of febrile events and recovery. Thus, indwelling catheters are prone to contamination by environmental fungi.

  16. A severe case of complex regional pain syndrome I (reflex sympathetic dystrophy) managed with spinal cord stimulation.

    Science.gov (United States)

    Canlas, Bernard; Drake, Thomas; Gabriel, Eric

    2010-01-01

    Complex regional pain syndrome is a condition that usually affects the upper or lower extremities. The cause is not clearly understood. We report a case of a severe form of a rapidly progressive complex regional pain syndrome type I developing after a right shoulder injury managed with spinal cord stimulation (SCS). After failed conservative treatments, a rechargeable SCS system was implanted in the cervical spine. Allodynia and dystonia improved but the patient subsequently developed similar symptoms in lower right extremity followed by her lower left extremity. The patient became wheelchair bound. A second rechargeable SCS with a paddle electrode was implanted for the lower extremity coverage. The patient's allodynia and skin lesions improved significantly. However, over time, her initial symptoms reappeared which included skin breakdown. Due to the need for frequent recharging, the system was removed. During explantation of the surgical paddle lead, it was noted by the neurosurgeon that the contacts of the paddle lead were detached from the lead. After successful implantation of another SCS system, the patient was able to reduce her medications and is now able to ambulate with the use of a left elbow crutch.

  17. Case complexity scores in congenital heart surgery: a comparative study of the Aristotle Basic Complexity score and the Risk Adjustment in Congenital Heart Surgery (RACHS-1) system.

    Science.gov (United States)

    Al-Radi, Osman O; Harrell, Frank E; Caldarone, Christopher A; McCrindle, Brian W; Jacobs, Jeffrey P; Williams, M Gail; Van Arsdell, Glen S; Williams, William G

    2007-04-01

    The Aristotle Basic Complexity score and the Risk Adjustment in Congenital Heart Surgery system were developed by consensus to compare outcomes of congenital cardiac surgery. We compared the predictive value of the 2 systems. Of all index congenital cardiac operations at our institution from 1982 to 2004 (n = 13,675), we were able to assign an Aristotle Basic Complexity score, a Risk Adjustment in Congenital Heart Surgery score, and both scores to 13,138 (96%), 11,533 (84%), and 11,438 (84%) operations, respectively. Models of in-hospital mortality and length of stay were generated for Aristotle Basic Complexity and Risk Adjustment in Congenital Heart Surgery using an identical data set in which both Aristotle Basic Complexity and Risk Adjustment in Congenital Heart Surgery scores were assigned. The likelihood ratio test for nested models and paired concordance statistics were used. After adjustment for year of operation, the odds ratios for Aristotle Basic Complexity score 3 versus 6, 9 versus 6, 12 versus 6, and 15 versus 6 were 0.29, 2.22, 7.62, and 26.54 (P Aristotle Basic Complexity (likelihood ratio chi2 = 162, P Aristotle Basic Complexity contributed much less predictive value over Risk Adjustment in Congenital Heart Surgery (likelihood ratio chi2 = 13.4, P = .009). Neither system fully adjusted for the child's age. The Risk Adjustment in Congenital Heart Surgery scores were more concordant with length of stay compared with Aristotle Basic Complexity scores (P Aristotle Basic Complexity. The use of Aristotle Basic Complexity or Risk Adjustment in Congenital Heart Surgery as risk stratification and trending tools to monitor outcomes over time and to guide risk-adjusted comparisons may be valuable.

  18. Negative pressure wound therapy with Bio-Dome dressing technology in the treatment of complex wounds: a case series.

    Science.gov (United States)

    Penny, H L; Spinazzola, J; Green, A; Rifkah, M; Faretta, M; Youshaw, D; Weaver, A; Zaki, P

    2014-04-01

    The treatment of complex wounds is difficult and not always effective. Various treatment options are used with varying degrees of success. Negative pressure wound therapy (NPWT) is a cost-efficient and effective way to help treat these wounds. The use of a vacuum device applies the negative pressure to the site of the wound and promotes waste removal and increases circulation and tissue formation. While various NPWT systems are currently on the market, we utilised the ConvaTec Engenex® system with Bio-DomeTM technology; however, our case study is not intended to advocate the specific use of this system, but instead focuses on the use of NPWT as a viable option for wound healing. Each of the following case study patients presented with difficult-to-heal wounds that failed traditional therapeutic approaches. Through the use of NPWT, our patients saw major wound size reductions. Each patient exhibited at least a 94% reduction in wound area, wound volume or both.

  19. Collet-Sicard Syndrome from Thrombosis of the Sigmoid-Jugular Complex: A Case Report and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Tom P. B. Handley

    2010-01-01

    Full Text Available Purpose. Collet-Sicard syndrome is a very rare condition characterised by unilateral palsy of the IX–XII cranial nerves. It is distinguished from Villaret syndrome by lack of presence of sympathetic involvement. Current literature contains only two cases of Collet-Sicard syndrome due to idiopathic internal jugular vein thrombosis. Method and Results. We report the case of Collet-Sicard syndrome in a 30-year-old man who presented with delayed development of XIth nerve dysfunction, due to internal jugular vein-sigmoid sinus thrombosis. A multidisciplinary team approach was employed in the management of this patient. At three-month followup, he had significantly improved swallowing, and repeat computed tomography neck scan showed partial recanalisation of the right internal jugular vein. Conclusion. In suspected Collet-Sicard syndrome, a focal primary lesion or metastasis to the temporal bone must be excluded, and sigmoid-jugular complex thrombosis should be considered in the differential diagnosis. Early recognition and treatment may result in significant functional recovery.

  20. Collet-Sicard Syndrome from Thrombosis of the Sigmoid-Jugular Complex: A Case Report and Review of the Literature

    Science.gov (United States)

    Handley, Tom P. B.; Miah, Mohammed S.; Majumdar, Samit; Hussain, S. S. Musheer

    2010-01-01

    Purpose. Collet-Sicard syndrome is a very rare condition characterised by unilateral palsy of the IX–XII cranial nerves. It is distinguished from Villaret syndrome by lack of presence of sympathetic involvement. Current literature contains only two cases of Collet-Sicard syndrome due to idiopathic internal jugular vein thrombosis. Method and Results. We report the case of Collet-Sicard syndrome in a 30-year-old man who presented with delayed development of XIth nerve dysfunction, due to internal jugular vein-sigmoid sinus thrombosis. A multidisciplinary team approach was employed in the management of this patient. At three-month followup, he had significantly improved swallowing, and repeat computed tomography neck scan showed partial recanalisation of the right internal jugular vein. Conclusion. In suspected Collet-Sicard syndrome, a focal primary lesion or metastasis to the temporal bone must be excluded, and sigmoid-jugular complex thrombosis should be considered in the differential diagnosis. Early recognition and treatment may result in significant functional recovery. PMID:20706543

  1. Complex Systems Education for natural Hazards and from down to up Pushing of Government and Officials: A Case Study

    Science.gov (United States)

    Zvelebil, J.

    2009-04-01

    interplays of highly organized entities. Of course, such efforts mainly fail due to existence of qualitative differences between description of the same phenomena on different time-space scales or functional levels. Main features of a basic course "Application of nonlinear dynamics and Theory of Complex Systems for Physical Geographers" are described. They also partially follow the course reader's opinion about necessity of new reunion of modern philosophy and methodology of natural and human sciences Dangerous distortion of reflections of reality by the frequently proposed substitution of human science methodology by the natural science one is stressed. On the contrary, examples from philosophy (Bergson 1919, Wittgenstein 1953), which had anticipated and even defined some profound themes of Complex Systems (e.g. Kauffman 1993), as e.g. self-organizing, entropy decreasing behavior, or existence of discontinuities between description of the same phenomena on different time-space scales or functional levels. The second priority has information dissemination for decisions makers of natural Hazards management. Any successful Case history is better then ten popular lectures for those decision makers. A case history of highly computerized Integrated Information System (IIS) for unstable rock slope monitoring, on-line rock fall precursors diagnostics of time series and automated early warning launching, the both with the use of predominantly nonlinear tools is outlined. It stands to support author's opinion that pushing of officials is effective only if it is provided from down to up. That means it is based on satisfactory solution of specific community needs, instead of from up to down flowing more or less general directives of some far away sitting clerks. The third tactical item is rather long-distance run. Change of paradigm cannot be ordered, it is matter of generation change, as on scientific, as well as on decision makers (hopefully recruited from students already aware of

  2. Whole exome sequencing in 342 congenital cardiac left sided lesion cases reveals extensive genetic heterogeneity and complex inheritance patterns.

    Science.gov (United States)

    Li, Alexander H; Hanchard, Neil A; Furthner, Dieter; Fernbach, Susan; Azamian, Mahshid; Nicosia, Annarita; Rosenfeld, Jill; Muzny, Donna; D'Alessandro, Lisa C A; Morris, Shaine; Jhangiani, Shalini; Parekh, Dhaval R; Franklin, Wayne J; Lewin, Mark; Towbin, Jeffrey A; Penny, Daniel J; Fraser, Charles D; Martin, James F; Eng, Christine; Lupski, James R; Gibbs, Richard A; Boerwinkle, Eric; Belmont, John W

    2017-10-31

    Left-sided lesions (LSLs) account for an important fraction of severe congenital cardiovascular malformations (CVMs). The genetic contributions to LSLs are complex, and the mutations that cause these malformations span several diverse biological signaling pathways: TGFB, NOTCH, SHH, and more. Here, we use whole exome sequence data generated in 342 LSL cases to identify likely damaging variants in putative candidate CVM genes. Using a series of bioinformatics filters, we focused on genes harboring population-rare, putative loss-of-function (LOF), and predicted damaging variants in 1760 CVM candidate genes constructed a priori from the literature and model organism databases. Gene variants that were not observed in a comparably sequenced control dataset of 5492 samples without severe CVM were then subjected to targeted validation in cases and parents. Whole exome sequencing data from 4593 individuals referred for clinical sequencing were used to bolster evidence for the role of candidate genes in CVMs and LSLs. Our analyses revealed 28 candidate variants in 27 genes, including 17 genes not previously associated with a human CVM disorder, and revealed diverse patterns of inheritance among LOF carriers, including 9 confirmed de novo variants in both novel and newly described human CVM candidate genes (ACVR1, JARID2, NR2F2, PLRG1, SMURF1) as well as established syndromic CVM genes (KMT2D, NF1, TBX20, ZEB2). We also identified two genes (DNAH5, OFD1) with evidence of recessive and hemizygous inheritance patterns, respectively. Within our clinical cohort, we also observed heterozygous LOF variants in JARID2 and SMAD1 in individuals with cardiac phenotypes, and collectively, carriers of LOF variants in our candidate genes had a four times higher odds of having CVM (odds ratio = 4.0, 95% confidence interval 2.5-6.5). Our analytical strategy highlights the utility of bioinformatic resources, including human disease records and model organism phenotyping, in novel gene

  3. Whole exome sequencing in 342 congenital cardiac left sided lesion cases reveals extensive genetic heterogeneity and complex inheritance patterns

    Directory of Open Access Journals (Sweden)

    Alexander H. Li

    2017-10-01

    Full Text Available Abstract Background Left-sided lesions (LSLs account for an important fraction of severe congenital cardiovascular malformations (CVMs. The genetic contributions to LSLs are complex, and the mutations that cause these malformations span several diverse biological signaling pathways: TGFB, NOTCH, SHH, and more. Here, we use whole exome sequence data generated in 342 LSL cases to identify likely damaging variants in putative candidate CVM genes. Methods Using a series of bioinformatics filters, we focused on genes harboring population-rare, putative loss-of-function (LOF, and predicted damaging variants in 1760 CVM candidate genes constructed a priori from the literature and model organism databases. Gene variants that were not observed in a comparably sequenced control dataset of 5492 samples without severe CVM were then subjected to targeted validation in cases and parents. Whole exome sequencing data from 4593 individuals referred for clinical sequencing were used to bolster evidence for the role of candidate genes in CVMs and LSLs. Results Our analyses revealed 28 candidate variants in 27 genes, including 17 genes not previously associated with a human CVM disorder, and revealed diverse patterns of inheritance among LOF carriers, including 9 confirmed de novo variants in both novel and newly described human CVM candidate genes (ACVR1, JARID2, NR2F2, PLRG1, SMURF1 as well as established syndromic CVM genes (KMT2D, NF1, TBX20, ZEB2. We also identified two genes (DNAH5, OFD1 with evidence of recessive and hemizygous inheritance patterns, respectively. Within our clinical cohort, we also observed heterozygous LOF variants in JARID2 and SMAD1 in individuals with cardiac phenotypes, and collectively, carriers of LOF variants in our candidate genes had a four times higher odds of having CVM (odds ratio = 4.0, 95% confidence interval 2.5–6.5. Conclusions Our analytical strategy highlights the utility of bioinformatic resources, including human

  4. [Application of hair analysis of selected psychoactive substances for medico-legal purposes. Part II. Cases of complex fatal poisonings: interactions of heroine - cocaine - amphetamines].

    Science.gov (United States)

    Rojek, Sebastian; Kłys, Małgorzata; Rzepecka-Woźniak, Ewa; Konopka, Tomasz

    2010-01-01

    The study represents an attempt at employing segmental hair analysis in complex poisonings with xenobiotic mixtures of heroine - cocaine - amphetamines in the context of the cause of death as a consequence of complex interaction mechanisms which occurred prior to death. Two cases of complex poisonings: heroine - cocaine and heroine - cocaine - amphetamines were analyzed and documented with macro- and microscopic examinations and complex toxicological examinations, including the analysis of classic biological material, i.e. samples of selective blood, and alternative material, i.e. hair samples. Determinations of opioids, cocaine and its metabolite and amphetamines in the hair biological matrix were performed using high performance liquid chromatography--atmospheric pressure chemical ionization--tandem mass spectrometry (HPLC-APCI-MS-MS). Segmental hair analysis of the investigated cases indicated a prolonged intake of similar psychoactive substances and a developed adaptation of the addicted to interaction mechanisms, which, however, led gradually to multiorgan anatomopathological changes, and in consequence to death.

  5. A multi-disciplinary approach to study coastal complex landslides: the case of Torino di Sangro (Central Italy)

    Science.gov (United States)

    Sciarra, Marco; Carabba, Luigi; Urbano, Tullio; Calista, Monia

    2016-04-01

    This work illustrates the studies carried out on a complex landslide phenomenon between the Sangro and Osento River's mouths, near Torino di Sangro village in Southern Abruzzo Region (Italy). Historical activity of this landslide is well-documented since 1916; the activation/reactivation of the movements caused several interruptions of a national railway and the damage of few houses. The Torino di Sangro case study can be regarded as representative of many large landslides distributed along the central Adriatic coast (e.g., Ancona, Ortona, Vasto and Petacciato Landslides) that affect densely populated urban areas with a large amount of man-made infrastructure. The main controlling factors of these large and deep-seated landslides are still debated. From the geological and geomorphological viewpoint, the central Adriatic coast is characterized by a low-relief landscape (mesa) carved on clay-sandstone-conglomerate bedrock belonging to the Upper Pliocene - Lower Pleistocene marine deposits and locally to the Middle Pleistocene marine to continental transitional deposits. This high coast is widely affected by slope instability (rock falls, rotational, complex and shallow landslides) on both active and inactive sea cliffs, the first being mainly affected by wave-cut erosion and the latter influenced by heavy rainfall and changes of pore pressure. The main landslide has the typical characteristics of a deep-seated gravitation deformation. The landslide study was based on a multidisciplinary approach including: 1) definition and GIS mapping of geology and geomorphology factors (slope, aspect, topographic curvature, bedrock lithology, near-surface deposits, deposit thickness and land use), by means of DTM processing, multi-temporal analysis, and large-scale geomorphological field survey; 2) monitoring system in the landslide; 3) application of empiric models for the analysis of unstable sandstone-conglomerate escarpments; 4) slope stability analysis performed using a

  6. Vector control in a malaria epidemic occurring within a complex emergency situation in Burundi: a case study

    Directory of Open Access Journals (Sweden)

    D'Alessandro Umberto

    2007-07-01

    Full Text Available Abstract Background African highlands often suffer of devastating malaria epidemics, sometimes in conjunction with complex emergencies, making their control even more difficult. In 2000, Burundian highlands experienced a large malaria outbreak at a time of civil unrest, constant insecurity and nutritional emergency. Because of suspected high resistance to the first and second line treatments, the provincial health authority and Médecins Sans Frontières (Belgium decided to implement vector control activities in an attempt to curtail the epidemic. There are few reported interventions of this type to control malaria epidemics in complex emergency contexts. Here, decisions and actions taken to control this epidemic, their impact and the lessons learned from this experience are reported. Case description Twenty nine hills (administrative areas were selected in collaboration with the provincial health authorities for the vector control interventions combining indoor residual spraying with deltamethrin and insecticide-treated nets. Impact was evaluated by entomological and parasitological surveys. Almost all houses (99% were sprayed and nets use varied between 48% and 63%. Anopheles indoor resting density was significantly lower in treated as compared to untreated hills, the latter taken as controls. Despite this impact on the vector, malaria prevalence was not significantly lower in treated hills except for people sleeping under a net. Discussion Indoor spraying was feasible and resulted in high coverage despite being a logistically complex intervention in the Burundian context (scattered houses and emergency situation. However, it had little impact on the prevalence of malaria infection, possibly because it was implemented after the epidemic's peak. Nevertheless, after this outbreak the Ministry of Health improved the surveillance system, changed its policy with introduction of effective drugs and implementation of vector control to prevent new

  7. Dynamical responses to external stimuli for both cases of excitatory and inhibitory synchronization in a complex neuronal network.

    Science.gov (United States)

    Kim, Sang-Yoon; Lim, Woochang

    2017-10-01

    For studying how dynamical responses to external stimuli depend on the synaptic-coupling type, we consider two types of excitatory and inhibitory synchronization (i.e., synchronization via synaptic excitation and inhibition) in complex small-world networks of excitatory regular spiking (RS) pyramidal neurons and inhibitory fast spiking (FS) interneurons. For both cases of excitatory and inhibitory synchronization, effects of synaptic couplings on dynamical responses to external time-periodic stimuli S ( t ) (applied to a fraction of neurons) are investigated by varying the driving amplitude A of S ( t ). Stimulated neurons are phase-locked to external stimuli for both cases of excitatory and inhibitory couplings. On the other hand, the stimulation effect on non-stimulated neurons depends on the type of synaptic coupling. The external stimulus S ( t ) makes a constructive effect on excitatory non-stimulated RS neurons (i.e., it causes external phase lockings in the non-stimulated sub-population), while S ( t ) makes a destructive effect on inhibitory non-stimulated FS interneurons (i.e., it breaks up original inhibitory synchronization in the non-stimulated sub-population). As results of these different effects of S ( t ), the type and degree of dynamical response (e.g., synchronization enhancement or suppression), characterized by the dynamical response factor [Formula: see text] (given by the ratio of synchronization degree in the presence and absence of stimulus), are found to vary in a distinctly different way, depending on the synaptic-coupling type. Furthermore, we also measure the matching degree between the dynamics of the two sub-populations of stimulated and non-stimulated neurons in terms of a "cross-correlation" measure [Formula: see text]. With increasing A , based on [Formula: see text], we discuss the cross-correlations between the two sub-populations, affecting the dynamical responses to S ( t ).

  8. The Use of Best Practice in the Treatment of a Complex Diabetic Foot Ulcer: A Case Report

    Directory of Open Access Journals (Sweden)

    Melodie Blakely

    2016-03-01

    Full Text Available Background and Purpose: Published guidelines for effective management of diabetic foot ulcers (DFU include total contact casting (TCC. The purpose of this case study is to describe the application of best practice guidelines for the treatment of a diabetic foot ulcer (DFU in a complex patient where TCC offloading could not be utilized. Case Description: The patient was a 47 year-old female with a five-plus year history of a full-thickness DFU on the left plantar mid-foot. Treatment included sharp and ultrasound debridement, the use of a silver hydrofiber dressing, edema management via compression therapy, negative pressure wound therapy, offloading via customized 1/4 inch adhesive-backed felt applied to the plantar foot in addition to an offloading boot and use of a wheelchair, patient education regarding diabetes management, and the application of a bilayered living skin-equivalent biologic dressing. Outcomes: At 15 weeks the wound was closed and the patient was transitioned into diabetic footwear. Discussion: The felt offloading was a beneficial alternative to TCC. The patient’s longer than average healing rate may have been complicated by the duration of her wound, her 41 year history of diabetes, and the fact that gold standard offloading (TCC was not able to be used. Further research is needed regarding the use of felt for offloading, such as application technique for wounds on different areas of the foot, comparison of different types of felt, and the use of felt in conjunction with various offloading devices.

  9. Phase-based treatment of a complex severely mentally ill case involving complex posttraumatic stress disorder and psychosis related to dandy walker syndrome

    NARCIS (Netherlands)

    Mauritz, M.W.; Sande, R. van der; Goossens, P.J.J.; Achterberg, T. van; Draijer, N.

    2014-01-01

    For patients with comorbid complex posttraumatic stress disorder (PTSD) and psychotic disorder, trauma-focused therapy may be difficult to endure. Phase-based treatment including (a) stabilization, (b) trauma-focused therapy, and (c) integration of personality with recovery of connection appears to

  10. Phase-based treatment of a complex severely mentally ill case involving complex posttraumatic stress disorder and psychosis related to Dandy Walker syndrome

    NARCIS (Netherlands)

    Mauritz, M.W.; van de Sande, R.; Goossens, P.J.J.; van Achterberg, T.; Draijer, N.

    2014-01-01

    For patients with comorbid complex posttraumatic stress disorder (PTSD) and psychotic disorder, trauma-focused therapy may be difficult to endure. Phase-based treatment including (a) stabilization, (b) trauma-focused therapy, and (c) integration of personality with recovery of connection appears to

  11. Complex odontoma.

    Science.gov (United States)

    Preetha, A; Balikai, Bharati S; Sujatha, D; Pai, Anuradha; Ganapathy, K S

    2010-01-01

    Odontomas are hamartomatous lesions or malformations composed of mature enamel, dentin, and pulp. They may be compound or complex, depending on the extent of morphodifferentiation or their resemblance to normal teeth. The etiology of odontoma is unknown, although several theories have been proposed. This article describes a case of a large infected complex odontoma in the residual mandibular ridge, resulting in considerable mandibular expansion.

  12. Local development and globalization: the case of the formation of the agroindustrial complex of lemon in Colima, México

    Directory of Open Access Journals (Sweden)

    Saúl Martínez González

    2008-03-01

    Full Text Available The multinational company has been the main vehicle of internationalization of capital and trade integration between countries. The global expansion phase of the transnational corporation is associated with the hegemony of capitalism in the United States, whose influence has been decisive in the territories where it operates. This essay is a case of the influence of transnational company Coca Cola in the formation of the region of Tecoman, Colima, as providing an input to the company during the period dominated by Fordism. This region is formed from exogenous impulses of the needs of lemon essential oil by transnational companies which in turn have determined the stages of growth and expansion in the region that occur in phases of boom and bust. Dependence on oil exports Mexican lime by an American multinational company is determined, in turn, by the behavior of the economic cycle in the United States. This study highlights the stage of formation of the agroindustrial complex and does not attempt to analyze the current situation

  13. The Role of Complex Treatment in Mixed Leg Ulcers – A Case Report of Vascular, Surgical and Physical Therapy

    Science.gov (United States)

    Wollina, Uwe; Heinig, Birgit; Stelzner, Christian; Hansel, Gesina; Schönlebe, Jacqueline; Tchernev, Georgi; Lotti, Torello

    2018-01-01

    BACKGROUND: Leg ulcers are a burden to patients, their families and society. The second most common cause of chronic leg ulcers is the mixed arterio-venous type. An 80-year-old female patient presented to our department due to painful enlarging chronic leg ulcer of mixed arteriovenous origin on her left lower leg. She suffered from peripheral arterial occlusive disease stage I and chronic venous insufficiency Widmer grade IIIa, and a number of comorbidities. AIM: The aim of our ulcer treatment was a complete and stable wound closure that was hampered by arterial occlusion, exposed tendon, and renal insiffuciency. CASE REPORT: To improve the prognosis for ulcer surgery, we performed percutaneous transluminal angioplasty, transcutaneous CO2 and deep ulcer shaving. The wound was closed by sandwich transplantation using elastin-collagen dermal template and meshed split skin graft. She had a 100% graft take with rapid reduction of severe wound pain. CONCLUSION: Complex approaches are necessary, to gain optimum results in leg ulcer therapy in mixed leg ulcers. Therapeutic nihilism should be abandonend. PMID:29483986

  14. Complex treatment of primary brain neuroblastoma with four local recurrences for period of 5 years -clinical case from our practice

    International Nuclear Information System (INIS)

    Marinova, L.; Georgiev, R.; Mihaylova, I.; Belcheva, M.

    2017-01-01

    We present a clinical case of 17 years old girl with primary brain neuroblastoma (supratentorial primitive neuro-ectodermal tumor - PNET in right temporo-parietal brain region). Complex treatment has been applied, including subtotal operation, standard fractioned cranio-spinal external beam radiotherapy with boost up to 56 Gy in the locus of the tumor remnant and 6 courses of adjuvant chemotherapy with Carboplatin and Etoposide. Despite the applied local treatment methods (radical surgery, standard fractioned cranio-spinal external beam radiotherapy and radio-surgery with single total dose of 14 Gy), four recurrences have appeared for period of 5 years in the locus of the primary tumor. The risk of appearance of local recurrences, necessitating re-operations, chemotherapy, bone marrow transplantation of stem cells and radio-surgery was discussed. We are also discussing the radio sensitivity of the PNET and the possibilities for overcoming it with implementation of hyper fractioned cranio-spinal external beam radiotherapy in combination with chemotherapy, followed by bone marrow transplantation of stem cells. Key words: Primary Brain Neuroblastoma. Radio Sensitivity. Cranio-Spinal External Beam Radiotherapy. Adjuvant Chemotherapy [bg

  15. Long-term weekly ACTH therapy for relapsed West syndrome in tuberous sclerosis complex: A case report.

    Science.gov (United States)

    Nakata, Masatoshi; Kato, Takeo; Ide, Minako; Saito, Keiko; Yoshida, Takeshi; Awaya, Tomonari; Shibata, Minoru; Heike, Toshio

    2016-04-01

    In Japan, adrenocorticotropic hormone (ACTH) therapy has been the mainstay of treatment of West syndrome. Conventional ACTH therapy is administered short-term with efficacy, yet the relapse rate is high. Relapse after initial ACTH therapy is a poor prognostic factor for long-term seizure control and outcome of cognitive function. Here, we report successful long-term weekly ACTH therapy for relapsed WS in a tuberous sclerosis complex (TSC) child after conventional ACTH therapy. The patient had a series of epileptic spasms (ES) and hypsarrhythmia at age 3 months. She was diagnosed with WS associated with TSC, and was treated with conventional ACTH therapy at age 4 months, and a second course of ACTH therapy at age 8 months. Both courses of therapy were transiently effective. A third course of ACTH therapy was started at age 1 year and 2 months, and long-term weekly ACTH therapy was continued thereafter. During this therapy, both ES and hypsarrhythmia remained completely resolved. Therapy was continued, and dose reduction was started when the patient was 2 years and 10 months old. No serious adverse events had occurred during this therapy. This case demonstrated that long-term weekly ACTH may be safe and effective. Although at present, this therapy may only be considered for relapsed symptomatic WS patients, it may be a good alternative therapy when frequent relapses occur after favorable response to conventional ACTH therapy. Copyright © 2015 The Japanese Society of Child Neurology. Published by Elsevier B.V. All rights reserved.

  16. Infection with the Mycobacterium avium complex in patients without predisposing conditons: a case report and literature review

    Directory of Open Access Journals (Sweden)

    Andrea Barral Martins

    Full Text Available Nontuberculous Mycobacteria (NTM, especially Mycobacterium avium-intracellulare complex (MAC, has been considered responsible for human disease, especially in HIV patients. Nevertheless, it has been diagnosed in immunocompetent elderly men, frequently with previous pulmonary disease: chronic obstructive lung disease (COPD, complications of tuberculosis, pulmonary fibrosis and bronchiectasis. We relate the case of a female patient, 51 years old, with continuously acid fast bacilli (AFB smears and with three previous treatments, which were conducted at the multiresistant tuberculosis (MRTB service. MAC was identified in the sputum culture, and she received treatment for one year. The posterior sputum exams were negative. The cavity lesions observed in the high-resolution computed tomography (HRCT were reduced, and some of the nodule lesions became bronchiectasis, even after the end of treatment. We agree with the literature reports that indicate that MAC is the cause of bronchiectasis. It is necessary to identify the type of mycobacteria in immunocompetent individuals with positive AFB smears that do not become negative with tuberculosis treatment.

  17. Relating catalytic activity and electrochemical properties: The case of arene-ruthenium phenanthroline complexes catalytically active in transfer hydrogenation

    Czech Academy of Sciences Publication Activity Database

    Štěpnička, P.; Ludvík, Jiří; Canivet, J.; Süss-Fink, G.

    2006-01-01

    Roč. 359, č. 8 (2006), s. 2369-2374 ISSN 0020-1693 R&D Projects: GA AV ČR IAA4040304 Institutional research plan: CEZ:AV0Z40400503 Keywords : arene complexes * chloro complexes * aqua complexes Subject RIV: CG - Electrochemistry Impact factor: 1.674, year: 2006

  18. Deciphering complex dynamics of water counteraction around secondary structural elements of allosteric protein complex: Case study of SAP-SLAM system in signal transduction cascade

    Science.gov (United States)

    Samanta, Sudipta; Mukherjee, Sanchita

    2018-01-01

    The first hydration shell of a protein exhibits heterogeneous behavior owing to several attributes, majorly local polarity and structural flexibility as revealed by solvation dynamics of secondary structural elements. We attempt to recognize the change in complex water counteraction generated due to substantial alteration in flexibility during protein complex formation. The investigation is carried out with the signaling lymphocytic activation molecule (SLAM) family of receptors, expressed by an array of immune cells, and interacting with SLAM-associated protein (SAP), composed of one SH2 domain. All atom molecular dynamics simulations are employed to the aqueous solutions of free SAP and SLAM-peptide bound SAP. We observed that water dynamics around different secondary structural elements became highly affected as well as nicely correlated with the SLAM-peptide induced change in structural rigidity obtained by thermodynamic quantification. A few instances of contradictory dynamic features of water to the change in structural flexibility are explained by means of occluded polar residues by the peptide. For βD, EFloop, and BGloop, both structural flexibility and solvent accessibility of the residues confirm the obvious contribution. Most importantly, we have quantified enhanced restriction in water dynamics around the second Fyn-binding site of the SAP due to SAP-SLAM complexation, even prior to the presence of Fyn. This observation leads to a novel argument that SLAM induced more restricted water molecules could offer more water entropic contribution during the subsequent Fyn binding and provide enhanced stability to the SAP-Fyn complex in the signaling cascade. Finally, SLAM induced water counteraction around the second binding site of the SAP sheds light on the allosteric property of the SAP, which becomes an integral part of the underlying signal transduction mechanism.

  19. Deciphering complex dynamics of water counteraction around secondary structural elements of allosteric protein complex: Case study of SAP-SLAM system in signal transduction cascade.

    Science.gov (United States)

    Samanta, Sudipta; Mukherjee, Sanchita

    2018-01-28

    The first hydration shell of a protein exhibits heterogeneous behavior owing to several attributes, majorly local polarity and structural flexibility as revealed by solvation dynamics of secondary structural elements. We attempt to recognize the change in complex water counteraction generated due to substantial alteration in flexibility during protein complex formation. The investigation is carried out with the signaling lymphocytic activation molecule (SLAM) family of receptors, expressed by an array of immune cells, and interacting with SLAM-associated protein (SAP), composed of one SH2 domain. All atom molecular dynamics simulations are employed to the aqueous solutions of free SAP and SLAM-peptide bound SAP. We observed that water dynamics around different secondary structural elements became highly affected as well as nicely correlated with the SLAM-peptide induced change in structural rigidity obtained by thermodynamic quantification. A few instances of contradictory dynamic features of water to the change in structural flexibility are explained by means of occluded polar residues by the peptide. For βD, EFloop, and BGloop, both structural flexibility and solvent accessibility of the residues confirm the obvious contribution. Most importantly, we have quantified enhanced restriction in water dynamics around the second Fyn-binding site of the SAP due to SAP-SLAM complexation, even prior to the presence of Fyn. This observation leads to a novel argument that SLAM induced more restricted water molecules could offer more water entropic contribution during the subsequent Fyn binding and provide enhanced stability to the SAP-Fyn complex in the signaling cascade. Finally, SLAM induced water counteraction around the second binding site of the SAP sheds light on the allosteric property of the SAP, which becomes an integral part of the underlying signal transduction mechanism.

  20. German Children's Use of Word Order and Case Marking to Interpret Simple and Complex Sentences: Testing Differences between Constructions and Lexical Items

    Science.gov (United States)

    Brandt, Silke; Lieven, Elena; Tomasello, Michael

    2016-01-01

    Children and adults follow cues such as case marking and word order in their assignment of semantic roles in simple transitives (e.g., "the dog chased the cat"). It has been suggested that the same cues are used for the interpretation of complex sentences, such as transitive relative clauses (RCs) (e.g., "that's the dog that chased…

  1. Identifying Complex Cultural Interactions in the Instructional Design Process: A Case Study of a Cross-Border, Cross-Sector Training for Innovation Program

    Science.gov (United States)

    Russell, L. Roxanne; Kinuthia, Wanjira L.; Lokey-Vega, Anissa; Tsang-Kosma, Winnie; Madathany, Reeny

    2013-01-01

    The purpose of this research is to identify complex cultural dynamics in the instructional design process of a cross-sector, cross-border training environment by applying Young's (2009) Culture-Based Model (CBM) as a theoretical framework and taxonomy for description of the instructional design process under the conditions of one case. This…

  2. Implementing a Case-Based E-Learning Environment in a Lecture-Oriented Anaesthesiology Class: Do Learning Styles Matter in Complex Problem Solving over Time?

    Science.gov (United States)

    Choi, Ikseon; Lee, Sang Joon; Kang, Jeongwan

    2009-01-01

    This study explores how students' learning styles influence their learning while solving complex problems when a case-based e-learning environment is implemented in a conventional lecture-oriented classroom. Seventy students from an anaesthesiology class at a dental school participated in this study over a 3-week period. Five learning-outcome…

  3. Molecular characterization of KMT2A fusion partner genes in 13 cases of pediatric leukemia with complex or cryptic karyotypes.

    Science.gov (United States)

    Ney Garcia, Daniela R; de Souza, Mariana T; de Figueiredo, Amanda F; Othman, Moneeb A K; Rittscher, Katharina; Abdelhay, Eliana; Capela de Matos, Roberto R; Meyer, Claus; Marschalek, Rolf; Land, Marcelo G P; Liehr, Thomas; Ribeiro, Raul C; Silva, Maria Luiza Macedo

    2017-12-01

    In pediatric acute leukemias, reciprocal chromosomal translocations frequently cause gene fusions involving the lysine (K)-specific methyltransferase 2A gene (KMT2A, also known as MLL). Specific KMT2A fusion partners are associated with the disease phenotype (lymphoblastic vs. myeloid), and the type of KMT2A rearrangement also has prognostic implications. However, the KMT2A partner gene cannot always be identified by banding karyotyping. We sought to identify such partner genes in 13 cases of childhood leukemia with uninformative karyotypes by combining molecular techniques, including multicolor banding FISH, reverse-transcriptase PCR, and long-distance inverse PCR. Of the KMT2A fusion partner genes, MLLT3 was present in five patients, all with acute lymphoblastic leukemia, MLLT1 in two patients, and MLLT10, MLLT4, MLLT11, and AFF1 in one patient each. Reciprocal reading by long-distance inverse PCR also disclosed KMT2A fusions with PITPNA in one patient, with LOC100132273 in another patient, and with DNA sequences not compatible with any gene in three patients. The most common KMT2A breakpoint region was intron/exon 9 (3/8 patients), followed by intron/exon 11 and 10. Finally, multicolor banding revealed breakpoints in other chromosomes whose biological and prognostic implications remain to be determined. We conclude that the combination of molecular techniques used in this study can efficiently identify KMT2A fusion partners in complex pediatric acute leukemia karyotypes. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

  4. Switching industrial production processes from complex to defined media: method development and case study using the example of Penicillium chrysogenum.

    Science.gov (United States)

    Posch, Andreas E; Spadiut, Oliver; Herwig, Christoph

    2012-06-22

    Filamentous fungi are versatile cell factories and widely used for the production of antibiotics, organic acids, enzymes and other industrially relevant compounds at large scale. As a fact, industrial production processes employing filamentous fungi are commonly based on complex raw materials. However, considerable lot-to-lot variability of complex media ingredients not only demands for exhaustive incoming components inspection and quality control, but unavoidably affects process stability and performance. Thus, switching bioprocesses from complex to defined media is highly desirable. This study presents a strategy for strain characterization of filamentous fungi on partly complex media using redundant mass balancing techniques. Applying the suggested method, interdependencies between specific biomass and side-product formation rates, production of fructooligosaccharides, specific complex media component uptake rates and fungal strains were revealed. A 2-fold increase of the overall penicillin space time yield and a 3-fold increase in the maximum specific penicillin formation rate were reached in defined media compared to complex media. The newly developed methodology enabled fast characterization of two different industrial Penicillium chrysogenum candidate strains on complex media based on specific complex media component uptake kinetics and identification of the most promising strain for switching the process from complex to defined conditions. Characterization at different complex/defined media ratios using only a limited number of analytical methods allowed maximizing the overall industrial objectives of increasing both, method throughput and the generation of scientific process understanding.

  5. Advantages of conducting in-situ U-Pb age dating of multiple U-bearing minerals from a single complex: Case in point - the Oka Carbonatite Complex

    Science.gov (United States)

    Chen, W.; Simonetti, A.

    2012-12-01

    A detailed radiometric investigation is currently underway focusing on U-bearing accessory minerals apatite, perovskite, and niocalite from the Oka Carbonatite Complex (Canada). One of the main objectives is to obtain a comparative chronology of melt crystallization for the complex. Unlike other commonly adopted U-bearing minerals (e.g., zircon, monazite) for in-situ dating investigations, apatite, perovskite, and niocalite contain relatively high contents of common Pb. Hence, careful assessment of the proportion and composition of the common Pb, and usage of appropriate matrix-matched external standards are imperative. The Madagascar apatite was utilized as the external standard for apatite dating, and the Emerald Lake and Durango apatites were adopted as secondary standards; the latter yield ages of 92.6 ±1.8 and 32.2 ±1.1 Ma, respectively, and these are identical to their accepted ages. Pb/U ages for apatite from Oka were obtained for different rock types, including 8 carbonatites, 4 okaites, 3 ijolites and 3 alnoites, and these define a range of ages between ~105 and ~135 Ma; this result suggests a protracted crystallization history. In total, 266 individual analyses define two peaks at ~115 and ~125Ma. For perovskite dating, the Ice River perovskite standard was utilized as the external standard. The perovskites from one okaite sample yield an age of 112.2 ±1.9 Ma, and is much younger than the previously reported U-Pb perovskite age of 131 ±7 Ma. Hence, the combined U-Pb perovskite ages also suggest a rather prolonged time of melt crystallization. Niocalite is a rare, accessory silicate mineral that occurs within the carbonatites at Oka. The international zircon standard BR266 was selected for use as the external standard and rastering was employed to minimize the Pb-U fractionation. Two niocalite samples give young ages at 110.6 ±1.2 and 115.0 ±1.9 Ma, and are identical to their respective apatite ages (given associated uncertainties) from the same

  6. Complexity Plots

    KAUST Repository

    Thiyagalingam, Jeyarajan

    2013-06-01

    In this paper, we present a novel visualization technique for assisting the observation and analysis of algorithmic complexity. In comparison with conventional line graphs, this new technique is not sensitive to the units of measurement, allowing multivariate data series of different physical qualities (e.g., time, space and energy) to be juxtaposed together conveniently and consistently. It supports multivariate visualization as well as uncertainty visualization. It enables users to focus on algorithm categorization by complexity classes, while reducing visual impact caused by constants and algorithmic components that are insignificant to complexity analysis. It provides an effective means for observing the algorithmic complexity of programs with a mixture of algorithms and black-box software through visualization. Through two case studies, we demonstrate the effectiveness of complexity plots in complexity analysis in research, education and application. © 2013 The Author(s) Computer Graphics Forum © 2013 The Eurographics Association and Blackwell Publishing Ltd.

  7. Mycobacterium avium complex olecranon bursitis resolves without antimicrobials or surgical intervention: A case report and review of the literature

    Directory of Open Access Journals (Sweden)

    Selene Working

    2015-01-01

    Conclusion: This case raises an important clinical question of whether close observation off antimicrobials is appropriate in select cases of immunocompetent patients with localized atypical mycobacterial disease of soft tissue and skeletal structures.

  8. Multicolor-FISH applied to resolve complex chromosomal changes in a case of T-ALL (FAB L2)

    NARCIS (Netherlands)

    Mkrtchyan, H.; Glaser, M.; Gross, M.; Wedding, U.; Hoeffken, K.; Liehr, T.; Aroutiounian, R.

    2006-01-01

    We report on a patient with a clinically diagnosed acute lymphoblastic leukemia (ALL) with partial unrecorded complex translocation events especially involving chromosomes 5,9 and 18. At the GTG-band level the karyotype was abnormal in 20% of the analyzed cells. The complex karyotype was studied in

  9. The utility of 3D printing for surgical planning and patient-specific implant design for complex spinal pathologies: case report.

    Science.gov (United States)

    Mobbs, Ralph J; Coughlan, Marc; Thompson, Robert; Sutterlin, Chester E; Phan, Kevin

    2017-04-01

    OBJECTIVE There has been a recent renewed interest in the use and potential applications of 3D printing in the assistance of surgical planning and the development of personalized prostheses. There have been few reports on the use of 3D printing for implants designed to be used in complex spinal surgery. METHODS The authors report 2 cases in which 3D printing was used for surgical planning as a preoperative mold, and for a custom-designed titanium prosthesis: one patient with a C-1/C-2 chordoma who underwent tumor resection and vertebral reconstruction, and another patient with a custom-designed titanium anterior fusion cage for an unusual congenital spinal deformity. RESULTS In both presented cases, the custom-designed and custom-built implants were easily slotted into position, which facilitated the surgery and shortened the procedure time, avoiding further complex reconstruction such as harvesting rib or fibular grafts and fashioning these grafts intraoperatively to fit the defect. Radiological follow-up for both cases demonstrated successful fusion at 9 and 12 months, respectively. CONCLUSIONS These cases demonstrate the feasibility of the use of 3D modeling and printing to develop personalized prostheses and can ease the difficulty of complex spinal surgery. Possible future directions of research include the combination of 3D-printed implants and biologics, as well as the development of bioceramic composites and custom implants for load-bearing purposes.

  10. Glacial recession in the Tropical Andes from the Little Ice Age: the case of Ampato Volcanic Complex (Southern Peru

    Science.gov (United States)

    Alcalá, J.; Palacios, D.; Zamorano, J. J.

    2010-03-01

    the Ampato volcanic complex (15º24´- 15º 51´ S, 71º 51´ - 73º W; 6.288 masl), one of the most important complexes of the northern sector of the CVZ. Photointerpretation of aerial photographs and teledetection through satellite images of Huayuray Valley (15º 41´ 14´´ S - 71º 51´ 53´´ W), located to the north of the complex, aided in accurately reconstructing the area occupied by the ice mass at different times (LIA, 1955, 2000 and 2008). Also the paleo-ELA (Equilibrium Line Altitude) and the ELA were calculated using the Accumulation Area (AA) method (Kaser and Osmaston, 2002; Osmaston, 2005) in a GIS. The ELA shows the relationship between climate and glacier mass balance (González Trueba, 2005). The data from Huayuray Valley show that the glaciers reached a minimum altitude of 5400 masl and covered an area of ~2.81 Km2 during the LIA. The paleo-ELA was located at ~5780 masl, ~120 m below the current ELA (~5900 m). Based on a vertical thermal gradient of 0.65ºC/100 m, the temperature during this event would have been about 0.7º C colder than present temperature in the Ampato volcanic complex. In 1955, Huayuray glacier covered ~2.45 km2, 12.8% less than in the LIA. In the same year, the glaciers in the Huayuray valley reached a minimum elevation of ~5660 masl and the ELA rose ~20 m, to 5800 masl. In only 45 years (1955 - 2000) the surface area of the ice was significantly reduced (~1 km2), i.e. 40.8%. The ELA continued to rise, until it reached 5890 masl in 2000. From 2000 - 2008, the Huayuray glacier was reduced to ~0.78 km2 and the ELA rised ~10 m to reach the 5900 masl These results from the CVZ confirm the dramatic recession of the glaciers in the tropical Andes during recent decades. They also suggest that if the rate of recession associated with the period 2000-2008 continues, glaciers in the Ampato volcanic complex will disappear in 10 years approximately. References González Trueba, J.J. (2005): La Pequeña Edad del Hielo en los Picos de

  11. The Challenge of Integrating Care in Dual Diagnosis; Anti-NMDA-Receptor Encephalitis; Presentation And Outcome In 3 Cases Referred For Complex Specialist Rehabilitation Services

    LENUS (Irish Health Repository)

    Carroll, A

    2018-03-01

    The successful implementation of an integrated care pathway (ICP) for any given condition is a challenge. Even more challenging is successful ICP implementation for individuals who have multiple co-morbidities. This is further compounded when there are dual mental health and physical disabilities that require integrated working across multiple disciplines, specialties, institutions and organisations. Anti-NMDA-Receptor encephalitis (aNMDARe) is a relatively new diagnostic entity with patients typically presenting with significant psychiatric symptoms followed by progressive neurological deterioration. In this case series, we describe 3 cases of females with aNMDARe who were referred for complex specialist rehabilitation (CSR) to The National Rehabilitation Hospital. CSR is the total active care of patients with a disabling condition, and their families, by a multi-professional team who have undergone recognised specialist training in rehabilitation, led \\/supported by a consultant trained and accredited in rehabilitation medicine (RM). These services provide for patients with highly complex rehabilitation needs that are beyond the scope of local services. In these cases, referral to CSR resulted in the construction of a bespoke integrated care pathway (ICP) that transcended the barriers between primary, secondary and tertiary care and across the boundaries of physical and mental health. A care pathway is a complex intervention for the mutual decision-making and organisation of care processes Rehabilitation services acted as the coordinator of services in these cases to ensure implementation of the care plan and to ensure successful transitions of care and supported local specialist and general teams in the management of these complex cases.

  12. Learning from Simple Ebooks, Online Cases or Classroom Teaching When Acquiring Complex Knowledge. A Randomized Controlled Trial in Respiratory Physiology and Pulmonology

    Science.gov (United States)

    Worm, Bjarne Skjødt

    2013-01-01

    Background and Aims E-learning is developing fast because of the rapid increased use of smartphones, tablets and portable computers. We might not think of it as e-learning, but today many new e-books are in fact very complex electronic teaching platforms. It is generally accepted that e-learning is as effective as classroom teaching methods, but little is known about its value in relaying contents of different levels of complexity to students. We set out to investigate e-learning effects on simple recall and complex problem-solving compared to classroom teaching. Methods 63 nurses specializing in anesthesiology were evenly randomized into three groups. They were given internet-based knowledge tests before and after attending a teaching module about respiratory physiology and pulmonology. The three groups was either an e-learning group with eBook teaching material, an e-learning group with case-based teaching or a group with face-to-face case-based classroom teaching. After the module the students were required to answer a post-test. Time spent and the number of logged into the system was also measured. Results For simple recall, all methods were equally effective. For problem-solving, the eCase group achieved a comparable knowledge level to classroom teaching, while textbook learning was inferior to both (p<0.01). The textbook group also spent the least amount of time on acquiring knowledge (33 minutes, p<0.001), while the eCase group spent significantly more time on the subject (53 minutes, p<0.001) and logged into the system significantly more (2.8 vs 1.6, p<0.001). Conclusions E-learning based cases are an effective tool for teaching complex knowledge and problem-solving ability, but future studies using higher-level e-learning are encouraged.Simple recall skills, however, do not require any particular learning method. PMID:24039917

  13. 3-Dimensional computed tomography imaging of the ring-sling complex with non-operative survival case in a 10-year-old female

    OpenAIRE

    Fukuda, Hironobu; Imataka, George; Drago, Fabrizio; Maeda, Kosaku; Yoshihara, Shigemi

    2017-01-01

    We report a case of a 10-year-old female patient who survived ring-sling complex without surgery. The patient had congenital wheezing from the neonatal period and was treated after a tentative diagnosis of infantile asthma. The patient suffered from allergy and was hospitalized several times due to severe wheezing, and when she was 22 months old, she was diagnosed with ring-sling complex. We used a segmental 4 mm internal diameter of the trachea for 3-dimensional computed tomography (3D-CT). ...

  14. The TOM Complex of Amoebozoans: the Cases of the Amoeba Acanthamoeba castellanii and the Slime Mold Dictyostelium discoideum.

    Science.gov (United States)

    Wojtkowska, Małgorzata; Buczek, Dorota; Stobienia, Olgierd; Karachitos, Andonis; Antoniewicz, Monika; Slocinska, Małgorzata; Makałowski, Wojciech; Kmita, Hanna

    2015-07-01

    Protein import into mitochondria requires a wide variety of proteins, forming complexes in both mitochondrial membranes. The TOM complex (translocase of the outer membrane) is responsible for decoding of targeting signals, translocation of imported proteins across or into the outer membrane, and their subsequent sorting. Thus the TOM complex is regarded as the main gate into mitochondria for imported proteins. Available data indicate that mitochondria of representative organisms from across the major phylogenetic lineages of eukaryotes differ in subunit organization of the TOM complex. The subunit organization of the TOM complex in the Amoebozoa is still elusive, so we decided to investigate its organization in the soil amoeba Acanthamoeba castellanii and the slime mold Dictyostelium discoideum. They represent two major subclades of the Amoebozoa: the Lobosa and Conosa, respectively. Our results confirm the presence of Tom70, Tom40 and Tom7 in the A. castellanii and D. discoideum TOM complex, while the presence of Tom22 and Tom20 is less supported. Interestingly, the Tom proteins display the highest similarity to Opisthokonta cognate proteins, with the exception of Tom40. Thus representatives of two major subclades of the Amoebozoa appear to be similar in organization of the TOM complex, despite differences in their lifestyle. Copyright © 2015 The Authors. Published by Elsevier GmbH.. All rights reserved.

  15. First Complex Allotransplantation of Neck Organs: Larynx, Trachea, Pharynx, Esophagus, Thyroid, Parathyroid Glands, and Anterior Cervical Wall: A Case Report.

    Science.gov (United States)

    Grajek, Maciej; Maciejewski, Adam; Giebel, Sebastian; Krakowczyk, Łukasz; Ulczok, Rafał; Szymczyk, Cezary; Wierzgon, Janusz; Szumniak, Ryszard; Dobrut, Miroslaw; Oleś, Krzysztof; Drozdowski, Piotr; Walczak, Dominik; Szpak-Ulczok, Sylwia; Poltorak, Stanislaw

    2017-08-01

    Evaluate the possibility of performing a complex vascular allotransplant of all neck organs including skin. There are 2 previous attempts described in the literature, none of them being that complex. The first one is nonfunctional due to chronic rejection, the second one is viable yet considerably limited in complexity (no parathyroids, no skin). The allotransplantation was performed simultaneously on 2 adjacent operating rooms, using microsurgical techniques. The patient's voice, breathing through mouth, swallowing, and endocrinal functions have been fully restored. Achieved results show clearly that such operations performed in selected patients can nearly fully restore functional and aesthetic effects in 1 single procedure.

  16. Complex regional pain syndrome in a competitive athlete and regional osteoporosis assessed by dual-energy X-ray absorptiometry: a case report.

    Science.gov (United States)

    Hind, Karen; Johnson, Mark I

    2014-05-27

    Dual-energy X-ray absorptiometry is rarely utilized in the clinical care of patients with complex regional pain syndrome, but may be useful for the non-invasive determination of regional bone fragility and fracture risk, as well as muscular atrophy and regional body composition. This is the first report in the literature of complex regional pain syndrome and musculoskeletal co-morbidities in an athlete, and is the first to focus on dual-energy X-ray absorptiometry for the clinical assessment of complex regional pain syndrome. In this report, we describe the case of a 29-year-old Caucasian man with type 1 complex regional pain syndrome. His body mass index was 29.4kg/m2 at the time of presentation. Despite severe complex regional pain syndrome in the left limb and long term use of a wheelchair, the patient participated in high-performance powerlifting. Dual-energy X-ray absorptiometry revealed marked unilateral differences in bone strength and lean mass between the affected regions and the contralateral regions. Low bone mineral density for age was found in the left hip, with Z-scores ranging from -2.2 to -3.0, and the patient had previously suffered two fractures. Bone density Z-scores in the right hip and legs were normal. Dual-energy X-ray absorptiometry is a valuable tool for the clinical investigation of musculoskeletal health in patients with complex regional pain syndrome. Regional osteoporosis in complex regional pain syndrome patients is complicated and should be investigated and monitored. Physical activity is possible for some complex regional pain syndrome patients, depending on the type of exercise and the region affected, and it may protect bone density and strength at non affected skeletal sites.

  17. High-resolution numerical simulation of summer wind field comparing WRF boundary-layer parametrizations over complex Arctic topography: case study from central Spitsbergen

    Czech Academy of Sciences Publication Activity Database

    Láska, K.; Chládová, Zuzana; Hošek, Jiří

    2017-01-01

    Roč. 26, č. 4 (2017), s. 391-408 ISSN 0941-2948 Institutional support: RVO:68378289 Keywords : surface wind field * model evaluation * topographic effect * circulation pattern * Svalbard Subject RIV: DG - Athmosphere Sciences, Meteorology OBOR OECD: Meteorology and atmospheric sciences Impact factor: 1.989, year: 2016 http://www.schweizerbart.de/papers/metz/detail/prepub/87659/High_resolution_numerical_simulation_of_summer_wind_field_comparing_WRF_boundary_layer_parametrizations_over_complex_Arctic_topography_case_study_from_central_Spitsbergen

  18. On the Worst-Case Complexity of the Gradient Method with Exact Line Search for Smooth Strongly Convex Functions

    NARCIS (Netherlands)

    de Klerk, Etienne; Glineur, Francois; Taylor, Adrien

    2016-01-01

    We consider the gradient (or steepest) descent method with exact line search applied to a strongly convex function with Lipschitz continuous gradient. We establish the exact worst-case rate of convergence of this scheme, and show that this worst-case behavior is exhibited by a certain convex

  19. On the worst-case complexity of the gradient method with exact line search for smooth strongly convex functions

    NARCIS (Netherlands)

    de Klerk, Etienne; Glineur, Francois; Taylor, Adrien

    2017-01-01

    We consider the gradient (or steepest) descent method with exact line search applied to a strongly convex function with Lipschitz continuous gradient. We establish the exact worst-case rate of convergence of this scheme, and show that this worst-case behavior is exhibited by a certain convex

  20. Existence of species complex largely reduced barcoding success for invasive species of Tephritidae: a case study in Bactrocera spp.

    Science.gov (United States)

    Jiang, F; Jin, Q; Liang, L; Zhang, A B; Li, Z H

    2014-11-01

    Fruit flies in the family Tephritidae are the economically important pests that have many species complexes. DNA barcoding has gradually been verified as an effective tool for identifying species in a wide range of taxonomic groups, and there are several publications on rapid and accurate identification of fruit flies based on this technique; however, comprehensive analyses of large and new taxa for the effectiveness of DNA barcoding for fruit flies identification have been rare. In this study, we evaluated the COI barcode sequences for the diagnosis of fruit flies using 1426 sequences for 73 species of Bactrocera distributed worldwide. Tree-based [neighbour-joining (NJ)]; distance-based, such as Best Match (BM), Best Close Match (BCM) and Minimum Distance (MD); and character-based methods were used to evaluate the barcoding success rates obtained with maintaining the species complex in the data set, treating a species complex as a single taxon unit, and removing the species complex. Our results indicate that the average divergence between species was 14.04% (0.00-25.16%), whereas within a species this was 0.81% (0.00-9.71%); the existence of species complexes largely reduced the barcoding success for Tephritidae, for example relatively low success rates (74.4% based on BM and BCM and 84.8% based on MD) were obtained when the sequences from species complexes were included in the analysis, whereas significantly higher success rates were achieved if the species complexes were treated as a single taxon or removed from the data set - BM (98.9%), BCM (98.5%) and MD (97.5%), or BM (98.1%), BCM (97.4%) and MD (98.2%). © 2014 John Wiley & Sons Ltd.

  1. Development of the Andalusian Registry of Patients Receiving Community Case Management, for the follow-up of people with complex chronic diseases.

    Science.gov (United States)

    Morales-Asencio, Jose M; Kaknani-Uttumchandani, Shakira; Cuevas-Fernández-Gallego, Magdalena; Palacios-Gómez, Leopoldo; Gutiérrez-Sequera, José L; Silvano-Arranz, Agustina; Batres-Sicilia, Juan Pedro; Delgado-Romero, Ascensión; Cejudo-Lopez, Ángela; Trabado-Herrera, Manuel; García-Lara, Esteban L; Martin-Santos, Francisco J; Morilla-Herrera, Juan C

    2015-10-01

    Complex chronic diseases are a challenge for the current configuration of health services. Case management is a service frequently provided for people with chronic conditions, and despite its effectiveness in many outcomes, such as mortality or readmissions, uncertainty remains about the most effective form of team organization, structures and the nature of the interventions. Many processes and outcomes of case management for people with complex chronic conditions cannot be addressed with the information provided by electronic clinical records. Registries are frequently used to deal with this weakness. The aim of this study was to generate a registry-based information system of patients receiving case management to identify their clinical characteristics, their context of care, events identified during their follow-up, interventions developed by case managers and services used. The study was divided into three phases, covering the detection of information needs, the design and its implementation in the health care system, using literature review and expert consensus methods to select variables that would be included in the registry. A total of 102 variables representing structure, processes and outcomes of case management were selected for their inclusion in the registry after the consensus phase. A web-based registry with modular and layered architecture was designed. The framework follows a pattern based on the model-view-controller approach. In its first 6 months after the implementation, 102 case managers have introduced an average number of 6.49 patients each one. The registry permits a complete and in-depth analysis of the characteristics of the patients who receive case management, the interventions delivered and some major outcomes as mortality, readmissions or adverse events. © 2015 John Wiley & Sons, Ltd.

  2. Bringing content understanding into usability testing in complex application domains—a case study in eHealth

    DEFF Research Database (Denmark)

    Andersen, Simon Bruntse; Rasmussen, Claire Kirchert; Frøkjær, Erik

    2017-01-01

    A usability evaluation technique, Cooperative Usability Testing with Questions of Understanding (CUT with QU) intended to illuminate users’ ability to understand the content information of an application is proposed. In complex application domains as for instance the eHealth domain, this issue...... the participation of four physiotherapists and four clients in a period of 3.5 months, it was demonstrated how CUT with QU can complement conventional usability testing and provide insight into users’ challenges with understanding of a new complex eHealth application. More experiments in other complex application...... domains involving different kinds of users and evaluators are needed before we can tell whether CUT with QU is an effective usability testing technique of wider applicability. Performing CUT with QU is very demanding by drawing heavily on the evaluators’ ability to respond effectively to openings...

  3. Metastatic Group 3 Medulloblastoma in a Patient With Tuberous Sclerosis Complex: Case Description and Molecular Characterization of the Tumor.

    Science.gov (United States)

    Moavero, Romina; Folgiero, Valentina; Carai, Andrea; Miele, Evelina; Ferretti, Elisabetta; Po, Agnese; Diomedi Camassei, Francesca; Lepri, Francesca Romana; Vigevano, Federico; Curatolo, Paolo; Valeriani, Massimiliano; Colafati, Giovanna S; Locatelli, Franco; Tornesello, Assunta; Mastronuzzi, Angela

    2016-04-01

    Medulloblastoma is the most common pediatric brain tumor. We describe a child with tuberous sclerosis complex that developed a Group 3, myc overexpressed, metastatic medulloblastoma (MB). Considering the high risk of treatment-induced malignancies, a tailored therapy, omitting radiation, was given. Based on the evidence of mammalian target of rapamycin mTORC, mTOR Complex; RAS, Rat sarcoma; RAF, rapidly accelerated fibrosarcoma (mTOR) pathway activation in the tumor, targeted therapy was applied resulting in complete remission of disease. Although the PI3K/AKT/mTOR signaling pathway plays a role in MB, we did not find TSC1/TSC2 (TSC, tuberous sclerosis complex) mutation in our patient. We speculate that a different pathway resulting in mTOR activation is the basis of both TSC and MB in this child; H&E, haematoxilin and eosin; Gd, gadolinium. © 2015 Wiley Periodicals, Inc.

  4. Case complexity in outpatients in a centre of excellence for somatic symptom disorder : A cross-sectional study

    NARCIS (Netherlands)

    van Eck van der Sluijs, J.F.; de Vroege, L.; van Manen, A.S.; van der Thiel, E.; Timmermans, A.; Pouwer, F.; van der Feltz-Cornelis, C.M.

    2016-01-01

    Background: At the Clinical Centre of Excellence for Body, Mind and Health, integrated care models are used to provide treatment to patients with Somatic Symptom and Related Disorders (SSD). The aim of this study is to describe complexity of SSD patients using the INTERMED. This instrument has been

  5. Advances in Multi-Sensor Scanning and Visualization of Complex Plants: the Utmost Case of a Reactor Building

    Science.gov (United States)

    Hullo, J.-F.; Thibault, G.; Boucheny, C.

    2015-02-01

    In a context of increased maintenance operations and workers generational renewal, a nuclear owner and operator like Electricité de France (EDF) is interested in the scaling up of tools and methods of "as-built virtual reality" for larger buildings and wider audiences. However, acquisition and sharing of as-built data on a large scale (large and complex multi-floored buildings) challenge current scientific and technical capacities. In this paper, we first present a state of the art of scanning tools and methods for industrial plants with very complex architecture. Then, we introduce the inner characteristics of the multi-sensor scanning and visualization of the interior of the most complex building of a power plant: a nuclear reactor building. We introduce several developments that made possible a first complete survey of such a large building, from acquisition, processing and fusion of multiple data sources (3D laser scans, total-station survey, RGB panoramic, 2D floor plans, 3D CAD as-built models). In addition, we present the concepts of a smart application developed for the painless exploration of the whole dataset. The goal of this application is to help professionals, unfamiliar with the manipulation of such datasets, to take into account spatial constraints induced by the building complexity while preparing maintenance operations. Finally, we discuss the main feedbacks of this large experiment, the remaining issues for the generalization of such large scale surveys and the future technical and scientific challenges in the field of industrial "virtual reality".

  6. Prenatal diagnosis of cerebral lesions in Tuberous sclerosis complex (TSC). Case report and review of the literature.

    NARCIS (Netherlands)

    Wortmann, S.B.; Reimer, A.G.; Creemers, J.W.T.; Mullaart, R.A.

    2008-01-01

    Tuberous sclerosis complex (TSC) is an autosomal-dominant neurocutaneous disorder with multi-organ involvement. The diagnosis is suspected at fetal ultrasound on the discovery of multiple cardiac rhabdomyomas (CRs). They typically develop in utero and undergo spontaneous regression during the first

  7. Comparison of Metabolomics Approaches for Evaluating the Variability of Complex Botanical Preparations: Green Tea (Camellia sinensis) as a Case Study.

    Science.gov (United States)

    Kellogg, Joshua J; Graf, Tyler N; Paine, Mary F; McCune, Jeannine S; Kvalheim, Olav M; Oberlies, Nicholas H; Cech, Nadja B

    2017-05-26

    A challenge that must be addressed when conducting studies with complex natural products is how to evaluate their complexity and variability. Traditional methods of quantifying a single or a small range of metabolites may not capture the full chemical complexity of multiple samples. Different metabolomics approaches were evaluated to discern how they facilitated comparison of the chemical composition of commercial green tea [Camellia sinensis (L.) Kuntze] products, with the goal of capturing the variability of commercially used products and selecting representative products for in vitro or clinical evaluation. Three metabolomic-related methods-untargeted ultraperformance liquid chromatography-mass spectrometry (UPLC-MS), targeted UPLC-MS, and untargeted, quantitative 1 HNMR-were employed to characterize 34 commercially available green tea samples. Of these methods, untargeted UPLC-MS was most effective at discriminating between green tea, green tea supplement, and non-green-tea products. A method using reproduced correlation coefficients calculated from principal component analysis models was developed to quantitatively compare differences among samples. The obtained results demonstrated the utility of metabolomics employing UPLC-MS data for evaluating similarities and differences between complex botanical products.

  8. Electron Transfer Across Multiple Hydrogen Bonds: The Case of Ureapyrimidinedione-Substituted Vinyl Ruthenium and Osmium Complexes

    Czech Academy of Sciences Publication Activity Database

    Pichlmaier, M.; Winter, R. F.; Zabel, M.; Záliš, Stanislav

    2009-01-01

    Roč. 131, č. 13 (2009), s. 4892-4903 ISSN 0002-7863 R&D Projects: GA MŠk OC 139; GA AV ČR KAN100400702 Institutional research plan: CEZ:AV0Z40400503 Keywords : bridget diruthenium complexes * supramolecular polymers * distance dependence Subject RIV: CG - Electrochemistry Impact factor: 8.580, year: 2009

  9. Ruthenium Complexes with Vinyl, Styryl, and Vinylpyrenyl Ligands: A Case of Non-Innocence in Organometallic Chemistry

    Czech Academy of Sciences Publication Activity Database

    Maurer, J.; Linseis, M.; Sarkar, B.; Schwederski, B.; Niemeyer, M.; Kaim, W.; Záliš, Stanislav; Anson, Ch.; Zabel, M.; Winter, R. F.

    2008-01-01

    Roč. 130, č. 1 (2008), s. 259-268 ISSN 0002-7863 R&D Projects: GA AV ČR 1ET400400413; GA MŠk OC 139 Institutional research plan: CEZ:AV0Z40400503 Keywords : ruthenium complexes * organometallic chemistry * vinyl Subject RIV: CG - Electrochemistry Impact factor: 8.091, year: 2008

  10. Critical analysis of the data on complexation of lanthanides and actinides by natural organic matter: particular case of humic substances; Analyse critique des donnees de complexation des lanthanides et actinides par la matiere organique naturelle: cas des substances humiques

    Energy Technology Data Exchange (ETDEWEB)

    Reiller, P.

    2010-07-01

    This document proposes a critical analysis of the models that describe the actinides and lanthanides complexation by natural organic matter in general and by humic substances in particular. In order to better delimit the particular properties of these substances the most influent physical and chemical properties on complexation are recalled as a preamble. Models as well as data that has been used are reviewed, compiled, and eventually compared to independent data in order to identify (i) their application domain, (ii) the possible simplifications which permit to obtain operational models, (iii) the conditions in which simplifications cannot be ascertained yet, and (iv) the data or fields of knowledge which are still too uncertain. A comparison between the different models is proposed in order to adapt parameters from one model to another minimising the experimental acquisitions, or at least to focus on missing data. Usually, data on the complexation of free ions M{sup z+} are reliable; as soon as hydrolysis, or competition with another ligand in general, in at stake data are much less reliable. Predictions from models are much more uncertain: formation of mixed complexes with hydroxide or carbonate anions is not univocal whatever the modelling strategy. Hints for transfer functions between models which are believed to be incompatible could be explored in order to justify necessary simplifications for using operational modelling. Influence on the solubility of oxides could be quantified, but it is difficult to clearly separate it from colloidal particles stabilisation. The account of the competition between cations by the models has also been tested. In view of the small number of available experimental data there still lie some uncertainties especially for the media that are close to neutrality and in the case of competition with magnesium, but overall in the case of the competition with aluminium and iron. The influence of redox activity of humic substances is

  11. Delay-dependent dynamical analysis of complex-valued memristive neural networks: Continuous-time and discrete-time cases.

    Science.gov (United States)

    Wang, Jinling; Jiang, Haijun; Ma, Tianlong; Hu, Cheng

    2018-05-01

    This paper considers the delay-dependent stability of memristive complex-valued neural networks (MCVNNs). A novel linear mapping function is presented to transform the complex-valued system into the real-valued system. Under such mapping function, both continuous-time and discrete-time MCVNNs are analyzed in this paper. Firstly, when activation functions are continuous but not Lipschitz continuous, an extended matrix inequality is proved to ensure the stability of continuous-time MCVNNs. Furthermore, if activation functions are discontinuous, a discontinuous adaptive controller is designed to acquire its stability by applying Lyapunov-Krasovskii functionals. Secondly, compared with techniques in continuous-time MCVNNs, the Halanay-type inequality and comparison principle are firstly used to exploit the dynamical behaviors of discrete-time MCVNNs. Finally, the effectiveness of theoretical results is illustrated through numerical examples. Copyright © 2018 Elsevier Ltd. All rights reserved.

  12. Complexity of Type 2 Diabetes Mellitus Data Sets Emerging from Nutrigenomic Research: A Case for Dimensionality Reduction?

    Science.gov (United States)

    Kaput, Jim; Dawson, Kevin

    2007-01-01

    Nutrigenomics promises personalized nutrition and an improvement in preventing, delaying, and reducing the symptoms of chronic diseases such as diabetes. Nutritional genomics is the study of how foods affect the expression of genetic information in an individual and how an individual's genetic makeup affects the metabolism and response to nutrients and other bioactive components in food. The path to those promises has significant challenges, from experimental designs that include analysis of genetic heterogeneity to the complexities of food and environmental factors. One of the more significant complications in developing the knowledge base and potential applications is how to analyze high-dimensional datasets of genetic, nutrient, metabolomic (clinical), and other variables influencing health and disease processes. Type 2 diabetes mellitus (T2DM) is used as an illustration of the challenges in studying complex phenotypes with nutrigenomics concepts and approaches. PMID:17559889

  13. Complexity of type 2 diabetes mellitus data sets emerging from nutrigenomic research: a case for dimensionality reduction?

    Science.gov (United States)

    Kaput, Jim; Dawson, Kevin

    2007-09-01

    Nutrigenomics promises personalized nutrition and an improvement in preventing, delaying, and reducing the symptoms of chronic diseases such as diabetes. Nutritional genomics is the study of how foods affect the expression of genetic information in an individual and how an individual's genetic makeup affects the metabolism and response to nutrients and other bioactive components in food. The path to those promises has significant challenges, from experimental designs that include analysis of genetic heterogeneity to the complexities of food and environmental factors. One of the more significant complications in developing the knowledge base and potential applications is how to analyze high-dimensional datasets of genetic, nutrient, metabolomic (clinical), and other variables influencing health and disease processes. Type 2 diabetes mellitus (T2DM) is used as an illustration of the challenges in studying complex phenotypes with nutrigenomics concepts and approaches.

  14. Skills based constraints and complexities affecting small-scale-entrepreneurship: A case of communal cattle farmers in Vhembe District

    OpenAIRE

    Mavhungu Abel Mafukata

    2015-01-01

    This paper investigates constraints and complexities affecting entrepreneurial and Agri-business small-scale farming success and sustainability in the Vhembe District of Limpopo Province, South Africa. The respondent entrepreneur farmers were purposively selected (n=55) amongst 183 other farmers in the district for primary data collection through a semi-structured cross-language (Tshivenda) questionnaire. Key Informant Interviews (KIIs) and Focus Group Discussions (FGDs) also formed part of d...

  15. Air quality impacted by local pollution sources and beyond - Using a prominent petro-industrial complex as a study case.

    Science.gov (United States)

    Chen, Sheng-Po; Wang, Chieh-Heng; Lin, Wen-Dian; Tong, Yu-Huei; Chen, Yu-Chun; Chiu, Ching-Jui; Chiang, Hung-Chi; Fan, Chen-Lun; Wang, Jia-Lin; Chang, Julius S

    2018-05-01

    The present study combines high-resolution measurements at various distances from a world-class gigantic petrochemical complex with model simulations to test a method to assess industrial emissions and their effect on local air quality. Due to the complexity in wind conditions which were highly seasonal, the dominant wind flow patterns in the coastal region of interest were classified into three types, namely northeast monsoonal (NEM) flows, southwest monsoonal (SEM) flows and local circulation (LC) based on six years of monitoring data. Sulfur dioxide (SO 2 ) was chosen as an indicative pollutant for prominent industrial emissions. A high-density monitoring network of 12 air-quality stations distributed within a 20-km radius surrounding the petrochemical complex provided hourly measurements of SO 2 and wind parameters. The SO 2 emissions from major industrial sources registered by the monitoring network were then used to validate model simulations and to illustrate the transport of the SO 2 plumes under the three typical wind patterns. It was found that the coupling of observations and modeling was able to successfully explain the transport of the industrial plumes. Although the petrochemical complex was seemingly the only major source to affect local air quality, multiple prominent sources from afar also played a significant role in local air quality. As a result, we found that a more complete and balanced assessment of the local air quality can be achieved only after taking into account the wind characteristics and emission factors of a much larger spatial scale than the initial (20 km by 20 km) study domain. Copyright © 2018 Elsevier Ltd. All rights reserved.

  16. Posterior Fixation for Atlantoaxial Subluxation in a Case with Complex Anomaly of Persistent First Intersegmental Artery and Assimilation in the C1 Vertebra

    Science.gov (United States)

    Umebayashi, Daisuke; Hara, Masahito; Nakajima, Yasuhiro; Nishimura, Yusuke; Wakabayashi, Toshihiko

    2013-01-01

    We report a very rare case of atlantoaxial subluxation (AAS) with persistent first intersegmental artery (PFIA) and assimilation in the atlas (C1) vertebra. This case demonstrates the difficulty of deciding on a surgical strategy for complex anomalies. A 63-year-old man presented with gait disturbance, neck pain, and severe dysesthesia in his left arm. Past history included a whiplash injury. Dynamic X-ray studies demonstrated an irreducible AAS and assimilation of C1. This subluxation was slightly deteriorated in an extended position. A three-dimensional computed tomography angiography (3DCTA) indicated that the PFIA was located on the left side. We performed a C1 posterior arch resection and C1 lateral mass–axis pedicle screw (C1LM–C2PS) fixation using the modified technique of skewering the occipital condyle and C1 lateral mass. The patient had no postoperative morbidity and his symptoms disappeared immediately after operation. Complex anomalies cause difficulty in determining surgical strategy although several surgical methods for simple craniovertebral junction anomaly have been reported. To avoid significant morbidities associated with vertebral artery injury, surgical strategies for these complex conditions are discussed. The modified technique of a C1 lateral mass screw penetrating the occipital condyle is a viable treatment option. PMID:24097089

  17. A Mathematical Framework for the Complex System Approach to Group Dynamics: The Case of Recovery House Social Integration.

    Science.gov (United States)

    Light, John M; Jason, Leonard A; Stevens, Edward B; Callahan, Sarah; Stone, Ariel

    2016-03-01

    The complex system conception of group social dynamics often involves not only changing individual characteristics, but also changing within-group relationships. Recent advances in stochastic dynamic network modeling allow these interdependencies to be modeled from data. This methodology is discussed within a context of other mathematical and statistical approaches that have been or could be applied to study the temporal evolution of relationships and behaviors within small- to medium-sized groups. An example model is presented, based on a pilot study of five Oxford House recovery homes, sober living environments for individuals following release from acute substance abuse treatment. This model demonstrates how dynamic network modeling can be applied to such systems, examines and discusses several options for pooling, and shows how results are interpreted in line with complex system concepts. Results suggest that this approach (a) is a credible modeling framework for studying group dynamics even with limited data, (b) improves upon the most common alternatives, and (c) is especially well-suited to complex system conceptions. Continuing improvements in stochastic models and associated software may finally lead to mainstream use of these techniques for the study of group dynamics, a shift already occurring in related fields of behavioral science.

  18. Learning from simple ebooks, online cases or classroom teaching when acquiring complex knowledge. A randomized controlled trial in respiratory physiology and pulmonology.

    Directory of Open Access Journals (Sweden)

    Bjarne Skjødt Worm

    Full Text Available BACKGROUND AND AIMS: E-learning is developing fast because of the rapid increased use of smartphones, tablets and portable computers. We might not think of it as e-learning, but today many new e-books are in fact very complex electronic teaching platforms. It is generally accepted that e-learning is as effective as classroom teaching methods, but little is known about its value in relaying contents of different levels of complexity to students. We set out to investigate e-learning effects on simple recall and complex problem-solving compared to classroom teaching. METHODS: 63 nurses specializing in anesthesiology were evenly randomized into three groups. They were given internet-based knowledge tests before and after attending a teaching module about respiratory physiology and pulmonology. The three groups was either an e-learning group with eBook teaching material, an e-learning group with case-based teaching or a group with face-to-face case-based classroom teaching. After the module the students were required to answer a post-test. Time spent and the number of logged into the system was also measured. RESULTS: For simple recall, all methods were equally effective. For problem-solving, the eCase group achieved a comparable knowledge level to classroom teaching, while textbook learning was inferior to both (p<0.01. The textbook group also spent the least amount of time on acquiring knowledge (33 minutes, p<0.001, while the eCase group spent significantly more time on the subject (53 minutes, p<0.001 and logged into the system significantly more (2.8 vs 1.6, p<0.001. CONCLUSIONS: E-learning based cases are an effective tool for teaching complex knowledge and problem-solving ability, but future studies using higher-level e-learning are encouraged.Simple recall skills, however, do not require any particular learning method.

  19. Ambiguity in the Manifestation of Adult Separation Anxiety Disorder Occurring in Complex Anxiety Presentations: Two Clinical Case Reports

    Science.gov (United States)

    Dudaee-Faass, Sigal; Marnane, Claire; Wagner, Renate

    2009-01-01

    Two case reports are described in which patients presented for the treatment of multiple comorbid anxiety disorders, all of which appeared to derive from prolonged separation anxiety disorder. In particular, these adults had effectively altered their lifestyles to avoid separation, thereby displaying only ambiguous separation anxiety symptoms that…

  20. Cor triatriatum dexter, a very rare congenital anomaly presented in a complex pathological context – case presentation

    Directory of Open Access Journals (Sweden)

    Gozar Liliana

    2014-08-01

    Full Text Available Background Cor triatriatum dexter is an extremely rare congenital anomaly, and in most cases, without hemodynamic significance. Congenital cytomegalovirus infection is the most common viral infection, the majority of infected infants being asymptomatic and only 5-15% being symptomatic in the neonatal period.

  1. Single-stage surgical repair in a complex case of aberrant right subclavian artery aneurysm and common carotid trunk.

    Science.gov (United States)

    Kokotsakis, Ioannis; Harling, Leanne; Anagnostakou, Vania; Tassopoulos, Dimitris; Charitos, Christos; Ashrafian, Hutan; Athanasiou, Thanos

    2013-04-25

    Aberrant right subclavian artery with coexisting common carotid trunk is an extremely rare congenital anomaly affecting <0.1% of the population. We report the case of a 77-year-old Caucasian man presenting with dysphagia and dyspnea secondary to an aberrant right subclavian artery aneurysm and describe our technique for open surgical repair.

  2. Air Quality Analysis of a Multilevel Complex Interchange : Case Study Using the Improved TSC/EPA Model

    Science.gov (United States)

    1976-12-01

    This report describes a case study of an air quality analysis prepared by the U.S. Department of Transportation (DOT), Transportation Systems Center (TSC). The site analyzed was the proposed I-83/I-95 interchange in Baltimore, Maryland. This intercha...

  3. A rare case of OEIS complex – newer approach to diagnosis of exstrophy bladder by color doppler and its differentiation from simple omphalocele

    Science.gov (United States)

    Aneja, Kavita

    2017-01-01

    The objective of this article is to present a new approach to diagnose and differentiate similar ventral masses by color Doppler. Two cases of ventral masses, a rare case of OEIS complex (Omphalocele-exstrophy-imperforate anus-spinal defects) with unusual presentation of exstrophy bladder and another of simple omphalocele, were studied by color Doppler for diagnosis and differentiation between the nature of similar masses. Ventral mass with absent bladder, normal kidneys, and normal amniotic fluid index raised the suspicion of exstrophy bladder. Color Doppler depicting altered intrafetal course of umbilical arteries and umbilical arteries coursing along the sides of ventral mass substantiated the diagnosis. The spatial relation between umbilical artery and aorta (which has no mention in the current literature) in sagittal view has been identified as an acute angle in a normal fetus and coined as “K angle” arbitrarily by the author. Color Doppler reveals altered (widened) “K angle” in exstrophy bladder compared to normal fetuses. Other combined anomalies pointed to the diagnosis of OEIS complex. The second case of simple omphalocele depicts normal intrafetal course of umbilical arteries and normal acute umbilical artery–aorta angle (K angle) on color Doppler. Color Doppler aids the early diagnosis of ventral defects. New method by umbilical artery-aorta angle (K angle) assessment on color Doppler helps differentiate exstrophy bladder from omphalocele. PMID:29379239

  4. A rare case of OEIS complex –newer approach to diagnosis of exstrophy bladder by color doppler and its differentiation from simple omphalocele

    Directory of Open Access Journals (Sweden)

    Kavita Aneja

    2017-01-01

    Full Text Available The objective of this article is to present a new approach to diagnose and differentiate similar ventral masses by color Doppler. Two cases of ventral masses, a rare case of OEIS complex (Omphalocele-exstrophy-imperforate anus-spinal defects with unusual presentation of exstrophy bladder and another of simple omphalocele, were studied by color Doppler for diagnosis and differentiation between the nature of similar masses. Ventral mass with absent bladder, normal kidneys, and normal amniotic fluid index raised the suspicion of exstrophy bladder. Color Doppler depicting altered intrafetal course of umbilical arteries and umbilical arteries coursing along the sides of ventral mass substantiated the diagnosis. The spatial relation between umbilical artery and aorta (which has no mention in the current literature in sagittal view has been identified as an acute angle in a normal fetus and coined as “K angle” arbitrarily by the author. Color Doppler reveals altered (widened “K angle” in exstrophy bladder compared to normal fetuses. Other combined anomalies pointed to the diagnosis of OEIS complex. The second case of simple omphalocele depicts normal intrafetal course of umbilical arteries and normal acute umbilical artery–aorta angle (K angle on color Doppler. Color Doppler aids the early diagnosis of ventral defects. New method by umbilical artery-aorta angle (K angle assessment on color Doppler helps differentiate exstrophy bladder from omphalocele.

  5. A rare case of OEIS complex - newer approach to diagnosis of exstrophy bladder by color doppler and its differentiation from simple omphalocele.

    Science.gov (United States)

    Aneja, Kavita

    2017-01-01

    The objective of this article is to present a new approach to diagnose and differentiate similar ventral masses by color Doppler. Two cases of ventral masses, a rare case of OEIS complex (Omphalocele-exstrophy-imperforate anus-spinal defects) with unusual presentation of exstrophy bladder and another of simple omphalocele, were studied by color Doppler for diagnosis and differentiation between the nature of similar masses. Ventral mass with absent bladder, normal kidneys, and normal amniotic fluid index raised the suspicion of exstrophy bladder. Color Doppler depicting altered intrafetal course of umbilical arteries and umbilical arteries coursing along the sides of ventral mass substantiated the diagnosis. The spatial relation between umbilical artery and aorta (which has no mention in the current literature) in sagittal view has been identified as an acute angle in a normal fetus and coined as "K angle" arbitrarily by the author. Color Doppler reveals altered (widened) "K angle" in exstrophy bladder compared to normal fetuses. Other combined anomalies pointed to the diagnosis of OEIS complex. The second case of simple omphalocele depicts normal intrafetal course of umbilical arteries and normal acute umbilical artery-aorta angle (K angle) on color Doppler. Color Doppler aids the early diagnosis of ventral defects. New method by umbilical artery-aorta angle (K angle) assessment on color Doppler helps differentiate exstrophy bladder from omphalocele.

  6. Molecular studies reveal a MLL-MLLT3 gene fusion displaced in a case of childhood acute lymphoblastic leukemia with complex karyotype.

    Science.gov (United States)

    Ney Garcia, Daniela Ribeiro; Liehr, Thomas; Emerenciano, Mariana; Meyer, Claus; Marschalek, Rolf; Pombo-de-Oliveira, Maria do Socorro; Ribeiro, Raul C; Poirot Land, Marcelo Gerardin; Macedo Silva, Maria Luiza

    2015-04-01

    Rearrangement of the mixed lineage-leukemia gene (MLL-r) is common in hematological diseases and is generally associated with poor prognosis. The mixed-lineage leukemia gene translocated to, 3 (MLLT3) gene (9p22) is a frequent MLL-r partner (∼18% of leukemias with MLL rearrangement) and is characterized by the translocation t(9;11) (p22;q23), forming an MLL-MLLT3 gene fusion. MLL-r are usually simple reciprocal translocations between two different chromosomes, although karyotypes with complex MLL-r have been observed. We present a rare case of a child with acute lymphoblastic leukemia with a complex karyotype in which the classical t(9;11) (p22;q23) was cryptically relocated into a third chromosome in a balanced three-way translocation. At the genome level, however, the MLL-MLLT3 three-way translocation still displayed both reciprocal fusion transcripts. This argues in favor for a model where a simple two-way t(9;11) (p22;q23) was likely the first step that then evolved in to a more complex karyotype. Multicolor banding techniques can be used to greatly refine complex karyotypes and its chromosomal breakpoints. Also in the presence of putative new rearrangements, Long distance inverse-PCR is an important tool to identify which gene fusion is involved. Copyright © 2015 Elsevier Inc. All rights reserved.

  7. Case Report: Gollop-Wolfgang Complex in a 5 month old baby [v3; ref status: indexed, http://f1000r.es/53y

    Directory of Open Access Journals (Sweden)

    Ihtesham A. Qureshi

    2015-02-01

    Full Text Available Skeletal dysplasias are disorders associated with a generalized abnormality in the skeleton. The Gollop-Wolfgang complex (GWC is a limb deficiency disorder and an unusual limb malformation with highly variable manifestations. Here we report an interesting case of a 5-month old male baby from India with Gollop-Wolfgang Complex showing bifurcation of the right femur, ectrodactyly of both feet, ectrodactyly of left hand, syndactyly of right hand and unusual presentation of bilateral fibular agenesis and caudal (Sacrococcygeal agenesis. The etiology of GWC in this 5 month old male baby could possibly be attributed to spontaneous gene mutation. The clinical, radiographic findings and the unusual presentation are presented in detail.

  8. Ecohydrodynamics of cold-water coral reefs: a case study of the Mingulay Reef Complex (western Scotland.

    Directory of Open Access Journals (Sweden)

    Juan Moreno Navas

    Full Text Available Ecohydrodynamics investigates the hydrodynamic constraints on ecosystems across different temporal and spatial scales. Ecohydrodynamics play a pivotal role in the structure and functioning of marine ecosystems, however the lack of integrated complex flow models for deep-water ecosystems beyond the coastal zone prevents further synthesis in these settings. We present a hydrodynamic model for one of Earth's most biologically diverse deep-water ecosystems, cold-water coral reefs. The Mingulay Reef Complex (western Scotland is an inshore seascape of cold-water coral reefs formed by the scleractinian coral Lophelia pertusa. We applied single-image edge detection and composite front maps using satellite remote sensing, to detect oceanographic fronts and peaks of chlorophyll a values that likely affect food supply to corals and other suspension-feeding fauna. We also present a high resolution 3D ocean model to incorporate salient aspects of the regional and local oceanography. Model validation using in situ current speed, direction and sea elevation data confirmed the model's realistic representation of spatial and temporal aspects of circulation at the reef complex including a tidally driven current regime, eddies, and downwelling phenomena. This novel combination of 3D hydrodynamic modelling and remote sensing in deep-water ecosystems improves our understanding of the temporal and spatial scales of ecological processes occurring in marine systems. The modelled information has been integrated into a 3D GIS, providing a user interface for visualization and interrogation of results that allows wider ecological application of the model and that can provide valuable input for marine biodiversity and conservation applications.

  9. On the complexity of the boundary layer structure and aerosol vertical distribution in the coastal Mediterranean regions: a case study

    Directory of Open Access Journals (Sweden)

    Giandomenico Pace

    2015-10-01

    Full Text Available The planetary boundary layer structure in the coastal areas, and particularly in complex orography regions such as the Mediterranean, is extremely intricate. In this study, we show the evolution of the planetary boundary layer based on in situ airborne measurements and ground-based remote sensing observations carried out during the MORE (Marine Ozone and Radiation Experiment campaign in June 2010. The campaign was held in a rural coastal Mediterranean region in Southern Italy. The study focuses on the observations made on 17 June. Vertical profiles of meteorological parameters and aerosol size distribution were measured during two flights: in the morning and in the afternoon. Airborne observations were combined with ground-based LIDAR, SODAR, microwave and visible radiometer measurements, allowing a detailed description of the atmospheric vertical structure. The analysis was complemented with data from a regional atmospheric model run with horizontal resolutions of 12, 4 and 1 km, respectively; back-trajectories were calculated at these spatial resolutions. The observations show the simultaneous occurrence of dust transport, descent of mid-tropospheric air and sea breeze circulation on 17 June. Local pollution effects on the aerosol distribution, and a possible event of new particles formation were also observed. A large variability in the thermodynamical structure and aerosol distribution in the flight region, extending by approximately 30 km along the coast, was found. Within this complex, environment-relevant differences in the back-trajectories calculated at different spatial resolutions are found, suggesting that the description of several dynamical processes, and in particular the sea breeze circulation, requires high-resolution meteorological analyses. The study also shows that the integration of different observational techniques is needed to describe these complex conditions; in particular, the availability of flights and their timing

  10. Multi-level factors influence the implementation and use of complex innovations in cancer care: a multiple case study of synoptic reporting.

    Science.gov (United States)

    Urquhart, Robin; Porter, Geoffrey A; Sargeant, Joan; Jackson, Lois; Grunfeld, Eva

    2014-09-16

    The implementation of innovations (i.e., new tools and practices) in healthcare organizations remains a significant challenge. The objective of this study was to examine the key interpersonal, organizational, and system level factors that influenced the implementation and use of synoptic reporting tools in three specific areas of cancer care. Using case study methodology, we studied three cases in Nova Scotia, Canada, wherein synoptic reporting tools were implemented within clinical departments/programs. Synoptic reporting tools capture and present information about a medical or surgical procedure in a structured, checklist-like format and typically report only items critical for understanding the disease and subsequent impacts on patient care. Data were collected through semi-structured interviews with key informants, document analysis, nonparticipant observation, and tool use/examination. Analysis involved production of case histories, in-depth analysis of each case, and a cross-case analysis. Numerous techniques were used during the research design, data collection, and data analysis stages to increase the rigour of this study. The analysis revealed five common factors that were particularly influential to implementation and use of synoptic reporting tools across the three cases: stakeholder involvement, managing the change process (e.g., building demand, communication, training and support), champions and respected colleagues, administrative and managerial support, and innovation attributes (e.g., complexity, compatibility with interests and values). The direction of influence (facilitating or impeding) of each of these factors differed across and within cases. The findings demonstrate the importance of a multi-level contextual analysis to gaining both breadth and depth to our understanding of innovation implementation and use in health care. They also provide new insights into several important issues under-reported in the literature on moving innovations into

  11. Linguistic and Cross-Cultural Complexities of A Specialized Legal Item: The ‘True And Fair’ Case

    Directory of Open Access Journals (Sweden)

    Annalisa Zanola

    2014-01-01

    The aim of our contribution is that of analysing the possible linguistic and cross-cultural contexts where the hendiadys true and fair was born, and exploring the meaning implications of the same ‘formula’ during the centuries. We start from the hypothesis that true and fair is a hendiadys, to show that the two terms take strength and completeness one from the other, so as to generate an only complex meaning, whose original usage was, last but not least,  a literary and poetical one. The analysis of the hendiadys moves from the non-legal to the legal context, following steps of the etymological and lexical research methodology.

  12. Influence of complex circumstances and risks related to human relibaility: case of integral circuits fabrication in sterile environment

    International Nuclear Information System (INIS)

    Doniol-Shaw, G.

    1991-08-01

    Concepts of operating the complex and risk bearing utilities tend to separate operators from potential sources of risk (automation, and remote control). Since isolation of operators from risk sources is not always possible and constant their exposure to risks during operation, the question of human errors is always an important issue. In such situations, independent of the control and failure detection systems, operators are responsible for achieving two objectives simultaneously: operation and safety. This presentation shows how human behaviour can be determined by safety conditions of a plant, in the frame of managing minor real risks that would cause minor

  13. Clinical signs in the Wernicke-Korsakoff complex: a retrospective analysis of 131 cases diagnosed at necropsy.

    Science.gov (United States)

    Harper, C G; Giles, M; Finlay-Jones, R

    1986-01-01

    A recent necropsy study has shown that 80% of patients with the Wernicke-Korsakoff syndrome were not diagnosed as such during life. Review of the clinical signs of these cases revealed that only 16% had the classical clinical triad and 19% had no documented clinical signs. The incidence of clinical signs in this and other retrospective pathological studies is very different from that of prospective clinical studies. This discrepancy may relate to "missed" clinical signs but the magnitude of the difference suggests that at least some cases of the Wernicke-Korsakoff syndrome may be the end result of repeated subclinical episodes of vitamin B1 deficiency. In order to make the diagnosis, clinicians must maintain a high index of suspicion in the "at risk" group of patients, particularly alcoholics. Investigations of thiamine status may be helpful and if the diagnosis is suspected, parenteral thiamine should be given. PMID:3701343

  14. Shwachman-Diamond syndrome: a complex case demonstrating the potential for misdiagnosis as asphyxiating thoracic dystrophy (Jeune syndrome

    Directory of Open Access Journals (Sweden)

    Keogh Steven J

    2012-05-01

    Full Text Available Abstract Background The differential diagnosis of a neonate or fetus presenting with a bell-shaped or long narrow thorax includes a wide range of bony dysplasia syndromes. Where this is accompanied by respiratory distress, asphyxiating thoracic dystrophy (ATD, Jeune syndrome is an important potential diagnosis. Shwachman-Diamond syndrome (SDS is widely recognised as a cause of exocrine pancreatic dysfunction, short stature and bone marrow failure. It is not so well appreciated that rib and/or thoracic cage abnormalities occur in 30–50% of patients and that, in severe cases, these abnormalities may lead to thoracic dystrophy and respiratory failure in the newborn. There are, however, at least three previous case reports of children who were initially diagnosed with ATD who were subsequently shown to have SDS. Case presentation This report details the case history of a patient misdiagnosed as having ATD as a neonate following the neonatal asphyxial death of her brother. She subsequently developed progressive pancytopenia but was only diagnosed with SDS at 11 years of age after referral for haematopoietic stem cell transplantation for bone marrow failure accompanied by trilineage dysplasia and clonal cytogenetic abnormalities on bone marrow examination. Subsequent testing revealed the presence of fat globules in stools, reduced faecal chymotrypsin, fat-soluble vitamin deficiency, metaphyseal dysplasia on skeletal survey and heterozygous mutations of the SBDS gene. Conclusion This report highlights the potential for diagnostic confusion between ATD and SDS. It is important to include SDS in the differential diagnosis of newborns with thoracic dystrophy and to seek expert clinical and radiological assessment of such children.

  15. Interpretation of plain film radiology in infants and children with cardiac and vascular malformations. Pt. 2. Complex angiocardiopathies exemplified by pulmonary atresia and tricuspid valve atresia cases

    Energy Technology Data Exchange (ETDEWEB)

    Rautenburg, H.W.

    1987-04-01

    This second part shows that its interpreted correctly diagnostic plain film radiology may contribute important information to an often complicated differential diagnosis of complex angiocardiopthies exemplified here by various subforms and types of pulmonary and tricuspid atresias. Diagnostic plainfilm radiology, however, is just one part of total preliminary cardiological diagnostics. In many cases of congenital heart and vessel malformations, it is of great diagnostic value in the practical medical environment and does not compete with echo cardiography especially in easy diagnoses like that of lung perfusion.

  16. Managing scientific complexity in public policy: the case of U.S. climate change legislation in the 111th Congress

    Science.gov (United States)

    Mueller, J. A.; Runci, P. J.

    2009-12-01

    The recent passage of the American Climate and Energy Security Act by the U.S. House of Representatives in June of this year was a landmark in U.S. efforts to move climate change legislation through Congress. Although an historic achievement, the bill (and surrounding debate) highlights many concerns about the processes by which lawmakers and the public inform themselves about scientifically relevant problems and, subsequently, by which policy responses are crafted in a context of complexity, uncertainty, and competition for resources and attention. In light of the ever-increasing specialization of expertise in the sciences and other technical fields, and the inherent complexity of scientifically relevant problems such as climate change, society faces significant hurdles in its efforts to integrate knowledge and develop sufficient understanding of these problems to which it must respond with legislation or other effective collective or individual action. The emergence of a new class of experts who act as science-policy brokers may not be sufficient to cross these hurdles. Herein, we explore how society and the scientific community in particular can work toward closing the ever-growing gap between technical knowledge and society’s ability to comprehend and use it. Both authors are currently legislative fellows working on energy and climate change issues in the U.S. Senate.

  17. Microsatellite marker development by multiplex ion torrent PGM sequencing: a case study of the endangered Odorrana narina complex of frogs.

    Science.gov (United States)

    Igawa, Takeshi; Nozawa, Masafumi; Nagaoka, Mai; Komaki, Shohei; Oumi, Shohei; Fujii, Tamotsu; Sumida, Masayuki

    2015-01-01

    The endangered Ryukyu tip-nosed frog Odorrana narina and its related species, Odorrana amamiensis, Odorrana supranarina, and Odorrana utsunomiyaorum, belong to the family Ranidae and are endemically distributed in Okinawa (O. narina), Amami and Tokunoshima (O. amamiensis), and Ishigaki and Iriomote (O. supranarina and O. utsunomiyaorum) Islands. Because of varying distribution patterns, this species complex is an intrinsic model for speciation and adaptation. For effective conservation and molecular ecological studies, further genetic information is needed. For rapid, cost-effective development of several microsatellite markers for these and 2 other species, we used next-generation sequencing technology of Ion Torrent PGM™. Distribution patterns of repeat motifs of microsatellite loci in these modern frog species (Neobatrachia) were similarly skewed. We isolated and characterized 20 new microsatellite loci of O. narina and validated cross-amplification in the three-related species. Seventeen, 16, and 13 loci were cross-amplified in O. amamiensis, O. supranarina, and O. utsunomiyaorum, respectively, reflecting close genetic relationships between them. Mean number of alleles and expected heterozygosity of newly isolated loci varied depending on the size of each inhabited island. Our findings suggested the suitability of Ion Torrent PGM™ for microsatellite marker development. The new markers developed for the O. narina complex will be applicable in conservation genetics and molecular ecological studies. © The American Genetic Association 2014. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  18. Hyperspectral Sensor Data Capability for Retrieving Complex Urban Land Cover in Comparison with Multispectral Data: Venice City Case Study (Italy

    Directory of Open Access Journals (Sweden)

    Federico Santini

    2008-05-01

    Full Text Available This study aims at comparing the capability of different sensors to detect land cover materials within an historical urban center. The main objective is to evaluate the added value of hyperspectral sensors in mapping a complex urban context. In this study we used: (a the ALI and Hyperion satellite data, (b the LANDSAT ETM+ satellite data, (c MIVIS airborne data and (d the high spatial resolution IKONOS imagery as reference. The Venice city center shows a complex urban land cover and therefore was chosen for testing the spectral and spatial characteristics of different sensors in mapping the urban tissue. For this purpose, an object-oriented approach and different common classification methods were used. Moreover, spectra of the main anthropogenic surfaces (i.e. roofing and paving materials were collected during the field campaigns conducted on the study area. They were exploited for applying band-depth and sub-pixel analyses to subsets of Hyperion and MIVIS hyperspectral imagery. The results show that satellite data with a 30m spatial resolution (ALI, LANDSAT ETM+ and HYPERION are able to identify only the main urban land cover materials.

  19. Evidence for Complex P-T-t Histories in Subduction Zone Rocks: A Case Study from Syros, Greece

    Science.gov (United States)

    Gorce, J. S.; Kendall, J.; Caddick, M. J.; Baxter, E. F.

    2017-12-01

    Numerical models predict that material can move freely at the interface between the subducting slab and the overlying mantle wedge (mélange zone) independent of the motion of the subducting slab (i.e. Cloos 1982, Gerya et al. 2002). This is possible because the mélange zone consists of rigid blocks of metagabbroic and metabasic material suspended in a strongly sheared matrix of serpentinite, talc, and chlorite. The implication of this is that blocks of subducted material exposed in outcrops at the earth's surface could experience complex Pressure-Temperature-time (P-T-t) paths due to the cycling and recycling of subducted material within the mélange zone. Such behavior can affect the expulsion and retention of fluid during metamorphism and thus affect elemental cycles, geodynamics, mineral phase equilibra and mass transport of materials in the mélange zone depending on the physical properties and location of the blocks. The island of Syros, Greece preserves rocks that experienced blueschist-eclogite grade metamorphism during the subduction of the Pindos Oceanic Unit and thus provides a natural laboratory for investigating the evolution of subducted lithologies. Complex compositional zoning in a garnet-bearing quartz mica schist indicates that garnet crystals grew in two distinct stages. The presence of distinct cores and rims is interpreted as the result of a complex P-T-t history. Through the use of thermodynamic modeling, we calculate that the core of the garnet equilibrated at 485oC and 22.5 kbars. The edge of the first growth zone is predicted to stop growing at approximately 530oC and 20.5 kbars. We calculate that the rim began to grow at 21.7 kbars and 560oC and that the end of garnet growth occurred at approximately 16 kbars and 500oC. Sm/Nd garnet geochronology was used to date the cores of the garnets at 47 ± 3 Ma, with preliminary results suggesting that the rims grew at a significantly younger age. These data support the hypothesis that the cycling

  20. Engineering Economic Analysis for Feed Gas Cooler (Cold box: a Case of a Gas Processing Complex in Malaysia

    Directory of Open Access Journals (Sweden)

    Ghazali Zulkipli

    2014-07-01

    Full Text Available This study examine the economic feasibility of a proposal to replace an existing Feed Gas Cooler (Cold Box with a new unit in a gas processing complex in Malaysia. Economic justification is essential to make the decision on the feasibility of this undertaking because of the high capital investment. The mathematical model presented in the paper includes net present worth, payback period, rate of return, investment balance analysis, and sensitivity analysis. Critical analyses on four factors of the estimates were done to assess their influence on the overall economic justification of the proposal. The results indicate an acceptable return on investment. However, the proposal is susceptible to the variation in demand of the Feed Gas Load.

  1. Deep brain stimulation for Tourette’s syndrome: the case for targeting the thalamic centromedian-parafascicular complex.

    Directory of Open Access Journals (Sweden)

    Paola Testini

    2016-11-01

    Full Text Available Tourette syndrome is a neurologic condition characterized by both motor and phonic tics and is typically associated with psychiatric comorbidities, including obsessive-compulsive disorder/behavior and attention deficit hyperactivity disorder and can be psychologically and socially debilitating. It is considered a disorder of the cortico-striato-thalamo-cortical circuitry, as suggested by pathophysiology studies and therapeutic options. Among these, deep brain stimulation of the centromedian-parafascicular nuclear complex (CM-Pf of the thalamus is emerging as a valuable treatment modality for patients affected by severe, treatment resistant TS. Here we review the most recent experimental evidence for the pivotal role of CM-Pf in the pathophysiology of Tourette syndrome, discuss potential mechanisms of action that may mediate the effects of CM-Pf deep brain stimulation in Tourette syndrome, and summarize its clinical efficacy.

  2. POTENTIAL BENEFITS AND COMPLEXITIES OF BLENDED LEARNING IN HIGHER EDUCATION: The case of the University of Botswana

    Directory of Open Access Journals (Sweden)

    Regina K. MASALELA

    2009-01-01

    Full Text Available Blended/hybrid learning is dominating news in higher education as a training and educational delivery method of choice. It is seen as a link between instructors, learners and classrooms located in different places to enhance learning. Based on the interviews with 15 faculty members and one administrator that had direct experience with this form of delivery at the University of Botswana (UB the findings suggested two major themes that dominated faculty members ’accounts: potential benefits and challenges of blended learning. The study was guided by the Diffusion of Innovation theory. The potential benefits of blended learning included improved pedagogy; engagement in learning; and added flexibility in the teaching and learning to mention a few. Faculty members perceived complexities such as lack of students’ readiness to use the course management system, slow network and breakdowns; lack of computers for students and lack of time. The article concludes by suggesting future directions for blended learning (BL at the UB.

  3. Estimation of Circulating Immune Complexes in patients with Oral Leukoplakia and Oral Submucous Fibrosis: A Case Control Study

    Science.gov (United States)

    H., Maheswari; M.A., Eswaran; S., Srividhya; R., Malavika; R., Prabhu; K.R., Geetha

    2014-01-01

    Purpose of the Study: The present study was conducted to estimate the serum levels of Circulating Immune Complexes in patients with Oral Leukoplakia ,Oral sub mucous fibrosis and normal subjects and correlate these values with the clinical grades of the diseases. Materials and Methods: The study consisted of 25 Oral Leukoplakia patients, 25 Oral sub mucous fibrosis patients and 25 Normal subjects. Results: The mean serum levels of CIC showed a gradual increase from normal subjects to Oral Leukoplakia patients and showed a high values in Oral sub mucous fibrosis patients. The mean serum levels of CIC also showed a gradual increase from clinical grade I to grade IV of Oral sub mucous fibrosis. Conclusion: Serum levels of CIC may be taken as a prognostic marker for disease progression of patients with Oral Leukoplakia and Oral sub mucous fibrosis. PMID:24596781

  4. Clinical, pathological, and genetic evaluations of Chinese patient with otodental syndrome and multiple complex odontoma: Case report.

    Science.gov (United States)

    Liu, Anqi; Wu, Meiling; Guo, Xiaohe; Guo, Hao; Zhou, Zhifei; Wei, Kewen; Xuan, Kun

    2017-02-01

    Otodental syndrome is a rare autosomal-dominant disease characterized by globodontia, associated with sensorineural, high-frequency hearing loss. Here, we describe the clinical, pathological, and genetic evaluations of a 9-year-old girl with otodental syndrome and multiple complex odontoma.The patient presented with a draining sinus tract in her left cheek, globodontia, and hearing loss. The odontomas which caused the cutaneous sinus tracts were extracted because of the odontogenic infection. The extracted odontoma and primary tooth was studied by micro-CT and further observed histopathologically. The micro-CT findings revealed that the primary tooth had three crowns with two separated pulp chambers, and their root canals were partially fused. The histological findings showed abnormal morphologies of odontoblasts and dentin, hyperplasia of enamel, and malformation of odontogenic epithelium. Furthermore, DNA sequencing and analyze of deafness associated gene GJB2, GJB3, and PDS had not revealed any SNP or mutation; but exon 3 of the causative gene FGF3 could not be amplified, which may be associated with the microdeletion at chromosome 11q13.3. Three month after surgery, the patient was found to be asymptomatic and even the evidence of the extra-oral sinus had disappeared.The dental abnormality of otodental syndrome included congenital missing teeth, globodontia, and multiple complex odontoma. Globodontia exhibited characteristic features of fusion teeth. In addition, gene FGF3 haploinsufficiency was likely to be the cause of otodental syndrome. The report provides some new information in the field of otodental syndrome, which would make dentists more familiar with this disease.

  5. A Complex Systems Approach to Energy Poverty in sub-Saharan Africa: Nigeria as a Case Study

    Science.gov (United States)

    Chidebell Emordi, Chukwunonso

    Energy poverty is pervasive in sub-Saharan Africa. Nigeria, located in sub-Saharan West Africa, is the world's seventh largest oil exporting country and is a resource-rich nation. It however experiences the same levels of energy poverty as most of its neighboring countries. Attributing this paradox only to corruption or the "Dutch Disease", where one sector booms at the expense of other sectors of the economy, is simplistic and enervates attempts at reform. In addition, data on energy consumption is aggregated at the national level via estimates, disaggregated data is virtually non-existent. Finally, the wave of decentralization of vertically integrated national utilities sweeping the developing world has caught on in sub-Saharan Africa. However, little is known of the economic and social implications of these transitions within the unique socio-technical system of the region's electricity sector, especially as it applies to energy poverty. This dissertation proposes a complex systems approach to measuring and mitigating energy poverty in Nigeria due to its multi-dimensional nature. This is done via a three-fold approach: the first section of the study delves into causation by examining the governance institutions that create and perpetuate energy poverty; the next section proposes a context-specific minimum energy poverty line based on field data collected on energy consumption; and the paper concludes with an indicator-based transition management framework encompassing institutional, economic, social, and environmental themes of sustainable transition within the electricity sector. This work contributes to intellectual discourse on systems-based mitigation strategies for energy poverty that are widely applicable within the sub-Saharan region, as well as adds to the knowledge-base of decision-support tools for addressing energy poverty in its complexity.

  6. Total corpus callosotomy for epileptic spasms after acute encephalopathy with biphasic seizures and late reduced diffusion (AESD) in a case with tuberous sclerosis complex.

    Science.gov (United States)

    Okanishi, Tohru; Fujimoto, Ayataka; Motoi, Hirotaka; Kanai, Sotaro; Nishimura, Mitsuyo; Yamazoe, Tomohiro; Takagi, Atsushi; Yamamoto, Takamichi; Enoki, Hideo

    2017-05-01

    Corpus callosotomy is a palliative therapy for refractory epilepsy, including West syndrome, without a resectable epileptic focus. The surgical outcome of corpus callosotomy is relatively favorable in cryptogenic (non-lesional) West syndrome. Tuberous sclerosis complex (TSC) is a disorder that frequently leads to the development of refractory seizures by multiple cortical tubers. The multiple cortical tubers cause multiple or wide epileptic networks in these cases. Most of West syndrome cases in TSC with multiple tubers need additional resective surgery after corpus callosotomy. We describe a case of TSC in a boy aged 4years and 8months. He had multiple cortical tubers on his brain and developed epileptic spasms. The seizures were controlled with valproate. At the age of 1year and 4months, he presented with acute encephalopathy with biphasic seizures and late reduced diffusion (AESD), and had relapsed epileptic spasms one month after the onset of the encephalopathy. The seizures were refractory to multiple antiepileptic drugs. A total corpus callosotomy was performed at the age of 3years and 8months. The patient did not show any seizures after the surgery. During 12months of the follow-up, the patient was free from any seizures. Even in cases of symptomatic WS with multiple lesions, total corpus callosotomy may be a good strategy if the patients have secondary diffuse brain insults. Copyright © 2016 The Japanese Society of Child Neurology. Published by Elsevier B.V. All rights reserved.

  7. Sufficient criterion of fracture in the case with a complex stress state and non-proportional deformation of the material in the pre-fracture zone

    Science.gov (United States)

    Kornev, V. M.; Kurguzov, V. D.

    2010-12-01

    A general case of proportional loading with a complex stress state of the material in the pre-fracture zone, which is typical for polycrystalline solids with plastic deformation, is considered. A sufficient criterion of fracture is proposed for the case of a complex stress state with non-proportional deformation of the material in the pre-fracture zone. Critical parameters of fracture (pre-fracture zone length and load) for cracks propagating in quasi-brittle materials are obtained with the use of a modified Leonov-Panasyuk-Dugdale model. The pre-fracture zone width is determined by solving the problem of the plasticity theory in the vicinity of the crack tip. The proposed modification of the Leonov-Panasyuk-Dugdale model makes it possible to estimate the critical opening of the crack and the critical displacement of the crack flanks. Inequalities that describe different mechanisms of material fracture under proportional loading (predominantly shear fracture mechanism and fracture mechanism through cleavage) are derived.

  8. Physical therapy under hypnosis for the treatment of patients with type 1 complex regional pain syndrome of the hand and wrist: Retrospective study of 20 cases.

    Science.gov (United States)

    Lebon, J; Rongières, M; Apredoaei, C; Delclaux, S; Mansat, P

    2017-06-01

    Type 1 complex regional painful syndrome (CRPS-1) has a complex physiopathology. The aim of this study was to evaluate the effectiveness of physical therapy under hypnotherapy to treat this condition. Twenty patients with CRPS-1 at the wrist and hand were evaluated retrospectively: 13 women and 7 men with an average age of 56 years (34-75). Thirteen patients were in the inflammatory phase and 7 in the dystrophic phase. The main endpoints were pain (VAS, analgesic use), stiffness (wrist and finger range of motion), and strength (pinch and grasp). Secondary endpoints were functional scores (QuickDASH, PWRE), patient satisfaction, return to work, and side effects. Results were satisfactory in all cases after 5.4 sessions on average. VAS decreased by 4 points, PWRE-pain by 4.1 points, and analgesic use was limited to paracetamol upon request. Finger and wrist range of motion increased and the QuickDASH decreased by 34 points, PRWE-function by 3.8 points, pinch strength increased 4 points, and grasp strength by 10 points. Return to work was possible in 80% of the cases. All patients were satisfied or very satisfied with the treatment. Physical therapy under hypnosis appears to be an effective treatment for CRPS-1 at the wrist and hand no matter the etiology. Copyright © 2017 SFCM. Published by Elsevier Masson SAS. All rights reserved.

  9. A case report on the treatment of complex chronic pain and opioid dependence by a multidisciplinary transitional pain service using the ACT Matrix and buprenorphine/naloxone

    Directory of Open Access Journals (Sweden)

    Weinrib AZ

    2017-03-01

    Full Text Available Aliza Z Weinrib,1,2 Lindsay C Burns,1,2 Alex Mu,1 Muhammad Abid Azam,1,2 Salima SJ Ladak,1 Karen McRae,1,3 Rita Katznelson,1,3 Saam Azargive,1 Cieran Tran,1 Joel Katz,1–3 Hance Clarke1,3 1Pain Research Unit, Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, 2Department of Psychology, York University, 3Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada Abstract: In an era of growing concern about opioid prescribing, the postsurgical period remains a critical window with the risk of significant opioid dose escalation, particularly in patients with a history of chronic pain and presurgical opioid use. The purpose of this case report is to describe the multidisciplinary care of a complex, postsurgical pain patient by an innovative transitional pain service (TPS. A 59-year-old male with complex chronic pain, as well as escalating long-term opioid use, presented with a bleeding duodenal ulcer requiring emergency surgery. After surgery, the TPS provided integrated pharmacological and behavioral treatment, including buprenorphine combined with naloxone and acceptance and commitment therapy (ACT using the ACT Matrix. The result was dramatic pain reduction and improved functioning and quality of life after 40+ years of chronic pain, thus changing the pain trajectory of a chronic, complex, opioid-dependent patient. Keywords: transitional pain service, postsurgical pain, chronic pain, opioid dependence, opioid weaning, acceptance and commitment therapy

  10. Thermographic mapping of a complex vernacular settlement: the case study of Casalnuovo District within the Sassi of Matera (Italy)

    Science.gov (United States)

    Cardinale, Tiziana; Balestra, Alessandro; Cardinale, Nicola

    2015-04-01

    Never as in the Sassi of Matera (Italy), the parties have a volumetric material identity and a special construction condition for which, first of all, you need to know the whole to which they give life, and then the individual components and their connections. The distribution of these building artifacts in symbiotic connection with the connective calcareous texture that hosts them, resulted in a spontaneously harmonious figurative balance that characterizes the constructive expedients employed and the distributive and morphological solutions. This is the reason why the Sassi, and the overlooking Park of Rupestrian Churches of Matera Murgia have been entered in 1993 in the UNESCO World Heritage List. Our research focuses on a largely abandoned area within the Casalnuovo District, situated in the extreme south of the city, probably the place of the future Demoethnoanthropological Museum. It is known today that the particular shape of the area is made up of settlements mainly in cave; during the time architectures above ground, in a very limited number, filled almost completely the limited building space. Here there are the most archaic types and forms of building and wine cellars within the Sassi, essentially derive from the natural cave only slightly structured by man. The exterior construction complete the elementary cave and it is called lamione. The complexity of a built space like this one determines the need for a non-traditional approach, so you have to combine last generation tools and canonical ones for survey and energy diagnosis within a dialectic between memory, tradition and innovation, in order to identify solutions for an environment friendly recover of a cultural heritage such this one. Since the evaluation of the historical buildings conservation state using destructive techniques should be avoided to prevent the integrity of the cultural heritage, the development of non-destructive and non-contact techniques is very important. For this reason, an

  11. Integration of borehole and seismic data to unravel complex stratigraphy: Case studies from the Mannville Group, Western Canada

    Science.gov (United States)

    Sarzalejo Silva, Sabrina Ester

    Understanding the stratigraphic architecture of geologically complex reservoirs, such as the heavy oil deposits of Western Canada, is essential to achieve an efficient hydrocarbon recovery. Borehole and 3-D seismic data were integrated to define the stratigraphic architecture and generate 3-dimensional geological models of the Mannville Group in Saskatchewan. The Mannville is a stratigraphically complex unit formed of fluvial to marine deposits. Two areas in west-central and southern Saskatchewan were examined in this study. In west-central Saskatchewan, the area corresponds to a stratigraphically controlled heavy oil reservoir with production from the undifferentiated Dina-Cummings Members of the Lower Cretaceous Mannville Group. The southern area, although non-prospective for hydrocarbons, shares many similarities with time-equivalent strata in areas of heavy oil production. Seismic sequence stratigraphic principles together with log signatures permitted the subdivision of the Mannville into different packages. An initial geological model was generated integrating seismic and well-log data Multiattribute analysis and neural networks were used to generate a pseudo-lithology or gamma-ray volume. The incorporation of borehole core data to the model and the subsequent integration with the lithological prediction were crucial to capture the distribution of reservoir and non-reservoir deposits in the study area. The ability to visualize the 3-D seismic data in a variety of ways, including arbitrary lines and stratal or horizon slicing techniques helped the definition of stratigraphic features such as channels and scroll bars that affect fluid flow in hydrocarbon producing areas. Small-scale heterogeneities in the reservoir were not resolved due to the resolution of the seismic data. Although not undertaken in this study, the resulting stratigraphic framework could be used to help construct a static reservoir model. Because of the small size of the 3-D seismic surveys

  12. Integrated package approach in delivering interventions during immunisation campaigns in a complex environment in Papua New Guinea: a case study.

    Science.gov (United States)

    Vince, John David; Datta, Siddhartha Sankar; Toikilik, Steven; Lagani, William

    2014-08-06

    Papua New Guinea's difficult and varied topography, poor transport infrastructure, changing dynamics of population and economy in recent times and understaffed and poorly financed health service present major challenges for successful delivery of vaccination and other preventative health interventions to both the rural majority and urban populations, thereby posing risks for vaccine preventable disease outbreaks in the country. The country has struggled to meet the vaccination coverage targets required for the eradication of poliomyelitis and elimination of measles. Escalation of inter and intra country migration resulting from major industrial developments, particularly in extraction industries, has substantially increased the risk of infectious disease importation. This case study documents the evolution of immunisation programmes since the introduction of supplementary immunisation activities (SIAs). Single antigen SIAs have advantages and disadvantages. In situations in which the delivery of preventative health interventions is difficult, it is likely that the cost benefit is greater for multiple than for single intervention. The lessons learned from the conduct of single antigen SIAs can be effectively used for programmes delivering multiple SIA antigens, routine immunisations, and other health interventions. This paper describes a successful and cost effective multiple intervention programme in Papua New Guinea. The review of the last SIA in Papua New Guinea showed relatively high coverage of all the interventions and demonstrated the operational feasibility of delivering multiple interventions in resource constrained settings. Studies in other developing countries such as Lesotho and Ethiopia have also successfully integrated health interventions with SIA. In settings such as Papua New Guinea there is a strong case for integrating supplementary immunisation activity with routine immunisation and other health interventions through a comprehensive outreach

  13. Case Management Models in Permanent Supported Housing Programs for People With Complex Behavioral Issues Who Are Homeless.

    Science.gov (United States)

    Clark, Colleen; Guenther, Christina C; Mitchell, Jessica N

    2016-01-01

    The purpose of this article is to examine two evidence-based models of case management for people with co-occurring disorders and histories of chronic homelessness and to better understand their roles in permanent supported housing. Critical Time Intervention and Assertive Community Treatment are examined in terms of key elements, how they assist in ending homelessness, as well as the role they play in an individual's recovery from co-occurring disorders. Participants in two supported housing programs were interviewed at baseline and 6 months. One program used Critical Time Intervention (n = 144) and the other used Assertive Community Treatment (n = 90). Staff in both programs were interviewed about their experiences and fidelity assessments were conducted for each program. Both programs operated at high levels of fidelity. Despite similar criteria for participation, there were significant differences between groups. Critical Time Intervention participants were older, were more likely to be male, were more likely to be homeless, and reported greater psychiatric symptoms and higher levels of substance use (all p's homelessness to stable housing; 88.6% of Assertive Community Treatment participants were homeless at baseline, while at 6 months 30% were homeless (p homeless at baseline, while 44.3% were homeless at 6 months (p homelessness to move to stable housing. Permanent supported housing seems to be an effective way to end homelessness among people with co-occurring disorders. Further research is needed to determine which case management models work most effectively with supported housing to help policy makers and program directors make informed decisions in developing these programs.

  14. Evaluating Complex Mixtures in the Zebrafish Embryo by Reconstituting Field Water Samples: A Metal Pollution Case Study.

    Science.gov (United States)

    Michiels, Ellen D G; Vergauwen, Lucia; Hagenaars, An; Fransen, Erik; Dongen, Stefan Van; Van Cruchten, Steven J; Bervoets, Lieven; Knapen, Dries

    2017-03-02

    Accurately assessing the toxicity of complex, environmentally relevant mixtures remains an important challenge in ecotoxicology. The goal was to identify biological effects after exposure to environmental water samples and to determine whether the observed effects could be explained by the waterborne metal mixture found in the samples. Zebrafish embryos were exposed to water samples of five different sites originating from two Flemish (Mol and Olen, Belgium) metal contaminated streams: "Scheppelijke Nete" (SN) and "Kneutersloop" (K), and a ditch (D), which is the contamination source of SN. Trace metal concentrations, and Na, K, Mg and Ca concentrations were measured using ICP-MS and were used to reconstitute site-specific water samples. We assessed whether the effects that were observed after exposure to environmental samples could be explained by metal mixture toxicity under standardized laboratory conditions. Exposure to "D" or "reconstituted D" water caused 100% mortality. SN and reconstituted SN water caused similar effects on hatching, swim bladder inflation, growth and swimming activity. A canonical discriminant analysis confirmed a high similarity between both exposure scenarios, indicating that the observed toxicity was indeed primarily caused by metals. The applied workflow could be a valuable approach to evaluate mixture toxicity that limits time and costs while maintaining biological relevance.

  15. Skills based constraints and complexities affecting small-scale-entrepreneurship: A case of communal cattle farmers in Vhembe District

    Directory of Open Access Journals (Sweden)

    Mavhungu Abel Mafukata

    2015-09-01

    Full Text Available This paper investigates constraints and complexities affecting entrepreneurial and Agri-business small-scale farming success and sustainability in the Vhembe District of Limpopo Province, South Africa. The respondent entrepreneur farmers were purposively selected (n=55 amongst 183 other farmers in the district for primary data collection through a semi-structured cross-language (Tshivenda questionnaire. Key Informant Interviews (KIIs and Focus Group Discussions (FGDs also formed part of data collection instruments. The results of this paper revealed that the entrepreneur farmers’ formal school educational levels and basic literacy skills in addition; subtraction; multiplication and division were reasonably higher while technological skills in farm risk management and production, and managerial competence in business financial skills; budgeting and marketing were low. Government sponsored extension service could be employed to improve some of these deficient skills through skills training amongst the entrepreneur farmers. Since the study area is in the proximity of the University of Venda and Madzivhandila Agricultural Colleges, these institutions could be enlisted to provide skills training to the entrepreneur farmers.

  16. Evaluating Complex Mixtures in the Zebrafish Embryo by Reconstituting Field Water Samples: A Metal Pollution Case Study

    Directory of Open Access Journals (Sweden)

    Ellen D. G. Michiels

    2017-03-01

    Full Text Available Accurately assessing the toxicity of complex, environmentally relevant mixtures remains an important challenge in ecotoxicology. The goal was to identify biological effects after exposure to environmental water samples and to determine whether the observed effects could be explained by the waterborne metal mixture found in the samples. Zebrafish embryos were exposed to water samples of five different sites originating from two Flemish (Mol and Olen, Belgium metal contaminated streams: “Scheppelijke Nete” (SN and “Kneutersloop” (K, and a ditch (D, which is the contamination source of SN. Trace metal concentrations, and Na, K, Mg and Ca concentrations were measured using ICP-MS and were used to reconstitute site-specific water samples. We assessed whether the effects that were observed after exposure to environmental samples could be explained by metal mixture toxicity under standardized laboratory conditions. Exposure to “D” or “reconstituted D” water caused 100% mortality. SN and reconstituted SN water caused similar effects on hatching, swim bladder inflation, growth and swimming activity. A canonical discriminant analysis confirmed a high similarity between both exposure scenarios, indicating that the observed toxicity was indeed primarily caused by metals. The applied workflow could be a valuable approach to evaluate mixture toxicity that limits time and costs while maintaining biological relevance.

  17. Approach of automatic 3D geological mapping: the case of the Kovdor phoscorite-carbonatite complex, NW Russia.

    Science.gov (United States)

    Kalashnikov, A O; Ivanyuk, G Yu; Mikhailova, J A; Sokharev, V A

    2017-07-31

    We have developed an approach for automatic 3D geological mapping based on conversion of chemical composition of rocks to mineral composition by logical computation. It allows to calculate mineral composition based on bulk rock chemistry, interpolate the mineral composition in the same way as chemical composition, and, finally, build a 3D geological model. The approach was developed for the Kovdor phoscorite-carbonatite complex containing the Kovdor baddeleyite-apatite-magnetite deposit. We used 4 bulk rock chemistry analyses - Fe magn , P 2 O 5 , CO 2 and SiO 2 . We used four techniques for prediction of rock types - calculation of normative mineral compositions (norms), multiple regression, artificial neural network and developed by logical evaluation. The two latter became the best. As a result, we distinguished 14 types of phoscorites (forsterite-apatite-magnetite-carbonate rock), carbonatite and host rocks. The results show good convergence with our petrographical studies of the deposit, and recent manually built maps. The proposed approach can be used as a tool of a deposit genesis reconstruction and preliminary geometallurgical modelling.

  18. Complexity of bioindicator selection for ecological, human, and cultural health: Chinook salmon and red knot as case studies.

    Science.gov (United States)

    Burger, Joanna; Gochfeld, Michael; Niles, Lawrence; Powers, Charles; Brown, Kevin; Clarke, James; Dey, Amanda; Kosson, David

    2015-03-01

    There is considerable interest in developing bioindicators of ecological health that are also useful indicators for human health. Yet, human health assessment usually encompasses physical/chemical exposures and not cultural well-being. In this paper, we propose that bioindicators can be selected for all three purposes. We use Chinook or king salmon (Oncorhynchus tshawytscha) and red knot (Calidris canutus rufa, a sandpiper) as examples of indicators that can be used to assess human, ecological, and cultural health. Even so, selecting endpoints or metrics for each indicator species is complex and is explored in this paper. We suggest that there are several endpoint types to examine for a given species, including physical environment, environmental stressors, habitat, life history, demography, population counts, and cultural/societal aspects. Usually cultural endpoints are economic indicators (e.g., number of days fished, number of hunting licenses), rather than the importance of a fishing culture. Development of cultural/societal endpoints must include the perceptions of local communities, cultural groups, and tribal nations, as well as governmental and regulatory communities (although not usually so defined, the latter have cultures as well). Endpoint selection in this category is difficult because the underlying issues need to be identified and used to develop endpoints that tribes and stakeholders themselves see as reasonable surrogates of the qualities they value. We describe several endpoints for salmon and knots that can be used for ecological, human, and cultural/societal health.

  19. Botulinum toxin A (Botox) for treatment of proximal myofascial pain in complex regional pain syndrome: two cases.

    Science.gov (United States)

    Safarpour, Delaram; Jabbari, Bahman

    2010-09-01

    To describe development of myofascial pain syndrome (MFPS) with trigger points in the proximal muscles of the patients with complex regional pain syndrome (CRPS1) and improvement of distal symptoms of CRPS 1 after successful treatment of proximal MFPS. In our practice, we frequently encounter patients in whom a proximal myofascial pain syndrome develops ipsilateral to the distal limb of CRPS1 patients. We describe two such patients in detail with their treatment. PATIENT 1: A 48-year-old woman experienced severe allodynia, swelling and autonomic changes in the right hand after surgery for carpal tunnel syndrome. Over the succeeding months, she developed painful trigger points in the right trapezius and upper back muscles which was treated with administration of botulinum toxin A (BoNT-A) into the trigger points (20 unit/point). PATIENT 2: A 41-year-old woman following a traumatic forearm injury suffered from CRPS1 affecting the left hand and forearm. Proximal MFPS gradually developed on the same side over 12 months and was treated with administration of BoNT-A into the trapezius, splenius capitis, and rhomboid muscle trigger points. In both patients treatment with BoNT-A improved the proximal pain of MFPS and the distal symptoms of CRPS1. proximal MFPS develops ipsilateral to the distal painful limb in patients with CRPS1. Administration of BoNT-A into the affected proximal muscles may alleviate both MFPS and the distal allodynia, discoloration and, tissue swelling of CRPS. Wiley Periodicals, Inc.

  20. Self-Regulation in the Midst of Complexity: A Case Study of High School Physics Students Engaged in Ill-Structured Problem Solving

    Science.gov (United States)

    Milbourne, Jeffrey David

    The purpose of this dissertation study was to explore the experiences of high school physics students who were solving complex, ill-structured problems, in an effort to better understand how self-regulatory behavior mediated the project experience. Consistent with Voss, Green, Post, and Penner's (1983) conception of an ill-structured problem in the natural sciences, the 'problems' consisted of scientific research projects that students completed under the supervision of a faculty mentor. Zimmerman and Campillo's (2003) self-regulatory framework of problem solving provided a holistic guide to data collection and analysis of this multi-case study, with five individual student cases. The study's results are explored in two manuscripts, each targeting a different audience. The first manuscript, intended for the Science Education Research community, presents a thick, rich description of the students' project experiences, consistent with a qualitative, case study analysis. Findings suggest that intrinsic interest was an important self-regulatory factor that helped motivate students throughout their project work, and that the self-regulatory cycle of forethought, performance monitoring, and self-reflection was an important component of the problem-solving process. Findings also support the application of Zimmerman and Campillo's framework to complex, ill-structured problems, particularly the cyclical nature of the framework. Finally, this study suggests that scientific research projects, with the appropriate support, can be a mechanism for improving students' selfregulatory behavior. The second manuscript, intended for Physics practitioners, combines the findings of the first manuscript with the perspectives of the primary, on-site research mentor, who has over a decade's worth of experience mentoring students doing physics research. His experience suggests that a successful research experience requires certain characteristics, including: a slow, 'on-ramp' to the research

  1. Fidelity and moderating factors in complex interventions: a case study of a continuum of care program for frail elderly people in health and social care.

    Science.gov (United States)

    Hasson, Henna; Blomberg, Staffan; Dunér, Anna

    2012-03-22

    Prior studies measuring fidelity of complex interventions have mainly evaluated adherence, and not taken factors affecting adherence into consideration. A need for studies that clarify the concept of fidelity and the function of factors moderating fidelity has been emphasized. The aim of the study was to systematically evaluate implementation fidelity and possible factors influencing fidelity of a complex care continuum intervention for frail elderly people. The intervention was a systematization of the collaboration between a nurse with geriatric expertise situated at the emergency department, the hospital ward staff, and a multi-professional team with a case manager in the municipal care services for older people. Implementation was evaluated between September 2008 and May 2010 with observations of work practices, stakeholder interviews, and document analysis according to a modified version of The Conceptual Framework for Implementation Fidelity. A total of 16 of the 18 intervention components were to a great extent delivered as planned, while some new components were added to the model. No changes in the frequency or duration of the 18 components were observed, but the dose of the added components varied over time. Changes in fidelity were caused in a complex, interrelated fashion by all the moderating factors in the framework, i.e., context, staff and participant responsiveness, facilitation, recruitment, and complexity. The Conceptual Framework for Implementation Fidelity was empirically useful and included comprehensive measures of factors affecting fidelity. Future studies should focus on developing the framework with regard to how to investigate relationships between the moderating factors and fidelity over time. ClinicalTrials.gov, NCT01260493.

  2. Fidelity and moderating factors in complex interventions: a case study of a continuum of care program for frail elderly people in health and social care

    Directory of Open Access Journals (Sweden)

    Hasson Henna

    2012-03-01

    Full Text Available Abstract Background Prior studies measuring fidelity of complex interventions have mainly evaluated adherence, and not taken factors affecting adherence into consideration. A need for studies that clarify the concept of fidelity and the function of factors moderating fidelity has been emphasized. The aim of the study was to systematically evaluate implementation fidelity and possible factors influencing fidelity of a complex care continuum intervention for frail elderly people. Methods The intervention was a systematization of the collaboration between a nurse with geriatric expertise situated at the emergency department, the hospital ward staff, and a multi-professional team with a case manager in the municipal care services for older people. Implementation was evaluated between September 2008 and May 2010 with observations of work practices, stakeholder interviews, and document analysis according to a modified version of The Conceptual Framework for Implementation Fidelity. Results A total of 16 of the 18 intervention components were to a great extent delivered as planned, while some new components were added to the model. No changes in the frequency or duration of the 18 components were observed, but the dose of the added components varied over time. Changes in fidelity were caused in a complex, interrelated fashion by all the moderating factors in the framework, i.e., context, staff and participant responsiveness, facilitation, recruitment, and complexity. Discussion The Conceptual Framework for Implementation Fidelity was empirically useful and included comprehensive measures of factors affecting fidelity. Future studies should focus on developing the framework with regard to how to investigate relationships between the moderating factors and fidelity over time. Trial registration ClinicalTrials.gov, NCT01260493.

  3. Prioritization methodology for the decommissioning of nuclear facilities: a study case on the Iraq former nuclear complex.

    Science.gov (United States)

    Jarjies, Adnan; Abbas, Mohammed; Monken Fernandes, Horst; Wong, Melanie; Coates, Roger

    2013-05-01

    There are a number of sites in Iraq which have been used for nuclear activities and which contain potentially significant amounts of radioactive waste. The principal nuclear site being Al-Tuwaitha. Many of these sites suffered substantial physical damage during the Gulf Wars and have been subjected to subsequent looting. All require decommissioning in order to ensure both radiological and non-radiological safety. However, it is not possible to undertake the decommissioning of all sites and facilities at the same time. Therefore, a prioritization methodology has been developed in order to aid the decision-making process. The methodology comprises three principal stages of assessment: i) a quantitative surrogate risk assessment ii) a range of sensitivity analyses and iii) the inclusion of qualitative modifying factors. A group of Tuwaitha facilities presented the highest risk among the evaluated ones, followed by a middle ranking grouping of Tuwaitha facilities and some other sites, and a relatively large group of lower risk facilities and sites. The initial order of priority is changed when modifying factors are taken into account. It has to be considered the Iraq's isolation from the international nuclear community over the last two decades and the lack of experienced personnel. Therefore it is appropriate to initiate decommissioning operations on selected low risk facilities at Tuwaitha in order to build capacity and prepare for work to be carried out in more complex and potentially high hazard facilities. In addition it is appropriate to initiate some prudent precautionary actions relating to some of the higher risk facilities. Copyright © 2012 Elsevier Ltd. All rights reserved.

  4. Resilience vs soft crisis: dynamic risk assessment in complex hybrid systems. Case history of Ginosa (Taranto, Southern Italy)

    Science.gov (United States)

    Parisi, Alessandro; Argentiero, Ilenia; Fidelibus, Maria Dolores; Pellicani, Roberta; Spilotro, Giuseppe

    2017-04-01

    Considering a natural system without human-induced modifications, its resilience can be altered by many natural drivers (e.g. geological characteristics, climate) and their spatial modifications over time. Therefore, natural hazardous phenomena could shift natural system over tipping points in an easier or more difficult way. So long as natural system does not involve human settlements or transport infrastructures, natural system risk assessment could not be a basic topic. Nowadays, human activities have modified many natural systems forming, as a result, hybrid systems (both human and natural), in which natural and human-induced drivers modify hybrid systems vulnerability in order to decrease or increase their resilience: scientists define this new age Anthropocene. In this context, dynamic risk assessment of hybrid systems is required in order to avoid disaster when hazardous phenomena occur, but it is a quite complex issue. In fact, soft crisis emerging signals are difficult to identify because of wrong risk perception and lack of communication. Furthermore, natural and human-induced modifications are rarely registered and supervised by governments, so it is fairly difficult defining how systems resilience changes over time. Inhabitants of Ginosa (Taranto, South of Italy) had modified many old rock dwellings over thousand years since the Middle Ages. Indeed, they had built up three-storey houses on three hypogeum levels of rock dwellings along the ravine. The Matrice street collapse in Ginosa is an example of how natural and human-induced spatial modifications over time had led a soft crisis to evolve in a disaster, fortunately without fatalities. This research aim is to revisit events before the Matrice street collapse on the 21st January 2014. The will is to define the relationship between the hybrid system resilience and soft crisis variation over time and how human and natural drivers were involved in the shift.

  5. Using mitochondrial and nuclear sequence data for disentangling population structure in complex pest species: a case study with Dermanyssus gallinae.

    Directory of Open Access Journals (Sweden)

    Lise Roy

    Full Text Available Among global changes induced by human activities, association of breakdown of geographical barriers and impoverishered biodiversity of agroecosystems may have a strong evolutionary impact on pest species. As a consequence of trade networks' expansion, secondary contacts between incipient species, if hybrid incompatibility is not yet reached, may result in hybrid swarms, even more when empty niches are available as usual in crop fields and farms. By providing important sources of genetic novelty for organisms to adapt in changing environments, hybridization may be strongly involved in the emergence of invasive populations. Because national and international trade networks offered multiple hybridization opportunities during the previous and current centuries, population structure of many pest species is expected to be the most intricate and its inference often blurred when using fast-evolving markers. Here we show that mito-nuclear sequence datasets may be the most helpful in disentangling successive layers of admixture in the composition of pest populations. As a model we used D. gallinae s. l., a mesostigmatid mite complex of two species primarily parasitizing birds, namely D. gallinae L1 and D. gallinae s. str. The latter is a pest species, considered invading layer farms in Brazil. The structure of the pest as represented by isolates from both wild and domestic birds, from European (with a focus on France, Australian and Brazilian farms, revealed past hybridization events and very recent contact between deeply divergent lineages. The role of wild birds in the dissemination of mites appears to be null in European and Australian farms, but not in Brazilian ones. In French farms, some recent secondary contact is obviously consecutive to trade flows. Scenarios of populations' history were established, showing five different combinations of more or less dramatic bottlenecks and founder events, nearly interspecific hybridizations and recent

  6. ITS Polymorphisms Shed Light on Hybrid Evolution in Apomictic Plants: A Case Study on the Ranunculus auricomus Complex

    Science.gov (United States)

    Hodač, Ladislav; Scheben, Armin Patrick; Hojsgaard, Diego; Paun, Ovidiu; Hörandl, Elvira

    2014-01-01

    The reconstruction of reticulate evolutionary histories in plants is still a major methodological challenge. Sequences of the ITS nrDNA are a popular marker to analyze hybrid relationships, but variation of this multicopy spacer region is affected by concerted evolution, high intraindividual polymorphism, and shifts in mode of reproduction. The relevance of changes in secondary structure is still under dispute. We aim to shed light on the extent of polymorphism within and between sexual species and their putative natural as well as synthetic hybrid derivatives in the Ranunculus auricomus complex to test morphology-based hypotheses of hybrid origin and parentage of taxa. We employed direct sequencing of ITS nrDNA from 68 individuals representing three sexuals, their synthetic hybrids and one sympatric natural apomict, as well as cloning of ITS copies in four representative individuals, RNA secondary structure analysis, and landmark geometric morphometric analysis on leaves. Phylogenetic network analyses indicate additivity of parental ITS variants in both synthetic and natural hybrids. The triploid synthetic hybrids are genetically much closer to their maternal progenitors, probably due to ploidy dosage effects, although exhibiting a paternal-like leaf morphology. The natural hybrids are genetically and morphologically closer to the putative paternal progenitor species. Secondary structures of ITS1-5.8S-ITS2 were rather conserved in all taxa. The observed similarities in ITS polymorphisms suggest that the natural apomict R. variabilis is an ancient hybrid of the diploid sexual species R. notabilis and the sexual species R. cassubicifolius. The additivity pattern shared by R. variabilis and the synthetic hybrids supports an evolutionary and biogeographical scenario that R. variabilis originated from ancient hybridization. Concerted evolution of ITS copies in R. variabilis is incomplete, probably due to a shift to asexual reproduction. Under the condition of

  7. HERITAGE AND TOURISM: A CASE STUDY ON THE RELATIONSHIP AMONG PARNAÍBA/PI DWELLERS AND "PORTO DAS BARCAS" COMPLEX

    Directory of Open Access Journals (Sweden)

    Andre Riani Costa Perinotto

    2011-09-01

    Full Text Available Abstract: Tourism plays a very important role within society. In addition to providing development by generating jobs and income it is a potential great supporter of culture leading to increase value of cultural heritage. This article aims to evaluate Paraiba´s dwellers perception on “Porto das Barcas” (Boates Port as heritage as well as to assess their knowledge about the history of the place. To achieve these goals, informal interviews were conducted, to better know the investigated issue and questionnaires with open and closed questions to assess the perception of dwellers, public servants and privet sector. Bibliographic research, observation, case study, quantitative and qualitative research as well as SWOT analysis were also part of the investigation. As a result researchers concluded that local dwellers  do not  still perceive the importance of Porto das Barcas heritage, so  a heritage education program is proposed as well as a photographic museum to favor  interaction between Paraiban citizens and their port.

  8. FLT-3 ITD Positive Acute Basophilic Leukemia with Rare Complex Karyotype Presenting with Acute Respiratory Failure: Case Report

    Directory of Open Access Journals (Sweden)

    Antohe Ion

    2018-01-01

    Full Text Available Background: Acute basophilic leukemia is a rare subtype of acute myeloid leukemia, as categorized by the 2008 World Health Organization classification of myeloid neoplasms. Acute basophilic leukemia diagnosis requires thorough morphological, cytochemical, immunophenotypic, molecular, and cytogenetic studies and exclusion of other hematological neoplasms associating basophilia. The disease course is defined by histamine driven, occasionally life-threatening respiratory, cardiovascular, cutaneous or digestive complications, as well as primary refractoriness to standard therapy. Clinical presentation: We herein report a case of a 63-year-old asthmatic female patient diagnosed with acute basophilic leukemia, associated with previously unpublished cytogenetic features and FLT-3 ITD mutation, pulmonary leukostasis and spontaneous pulmonary capillary leak syndrome, which worsened immediately following chemotherapy initiation. Respiratory complications were successfully managed, but recrudesced upon emergence of refractory disease and were ultimately fatal. We highlight the likelihood of pulmonary complications induced by basophil degranulation and tumor lysis in hypercellular acute basophilic leukemia and the potential benefit of histamine receptor blockade in this setting.

  9. Pulsed Radiofrequency of Dorsal Root Ganglia for the Treatment of Complex Regional Pain Syndrome in an Adolescent with Poliomyelitis Sequel: A Case Report.

    Science.gov (United States)

    Apiliogullari, Seza; Aydin, Bahattin Kerem; Onal, Ozkan; Kirac, Yunus; Celik, Jale Bengi

    2015-07-01

    Complex regional pain syndrome (CRPS) is a painful and disabling syndrome in which the patient presents with neuropathic pain, edema, or vasomotor or pseudomotor abnormalities that are often refractory to treatment. Polio paralysis is caused by the damage or destruction of motor neurons in the spine, which lead to corresponding muscle paralysis. This report is a case report on the application of a pulsed radiofrequency (PRF) current to dorsal root ganglia (DRG) for the treatment of CRPS type 1 in an adolescent patient. Single case report. Selcuk University Hospital. A 16-year-old girl who suffered from CRPS type 1 secondary to surgeries for the sequelae of poliomyelitis. PRF current application to the lumbar 4 and lumbar 5 DRG. Pain reduction. The patient had complete resolution of her symptoms, which was maintained at a 6-month follow-up. This case illustrates that PRF applied to lumbar 4 and lumbar 5 DRG may play a significant role in CRPS type 1 management after the surgical treatment of poliomyelitis sequelae in adolescent patients. Further randomized, controlled studies are needed to support this argument. Wiley Periodicals, Inc.

  10. Deformation of mantle pyroxenites provides clues to geodynamic processes in subduction zones: Case study of the Cabo Ortegal Complex, Spain

    Science.gov (United States)

    Henry, Hadrien; Tilhac, Romain; Griffin, William L.; O'Reilly, Suzanne Y.; Satsukawa, Takako; Kaczmarek, Mary-Alix; Grégoire, Michel; Ceuleneer, Georges

    2017-08-01

    In the Herbeira massif, Cabo Ortegal Complex, Spain, a well exposed assemblage of deformed dunites and pyroxenites offers a unique opportunity to investigate key upper mantle tectonic processes. Four types of pyroxenites are recognized: clinopyroxenites with enclosed dunitic lenses (type-1), massive websterites (type-2), foliated and commonly highly amphibolitized clinopyroxenites (type-3) and orthopyroxenites (type-4). Field and petrological observations together with EBSD analysis provide new insights on the physical behavior of the pyroxenes and their conditions of deformation and reveal the unexpected journey of the Cabo Ortegal pyroxenites. We show that, during deformation, type-1 pyroxenites, due to their enclosed dunitic lenses, are more likely to localize the deformation than types-2 and -4 pyroxenites and may latter act as preferred pathway for fluid/melt percolation, eventually resulting in type-3 pyroxenites. All pyroxenite types display a similar response to deformation. Orthopyroxene deformed mostly by dislocation creep; it shows kink bands and undulose extinction and its fabric is dominated by [001](100). Clinopyroxene displays subgrain rotation, dynamic recrystallization and fabric with [010] axes clustering next to the foliation pole and [001] axes clustering next to the lineation suggesting activation of [001]{110} and [001](100) in some samples. These observations are in good agreement with deformation at temperatures greater than 1000 °C. Olivine in type-1 and type-4 pyroxenites shows [100](010) or [001](010) fabrics that are consistent with deformation at temperatures >1000 °C and may indicate deformation in a hydrous environment. The amphibole [001](100) fabric gives insights on a lower-temperature deformation episode (∼800 to 500 °C). Our results, interpreted in the light of published experimental data, together with the regional geological and geochemical studies are consistent with the following tectonic evolution of the Cabo Ortegal

  11. Smoothed Complexity Theory

    NARCIS (Netherlands)

    Bläser, Markus; Manthey, Bodo

    Smoothed analysis is a new way of analyzing algorithms introduced by Spielman and Teng. Classical methods like worst-case or average-case analysis have accompanying complexity classes, such as P and Avg-P, respectively. Whereas worst-case or average-case analysis give us a means to talk about the

  12. The use of gentamicin-coated nails in complex open tibia fracture and revision cases: A retrospective analysis of a single centre case series and review of the literature.

    Science.gov (United States)

    Metsemakers, W J; Reul, M; Nijs, S

    2015-12-01

    Despite modern advances in fracture care, deep (implant-related) infection remains a problem in the treatment of tibia fractures. There is some evidence that antibiotic-coated implants are beneficial in the prevention of this sometimes devastating complication. In the following study we describe our results using a gentamicin-coated intramedullary tibia nail (Expert Tibia Nail (ETN) PROtect™) for the surgical treatment of complex open tibia fracture and revision cases. We describe the outcome of patients treated between January 2012 and September 2013, using a gentamicin-coated intramedullary tibia nail. Treatment indications included acute, Gustilo grade II-III, open tibia fractures or closed tibia fractures with long-term external fixation prior to intramedullary nailing and complex tibia fracture revision cases with a mean of three prior surgical interventions. Outcome parameters in this study were deep infection and nonunion. In total, 16 consecutive patients with 16 tibia fractures were treated with a gentamicin-coated intramedullary nail. The overall patient population was subdivided into two groups. The first group consisted of 11 patients (68.8%) with acute fractures who were treated with a gentamicin-coated intramedullary nail. The second group consisted of 5 complex revision cases (31.2%). In our patient population no deep infections could be noted after the treatment with a gentamicin-coated tibia nail. Nonunion was diagnosed in 4 patients (25.0%), 1 of these was a revision case. Musculoskeletal complications place a cost burden on total healthcare expenditure. Better understanding of the epidemiology and pathogenesis is essential because this can lead to prevention rather than treatment strategies. The purpose of the study was to evaluate a gentamicin-coated tibia nail in the prevention of deep (implant-related) infection. In our patient population no deep infections occurred after placement of the gentamicin-coated nail. Following this study and

  13. Assessment of the ARW-WRF model over complex terrain: the case of the Stellenbosch Wine of Origin district of South Africa

    Science.gov (United States)

    Soltanzadeh, Iman; Bonnardot, Valérie; Sturman, Andrew; Quénol, Hervé; Zawar-Reza, Peyman

    2017-08-01

    Global warming has implications for thermal stress for grapevines during ripening, so that wine producers need to adapt their viticultural practices to ensure optimum physiological response to environmental conditions in order to maintain wine quality. The aim of this paper is to assess the ability of the Weather Research and Forecasting (WRF) model to accurately represent atmospheric processes at high resolution (500 m) during two events during the grapevine ripening period in the Stellenbosch Wine of Origin district of South Africa. Two case studies were selected to identify areas of potentially high daytime heat stress when grapevine photosynthesis and grape composition were expected to be affected. The results of high-resolution atmospheric model simulations were compared to observations obtained from an automatic weather station (AWS) network in the vineyard region. Statistical analysis was performed to assess the ability of the WRF model to reproduce spatial and temporal variations of meteorological parameters at 500-m resolution. The model represented the spatial and temporal variation of meteorological variables very well, with an average model air temperature bias of 0.1 °C, while that for relative humidity was -5.0 % and that for wind speed 0.6 m s-1. Variation in model performance varied between AWS and with time of day, as WRF was not always able to accurately represent effects of nocturnal cooling within the complex terrain. Variations in performance between the two case studies resulted from effects of atmospheric boundary layer processes in complex terrain under the influence of the different synoptic conditions prevailing during the two periods.

  14. The complex clinical issues involved in an athlete's decision to retire from collision sport due to multiple concussions: a case study of a professional athlete

    Directory of Open Access Journals (Sweden)

    Andrew eGardner

    2013-09-01

    Full Text Available The issue of retirement from athletic participation due to repetitive concussive injuries remains controversial. The complexity of providing recommendations to elite athletes is highlighted by the prospect that offering inappropriate advice may foreseeably lead to engagement in a medico-legal challenge. Currently no evidenced-based, scientifically validated guidelines for forming the basis of such a decision exist. The current paper discusses the complexities of this challenge in addition to presenting a case study of a professional athlete. A number of central issues to consider when discussing athlete retirement revolve around the player’s medical and concussion histories, the current clinical profile, the athlete’s long-term life goals and understanding of the potential long-terms risks. Ensuring that thorough investigations of all possible differential diagnosis, that may explain the presenting symptoms, are conducted is also essential. Discussion pertaining to recommendations for guiding the clinical approach to the retirement issue for athletes with a history of multiple concussions is presented.

  15. Factors affecting the implementation of complex and evolving technologies: multiple case study of intensity-modulated radiation therapy (IMRT in Ontario, Canada

    Directory of Open Access Journals (Sweden)

    Bak Kate

    2011-07-01

    Full Text Available Abstract Background Research regarding the decision to adopt and implement technological innovations in radiation oncology is lacking. This is particularly problematic since these technologies are often complex and rapidly evolving, requiring ongoing revisiting of decisions regarding which technologies are the most appropriate to support. Variations in adoption and implementation decisions for new radiation technologies across cancer centres can impact patients' access to appropriate and innovative forms of radiation therapy. This study examines the key steps in the process of adopting and implementing intensity modulated radiation therapy (IMRT in publicly funded cancer centres and identifies facilitating or impeding factors. Methods A multiple case study design, utilizing document analysis and key informant interviews was employed. Four cancer centres in Ontario, Canada were selected and interviews were conducted with radiation oncologists, medical physicists, radiation therapists, and senior administrative leaders. Results Eighteen key informants were interviewed. Overall, three centres made fair to excellent progress in the implementation of IMRT, while one centre achieved only limited implementation as of 2009. Key factors that influenced the extent of IMRT implementation were categorized as: 1 leadership, 2 training, expertise and standardization, 3 collaboration, 4 resources, and 5 resistance to change. Conclusion A framework for the adoption and implementation of complex and evolving technologies is presented. It identifies the key factors that should be addressed by decision-makers at specific stages of the adoption/implementation process.

  16. Factors affecting the implementation of complex and evolving technologies: multiple case study of intensity-modulated radiation therapy (IMRT) in Ontario, Canada.

    Science.gov (United States)

    Bak, Kate; Dobrow, Mark J; Hodgson, David; Whitton, Anthony

    2011-07-31

    Research regarding the decision to adopt and implement technological innovations in radiation oncology is lacking. This is particularly problematic since these technologies are often complex and rapidly evolving, requiring ongoing revisiting of decisions regarding which technologies are the most appropriate to support. Variations in adoption and implementation decisions for new radiation technologies across cancer centres can impact patients' access to appropriate and innovative forms of radiation therapy. This study examines the key steps in the process of adopting and implementing intensity modulated radiation therapy (IMRT) in publicly funded cancer centres and identifies facilitating or impeding factors. A multiple case study design, utilizing document analysis and key informant interviews was employed. Four cancer centres in Ontario, Canada were selected and interviews were conducted with radiation oncologists, medical physicists, radiation therapists, and senior administrative leaders. Eighteen key informants were interviewed. Overall, three centres made fair to excellent progress in the implementation of IMRT, while one centre achieved only limited implementation as of 2009. Key factors that influenced the extent of IMRT implementation were categorized as: 1) leadership, 2) training, expertise and standardization, 3) collaboration, 4) resources, and 5) resistance to change. A framework for the adoption and implementation of complex and evolving technologies is presented. It identifies the key factors that should be addressed by decision-makers at specific stages of the adoption/implementation process.

  17. 3-Dimensional computed tomography imaging of the ring-sling complex with non-operative survival case in a 10-year-old female.

    Science.gov (United States)

    Fukuda, Hironobu; Imataka, George; Drago, Fabrizio; Maeda, Kosaku; Yoshihara, Shigemi

    2017-09-01

    We report a case of a 10-year-old female patient who survived ring-sling complex without surgery. The patient had congenital wheezing from the neonatal period and was treated after a tentative diagnosis of infantile asthma. The patient suffered from allergy and was hospitalized several times due to severe wheezing, and when she was 22 months old, she was diagnosed with ring-sling complex. We used a segmental 4 mm internal diameter of the trachea for 3-dimensional computed tomography (3D-CT). Bronchial asthma is considered an exacerbating factor in infantile period and frequently required treatment with bronchodilator. After the age of 10, the patient had recurrent breathing difficulties during physical activity and during night time, and this condition was assessed to be related to the pressure from the blood vessel on the ring. We repeated the 3D-CT evaluation later and discovered that the internal diameter of the trachea had grown to 5 mm. Eventually, patient's breathing difficulties disappeared after the treatment of bronchial asthma and restriction of physical activities. Our patient remained in stable condition without undergoing any surgical procedures even after she passed the age of 10.

  18. Political Challenges in Complex Place-Based Health Promotion Partnerships: Lessons From an Exploratory Case Study in a Disadvantaged Area of Queensland, Australia.

    Science.gov (United States)

    Del Fabbro, Letitia; Rowe Minniss, Fiona; Ehrlich, Carolyn; Kendall, Elizabeth

    2016-01-01

    Settings-based health promotion involving multiple strategies and partners is complex, especially in disadvantaged areas. Partnership development and organizational integration are examined in the literature; however, there is more to learn from the examination of practice stakeholders' experience of intersectoral partnership processes. This case study examines stakeholder experiences of challenges in new partnership work in the context of a culturally diverse and socioeconomically disadvantaged region in Queensland, Australia. Health promotion staff and community representatives participated in interviews and focus groups, and the thematic analysis included observations and documentary analyses. Our findings highlight the retrogressive influence of broader system dynamics, including policy reform and funding changes, upon partnership working. Partnership enablers are disrupted by external political influences and the internal politics (individual and organizational) of health promotion practice. We point to the need for organization level commitment to a consistent agreed vision specifically accounting for place, as a cornerstone of intersectoral health promotion partnership resilience. If organizations from diverse sectors can embed a vision for health that accounts for place, complex health promotion initiatives may be less vulnerable to broader system reforms, and health in all policy approaches more readily sustained.

  19. Mixed Phenotype Acute Leukemia with Two Immunophenotypically Distinct B and T Blasts Populations, Double Chromosome and Complex Karyotype: Report of an Unusual Case

    Directory of Open Access Journals (Sweden)

    Samah A. Kohla

    2015-01-01

    Full Text Available Mixed phenotype acute leukemia (MPAL is considered as a rare type of leukemia with an incidence of less than 4% of all acute leukemia based on the most recent 2008 WHO classification. Common subtypes are the B/myeloid and T/myeloid; B/T and trilineage MPAL being extremely rare. We present a case of a male in his 20s, whose peripheral blood smears showed 34% blast cells and bone marrow with 70% blasts. Immunophenotyping by multiparametric flow cytometry showed two populations of blasts, the major one with B-lineage and the minor one with T-lineage. Conventional karyotyping revealed complex karyotype with the presence of double Philadelphia chromosome ( Ph + . BCR/ABL1 rearrangement was confirmed by fluorescent in situ hybridization (FISH analysis. The BCR/ABL1 ES probe on interphase cells indicated pl90 minor m-BCR/ABL fusion in 46% and a second abnormal clone with double Ph + in 16% of the cells analyzed confirmed by reverse transcription-PCR (RT-PCR. The case was diagnosed as MPAL with double Philadelphia chromosome Ph + . The patient was treated with dasatinib, four cycle hyper CVAD/methotrexate cytarabin protocol, and allogeneic transplant. He is still alive in complete hematological, cytogenetic, and molecular remission. Mixed phenotype B/T acute leukemia is an extremely rare disease, particularly those with double Philadelphia chromosomes and clinically presents challenges in diagnosis and treatment.

  20. Complex sclerosing lesions and radial sclerosing lesions on core needle biopsy: Low risk of carcinoma on excision in cases with clinical and imaging concordance.

    Science.gov (United States)

    Nakhlis, Faina; Lester, Susan; Denison, Christine; Wong, Stephanie M; Mongiu, Anne; Golshan, Mehra

    2018-03-01

    Complex or radial sclerosing lesions (CSL/RSL) are uncommon diagnoses on core needle biopsy with a reported upgrade rate ranging between 0% and 23%. As a result, their management remains controversial. In this study, we sought to determine the rate of malignancy on excision for patients with pure CSL/RSL on core biopsy, and to evaluate future breast cancer risk when CSL/RSL is managed without excision. We retrospectively reviewed 118 cases of CSL/RSL diagnosed on image-guided breast biopsies between 2005 and 2014 at our institution. Of 98 analyzed patients, 34 (35%) underwent excision and 64 (65%) were observed. Demographic and clinical variables between excision and observation groups were compared. In excised specimens, factors associated with upgrade to malignancy were evaluated. The median age at diagnosis was 49 years (range, 27-88 years). In the excision group, 3/34 cases were associated with malignancy, an overall upgrade rate of 9%. All malignant cases had core needle biopsies interpreted as discordant and were BIRADS 4B or more on imaging. In the observation group, at a median follow-up of 2.2 years, 3/64 (5%) patients developed ipsilateral cancers, all of which were distant from the index CSL/RSL. In our series, we report a 9% malignancy rate on excision of BIRADS >4C lesions characterized as CSL/RSL on core biopsy. In patients with concordant biopsies and BIRADS 4A or lower lesions who underwent observation, we found a low rate of subsequent ipsilateral cancers. Further studies are needed to confirm that for CSL/RSL in concordant core biopsies and BIRADS 4A or lower, nonpalpable lesions, observation may be a reasonable alternative to excision. © 2017 Wiley Periodicals, Inc.

  1. Percutaneous ablation and retrieval of a right atrial myxoma.

    Science.gov (United States)

    Konecny, Tomas; Reeder, Guy; Noseworthy, Peter A; Konecny, Dana; Carney, J Aidan; Asirvatham, Samuel J

    2014-11-01

    We report the first case of percutaneous myxoma ablation and retrieval from the right atrium. This novel procedure may reduce the need for repeat surgical excisions in patients with Carney Complex and other recurrent myxoma syndromes. Copyright © 2014 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.

  2. The evaluation of complex clinical trial protocols: resources available to research ethics committees and the use of clinical trial registries--a case study.

    Science.gov (United States)

    Homedes, Núria; Ugalde, Antonio

    2015-06-01

    To assess the potential role of clinical trial (CT) registries and other resources available to research ethics committees (RECs) in the evaluation of complex CT protocols in low-income and middle-income countries. Using a case study approach, the authors examined the decision-making process of a REC in Argentina and its efforts to use available resources to decide on a complex protocol. We also analysed the information in the USA and other CT registries and consulted 24 CT experts in seven countries. Information requested by the Argentinean REC from other national RECs and ethics' experts was not useful to verify the adequacy of the REC's decision whether or not to approve the CT. The responses from the national regulatory agency and the sponsor were not helpful either. The identification of international resources that could assist was beyond the REC's capability. The information in the USA and other CT registries is limited, and at times misleading; and its accuracy is not verified by register keepers. RECs have limited access to experts and institutions that could assist them in their deliberations. Sponsors do not always answer RECs' request for information to properly conduct the ethical and methodological assessment of CT protocols. The usefulness of the CT registries is curtailed by the lack of appropriate codes and by data errors. Information about reasons for rejection, withdrawal or suspension of the trial should be included in the registries. Establishing formal channels of communication among national and foreign RECs and with independent international reference centres could strengthen the ethical review of CT protocols. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  3. Comparison of a traditional with a new approach based on Graph Theory to vulnerability assessment to natural hazards: a study case on a socio-economic complex system

    Science.gov (United States)

    Arosio, Marcello; Martina, Mario L. V.

    2017-04-01

    The emergent behaviour of the contemporary complex, socio-technical and interconnected society makes the collective risk greater than the sum of the parts and this requires a holistic, systematic and integrated approach. Although there have been major improvements in recent years, there are still some limitation in term of a holistic approach that is able to include the emergent value hidden in the connections between exposed elements and the interactions between the different spheres of the multi-hazards, vulnerability, exposure and resilience. To deal with these challenges it is necessary to consider the connections between the exposed elements (e.g. populations, schools, hospital, etc.) and to quantify the relative importance of the elements and their interconnections (e.g. the need of injured people to go to hospital or children to school). In a system (e.g. road, hospital and ecological network, etc.), or in a System of System (e.g. socio-technical urban service), there are critical elements that, beyond the intrinsic vulnerability, can be characterized by greater or lower vulnerability because of their physical, geographical, cyber or logical connections. To this aim, we propose in this study a comparative analysis between traditional reductionist approach and a new holistic approach to vulnerability assessment to natural hazards. The analysis considers a study case of a socio-economic complex system through an innovative approach based on the properties of graph G=(N,L). A graph consists of two sets N (nodes) and L (links): the nodes represent the single exposed elements (physical, social, environmental, etc.) to a hazard, while the links (or connections) represent the interaction between the elements. The final goal is to illustrate an application of this innovative approach of integrated collective vulnerability assessment.

  4. Towards a methodology for cluster searching to provide conceptual and contextual "richness" for systematic reviews of complex interventions: case study (CLUSTER).

    Science.gov (United States)

    Booth, Andrew; Harris, Janet; Croot, Elizabeth; Springett, Jane; Campbell, Fiona; Wilkins, Emma

    2013-09-28

    Systematic review methodologies can be harnessed to help researchers to understand and explain how complex interventions may work. Typically, when reviewing complex interventions, a review team will seek to understand the theories that underpin an intervention and the specific context for that intervention. A single published report from a research project does not typically contain this required level of detail. A review team may find it more useful to examine a "study cluster"; a group of related papers that explore and explain various features of a single project and thus supply necessary detail relating to theory and/or context.We sought to conduct a preliminary investigation, from a single case study review, of techniques required to identify a cluster of related research reports, to document the yield from such methods, and to outline a systematic methodology for cluster searching. In a systematic review of community engagement we identified a relevant project - the Gay Men's Task Force. From a single "key pearl citation" we conducted a series of related searches to find contextually or theoretically proximate documents. We followed up Citations, traced Lead authors, identified Unpublished materials, searched Google Scholar, tracked Theories, undertook ancestry searching for Early examples and followed up Related projects (embodied in the CLUSTER mnemonic). Our structured, formalised procedure for cluster searching identified useful reports that are not typically identified from topic-based searches on bibliographic databases. Items previously rejected by an initial sift were subsequently found to inform our understanding of underpinning theory (for example Diffusion of Innovations Theory), context or both. Relevant material included book chapters, a Web-based process evaluation, and peer reviewed reports of projects sharing a common ancestry. We used these reports to understand the context for the intervention and to explore explanations for its relative

  5. Towards a methodology for cluster searching to provide conceptual and contextual “richness” for systematic reviews of complex interventions: case study (CLUSTER)

    Science.gov (United States)

    2013-01-01

    Background Systematic review methodologies can be harnessed to help researchers to understand and explain how complex interventions may work. Typically, when reviewing complex interventions, a review team will seek to understand the theories that underpin an intervention and the specific context for that intervention. A single published report from a research project does not typically contain this required level of detail. A review team may find it more useful to examine a “study cluster”; a group of related papers that explore and explain various features of a single project and thus supply necessary detail relating to theory and/or context. We sought to conduct a preliminary investigation, from a single case study review, of techniques required to identify a cluster of related research reports, to document the yield from such methods, and to outline a systematic methodology for cluster searching. Methods In a systematic review of community engagement we identified a relevant project – the Gay Men’s Task Force. From a single “key pearl citation” we conducted a series of related searches to find contextually or theoretically proximate documents. We followed up Citations, traced Lead authors, identified Unpublished materials, searched Google Scholar, tracked Theories, undertook ancestry searching for Early examples and followed up Related projects (embodied in the CLUSTER mnemonic). Results Our structured, formalised procedure for cluster searching identified useful reports that are not typically identified from topic-based searches on bibliographic databases. Items previously rejected by an initial sift were subsequently found to inform our understanding of underpinning theory (for example Diffusion of Innovations Theory), context or both. Relevant material included book chapters, a Web-based process evaluation, and peer reviewed reports of projects sharing a common ancestry. We used these reports to understand the context for the intervention and to

  6. Non-invasive investigative techniques for the diachronic study of territorial compartments: a case study for the documentation and analysis of architectural complexes.

    Science.gov (United States)

    Di Lieto, Marco; Marchetta, Isabella; Ciriello, Rosanna; De Martino, Gregory; Della Mora, Dario

    2014-05-01

    The trend in the study of areas of land in their integrity and as dynamic, anthropic units in diachronic history has initiated long survey campaigns over several decades that have covered large areas mapping the evidence and attempting a reconstruction of the evolution of ancient settlements. The need for further study to disentangle the knots of modes and types of settlement boosted further investigations of targeted excavations, based on the quality and density of the findings from the field. Currently archaeological research can rely on non-invasive integrated methods to better define the areas to be investigated systematically obtaining new typologies of information and better management of time and research costs. In this paper we present a specific case study in which a variety of integrated survey methods have contributed to the documentation and analysis of monumental complexes linked to specific local contexts. The area under investigation lies in Italy, in the province of Potenza and, specifically in the town of Forenza. The survey activities, involving the entire municipality, have been running on and off for about 2 years and have already resulted in the collection of a lot of interesting data that will be useful to essential fieldwork. In particular, we carried out different types of investigation in three different sample sites: 1. monumental complex of Santa Maria de 'Armenis: to complement previous excavations which involved only a portion of the estimated area of interest, we carried out magnetometric and geo-electrical surveys aimed at a more precise definition of the true extent and interpretation of the monument in antiquity; 2. site of Monte Caruso: we carried out remote sensing using a remote-controlled UAV hexakopter drone with stereoscopic photogrammetric survey techniques aimed at the detailed documentation of the monumental evidence of a structure visible in elevation but in a context difficult to approach with traditional surveying

  7. The Perception of a Three-Dimensional-Printed Heart Model from the Perspective of Different Stakeholders: A Complex Case of Truncus Arteriosus

    Directory of Open Access Journals (Sweden)

    Giovanni Biglino

    2017-09-01

    Full Text Available The case of an 11-year-old male patient with truncus arteriosus is presented. The patient has a right aortic arch, a repaired truncus arteriosus, pulmonary artery stenosis, as well as conduit stenosis, with a complex surgical plan being discussed. In order to gather additional insight into the patient’s anatomy prior to the surgery and to facilitate communication with the patient’s parents, a three-dimensional (3D model of his heart and main vessels was created from computed tomography data. Feedback was collected from different stakeholders. The patient and his parents were both struck by the size of the heart, with the parents further elaborating on how the 3D model was more intuitive a tool than medical images as well as “an helpful talking point to the other members of the family” and potentially also at school. The surgeon and cardiologist commented on gaining better understanding of the 3D relationship between a markedly narrowed right pulmonary artery and the aorta, with the surgeon ultimately coming to a decision of dividing the ascending aorta quite high to access the right pulmonary artery for patch reconstruction and thus planning to arrest the circulation beforehand. The imaging expert remarked on the potential to “improve communication in multidisciplinary meetings,” while a medical trainee, who also had a chance to evaluate the model, remarked that “having the model in front of me and being able to see the exact abnormality makes this particular case much more memorable. […] 3D printed models could have immense potential in pathology and anatomy teaching for the training of healthcare professionals.”

  8. Complex relationships between occupation, environment, DNA adducts, genetic polymorphisms and bladder cancer in a case-control study using a structural equation modeling.

    Directory of Open Access Journals (Sweden)

    Stefano Porru

    Full Text Available DNA adducts are considered an integrate measure of carcinogen exposure and the initial step of carcinogenesis. Their levels in more accessible peripheral blood lymphocytes (PBLs mirror that in the bladder tissue. In this study we explore whether the formation of PBL DNA adducts may be associated with bladder cancer (BC risk, and how this relationship is modulated by genetic polymorphisms, environmental and occupational risk factors for BC. These complex interrelationships, including direct and indirect effects of each variable, were appraised using the structural equation modeling (SEM analysis. Within the framework of a hospital-based case/control study, study population included 199 BC cases and 213 non-cancer controls, all Caucasian males. Data were collected on lifetime smoking, coffee drinking, dietary habits and lifetime occupation, with particular reference to exposure to aromatic amines (AAs and polycyclic aromatic hydrocarbons (PAHs. No indirect paths were found, disproving hypothesis on association between PBL DNA adducts and BC risk. DNA adducts were instead positively associated with occupational cumulative exposure to AAs (p = 0.028, whereas XRCC1 Arg 399 (p<0.006 was related with a decreased adduct levels, but with no impact on BC risk. Previous findings on increased BC risk by packyears (p<0.001, coffee (p<0.001, cumulative AAs exposure (p = 0.041 and MnSOD (p = 0.009 and a decreased risk by MPO (p<0.008 were also confirmed by SEM analysis. Our results for the first time make evident an association between occupational cumulative exposure to AAs with DNA adducts and BC risk, strengthening the central role of AAs in bladder carcinogenesis. However the lack of an association between PBL DNA adducts and BC risk advises that these snapshot measurements are not representative of relevant exposures. This would envisage new scenarios for biomarker discovery and new challenges such as repeated measurements at different

  9. Restoration and conversion to re-use of historic buildings incorporating increased energy efficiency: A case study - the Haybarn complex, Hilandar Monastery, Mount Athos

    Directory of Open Access Journals (Sweden)

    Ivanović-Šekularac Jelena A.

    2016-01-01

    Full Text Available A proper approach to restoration of historic buildings is crucial for monumental heritage protection. The objective of the paper is to define a methodology for historic buildings restoration in order to increase energy efficiency and re-usability in accordance with modern standards. The main method used in the paper is the observation of historic buildings during their restoration and exploitation, analysis and evaluation of achieved results regarding energy efficiency and energy saving, through the examples of the buildings belonging to Hilandar Monastery, Mount Athos, in Greece. Mount Athos was inscribed on the UNESCO World Heritage List for its cultural and natural values. This case study discusses the abandoned and dilapidated historic buildings of the Haybarn Complex (Stable, Mulekeepers’ House and Haybarn, the achieved results regarding the restoration of these buildings, their energy efficiency and turning into the premises for occasional stays. The research results are recommendations for increasing energy efficiency while performing the restoration of historic buildings, so that these buildings could be re-used in a new way. The most significant contribution of the paper is the practical test of energy refurbishment of these historic buildings conducted using the principles and methods of energy efficiency, in compliance with conservation requirements and authenticity of historic buildings.

  10. Quantifying nonpoint source emissions and their water quality responses in a complex catchment: A case study of a typical urban-rural mixed catchment

    Science.gov (United States)

    Chen, Lei; Dai, Ying; Zhi, Xiaosha; Xie, Hui; Shen, Zhenyao

    2018-04-01

    As two key threats to receiving water bodies, the generation mechanisms and processes of urban and agricultural nonpoint sources (NPSs) show clear differences, which lead to distinct characteristics of water quality responses with mixed land-uses catchments compared to single land-use ones. However, few studies have provided such insights in these characteristic or quantified different water environment responses to NPS pollution. In this study, an integrated modelling approach was developed for those complex catchments by combining three commonly used models: SWMM (Storm Water Management Model), SWAT (Soil and Water Assessment Tool) and MIKE 11. A case study was performed in a typical urban-rural catchment of Chao Lake, China. The simulated results indicated that urban NPS pollution responded sensitively to rainfall events and was greatly affected by the antecedent dry days. Compare to urban NPS, agricultural NPS pollution was characterized with the time-lag to rainfall depended on soil moisture and the post-rain-season emissions carried by lateral flows, and were also affected by the local farm-practice schedule. With comprehensive impacts from urban-rural land-uses, the time-interleaved urban and agricultural NPS pollution emissions and more abundant pollution accumulation both led to a decrease in the responsive time and an increase in the frequency of peak pollution concentration values even during the dry season. These obtained characteristics can provide guidance for drafting watershed management plans in similar mixed land use catchments.

  11. Mind maps and network analysis to evaluate conceptualization of complex issues: A case example evaluating systems science workshops for childhood obesity prevention.

    Science.gov (United States)

    Frerichs, Leah; Young, Tiffany L; Dave, Gaurav; Stith, Doris; Corbie-Smith, Giselle; Hassmiller Lich, Kristen

    2018-03-05

    Across disciplines, it is common practice to bring together groups to solve complex problems. Facilitators are often asked to help groups organize information about and better understand the problem in order to develop and prioritize solutions. However, despite existence of several methods to elicit and characterize how individuals and groups think about and conceptualize an issue, many are difficult to implement in practice-based settings where resources such as technology and participant time are limited and research questions shift over time. This paper describes an easy-to-implement diagramming technique for eliciting conceptualization and a flexible network analysis method for characterizing changes in both individual and group conceptualization. We use a case example to illustrate how we used the methods to evaluate African American adolescent's conceptual understanding of obesity before and after participating in a series of four systems thinking workshops. The methods produced results that were sensitive to changes in conceptualization that were likely driven by the specific activities employed during the workshop sessions. The methods appear strong for capturing salient levels of conceptualization at both individual and collective levels. The paper concludes with a critical examination of strengths and weaknesses of the methods and implications for future practice and research. Copyright © 2018 Elsevier Ltd. All rights reserved.

  12. CHRONIC MYCOTIC-ASSOCIATED SURGICAL NAIL PATHOLOGY COMPLICATED WITH INGROWN NAIL (NAIL INCARNATION: THE ANALYSES OF CLINICAL CASES AND COMPLEX TREATMENT

    Directory of Open Access Journals (Sweden)

    A. R. Vergun

    2017-07-01

    Full Text Available Background. Conservative treatment of secondary recurrent unguis incarnatus are not very effective and Dupuytren’s method, Emmert-Schmiden surgeries etc. are very traumatic, disfigure nail bone, distort anatomic and functional unity of a nail. Objective. The aim of our research was the optimal sequence of holiatry, surgical moving away from nails, local and system therapy after excision of the staggered nails in case of destructive onychomycosis complicated by secondary ingrown nail for some patients with complicated mycotic defeat of nails. Clinical options of surgical treatment were clarified; morphologic changes were studied; causes of unsatisfactory outcomes of chronic pathology complex treatment were analyzed for prospective approaches to preventing of relapses. Methods. The analysis justifies the feasibility of establishing of predictive relationships between clinical variants of chronic purulent necrotic infections and combined comorbidity. System therapy by itraconazole before operative treatment (basic onychial defeats sanation and in a postoperative period was carried out. Types of operative treatment applied may be divided into five statistic groups. Results. Over a five-year period (2010-2015 436 unguis incarnates diagnosis (325 cases of incarnated onychomycosis in 259 men and 177 women aged 12-67 were performed, 38 of them with incarnated onychogryphosis had diabetes mellitus and 24 had metabolic syndrome. Analysis of subonychial scraping allowed stating the prevalence of red trichophytia in 31% of cases with the bacterial flora. Patients with combined pathology got 4-5 five-day system ‘pulses’ of 400 mg/day itraconazole therapy. In patients with primary advantage of providing low-impact methods of nail excision with access via onycholisation structure a nail extirpation and marginal matricectomy was carried out; dermatophytoms and stratification on a nail bed were deleted. Conclusions. Type of onychectomy wound cytograms in

  13. Multiple magmatism in an evolving suprasubduction zone mantle wedge: The case of the composite mafic-ultramafic complex of Gaositai, North China Craton

    Science.gov (United States)

    Yang, Fan; Santosh, M.; Tsunogae, T.; Tang, Li; Teng, Xueming

    2017-07-01

    The suprasubduction zone mantle wedge of active convergent margins is impregnated by melts and fluids leading to the formation of a variety of magmatic and metasomatic rock suites. Here we investigate a composite mafic-ultramafic intrusion at Gaositai, in the northern margin of the North China Craton (NCC). The hornblende gabbro-serpentinite-dunite-pyroxenite-gabbro-diorite suite surrounded by hornblendites of this complex has long been considered to represent an "Alaskan-type" zoned pluton. We present petrologic, mineral chemical, geochemical and zircon U-Pb and Lu-Hf data from the various rock types from Gaositai including hornblende gabbro, serpentinite, dunite, pyroxenite, diorite and the basement hornblendite which reveal the case of multiple melt generation and melt-peridotite interaction. Our new mineral chemical data from the mafic-ultramafic suite exclude an "Alaskan-type" affinity, and the bulk geochemical features are consistent with subduction-related magmatism with enrichment of LILE (K, Rb, and Ba) and LREE (La and Ce), and depletion of HFSE (Nb, Ta, Zr, and Hf) and HREE. Zircon U-Pb geochronology reveals that the hornblendites surrounding the Gaositai complex are nearly 2 billion years older than the intrusive complex and yield early Paleoproterozoic emplacement ages (2433-2460 Ma), followed by late Paleoproterozoic metamorphism (1897 Ma). The serpentinites trace the history of a long-lived and replenished ancient sub-continental lithospheric mantle with the oldest zircon population dated as 2479 Ma and 1896 Ma, closely corresponding with the ages obtained from the basement rock, followed by Neoproterozoic and Phanerozoic zircon growth. The oldest member in the Gaositai composite intrusion is the dunite that yields emplacement age of 755 Ma, followed by pyroxenite formed through the interaction of slab melt and wedge mantle peridotite at 401 Ma. All the rock suites also carry multiple population of younger zircons ranging in age from Paleozoic to

  14. Natural disease course and genotype-phenotype correlations in Complex I deficiency caused by nuclear gene defects: what we learned from 130 cases

    NARCIS (Netherlands)

    Koene, S.; Rodenburg, R.J.; van der Knaap, M.S.; Willemsen, M.A.A.P.; Sperl, W.; Laugel, V.; Ostergaard, E.; Tarnopolsky, M.; Martin, M.A.; Nesbitt, V.; Fletcher, J.; Edvardson, S.; Procaccio, V.; Slama, A.; van den Heuvel, L.P.W.J.; Smeitink, J.A.M.

    2012-01-01

    Mitochondrial complex I is the largest multi-protein enzyme complex of the oxidative phosphorylation system. Seven subunits of this complex are encoded by the mitochondrial and the remainder by the nuclear genome. We review the natural disease course and signs and symptoms of 130 patients (four new

  15. Natural disease course and genotype-phenotype correlations in Complex I deficiency caused by nuclear gene defects: what we learned from 130 cases.

    NARCIS (Netherlands)

    Koene, S.; Rodenburg, R.J.T.; Knaap, M.S. van der; Willemsen, M.A.A.P.; Sperl, W.; Laugel, V.; Ostergaard, E.; Tarnopolsky, M.; Martin, M.A.; Nesbitt, V.; Fletcher, J.; Edvardson, S.; Procaccio, V.; Slama, A.; Heuvel, L.P.W.J. van den; Smeitink, J.A.M.

    2012-01-01

    Mitochondrial complex I is the largest multi-protein enzyme complex of the oxidative phosphorylation system. Seven subunits of this complex are encoded by the mitochondrial and the remainder by the nuclear genome. We review the natural disease course and signs and symptoms of 130 patients (four new

  16. Investigation of practices to support the complex communication needs of children with hearing impairment and cerebral palsy in a rural district of Kenya: a case series.

    Science.gov (United States)

    Bunning, Karen; Gona, Joseph K; Buell, Susan; Newton, Charles R; Hartley, Sally

    2013-01-01

    Rehabilitation services are scarce in low-income countries, where under-representation of some specialist professions has led to the role extension of others. An example of this can be found in Kilifi in Kenya where the role of speech and language therapy has been taken on by occupational therapists and teachers. To investigate the communication practices used by these professional groups to support children with complex communication needs in a rural part of Kenya and to explore the ways in which this might be seen to facilitate or obstruct improved communication by asking the following questions: What are the critical features of interactional discourse in practitioner-child dyads with caregiver-child dyads providing a natural comparison? What communicative modalities and practice techniques are invoked? And how does this information relate to extending professional roles? An in-depth, descriptive study of a case series was conducted in a school for deaf children and the occupational therapy department of a district general hospital. A mixed methodology was used involving naturalistic observation and applied linguistics analysis. A convenience sample was established comprising six practitioner-child dyads assigned to partnership types: (A) three children with hearing impairment and their teachers; and (B) three children with cerebral palsy and their occupational therapists. As a natural comparator, the same three children in B were also observed with their mothers (partnership type C). Dyadic interaction was video recorded on three occasions. The video data were sampled, transcribed into standard orthography and translated. Codes were applied to determine turn structure, linguistic move types and communicative modalities. Sequential analysis was conducted on the move types. Partnership type A dyads showed a fairly even turn distribution between teacher and child. A common pattern was teacher-initiated Instruct and Model/Prompt, followed by child response in the

  17. Complex dynamics

    CERN Document Server

    Carleson, Lennart

    1993-01-01

    Complex dynamics is today very much a focus of interest. Though several fine expository articles were available, by P. Blanchard and by M. Yu. Lyubich in particular, until recently there was no single source where students could find the material with proofs. For anyone in our position, gathering and organizing the material required a great deal of work going through preprints and papers and in some cases even finding a proof. We hope that the results of our efforts will be of help to others who plan to learn about complex dynamics and perhaps even lecture. Meanwhile books in the field a. re beginning to appear. The Stony Brook course notes of J. Milnor were particularly welcome and useful. Still we hope that our special emphasis on the analytic side will satisfy a need. This book is a revised and expanded version of notes based on lectures of the first author at UCLA over several \\Vinter Quarters, particularly 1986 and 1990. We owe Chris Bishop a great deal of gratitude for supervising the production of cour...

  18. Greigite-related complex magnetic polarity records unraveled through an integrated rock magnetic analysis: A case study on Neogene sections in East Timor

    Science.gov (United States)

    Aben, F. M.; Bakker, R. R.; Dekkers, M. J.; Van Hinsbergen, D. J.; Harris, R. A.; Zachariasse, J.; Duffy, B. G.

    2013-12-01

    Inconsistent polarity patterns in greigite-bearing (marine) sediments are a common problem in magnetostratigraphic and paleomagnetic research. Prolonged diagenesis can result in multiple generations of greigite being present in a sedimentary record. The associated remanence ';haystack' can be filtered to some extent by paleomagnetic field tests but not all rock records are suitable for such an approach. Here, we test whether end-member modeling of IRM-acquisition curves as a basis for an integrated rock magnetic and (electron) microscopic research approach can be used to identify all magnetic mineral suites, to evaluate the nature of the magnetic remanences, and to use the acquired knowledge to isolate the ChRM from such complex magnetic records. To this end, a case study was performed on uppermost Miocene to Pliocene deep-marine clastic and chalk bearing Viqueque Type section in East Timor. This section was originally sampled to establish a bio- and magnetostratigraphic age model dating the uplift history of the young Timor-orogen. An in principle straightforward polarity record was obtained, which, however, was impossible to reconcile with the biostratigraphy of the section. Among the dominant magnetic carriers was greigite. Two magnetic end-members were distinguished in the Viqueque Type section, which were analyzed further for rock magnetic properties. With microscopy, three magnetic mineral suites are shown to result in the two end-members. The first suite occurs in all lithologies and consists of detrital magnetite with a viscous NRM, caused by partial reductive dissolution of detrital magnetite grains after deposition. This mineral suite therefore is unreliable for magnetostratigraphic use. The second and third suite both consist of interacting single domain greigite grains with a chemical remanent magnetization. The second suite is present in almost all clay levels of the Viqueque Type section and is characterized by early diagenetic framboidal greigite

  19. Clinical manifestations and enzymatic activities of mitochondrial respiratory chain complexes in Pearson marrow-pancreas syndrome with 3-methylglutaconic aciduria: a case report and literature review.

    Science.gov (United States)

    Sato, Takeshi; Muroya, Koji; Hanakawa, Junko; Iwano, Reiko; Asakura, Yumi; Tanaka, Yukichi; Murayama, Kei; Ohtake, Akira; Hasegawa, Tomonobu; Adachi, Masanori

    2015-12-01

    Pearson marrow-pancreas syndrome (PS) is a rare mitochondrial disorder. Impaired mitochondrial respiratory chain complexes (MRCC) differ among individuals and organs, which accounts for variable clinical pictures. A subset of PS patients develop 3-methylglutaconic aciduria (3-MGA-uria), but the characteristic symptoms and impaired MRCC remain unknown. Our patient, a girl, developed pancytopenia, hyperlactatemia, steatorrhea, insulin-dependent diabetes mellitus, liver dysfunction, Fanconi syndrome, and 3-MGA-uria. She died from cerebral hemorrhage at 3 years of age. We identified a novel 5.4-kbp deletion of mitochondrial DNA. The enzymatic activities of MRCC I and IV were markedly reduced in the liver and muscle and mildly reduced in skin fibroblasts and the heart. To date, urine organic acid analysis has been performed on 29 PS patients, including our case. Eight patients had 3-MGA-uria, while only one patient did not. The remaining 20 patients were not reported to have 3-MGA-uria. In this paper, we included these 20 patients as PS patients without 3-MGA-uria. PS patients with and without 3-MGA-uria have similar manifestations. Only a few studies have examined the enzymatic activities of MRCC. No clinical characteristics distinguish between PS patients with and without 3-MGA-uria. The correlation between 3-MGA-uria and the enzymatic activities of MRCC remains to be elucidated. • The clinical characteristics of patients with Pearson marrow-pancreas syndrome and 3-methylglutaconic aciduria remain unknown. • No clinical characteristics distinguish between Pearson marrow-pancreas syndrome patients with and without 3-methylglutaconic aciduria.

  20. Useless hearing in male Emblemasoma auditrix (Diptera, Sarcophagidae--a case of intralocus sexual conflict during evolution of a complex sense organ?

    Directory of Open Access Journals (Sweden)

    Reinhard Lakes-Harlan

    Full Text Available Sensory modalities typically are important for both sexes, although sex-specific functional adaptations may occur frequently. This is true for hearing as well. Consequently, distinct behavioural functions were identified for the different insect hearing systems. Here we describe a first case, where a trait of an evolutionary novelty and a highly specialized hearing organ is adaptive in only one sex. The main function of hearing of the parasitoid fly Emblemasoma auditrix is to locate the host, males of the cicada species Okanagana rimosa, by their calling song. This task is performed by female flies, which deposit larvae into the host. We show that male E. auditrix possess a hearing sense as well. The morphology of the tympanal organ of male E. auditrix is rather similar to the female ear, which is 8% broader than the male ear. In both sexes the physiological hearing threshold is tuned to 5 kHz. Behavioural tests show that males are able to orient towards the host calling song, although phonotaxis often is incomplete. However, despite extensive observations in the field and substantial knowledge of the biology of E. auditrix, no potentially adaptive function of the male auditory sense has been identified. This unique hearing system might represent an intralocus sexual conflict, as the complex sense organ and the behavioural relevant neuronal network is adaptive for only one sex. The correlated evolution of the sense organ in both sexes might impose substantial constraints on the sensory properties of the ear. Similar constraints, although hidden, might also apply to other sensory systems in which behavioural functions differ between sexes.

  1. Combined Innovative Portal Arthroscopy and Fluoroscopy-Assisted Reduction and Fixation in Subtle Injury of the Lisfranc Joint Complex: Analysis of 10 Cases.

    Science.gov (United States)

    Lien, Shiu-Bii; Shen, Hsain-Chung; Lin, Leou-Chyr

    Subtle injuries of the Lisfranc joint complex are uncommon and difficult to diagnose clinically and thus are easily missed even by experienced orthopedic doctors. Misdiagnosed injuries can lead to chronic disability until eventual fusion surgery. We describe 10 cases diagnosed with subtle injury of the Lisfranc joint that were treated with combined innovative portal arthroscopy and fluoroscopy-assisted reduction and percutaneous screw fixation in an interfragmentary fashion. The distance between the first and second metatarsals (the Lisfranc distance) and that between the medial cuneiform and fifth metatarsal base (foot arch height) was measured before and after surgery. The American Orthopaedic Foot and Ankle Society function score was evaluated perioperatively. The average preoperative and postoperative Lisfranc distance was 4.38 ± 0.39 mm and 2.68 ± 0.9 mm, the foot arch height was 12.63 ± 2.75 mm and 21.80 ± 3.50 mm, and the American Orthopaedic Foot and Ankle Society score was 59.1 ± 5.69 and 86.8 ± 10.1, respectively. Of the 10 patients, 3 had excellent outcomes, 6 had good outcomes, and 1 had a fair outcome. In conclusion, we report a useful and minimally invasive surgery for acute, subacute, and even chronic subtle injury of the Lisfranc joint. The Lisfranc distance, foot arch height, and function of the foot were restored clinically, and all measurements showed statistically significant differences. Copyright © 2016 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  2. Active faulting Vs other surface displacing complex geomorphic phenomena. Case studies from a tectonically active area, Abruzzi Region, central Apennines, Italy

    Science.gov (United States)

    Lo Sardo, Lorenzo; Gori, Stefano; Falcucci, Emanuela; Saroli, Michele; Moro, Marco; Galadini, Fabrizio; Lancia, Michele; Fubelli, Giandomenico; Pezzo, Giuseppe

    2016-04-01

    could be possible to infer the genesis of the scarps as due to complex tectono-karstic phenomena. As for case (ii), our ongoing analyses are aimed to analyze the tectonic "significance" of some closed depressions, up to 4 km long and to 0,5-1 km large, that occur along the south-western slope of the Gran Sasso Range. All these small depression are NW-SE trending. As already described by Bosi et al. (1989), Galadini and Giuliani (1993), D'Agostino et al. (1998), Falcucci et al. (2015), these closed depressions are bounded by scarps carved onto the carbonate bedrock and, subordinately, onto early Quaternary slope deposits, reaching height of up to 5 m. These scarps are preferentially NE dipping, even if in few cases some SW dipping scarp are also present . The field work has permitted to attest that these scarps are related to shear planes that that displaced two subsequent of Early Pleistocene breccias formations (the Valle Valiano Fm. and Fonte Vedice Fm.; Bosi e Bertini, 1993; D'agostino et al., 1997). A paleoseismological trench was also performed across one of these scarps, attesting the activity of these shear planes also in recent times, providing indications result about the deformation style. Reference Bertini, T., & Bosi, C. (1993). La tettonica quaternaria della conca di Fossa (L'Aquila). Il Quaternario, 6(2), 293-314. Bertini, T., Bosi, C., & Galadini, F. (1989). La conca di Fossa-S. Demetrio dei Vestini. CNR, Centro di Studio per la Geologia Tecnica, ENEA, PAS in Elementi di tettonica pliocenicoquaternaria ed indizi di sismicita olocenica nell'Appennino laziale-abruzzese, Societa Geologica Italiana, L'Aquila, 26-58. Bosi, C., & Bertini, T. (1970). Geologia della media valle dell'Aterno. Memorie Società Geologica Italiana, 9(4), 719-777. D'Agostino, N., F. Speranza, & R. Funiciello., (1997) "Le Brecce Mortadella dell'Appennino Centrale: primi risultati di stratigrafia magnetica." Il Quaternario10.2: 385-388. D'Agostino, N., Chamot-Rooke, N., Funiciello, R

  3. Complexity explained

    CERN Document Server

    Erdi, Peter

    2008-01-01

    This book explains why complex systems research is important in understanding the structure, function and dynamics of complex natural and social phenomena. Readers will learn the basic concepts and methods of complex system research.

  4. Complex Systems and Dependability

    CERN Document Server

    Zamojski, Wojciech; Sugier, Jaroslaw

    2012-01-01

    Typical contemporary complex system is a multifaceted amalgamation of technical, information, organization, software and human (users, administrators and management) resources. Complexity of such a system comes not only from its involved technical and organizational structure but mainly from complexity of information processes that must be implemented in the operational environment (data processing, monitoring, management, etc.). In such case traditional methods of reliability analysis focused mainly on technical level are usually insufficient in performance evaluation and more innovative meth

  5. The estimation of CO2 storage potential of gas-bearing shale complex at the early stage of reservoir characterization: the case of Baltic Basin (Poland).

    Science.gov (United States)

    Wójcicki, Adam; Jarosiński, Marek

    2017-04-01

    typical permeability of fractures under lithostatic stress we inferred negligible open space of natural fractures. Technological fracture space was calculated as an potential for hydraulic stimulation of vertical fractures until, due to elastic expansion of reservoir, the horizontal minimum stress equals the vertical one. In such a case, horizontal fractures start to open and the stimulation process gets to fail. Based on elastic anisotropy and tectonic stress differentiation, the maximum hydraulic horizontal extension was calculated for separated shale complexes. For further storage capacity we assumed that technological fracture space create primary pathway for CO2 transport is entirely accessible for the CO2. In general, the CO2 sorption capacity makes the predominant contribution and fracture space capacity is comparable or smaller than pore space contribution. When compare this with the best recognized Marcellus shale basin we can see that our calculations for the 35 m depth interval comprising formations with the higher TOC content show a slightly lower value than in the case of Marcellus.

  6. Complex chemistry

    International Nuclear Information System (INIS)

    Kim, Bong Gon; Kim, Jae Sang; Kim, Jin Eun; Lee, Boo Yeon

    2006-06-01

    This book introduces complex chemistry with ten chapters, which include development of complex chemistry on history coordination theory and Warner's coordination theory and new development of complex chemistry, nomenclature on complex with conception and define, chemical formula on coordination compound, symbol of stereochemistry, stereo structure and isomerism, electron structure and bond theory on complex, structure of complex like NMR and XAFS, balance and reaction on solution, an organo-metallic chemistry, biology inorganic chemistry, material chemistry of complex, design of complex and calculation chemistry.

  7. Multi-scalar agent-based complex design systems - the case of CECO (Climatic -Ecologies) Studio; informed generative design systems and performance-driven design workflows

    NARCIS (Netherlands)

    Mostafavi, S.; Yu, S.; Biloria, N.M.

    2014-01-01

    This paper illustrates the application of different types of complex systems for digital form finding and design decision making with underlying methodological and pedagogical aims to emphasize performance-driven design solutions via combining generative methods of complex systems with simulation

  8. A complexity analysis of 222Rn concentration variation: A case study for Domica cave, Slovakia for the period June 2010-June 2011

    Science.gov (United States)

    Mihailović, D. T.; Krmar, M.; Mimić, G.; Nikolić-Đorić, E.; Smetanová, I.; Holý, K.; Zelinka, J.; Omelka, J.

    2015-01-01

    In this paper we have analyzed 222Rn concentration variation in Domica cave (Slovakia) for the period June 2010-June 2011. In that sense we have applied a complexity analysis on 222Rn concentration time series. We have considered possible existence of a periodical component in the variation of 222Rn concentration and some environmental parameters, as well as possible correlation between them. In addition we have offered novel complexity measures based on the Kolmogorov complexity (KC), i.e. the Kolmogorov complexity spectrum, its highest value (KCM) and the integral Kolmogorov complexity (KCI). These measures have been applied on 222Rn concentration time series: (i) to establish the dependence of 222Rn concentration on cave environmental parameters (wind speed inside the cave, external wind speed, air temperature, atmospheric pressure and CO2 concentration) and (ii) to see whether influence of some parameters make the distribution of measured quantity less or more stochastic.

  9. Molecular characterization of complex chromosomal rearrangement: first report of novel t(7;12) (q11;q22) as part of a complex karyotype in de novo AML-M2 case.

    Science.gov (United States)

    Ahmad, Firoz; Dalvi, Rupa; Mandava, Swarna; Das, Bibhu R

    2014-12-01

    The strong association of diagnostic karyotype with clinical outcome has made cytogenetics one of the most valuable diagnostic and prognostic tools for acute myeloid leukemia (AML) till today. Complex chromosomal findings are reported to be seen in nearly 10-15% of adult AMLs and are generally associated with poor outcome. In the current report, we present the results of hematologic, immunophenotypic, cytogenetic, chromosomal microarray and molecular analyses of a 60-year-old female patient diagnosed with AML-M2. Cytogenetic analysis revealed complex chromosomal findings involving seven different chromosomes. However, cytogenetic analyses were not able to precisely unveil all karyotypic changes, hence chromosomal microarray was used for further characterization. The most interesting observation was identification of a t(7;12) (q11;q22) as part of this complex karyotype. To the best of our knowledge, this is the first report of identification of novel t(7;12) (q11;q22) as part of a complex karyotype in de novo AML-M2. Copyright © 2014 Elsevier GmbH. All rights reserved.

  10. Incorporating expert knowledge in calibrating a complex hydrological conceptual model: A FLEX-TOPO case study for a central European meso-scale catchment

    Science.gov (United States)

    Gharari, Shervan; Hrachowitz, Markus; Fenicia, Fabrizio; Gao, Hongkai; Euser, Tanja; Savenije, Huub

    2013-04-01

    Catchments are open systems meaning that it is impossible to find out the exact boundary conditions of the real system spatially and temporarily. Therefore models are essential tools in capturing system behavior spatially and extrapolating it temporarily for prediction. In recent years conceptual models have been in the center of attention rather than so called physically based models which are often over-parameterized and encounter difficulties for up-scaling of small scale processes. Conceptual models however are heavily dependent on calibration as one or more of their parameters can typically not be physically measured at the catchment scale. Parallel to the evolution of modeling attempts, our understanding of rainfall/runoff models increased due to improvements of measurement techniques. Heavily instrumented catchments have been studied, and measured system responses have been modeled for testing a priori hypothesis of system function. Although our understanding of how catchments may work has increased the lessons learned from the case specific studies remain locally valid and are not widely used in model calibration and development. In this study we try to constrain parameters of a complex conceptual model built on landscape units classified according to their hydrological functions, based on our logical considerations and general lessons from previous studies across the globe for the Luxembourgish meso-scale Wark catchment. The classified landscapes were used to assign different model structures to the individual hydrological response units. As an example deep percolation was defined as dominant process for plateaus, while rapid subsurface flow as dominant process for hillslope, and saturation overland flow as dominant process for wetlands. The modeled runoffs from each hydrological unit were combined in a parallel set-up to proportionally contribute to the total catchment runoff. The hydrological units are, in addition, linked by a common groundwater

  11. Ortho-para interconversion in cation-water complexes: The case of V+(H2O) and Nb+(H2O) clusters

    Science.gov (United States)

    Ward, T. B.; Miliordos, E.; Carnegie, P. D.; Xantheas, S. S.; Duncan, M. A.

    2017-06-01

    Vanadium and niobium cation-water complexes, V+(H2O) and Nb+(H2O), are produced by laser vaporization in a pulsed supersonic expansion, mass selected in a time-of-flight spectrometer, and studied with infrared photodissociation spectroscopy using rare gas atom (Ar, Ne) complex predissociation. The vibrational bands measured in the O-H stretching region contain K-type rotational sub-band structure, which provides insight into the structures of these complexes. However, rotational sub-bands do not exhibit the simple patterns seen previously for other metal ion-water complexes. The A rotational constants are smaller than expected and the normal 3:1 intensity ratios for K = odd:even levels for independent ortho:para nuclear spin states are missing for some complexes. We relied on highly correlated internally contracted multi-reference configuration interaction and Coupled Cluster [CCSD(T)] electronic structure calculations of those complexes with and without the rare gas atoms to investigate these anomalies. Rare gas atoms were found to bind via asymmetric motifs to the hydrated complexes undergoing large amplitude motions that vibrationally average to the quasi-C2v symmetry with a significant probability off the C2 axis, thus explaining the reduced A values. Both vanadium and niobium cations exhibit unusually strong nuclear spin coupling to the hydrogen atoms of water, the values of which vary with their electronic state. This catalyzes ortho-para interconversion in some complexes and explains the rotational patterns. The rate of ortho-para relaxation in the equilibrated complexes must therefore be greater than the collisional cooling rate in the supersonic expansion (about 106 s-1).

  12. Significance of fragmented QRS complexes for identifying culprit lesions in patients with non-ST-elevation myocardial infarction: a single-center, retrospective analysis of 183 cases

    Directory of Open Access Journals (Sweden)

    Guo Rong

    2012-06-01

    Full Text Available Abstract Background Fragmented QRS (fQRS complexes are novel electrocardiographic signals, which reflect myocardial conduction delays in patients with coronary artery disease (CAD. The importance of fQRS complexes in identifying culprit vessels was evaluated in this retrospective study. Methods A 12-lead surface electrocardiogram was obtained in 183 patients who had non-ST-elevation myocardial infarction (NSTEMI and subsequently underwent coronary angiography (CAG. On the basis of the frequency of fQRS complexes, indices such as sensitivity, specificity, positive and negative predictive values, and likelihood ratio were evaluated to determine the ability of fQRS complexes to identify the culprit vessels. Results Among the patients studied, elderly patients (age ≥ 65 years and those with diabetes had a significantly higher frequency of fQRS complexes (p = 0.005, p = 0.003, respectively. The fQRS complexes recorded in the 4 precordial leads had the highest specificity (81.8% for indentifying the culprit vessel (left anterior descending artery. However, the specificity of fQRS complexes to identify lesions in the left circumflex and right coronary arteries was lower for the inferior and lateral leads than for the limb leads (65.5% versus 71.7%; however, the limb leads had higher sensitivity (92.3% versus 89.4%. And the total sensitivity and specificity of fQRS (77.1% and 71.5% were higher than those values for ischemic T-waves. Conclusions The frequency of fQRS complexes was higher in elderly and diabetic patients with NSTEMI. The frequency of fQRS complexes recorded in each of the ECG leads can be used to identify culprit vessels in patients with NSTEMI.

  13. First-trimester prenatal sonographic findings associated with OEIS (omphalocele-exstrophy-imperforate anus-spinal defects) complex: a case and review of the literature.

    Science.gov (United States)

    Girz, B A; Sherer, D M; Atkin, J; Venanzi, M; Ahlborn, L; Cestone, L

    1998-01-01

    First-trimester sonographic findings associated with omphalocele-exstrophy-imperforate anus-spinal defects (OEIS) complex and review of the literature regarding this rare congenital anomaly are presented.

  14. Management approaches for environmental restoration at the U.S. Department of Energy Weapons Complex, Savannah River Site: A case study

    International Nuclear Information System (INIS)

    Johnson, S.V.; Mayberry, J.J.

    1993-01-01

    This paper introduces the management approaches for environmental restoration at the US Department of Energy Weapons Complex. A brief chronology of environmental restoration complex-wide is presented. This chronology, which focuses on the changing climate at DOE facilities, is then keyed to activities at the Savannah River Site (SRS) in Aiken, South Carolina, USA. Past, present, and future environmental restoration activities at SRS are discussed, reflecting the change in emphasis at the site

  15. Risk Management in Complex Construction Projects that Apply Renewable Energy Sources: A Case Study of the Realization Phase of the Energis Educational and Research Intelligent Building

    Science.gov (United States)

    Krechowicz, Maria

    2017-10-01

    Nowadays, one of the characteristic features of construction industry is an increased complexity of a growing number of projects. Almost each construction project is unique, has its project-specific purpose, its own project structural complexity, owner’s expectations, ground conditions unique to a certain location, and its own dynamics. Failure costs and costs resulting from unforeseen problems in complex construction projects are very high. Project complexity drivers pose many vulnerabilities to a successful completion of a number of projects. This paper discusses the process of effective risk management in complex construction projects in which renewable energy sources were used, on the example of the realization phase of the ENERGIS teaching-laboratory building, from the point of view of DORBUD S.A., its general contractor. This paper suggests a new approach to risk management for complex construction projects in which renewable energy sources were applied. The risk management process was divided into six stages: gathering information, identification of the top, critical project risks resulting from the project complexity, construction of the fault tree for each top, critical risks, logical analysis of the fault tree, quantitative risk assessment applying fuzzy logic and development of risk response strategy. A new methodology for the qualitative and quantitative risk assessment for top, critical risks in complex construction projects was developed. Risk assessment was carried out applying Fuzzy Fault Tree analysis on the example of one top critical risk. Application of the Fuzzy sets theory to the proposed model allowed to decrease uncertainty and eliminate problems with gaining the crisp values of the basic events probability, common during expert risk assessment with the objective to give the exact risk score of each unwanted event probability.

  16. Incorporating expert knowledge in a complex hydrological conceptual model: A FLEX-TOPO case study for a central European meso-scale catchment

    Science.gov (United States)

    Gharari, S.; Hrachowitz, M.; Fenicia, F.; Gao, H.; Savenije, H.

    2013-12-01

    Models are essential tools in capturing system behavior, catchments, spatially and extrapolating it temporarily for prediction. In recent years conceptual models have been in the center of attention rather than so called physically based models which are often over-parameterized and encounter difficulties for up-scaling of small scale processes. Conceptual models however are heavily dependent on calibration as one or more of their parameters can typically not be physically measured at the catchment scale. In this study we try to constrain parameters of a complex conceptual model built on landscape units classified according to their hydrological functions, based on our logical considerations and general lessons from previous studies across the globe for the Luxembourgish meso-scale Wark catchment. The classified landscapes were used to assign different model structures to the individual hydrological response units. As an example deep percolation was defined as dominant process for plateaus, while rapid subsurface flow as dominant process for hillslope, and saturation overland flow as dominant process for wetlands. The modeled runoffs from each hydrological unit were combined in a parallel set-up to proportionally contribute to the total catchment runoff. The hydrological units are, in addition, linked by a common groundwater reservoir. The parallel hydrological units, although increasing the number of parameters, have the benefit of separate calibration. By stepwise calibration different mechanisms can be calibrated at periods when these mechanisms are active in isolation. For instance, the groundwater module is calibrated during dry season recession and the wetland module during isolated summer storms when the hillslopes are below the activation threshold. Moreover, one can constrain parameters by realistic conditions. As an example, the lag time of wetlands is likely to be shorter than the lag time of water traveling to the outlet from a plateau. Moreover, due to

  17. Complex Narratives

    NARCIS (Netherlands)

    Simons, J.; Buckland, W.

    2014-01-01

    In the opening chapter, "Complex Narratives," Jan Simons brings together narratology, game theory, and complexity theory to untangle the intricate nature of complex narratives in contemporary cinema. He presents an overview of the different concepts - forking path narratives, mind-game films,

  18. phenanthroline complex

    Indian Academy of Sciences (India)

    ABHRANIL DE

    2018-02-28

    Feb 28, 2018 ... complex in a unique binding motif and provide additional stability to the compound in the solid state. This iron(II) complex is able to catalyze the cleavage of aromatic C-C linkage of 2,5-dihydroxybenzoic acid (Gentisic acid,. GA) in oxygen environment. The iron(II) complex in the presence of two equivalent ...

  19. (II) complexes

    African Journals Online (AJOL)

    activities of Schiff base tin (II) complexes. Neelofar1 ... Conclusion: All synthesized Schiff bases and their Tin (II) complexes showed high antimicrobial and ...... Singh HL. Synthesis and characterization of tin (II) complexes of fluorinated Schiff bases derived from amino acids. Spectrochim Acta Part A: Molec Biomolec.

  20. Using hydrogen deuterium exchange mass spectrometry to engineer optimized constructs for crystallization of protein complexes: Case study of PI4KIIIβ with Rab11.

    Science.gov (United States)

    Fowler, Melissa L; McPhail, Jacob A; Jenkins, Meredith L; Masson, Glenn R; Rutaganira, Florentine U; Shokat, Kevan M; Williams, Roger L; Burke, John E

    2016-04-01

    The ability of proteins to bind and interact with protein partners plays fundamental roles in many cellular contexts. X-ray crystallography has been a powerful approach to understand protein-protein interactions; however, a challenge in the crystallization of proteins and their complexes is the presence of intrinsically disordered regions. In this article, we describe an application of hydrogen deuterium exchange mass spectrometry (HDX-MS) to identify dynamic regions within type III phosphatidylinositol 4 kinase beta (PI4KIIIβ) in complex with the GTPase Rab11. This information was then used to design deletions that allowed for the production of diffraction quality crystals. Importantly, we also used HDX-MS to verify that the new construct was properly folded, consistent with it being catalytically and functionally active. Structures of PI4KIIIβ in an Apo state and bound to the potent inhibitor BQR695 in complex with both GTPγS and GDP loaded Rab11 were determined. This hybrid HDX-MS/crystallographic strategy revealed novel aspects of the PI4KIIIβ-Rab11 complex, as well as the molecular mechanism of potency of a PI4K specific inhibitor (BQR695). This approach is widely applicable to protein-protein complexes, and is an excellent strategy to optimize constructs for high-resolution structural approaches. © 2016 The Protein Society.

  1. Critical solvent thermodynamic effect on molecular recognition: The case of the complex formation of carboxylates and ammonium-squaramido based receptors

    Energy Technology Data Exchange (ETDEWEB)

    Piña, M. Nieves, E-mail: neus.pinya@uib.es; López, Kenia A.; Costa, Antoni; Morey, Jeroni, E-mail: jeroni.morey@uib.es

    2013-10-10

    Graphical abstract: - Highlights: • The enthalpy–entropy compensation in the complex is independent of the spacer used. • The enthalpy–entropy compensation is dependent on the microscopic nature of the binary mixture. • The enthalpy–entropy compensation is dependent on the proportion of the components of the binary mixture. - Abstract: An isothermal titration microcalorimetry (ITC) study on the supramolecular complex formation between carboxylates and ammonium-squaramido based receptors at different ethanol:water proportions is reported. The results obtained show that the formation enthalpy sign of a supramolecular complex in a water–ethanol binary mixture can be influenced by the proportion of the cosolvent. Moreover there is an enthalpy–entropy compensation process in the supramolecular complex formation; in poor water mixtures the process is endothermic, whilst in reach water mixtures the process is exothermic. This behavior is mostly due to the intrinsic nature of the mixture between water and ethanol, and particularly the process of solvation and desolvation of receptor, substrate and complex. When this study is repeated with binary mixtures of water–methanol and water–DMSO it is observed that the nature of the organic solvent affects the results. While the mixture water–methanol has a behavior similar to water–ethanol mixture, the water–DMSO mixture shows clear differences. In order to check this compensation process, △Cp values are calculated at two different proportions water–ethanol, and they are consistent with an enthalpy–entropy compensation process similar to that described by the inclusion process for certain hydrophilic cyclodextrines. The results obtained show that the enthalpy–entropy compensation detected in the supramolecular complex formation between carboxylates and ammonium-squaramido receptors is independent of the spacer used, and more dependent on the microscopic nature and proportion of the binary mixture.

  2. [Bacterially conditioned thromboembolism in dairy cows--a retrospective study of 31 necropsy cases with special consideration of the causative complex].

    Science.gov (United States)

    Müller, Matthias; Platz, Siegfried; Ehrlein, Jörn; Ewringmann, Thomas; Mölle, Gabriele; Weber, Albert

    2005-01-01

    A study of 340 necropsied dairy cattle from northern Bavaria resulted in 31 animals (9%) showing evidence of pyemic thromboembolism. The most frequent pathomorphologic lesions consisted in endocarditis valvularis thromboticans of the tricuspid and/or mitral valve (21), embolic pneumonia (26), nephritis (13) and renal infarction (12). The most common isolate found in bacteriologic culture was Arcanobacterium pyogenes in 26 of 31 cases, followed by Staphylococcus aureus (2), Mannheimia haemolytica (2) and Streptococcus bovis (1) in rare cases. In 27 of 31 cows a possible cause of pyemic thromboembolism was found; in 23 cases claw diseases and decubital ulcera were probably responsible.

  3. Intervention description is not enough: evidence from an in-depth multiple case study on the untold role and impact of context in randomised controlled trials of seven complex interventions

    Directory of Open Access Journals (Sweden)

    Wells Mary

    2012-06-01

    Full Text Available Abstract Background A number of single case reports have suggested that the context within which intervention studies take place may challenge the assumptions that underpin randomised controlled trials (RCTs. However, the diverse ways in which context may challenge the central tenets of the RCT, and the degree to which this information is known to researchers or subsequently reported, has received much less attention. In this paper, we explore these issues by focusing on seven RCTs of interventions varying in type and degree of complexity, and across diverse contexts. Methods This in-depth multiple case study using interviews, focus groups and documentary analysis was conducted in two phases. In phase one, a RCT of a nurse-led intervention provided a single exploratory case and informed the design, sampling and data collection within the main study. Phase two consisted of a multiple explanatory case study covering a spectrum of trials of different types of complex intervention. A total of eighty-four data sources across the seven trials were accessed. Results We present consistent empirical evidence across all trials to indicate that four key elements of context (personal, organisational, trial and problem context are crucial to understanding how a complex intervention works and to enable both assessments of internal validity and likely generalisability to other settings. The ways in which context challenged trial operation was often complex, idiosyncratic, and subtle; often falling outside of current trial reporting formats. However, information on such issues appeared to be available via first hand ‘insider accounts’ of each trial suggesting that improved reporting on the role of context is possible. Conclusions Sufficient detail about context needs to be understood and reported in RCTs of complex interventions, in order for the transferability of complex interventions to be assessed. Improved reporting formats that require and encourage

  4. Large erupted complex odontoma

    Directory of Open Access Journals (Sweden)

    Vijeev Vasudevan

    2009-01-01

    Full Text Available Odontomas are a heterogeneous group of jaw bone lesions, classified as odontogenic tumors which usually include well-diversified dental tissues. Odontoma is a term introduced to the literature by Broca in 1867. Trauma, infection and hereditary factors are the possible causes of forming this kind of lesions. Among odontogenic tumors, they constitute about 2/3 of cases. These lesions usually develop slowly and asymptomatically, and in most cases they do not cross the bone borders. Two types of odontoma are recognized: compound and complex. Complex odontomas are less common than the compound variety in the ratio 1:2.3. Eruption of an odontoma in the oral cavity is rare. We present a case of complex odontoma, in which apparent eruption has occurred in the area of the right maxillary second molar region.

  5. Learning from simple ebooks, online cases or classroom teaching when acquiring complex knowledge. A randomized controlled trial in respiratory physiology and pulmonology

    DEFF Research Database (Denmark)

    Worm, Bjarne Skjødt

    2013-01-01

    E-learning is developing fast because of the rapid increased use of smartphones, tablets and portable computers. We might not think of it as e-learning, but today many new e-books are in fact very complex electronic teaching platforms. It is generally accepted that e-learning is as effective...

  6. Polyelectrolyte complex formation and stability when mixing polyanions and polycations in salted media: A model study related to the case of body fluids

    Czech Academy of Sciences Publication Activity Database

    Etrych, Tomáš; Leclercq, L.; Boustta, M.; Vert, M.

    2005-01-01

    Roč. 25, 1-2 (2005), s. 281-288 ISSN 0928-0987 EU Projects: European Commission(XE) 512087 - GIANT Institutional research plan: CEZ:AV0Z40500505 Keywords : polyelectrolyte complex * selectivity * light scattering Subject RIV: CD - Macromolecular Chemistry Impact factor: 2.347, year: 2005

  7. How appropriate are two established concepts from higher education for solving complex real-world problems? A comparison of the Harvard and the ETH case study approach

    NARCIS (Netherlands)

    Steiner, G.; Laws, D.

    2006-01-01

    Purpose - The main focus of this paper is to discuss appropriate forms of higher education for building up students' competence for working on complex real-world problems. Design/methodology/approach - Within this paper the Harvard approach is accurately compared with the ETH approach by discussing

  8. Complex variable HVPT

    Energy Technology Data Exchange (ETDEWEB)

    Killingbeck, John P [Mathematics Department, University of Hull, Hull HU6 7RX (United Kingdom); Grosjean, Alain [Laboratoire d' Astrophysique de l' Observatoire de Besancon (CNRS, UPRES-A 6091), 41 bis Avenue de l' Observatoire, BP 1615, 25010 Besancon Cedex (France); Jolicard, Georges [Laboratoire d' Astrophysique de l' Observatoire de Besancon (CNRS, UPRES-A 6091), 41 bis Avenue de l' Observatoire, BP 1615, 25010 Besancon Cedex (France)

    2004-08-13

    Complex variable hypervirial perturbation theory is applied to the case of oscillator and Coulomb potentials perturbed by a single term potential of the form Vx{sup n} or Vr{sup n}, respectively. The trial calculations reported show that this approach can produce accurate complex energies for resonant states via a simple and speedy calculation and can also be useful in studies of PT symmetry and tunnelling resonance effects. (addendum)

  9. An erupted complex odontoma.

    Science.gov (United States)

    Tozoglu, Sinan; Yildirim, Umran; Buyukkurt, M Cemil

    2010-01-01

    Odontomas are benign tumors of odontogenic origin. The cause of the odontoma is unknown, but it is believed to be hereditary or due to a disturbance in tooth development triggered by trauma or infection. Odontomas may be either compound or complex. Although these tumors are seen frequently, erupted odontomas are rare. The purpose of this study is to present a rare case of complex odontoma that erupted into the oral cavity.

  10. Formation of ionic complexes in cryogenic matrices: a case study using co-deposition of Cu- with rare gas cations in solid argon.

    Science.gov (United States)

    Ludwig, Ryan M; Moore, David T

    2013-12-28

    Matrix isolation spectra have been obtained for ionic species formed from a beam of mass-selected ions, with a coincident beam of externally generated counter-ions used to provide charge balance. Infrared spectra were obtained for copper carbonyl complexes formed following deposition of Cu(-) ions with rare-gas counter-cations into CO-doped argon matrices. Both anionic and neutral copper carbonyl complexes Cu(CO)(n)(q) (n = 1-3; q = 0, -1) were observed in the spectra, with peak positions corresponding to previously reported assignments; new partially resolved bands appearing in the range 1830-1845 cm(-1) are assigned to larger [Cu(CO)3●(CO)n](-) aggregates, having additional CO ligands in the second solvation shell. The experimental geometry ensures that all Cu-centers initially arrive at the matrix as anions, so the relative abundance of anionic relative to neutral complexes is much higher than in previous studies employing alternative methods for ion deposition; this allows for monitoring of electron-transfer processes between anions and cations in the matrix. Comparison of time-dependent vs. temperature-dependent trends reveals that there are two distinct mechanisms by which the population of anionic complexes is converted into neutral complexes: short-range electron transfer between a cation-anion pair following diffusion, and long-range electron transfer involving photodetachment of an electron from the anion into the conduction band of solid argon, resulting in eventual recombination of the electron with a cation in a remote matrix site. The spectra also show a marked dependence on the deposition temperature and dopant concentration, in that 100-fold higher CO concentrations were required during deposition with the sample window at 10 K compared to that used at 20 K, in order to obtain a similar distribution of copper carbonyl complexes. Furthermore, although no carbonyl complexes are observed initially when low concentrations of CO are used at 10 K, upon

  11. EMD-RBFNN Coupling Prediction Model of Complex Regional Groundwater Depth Series: A Case Study of the Jiansanjiang Administration of Heilongjiang Land Reclamation in China

    Directory of Open Access Journals (Sweden)

    Qiang Fu

    2016-08-01

    Full Text Available The accurate and reliable prediction of groundwater depth is the basis of the sustainable utilization of regional groundwater resources. However, the complexity of the prediction has been ignored in previous studies of regional groundwater depth system analysis and prediction, making it difficult to realize the scientific management of groundwater resources. To address this defect, taking complexity diagnosis as the research foundation, this paper proposes a new coupling forecast strategy for evaluating groundwater depth based on empirical mode decomposition (EMD and a radial basis function neural network (RBFNN. The data used for complexity analysis and modelling are the monthly groundwater depth series monitoring data from 15 long-term monitoring wells from 1997 to 2007, which were collected from the Jiansanjiang Administration of Heilongjiang Agricultural Reclamation in China. The calculation results of the comprehensive complexity index for each groundwater depth series obtained are based on wavelet theory, fractal theory, and the approximate entropy method. The monthly groundwater depth sequence of District 8 of Farm Nongjiang, which has the highest complexity among the five farms in the Jiansanjiang Administration midland, was chosen as the modelling sample series. The groundwater depth series of District 8 of Farm Nongjiang was separated into five intrinsic mode function (IMF sequences and a remainder sequence by applying the EMD method, which revealed that local groundwater depth has a significant one-year periodic character and an increasing trend. The RBFNN was then used to forecast and stack each EMD separation sequence. The results suggest that the future groundwater depth will remain at approximately 10 m if the past pattern of water use continues, exceeding the ideal depth of groundwater. Thus, local departments should take appropriate countermeasures to conserve groundwater resources effectively.

  12. Quantum Entropy and Complexity

    Science.gov (United States)

    Benatti, F.; Oskouei, S. Khabbazi; Abad, A. Shafiei Deh

    We study the relations between the recently proposed machine-independent quantum complexity of P. Gacs [1] and the entropy of classical and quantum systems. On one hand, by restricting Gacs complexity to ergodic classical dynamical systems, we retrieve the equality between the Kolmogorov complexity rate and the Shannon entropy rate derived by A. A. Brudno [2]. On the other hand, using the quantum Shannon-McMillan theorem [3], we show that such an equality holds densely in the case of ergodic quantum spin chains.

  13. How do non-covalent complexes dissociate in droplets? A case study of the desolvation of dsDNA from a charged aqueous nanodrop.

    Science.gov (United States)

    Sharawy, Mahmoud; Consta, Styliani

    2015-10-14

    We present the desolvation mechanism of a double-stranded oligodeoxynucleotide (dsDNA) from an aqueous nanodrop studied by using atomistic molecular dynamics methods. The central theme of this study is the stability of a non-covalently bound complex, in general, and that of a dsDNA in particular, in a droplet environment. Among the factors that may affect the stability of a complex in an evaporating droplet we examine the increase in ion concentration and the distinct droplet morphologies arising from the charge-induced instability. We explore in detail a large set of aqueous nanodrops with excess negative charge, which comprise a dsDNA and Na(+), Cl(-) ions at various concentrations. We find that for a square of the charge to volume ratio above that of the Rayleigh limit the droplet attains distinct "spiky" morphologies that disperse the charge in larger volume relative to that of the spherical drop. Moreover, it is found that it is possible for a non-covalent complex to remain associated in an unstable droplet as long as there is enough solvent to accommodate the instability. In the presence of Na(+) and Cl(-) ions, the Na(+) ions form adducts with the double helical DNA in the minor groove, which help stabilise the duplex state in the gas phase. The negative ions may be released from the droplet. In a DNA-containing droplet with a net charge that is less negative than 50% of the dsDNA charge, the DNA maintains a double-stranded state in the gas phase. Several of our findings are in good agreement with experiments, while the spiky droplet morphology due to the charge-induced instability calls for new experiments. The results shed light on the association properties of complexes of macromolecules in droplet environments, which are critical intermediates in electrospray ionisation experiments.

  14. Comprehensive evaluation technology for shale gas sweet spots in the complex marine mountains, South China: A case study from Zhaotong national shale gas demonstration zone

    Directory of Open Access Journals (Sweden)

    Xing Liang

    2016-01-01

    Full Text Available The exploration and development of marine shale gas reservoirs in South China is challenged by complex geological and geographical conditions, such as strong transformation, post maturity, complex mountains and humanity. In this paper, the evaluations on shale gas sweet spots conducted in Zhaotong demonstration zone in the past six years and the construction of 500 million m3 shale gas productivity in Huangjinba region were discussed, and the results of shale gas reservoir evaluations in China and abroad were investigated. Accordingly, it is proposed that another two key indicators be taken into consideration in the evaluation on shale gas sweet spots in marine mountains in South China, i.e. shale gas preservation conditions and pore pressure, and the research on ground stress and natural microfracture systems should be strengthened. Then, systematic analysis was conducted by integrating shale gas multidisciplinary data and geological and engineering integration study was carried out. Finally, a 3D model, which was composed of “geophysics, reservoir geology, fracture system and rock geomechanics”, was established for shale gas reservoirs. Application practice shows that the geological engineering integration and the 3D reservoir modeling are effective methods for evaluating the shale gas sweet spots in complex marine mountains in South China. Besides, based on shale gas sweet spot evaluation, 3D spatial congruency and superposition effects of multiple attributes and multiple evaluation parameters are presented. Moreover, the short-plate principle is the factor controlling the distribution patterns and evaluation results of shale gas sweet spots. It is concluded that this comprehensive evaluation method is innovative and effective in avoiding complex geological and engineering risks, so it is of guiding significance in exploration and development of marine shale gas in South China.

  15. Populations genetically rifting within a complex geological system: The case of strong structure and low genetic diversity in the migratory freshwater catfish, Bagrus docmak, in East Africa

    OpenAIRE

    Basiita, Rose Komugisha; Zenger, Kyall Richard; Jerry, Dean Robert

    2017-01-01

    Abstract The complex geological history of East Africa has been a driving factor in the rapid evolution of teleost biodiversity. While there is some understanding of how macroevolutionary drivers have shaped teleost speciation in East Africa, there is a paucity of research into how the same biogeographical factors have affected microevolutionary processes within lakes and rivers. To address this deficiency, population genetic diversity, demography, and structure were investigated in a widely ...

  16. Cooperativity of complex salt bridges

    OpenAIRE

    Gvritishvili, Anzor G.; Gribenko, Alexey V.; Makhatadze, George I.

    2008-01-01

    The energetic contribution of complex salt bridges, in which one charged residue (anchor residue) forms salt bridges with two or more residues simultaneously, has been suggested to have importance for protein stability. Detailed analysis of the net energetics of complex salt bridge formation using double- and triple-mutant cycle analysis revealed conflicting results. In two cases, it was shown that complex salt bridge formation is cooperative, i.e., the net strength of the complex salt bridge...

  17. Total Hip Arthroplasty Dislocations Are More Complex Than They Appear: A Case Report of Intraprosthetic Dislocation of an Anatomic Dual-Mobility Implant After Closed Reduction

    Science.gov (United States)

    Waddell, Bradford S.; De Martino, Ivan; Sculco, Thomas; Sculco, Peter

    2016-01-01

    Background: Total hip arthroplasty is a successful operation for the treatment of hip pain. One of the common complications of hip arthroplasty is dislocation. While reduction of standard prosthetic dislocations is highly successful, new prostheses add the potential for new complications. Case Report: We present the case of a patient who experienced intraprosthetic dislocation of an anatomic dual-mobility total hip prosthesis after a closed hip reduction and include the prereduction and postreduction radiographic findings. Conclusion: Emergency department physicians should be aware of intraprosthetic dislocation. This complication can be easily missed because the metal/ceramic femoral head appears to be reduced in the acetabulum. PMID:27303232

  18. Analyses of the response of a complex weighted network to nodes removal strategies considering links weight: The case of the Beijing urban road system

    Science.gov (United States)

    Bellingeri, Michele; Lu, Zhe-Ming; Cassi, Davide; Scotognella, Francesco

    2018-02-01

    Complex network response to node loss is a central question in different fields of science ranging from physics, sociology, biology to ecology. Previous studies considered binary networks where the weight of the links is not accounted for. However, in real-world networks the weights of connections can be widely different. Here, we analyzed the response of real-world road traffic complex network of Beijing, the most prosperous city in China. We produced nodes removal attack simulations using classic binary node features and we introduced weighted ranks for node importance. We measured the network functioning during nodes removal with three different parameters: the size of the largest connected cluster (LCC), the binary network efficiency (Bin EFF) and the weighted network efficiency (Weg EFF). We find that removing nodes according to weighted rank, i.e. considering the weight of the links as a number of taxi flows along the roads, produced in general the highest damage in the system. Our results show that: (i) in order to model Beijing road complex networks response to nodes (intersections) failure, it is necessary to consider the weight of the links; (ii) to discover the best attack strategy, it is important to use nodes rank accounting links weight.

  19. Application of molecular cytogenetic techniques to clarify apparently balanced complex chromosomal rearrangements in two patients with an abnormal phenotype: case report

    Directory of Open Access Journals (Sweden)

    Rongen Michel A

    2009-07-01

    Full Text Available Abstract Background Complex chromosomal rearrangements (CCR are rare cytogenetic findings that are difficult to karyotype by conventional cytogenetic analysis partially because of the relative low resolution of this technique. High resolution genotyping is necessary in order to identify cryptic imbalances, for instance near the multiple breakpoints, to explain the abnormal phenotype in these patients. We applied several molecular techniques to elucidate the complexity of the CCRs of two adult patients with abnormal phenotypes. Results Multicolour fluorescence in situ hybridization (M-FISH showed that in patient 1 the chromosomes 1, 10, 15 and 18 were involved in the rearrangement whereas for patient 2 the chromosomes 5, 9, 11 and 13 were involved. A 250 k Nsp1 SNP-array analysis uncovered a deletion in chromosome region 10p13 for patient 1, harbouring 17 genes, while patient 2 showed no pathogenic gains or losses. Additional FISH analysis with locus specific BAC-probes was performed, leading to the identification of cryptic interstitial structural rearrangements in both patients. Conclusion Application of M-FISH and SNP-array analysis to apparently balanced CCRs is useful to delineate the complex chromosomal rearrangement in detail. However, it does not always identify cryptic imbalances as an explanation for the abnormal phenotype in patients with a CCR.

  20. Characterizing the complexity of the fleet dynamics for an effective fisheries management: The case of the Cíes Islands (NW Spain

    Directory of Open Access Journals (Sweden)

    Rosana Ouréns

    2015-12-01

    Full Text Available We analysed the fishing fleet dynamics in the Cíes Islands, located in a National Land-Marine Park of Galicia. By interviewing fishers we identified the fleet fishing in the study area and obtained temporal data on effort and catch. Then we performed multivariate analyses of the catch profiles to identify the fishing strategies and their temporal dynamics. Our results highlight the complexity of the fishery system, composed of 565 boats that used 19 fishing gears and 33 strategies in an area of 26.6 km2. Octopus and velvet crab pots, gillnets targeting hake, trammel nets targeting European spider crab or ballan wrasse, clam rakes, and hand harvesting of gooseneck barnacles and razor shells are the strategies most used. In addition, most of the boats are generalists and use up to seven different fishing strategies throughout the year. This flexibility of the fleet to change the target species generates a wide diversity of annual fishing patterns that increases the complexity of the fisheries and the difficulty of managing them. The implementation of data collection programmes that include fleet dynamics and spatial data are key factors for developing effective management regulations consistent with the complexity of the system.