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Sample records for carney complex case

  1. Neurosurgical implications of Carney complex.

    Science.gov (United States)

    Watson, J C; Stratakis, C A; Bryant-Greenwood, P K; Koch, C A; Kirschner, L S; Nguyen, T; Carney, J A; Oldfield, E H

    2000-03-01

    The authors present their neurosurgical experience with Carney complex. Carney complex, characterized by spotty skin pigmentation, cardiac myxomas, primary pigmented nodular adrenocortical disease, pituitary tumors, and nerve sheath tumors (NSTs), is a recently described, rare, autosomal-dominant familial syndrome that is relatively unknown to neurosurgeons. Neurosurgery is required to treat pituitary adenomas and a rare NST, the psammomatous melanotic schwannoma (PMS), in patients with Carney complex. Cushing's syndrome, a common component of the complex, is caused by primary pigmented nodular adrenocortical disease and is not secondary to an adrenocorticotropic hormone-secreting pituitary adenoma. The authors reviewed 14 cases of Carney complex, five from the literature and nine from their own experience. Of the 14 pituitary adenomas recognized in association with Carney complex, 12 developed growth hormone (GH) hypersecretion (producing gigantism in two patients and acromegaly in 10), and results of immunohistochemical studies in one of the other two were positive for GH. The association of PMSs with Carney complex was established in 1990. Of the reported tumors, 28% were associated with spinal nerve sheaths. The spinal tumors occurred in adults (mean age 32 years, range 18-49 years) who presented with pain and radiculopathy. These NSTs may be malignant (10%) and, as with the cardiac myxomas, are associated with significant rates of morbidity and mortality. Because of the surgical comorbidity associated with cardiac myxoma and/or Cushing's syndrome, recognition of Carney complex has important implications for perisurgical patient management and family screening. Study of the genetics of Carney complex and of the biological abnormalities associated with the tumors may provide insight into the general pathobiological abnormalities associated with the tumors may provide insight into the general pathobiological features of pituitary adenomas and NSTs.

  2. Carney complex review: Genetic features.

    Science.gov (United States)

    Bosco Schamun, María Belén; Correa, Ricardo; Graffigna, Patricia; de Miguel, Valeria; Fainstein Day, Patricia

    2018-01-01

    Carney complex is a multiple neoplasia syndrome having endocrine and non-endocrine manifestations. Diagnostic criteria include myxoma, lentigines, and primary pigmented nodular adrenocortical disease, amongst other signs/symptoms. In most cases it is an autosomal dominant disease, and diagnosis therefore requires study and follow-up of the family members. Inactivating mutations of the PRKAR1A gene were identified as the main cause of the disease, although since 2015 other disease-related genes, including PRKACA and PRKACB activating mutations, have also been related with Carney complex. This review will address the genetic aspects related to Carney complex. Copyright © 2017 SEEN y SED. Publicado por Elsevier España, S.L.U. All rights reserved.

  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. 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.

  5. Genetics Home Reference: Carney complex

    Science.gov (United States)

    ... cortisol (hypercortisolism) can lead to the development of Cushing syndrome. This syndrome causes weight gain in the face ... Institute of Diabetes and Digestive and Kidney Diseases: Cushing's Syndrome Educational Resources (6 links) Disease InfoSearch: Carney Complex ...

  6. Primary pigmented nodular adrenocortical disease associated with Carney complex: case report and literature review

    Directory of Open Access Journals (Sweden)

    Fabrícia Torres Gonçalves

    Full Text Available CONTEXT: Carney complex (CNC, a familial multiple neoplasm syndrome with dominant autosomal transmission, is characterized by tumors of the heart, skin, endocrine and peripheral nervous system, and also cutaneous lentiginosis. This is a rare syndrome and its main endocrine manifestation, primary pigmented nodular adrenal disease (PPNAD, is an uncommon cause of adrenocorticotropic hormone-independent Cushing's syndrome. CASE REPORT: We report the case of a 20-year-old patient with a history of weight gain, hirsutism, acne, secondary amenorrhea and facial lentiginosis. Following the diagnosing of CNC and PPNAD, the patient underwent laparoscopic bilateral adrenalectomy, and she evolved with decreasing hypercortisolism. Screening was also performed for other tumors related to this syndrome. The diagnostic criteria, screening and follow-up for patients and affected family members are discussed.

  7. 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...

  8. 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....

  9. A case of Carney complex misdiagnosed as neurofibromatosis type 1 – Diagnostic difficulty in a rare disease

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    Yoshitane Tsukamoto, MD, PhD

    2017-11-01

    Full Text Available We experienced a diagnostically challenging case of Carney complex (CNC. A 24-year-old woman had a past history of surgical removal of multiple cutaneous tumors in the childhood. She was followed as a patient of neurofibromatosis type 1 (NF1 and referred to our hospital for further treatment after she grew up to adulthood. At our hospital, several cutaneous tumors were excised, and the pathological diagnosis was myxoma arising from not deep soft tissue but cutis (so-called cutaneous myxoma. Despite previous clinical diagnosis of NF1, because of the probability of CNC, detailed systemic examination was undertaken including radiological and endocrinological tests. Imaging techniques showed multiple lumps in both breasts, a mass in left atrium and nodular lesions in adrenal glands. Serum ACTH level was markedly suppressed. Surgically resected specimens revealed breast myxomas, cardiac myxoma and primary pigmented nodular adrenocortical disease (PPNAD. These findings met the diagnostic criteria for CNC. Genetic analysis revealed known non-sense mutation of PRKAR1A c.124C>T (p.R42X (ClinVar ID 41382. Her 50-year-old mother was also shown to have cardiac myxomas, radiological finding of breast myxomatosis and the same PRKAR1A mutation as her daughter. In the present case, the accurate diagnosis of CNC was difficult not only because CNC is a rare disease but also because skin pigmentation was not obvious. Since cardiac myxoma might result in poor or fatal outcome, early and accurate diagnosis of CNC and subsequent systemic investigation including heart are important. Although pediatric cutaneous myxomas are rare, multiple cutaneous myxomas might suggest the possibility of CNC. In such cases, systemic investigation should be done for the accurate diagnosis.

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

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    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. 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.

  12. 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.

  13. 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

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

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    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.

  15. 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 ...

  16. 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.

  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.

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    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. PRKAR1A-negative familial Cushing's syndrome: two case reports.

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    Lim, Lee Ling; Kitan, Normayah; Paramasivam, Sharmila Sunita; Ratnasingam, Jeyakantha; Ibrahim, Luqman; Chan, Siew Pheng; Tan, Alexander Tong Boon; Vethakkan, Shireene Ratna

    2015-12-01

    Determining the etiology of Cushing's syndrome is very challenging to endocrinologists, with most of the difficulty arising from subtype differentiation of adrenocorticotropic hormone-dependent Cushing's syndrome. We present the pitfalls of evaluating a rare cause of adrenocorticotropic hormone-independent Cushing's syndrome in the transition period between adolescence and adulthood. A sibling pair with familial isolated primary pigmented nodular adrenocortical disease is described. The index case, a 20-year-old Chinese woman, presented with premenopausal osteoporosis with T12 compression fracture and young hypertension. Biochemical analysis confirmed adrenocorticotropic hormone-independent Cushing's syndrome (elevated 0800 h plasma cortisol 808 nmol/L with suppressed adrenocorticotropic hormone level Cushing's syndrome at age 18 years, with typical cushingoid habitus, but no osteoporosis or hypertension. His adrenal computed tomographic scans showed micronodularities over bilateral adrenal glands. He was successfully treated with bilateral adrenalectomy. Screening for Carney's complex and PRKAR1A gene mutation was negative. Signs and symptoms of Cushing's syndrome resolved after bilateral adrenalectomy for both patients. They were placed on lifelong glucocorticoid and mineralocorticoid replacement therapy and long-term surveillance for Carney's complex. The cases of these two patients illustrate the difficulties involved in diagnosing primary pigmented nodular adrenocortical disease, a variant of adrenocorticotropic hormone-independent Cushing's syndrome that is managed with bilateral adrenalectomy. A high index of suspicion for this disease is needed, especially in adolescents with adrenocorticotropic hormone-independent Cushing's syndrome who have a significant family history, features of Carney's complex, and no resolution of Cushing's syndrome after unilateral adrenalectomy. Patients with primary pigmented nodular adrenocortical disease can either have

  19. Infected Complex Odontoma: A Case Report

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    Shanthala Damodar

    2015-06-01

    Full Text Available Odontoma represent a hamartomatous malformation. They are usually asymptomatic and are diagnosed on routine radiological examination. Infection of an odontome is very uncommon. Few cases of infected odontoma are reported in the literature. We report a special case of infected complex odontoma and perforation of the cheeks with a tooth impacted upon along with computed tomographic (CT image. Thus, making the present case unusual. [Cukurova Med J 2015; 40(2.000: 379-383

  20. Unplanned complex suicide: Two case reports

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    Nikolić Slobodan

    2010-01-01

    Full Text Available Introduction The term complex suicide refers to suicides in which multiple suicidal methods are utilized, as opposed to simple suicide successfully done after one attempt. In planned complex suicides two or more methods are employed simultaneously in order to make sure that death will occur after failure of previous attempt. In unplanned complex suicides, several other methods of suicide tried after the first chosen method either failed or was too painful. Outline of Cases We report two cases of unplanned complex suicides. The first case was a female who first tried to commit suicide by cutting the wrists, and then hanged herself. In the other case, a male first tried to commit suicide by stubbing his chest with a knife, and then jumped into a well and drowned himself. In both reported cases the second, successful suicidal method was of higher lethality score. Conclusion From the forensic point of view, the presence of several injuries of different origin strongly suggests infliction by other person. The event could be reconstructed, based on autopsy findings and traces found at the scene. .

  1. Tuberous sclerosis complex: A case report

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    Soumyabrata Sarkar

    2016-01-01

    Full Text Available Tuberous sclerosis complex is an unusual autosomal dominant neurocutaneous syndrome characterized by the development of benign tumors affecting different body systems affecting the brain, skin, retina, and viscera. It is characterized by cutaneous changes, neurologic conditions, and the formation of hamartomas in multiple organs leading to morbidity and mortality. The most common oral manifestations are fibromas, gingival hyperplasia, and enamel hypoplasia. The management of these patients is often multidisciplinary involving specialists from various fields. Here, we present a case report of a 26-old-year male patient with characteristic clinical, radiological, and histological features of tuberous sclerosis complex.

  2. Fourth branchial complex anomalies: a case series.

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    Shrime, Mark; Kacker, Ashutosh; Bent, John; Ward, Robert F

    2003-11-01

    Anomalies of the fourth branchial arch complex are exceedingly rare, with approximately forty cases reported in the literature since 1972. The authors report experience with six fourth arch anomalies. Retrospective chart review of six consecutive patients presenting to the pediatric otolaryngology service at a tertiary care center with anomalies referable to the fourth branchial arch. All six patients presented within the first or second decade of life. All six had left-sided disease. Four patients presented with recurrent neck infection, one with asymptomatic cervical masses, and one with a neck mass and respiratory compromise. One patient had prior surgery presented with a recurrence. Diagnosis of fourth arch anomalies was suggested or confirmed by computed tomography and flexible laryngoscopy. Treatment was surgical in five patients; one patient is awaiting surgery. Surgical procedures included resection of the mass and endoscopic cauterization of the inner opening of the cyst. The presentation of a cervical mass, especially with recurrent infections and especially on the left side, in a child in the first or second decade of life heightens suspicion for an anomaly of the fourth branchial arch. Diagnosis can be difficult, but is aided by the use of flexible laryngoscopy, Computed tomography (CT) scanning and ultrasonography. Surgical resection of the cyst and cauterization of its pyriform sinus opening should be undertaken to minimize recurrence.

  3. The worst case complexity of maximum parsimony.

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    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.

  4. 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.

  5. First branchial complex anomalies: report of 3 cases

    International Nuclear Information System (INIS)

    Goten, A. van der; Hermans, R.; Hover, P. van; Crevits, I.; Baert, A.L.

    1997-01-01

    Three cases of first branchial cleft anomalies are presented. The embryology and pathology of first branchial complex anomalies, their imaging characteristics and differential diagnosis are discussed. (orig.). With 3 figs

  6. First branchial complex anomalies: report of 3 cases

    Energy Technology Data Exchange (ETDEWEB)

    Goten, A. van der [Department of Radiology, University Hospitals, Catholic University of Leuven, Leuven (Belgium); Hermans, R. [Department of Radiology, University Hospitals, Catholic University of Leuven, Leuven (Belgium); Hover, P. van [Department of Radiology, University Hospitals, Catholic University of Leuven, Leuven (Belgium); Crevits, I. [Department of Radiology, University Hospitals, Catholic University of Leuven, Leuven (Belgium); Baert, A.L. [Department of Radiology, University Hospitals, Catholic University of Leuven, Leuven (Belgium)

    1997-02-01

    Three cases of first branchial cleft anomalies are presented. The embryology and pathology of first branchial complex anomalies, their imaging characteristics and differential diagnosis are discussed. (orig.). With 3 figs.

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

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    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.

  8. Complex arteriovenous malformation - a case report

    International Nuclear Information System (INIS)

    Sirakov, S.; Penkov, M.; Marinov, M.; Kamenov, B.

    2014-01-01

    AVMs are composed of a network of channels interposed between feeding arteries and draining veins, without any direct shunt. Two different anatomic types of nidus may be more or less differentiated: The most frequent clinical presentations of brain AVMs are hemorrhage, seizure, chronic headache, and focal deficits not related to hemorrhage. We show a case of 27 years old female came to the hospital in heavy condition with subarachnoid hemorrhage Fisher 4. She had a history of 4 surgical operation of brain AVM in the last 10 years, without significant reduction of the malformation. After discussion of multidisciplinary team, of neuroradiologist and neurosurgeon was decided to be perform endovascular embolization, because of the better outcome for the patient. We performed endovascular treatment of the AVM with achieving subtotal embolization of malformation (90%). The patient recovery completely after 22 days and went home. For the next 18 months follow up there is no data of accidents for the patient. Key words: Arteriovenous Malformation. Subarachnoid hemorrhage. Endovascular treatment. Embolization

  9. Erupting complex odontoma: Report of a rare case

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    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.

  10. Case Mix Complexity Differences between Teaching and Nonteaching Hospitals.

    Science.gov (United States)

    Ament, Richard P.; And Others

    1981-01-01

    The differences between teaching and nonteaching hospitals in complexity and variety of cases seen are described. The results show that teaching hospitals could be expected to cost somewhat more per patient even if case mix were the only factor. (Author/MLW)

  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. Clinical decision-making by midwives: managing case complexity.

    Science.gov (United States)

    Cioffi, J; Markham, R

    1997-02-01

    In making clinical judgements, it is argued that midwives use 'shortcuts' or heuristics based on estimated probabilities to simplify the decision-making task. Midwives (n = 30) were given simulated patient assessment situations of high and low complexity and were required to think aloud. Analysis of verbal protocols showed that subjective probability judgements (heuristics) were used more frequently in the high than low complexity case and predominated in the last quarter of the assessment period for the high complexity case. 'Representativeness' was identified more frequently in the high than in the low case, but was the dominant heuristic in both. Reports completed after each simulation suggest that heuristics based on memory for particular conditions affect decisions. It is concluded that midwives use heuristics, derived mainly from their clinical experiences, in an attempt to save cognitive effort and to facilitate reasonably accurate decisions in the decision-making process.

  13. 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.

  14. Complexities and dilemmas in the sharing economy : the Uber case

    NARCIS (Netherlands)

    Boshuijzen van Burken, C.; Haftor, D.M.

    2017-01-01

    By taking Uber as a case, we take a practice focus, in-depth analysis of the sharing economy. The business model that is typical for the sharing economy is based on using underutilized goods by private persons through digital technologies. In this paper, we bring together the complex reality of the

  15. Severe calcified stylohyoid complex in twins: a case report

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Jo Eun; Min, Jung Hyun; Park, Hae Rang; Choi, Bo Ram; Huh, Kyung Hoe [School of Dentistry, Seoul National University, Seoul (Korea, Republic of); Choi, Jin Woo [Dankook University College of Dentistry, Cheonan (Korea, Republic of)

    2012-06-15

    The styloid process is a cylindrical, long cartilaginous bone located on the temporal bone. The calcified stylohyoid ligament and elongated styloid process can be identified radiographically, and they are associated with a number of syndromes and symptoms. The exact cause of the styloid process elongation due to calcification and subsequent ossification of ligament is unclear. This report presents a case of severely calcified stylohyoid ligament complex occurred in twins who have the same pattern of calcification.

  16. Procuring complex performance:case: public infrastructure projects

    OpenAIRE

    Leppänen, T. (Tero)

    2015-01-01

    Abstract This research studies procuring complex performance (PCP) in the case of public infrastructure projects. Focus of the research is on the interface between public clients and private sector contractors. Purpose of this research is to find out what are the main challenges of different project delivery methods according to literature (RQ1) and what are the practical challenges of public procurement (RQ2). As an end re...

  17. 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.

  18. Superior shoulder suspensory complex fracture dislocation case report

    International Nuclear Information System (INIS)

    Lidgett, T.; Bate, E.; Pittock, L.

    2017-01-01

    Background: Acromioclavicular joint dislocation can be more complex than it first appears. The presented case had an unusual combination of injuries to the superior shoulder suspensory complex, which yielded some interesting learning points. Case summary: The injuries were sustained after a fall from a push bike and included acromioclavicular dislocation with coracoid process, clavicle and acromion process fractures. These were identified on the initial X-ray examination, which was followed by computed tomography for surgical planning. The injuries were successfully treated by internal fixation. Conclusion: The unexpected complexity of the injuries could have led to subtle but important findings being overlooked. This case highlights the importance of a thorough search strategy, consideration of injury biomechanics and knowledge of associated injuries. - Highlights: • Search for associated fractures in acromioclavicular joint dislocation. • Assess the clavicle, acromion process and coracoid process in particular. • Do not end the shoulder X-ray examination after seeing one injury. • Both axial and cranially angulated anteroposterior projections are beneficial. • Acromioclavicular joint fracture dislocation treatment may require further research.

  19. 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.

  20. 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.

  1. 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.

  2. Safety of gentamicin bladder irrigations in complex urological cases.

    Science.gov (United States)

    Defoor, William; Ferguson, Denise; Mashni, Susan; Creelman, Lisa; Reeves, Deborah; Minevich, Eugene; Reddy, Pramod; Sheldon, Curtis

    2006-05-01

    Recurrent urinary tract infections are common in complex pediatric urological cases, particularly those requiring clean intermittent catheterization. At our institution gentamicin bladder irrigations have been used for antimicrobial prophylaxis and to treat symptomatic bacteriuria, particularly when the infection does not involve the upper urinary tract. The purpose of this study was to assess the safety of this therapy. A retrospective study was performed of all children treated with gentamicin bladder irrigations from 1999 to 2004. The dose was 14 mg gentamicin in 30 ml saline instilled via catheter once or twice daily. Serum creatinine and random gentamicin levels were obtained according to a protocol based on risk of gentamicin toxicity. Patient demographics, laboratory results and outcomes were abstracted from the medical records. A total of 80 patients (38 males and 42 females) were identified. Median patient age was 10 years and median duration of treatment was 90 days. No patient had detectable serum gentamicin levels greater than 0.4 mg/dl. Small increases in serum creatinine were seen in 3 patients, all of whom had chronic renal insufficiency. A total of 21 patients (26%) had breakthrough UTIs, of which 5 (24%) were gentamicin resistant. No adverse events were documented. Gentamicin bladder irrigations are a helpful adjunct in the management of complex pediatric urological cases involving recurrent symptomatic bacteriuria. We no longer require intensive laboratory monitoring of low risk patients at our institution.

  3. [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.

  4. 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.

  5. 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.

  6. 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.

  7. 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.

  8. 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,…

  9. 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...

  10. [A complex case of diabetes due to LMNA mutation].

    Science.gov (United States)

    Ambonville, C; Bouldouyre, M-A; Laforêt, P; Richard, P; Benveniste, O; Vigouroux, C

    2017-10-01

    Laminopathies (diseases related to A/C mutations of lamines) are rare genetic diseases with an extensive phenotypic spectrum, including lipodystrophic syndromes-characterized by a selective loss of adipose tissue-of which the partial Dunnigan family type is the most frequent. We report on a 55-year-old woman with diabetes and long-term disabling myalgia. Her cushingoid morphotype, associated with cutaneous lipo-atrophy and muscle hypertrophy in addition to a genetic heritage, led us to the diagnosis of complex partial familial lipodystrophy heterozygous LMNA_c.82C>T, p.Arg28Trp mutation. Familial partial lipodystrophic syndromes may have varied phenotypes, mainly cardio-metabolic, which could mimic a particularly severe type 2 diabetes. The diagnostic work-up of this disease has to include a careful investigation of gait troubles and paroxysmal conduction that could lead to sudden death, as well as a genetic examination. In some cases, recombinant leptin can be proposed. Copyright © 2017 Société Nationale Française de Médecine Interne (SNFMI). Published by Elsevier SAS. All rights reserved.

  11. 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)

  12. Measuring case-mix complexity of tertiary care hospitals using DRGs.

    Science.gov (United States)

    Park, Hayoung; Shin, Youngsoo

    2004-02-01

    The objectives of the study were to develop a model that measures and evaluates case-mix complexity of tertiary care hospitals, and to examine the characteristics of such a model. Physician panels defined three classes of case complexity and assigned disease categories represented by Adjacent Diagnosis Related Groups (ADRGs) to one of three case complexity classes. Three types of scores, indicating proportions of inpatients in each case complexity class standardized by the proportions at the national level, were defined to measure the case-mix complexity of a hospital. Discharge information for about 10% of inpatient episodes at 85 hospitals with bed size larger than 400 and their input structure and research and education activity were used to evaluate the case-mix complexity model. Results show its power to predict hospitals with the expected functions of tertiary care hospitals, i.e. resource intensive care, expensive input structure, and high levels of research and education activities.

  13. Cultural complexity and demography: the case of folktales

    NARCIS (Netherlands)

    Acerbi, A.; Kendal, J.; Tehrani, J.

    2017-01-01

    We investigate the relationship between cultural complexity and population size in a non-technological cultural domain for which we have suitable quantitative records: folktales. We define three levels of complexity for folk narratives: the number of tale types, the number of narrative motifs, and,

  14. 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.

  15. Complex phonic tic and disinhibition in Tourette syndrome: case report

    Directory of Open Access Journals (Sweden)

    Maia Débora Palmini

    2001-01-01

    Full Text Available Tourette syndrome (TS is a neuropsychiatric disorder characterized by a combination of multiple motor tics and at least one phonic tic. TS patients often have associated behavioral abnormalities such as obsessive compulsive disorder, attention deficit and hyperactive disorder. Coprolalia, defined as emission of obscenities or swearing, is one type of complex vocal tic, present in 8% to 26% of patients. The pathophysiology of coprolalia and other complex phonic tics remains ill-defined. We report a patient whose complex phonic tic was characterized by repetitively saying "breast cancer" on seeing the son of aunt who suffered from this condition. The patient was unable to suppress the tic and did not meet criteria for obsessive compulsive disorder. The phenomenology herein described supports the theory that complex phonic tics result from disinhibition of the loop connecting the basal ganglia with the limbic cortex.

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

    DEFF Research Database (Denmark)

    Myrodia, Anna

    of products, with features more custom-made to cover individual needs, both regarding characteristics of products and support services. This necessity leads to a considerable increase of the complexity in the company, which affects the product portfolio, production and supply chain, market segments......, IT systems, and business processes. In order to identify and eliminate complexity, several approaches are used, both by researchers and practitioners. The purpose of this thesis is to contribute to the existing knowledge of complexity management theory. This research focuses on the relationship between......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...

  17. [Patient-related complexity in nursing care - Collective case studies in the acute care hospital].

    Science.gov (United States)

    Gurtner, Caroline; Spirig, Rebecca; Staudacher, Diana; Huber, Evelyn

    2018-06-04

    Patient-related complexity in nursing care - Collective case studies in the acute care hospital Abstract. Patient-related complexity of nursing is defined by the three characteristics "instability", "uncertainty", and "variability". Complexity increased in the past years, due to reduced hospital length of stay and a growing number of patients with chronic and multiple diseases. We investigated the phenomenon of patient-related complexity from the point of view of nurses and clinical nurse specialists in an acute care hospital. In the context of a collective case study design, nurses and clinical nurse specialists assessed the complexity of nursing situations with a questionnaire. Subsequently, we interviewed nurses and clinical nurse specialists about their evaluation of patient-related complexity. In a within-case-analysis we summarized data inductively to create case narratives. By means of a cross-case-analysis we compared the cases with regard to deductively derived characteristics. The four cases exemplarily showed that the degree of complexity depends on the controllability and predictability of clinical problems. Additionally, complexity increases or decreases, according to patients' individual resources. Complex patient situations demand professional expertise, experience, communicative competencies and the ability for reflection. Beginner nurses would benefit from support and advice by experienced nurses to develop these skills.

  18. Noise problems in coal mining complex- a case discussion

    International Nuclear Information System (INIS)

    Mishra, Y.; Mitra, H.; Ghosh, S.; Pal, A.K.

    1996-01-01

    Noise monitoring study was conducted at Moonidih mining complex of Jharia coal-field. The study included monitoring and analysis of ambient as well as workplace noise levels. An attempt has been made to critically analyse the noise situation through octave band analysis, thereby identifying alarming noise frequencies for each noise generating equipment having Leq level more than 90 dBA. A noise model has also been developed to draw noise contours of the entire mining complex. Based on these studies, suitable control measures have been suggested. (author). 6 refs., 3 figs

  19. Modeling geophysical complexity: a case for geometric determinism

    Directory of Open Access Journals (Sweden)

    C. E. Puente

    2007-01-01

    Full Text Available It has been customary in the last few decades to employ stochastic models to represent complex data sets encountered in geophysics, particularly in hydrology. This article reviews a deterministic geometric procedure to data modeling, one that represents whole data sets as derived distributions of simple multifractal measures via fractal functions. It is shown how such a procedure may lead to faithful holistic representations of existing geophysical data sets that, while complementing existing representations via stochastic methods, may also provide a compact language for geophysical complexity. The implications of these ideas, both scientific and philosophical, are stressed.

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

    African Journals Online (AJOL)

    2015-02-26

    Feb 26, 2015 ... 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 ... listed by the World Health Organization in 1992.

  1. 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, ...

  2. Design scenarios for renovation of sports complex: a case study

    Science.gov (United States)

    Nižetić, S.

    2018-02-01

    This paper elaborates design scenarios for a sports complex in Croatia from a technical and economic aspect. Different energy options are analysed and two are additionally addressed and discussed as the most viable ones. The possibilities of sports complex renovation are shown by properly choosing the appropriate energy concept and thus reducing the overall cost for produced thermal energy by around 33% and reducing the carbon dioxide emission by a factor of 1.8 in comparison with its present state. Finally, this study presents an example of good practice, where renewable energy solutions can be proposed and where it is possible to cover around 70-80% of overall yearly costs from achieved energy savings for the novel plant that is assumed to be financed through a bank loan.

  3. 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.

  4. Integrating technology into complex intervention trial processes: a case study.

    Science.gov (United States)

    Drew, Cheney J G; Poile, Vincent; Trubey, Rob; Watson, Gareth; Kelson, Mark; Townson, Julia; Rosser, Anne; Hood, Kerenza; Quinn, Lori; Busse, Monica

    2016-11-17

    Trials of complex interventions are associated with high costs and burdens in terms of paperwork, management, data collection, validation, and intervention fidelity assessment occurring across multiple sites. Traditional data collection methods rely on paper-based forms, where processing can be time-consuming and error rates high. Electronic source data collection can potentially address many of these inefficiencies, but has not routinely been used in complex intervention trials. Here we present the use of an on-line system for managing all aspects of data handling and for the monitoring of trial processes in a multicentre trial of a complex intervention. We custom built a web-accessible software application for the delivery of ENGAGE-HD, a multicentre trial of a complex physical therapy intervention. The software incorporated functionality for participant randomisation, data collection and assessment of intervention fidelity. It was accessible to multiple users with differing levels of access depending on required usage or to maintain blinding. Each site was supplied with a 4G-enabled iPad for accessing the system. The impact of this system was quantified through review of data quality and collation of feedback from site coordinators and assessors through structured process interviews. The custom-built system was an efficient tool for collecting data and managing trial processes. Although the set-up time required was significant, using the system resulted in an overall data completion rate of 98.5% with a data query rate of 0.1%, the majority of which were resolved in under a week. Feedback from research staff indicated that the system was highly acceptable for use in a research environment. This was a reflection of the portability and accessibility of the system when using the iPad and its usefulness in aiding accurate data collection, intervention fidelity and general administration. A combination of commercially available hardware and a bespoke online database

  5. Tuberous schlerosis complex and astrocytoma: a case report, Hiroshima

    Energy Technology Data Exchange (ETDEWEB)

    Rudnick, P A; Hoshino, N; Kitaoka, T; Miura, M

    1961-02-10

    This case report concerned a young woman with cutaneous, osseous, and retinal changes of tuberous sclerosis, referred to ABCC for evaluation of blindness and increased intracranial pressure. A right lateral ventricle astrocytoma was successfully removed, but the patient's sight was not restored. The development of cerebral neoplasms in these patients is discussed. A careful search for resectable brain lesions should be made in all patients with tuberous sclerosis who have signs and symptoms of increased intracranial pressure. 14 references, 6 figures.

  6. Media framing of complex issues: The case of endangered languages.

    Science.gov (United States)

    Rivenburgh, Nancy K

    2013-08-01

    This study investigates how media frame a global trend that is complex in nature, emergent in terms of scientific understanding, and has public policy implications: the rapid disappearance of languages. It analyzes how English-language media from 15 western, industrialized countries frame the causes and implications of endangered languages over 35 years (1971-2006) - a time period notable for growing, interdisciplinary concerns over the potential negative impacts of losing the world's linguistic diversity. The results reveal a media discourse characterized by three complementary frames that are sympathetic to the plight of endangered languages, but that present the problem, its cause, and societal implications in a logical structure that would promote public complacency.

  7. Pulmonary choriostoma in a case of tuberous sclerosis complex

    Directory of Open Access Journals (Sweden)

    S Spalgais

    2015-01-01

    Full Text Available A 52 years old lady was diagnosed to have Tuberous Sclerosis Complex (TSC on the basis of 2 major and one minor criterion. She had family history of similar complaints in her sister and two sons. There was involvement of kidney in the form of angiomyolipoma, skin in the form of facial angiofibroma and teeth with a dental pit. She had an unusual lung involvement in the form of multiple small choristomas. Choristoma was diagnosed on transbronchial lung biopsy and was present in the form of disorganised striated muscles. The reported pulmonary manifestations of TCS i.e. lymphangioleiomyomatosis (LAM and multifocal micronodular pneumocyte hyperplasia (MMPH are types of hamartomas. Hamartomas and choristomas are both types of disorganized tissue. ′Choristoma′of lung in TSC however is not reported. Clinopathological correlation of pulmonary hamartoma and choristoma, and treatment in TSC has been discussed.

  8. Tuberous schlerosis complex and astrocytoma: a case report, Hiroshima

    Energy Technology Data Exchange (ETDEWEB)

    Rudnick, P.A.; Hoshino, N.; Kitaoka, T.; Miura, M.

    1961-02-10

    This case report concerned a young woman with cutaneous, osseous, and retinal changes of tuberous sclerosis, referred to ABCC for evaluation of blindness and increased intracranial pressure. A right lateral ventricle astrocytoma was successfully removed, but the patient's sight was not restored. The development of cerebral neoplasms in these patients is discussed. A careful search for resectable brain lesions should be made in all patients with tuberous sclerosis who have signs and symptoms of increased intracranial pressure. 14 references, 6 figures.

  9. Assessing health care needs and clinical outcome with Urological case complexity : A study using INTERMED

    NARCIS (Netherlands)

    Herms, AMRD; Pinggera, GM; De Jonge, P; Strasser, H; Sollner, W

    2003-01-01

    Urinary tract symptoms and, particularly, urinary incontinence are often chronic and complex conditions that cause diagnosis, treatment, and management problems. In many cases, psychosocial factors contribute to the development of a chronic condition. The authors investigated whether INTERMED, an

  10. 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

  11. 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.

  12. [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.

  13. 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.

  14. Large Complex Odontoma of Mandible in a Young Boy: A Rare and Unusual Case Report

    Directory of Open Access Journals (Sweden)

    G. Siva Prasad Reddy

    2014-01-01

    Full Text Available Odontomas are the most common odontogenic tumors. They are broadly classified in to Compound Odontoma and Complex Odontoma. Among them complex odontoma is a rare tumor. Occasionally this tumor becomes large, causing expansion of bone followed by facial asymmetry. Otherwise these tumors are asymptomatic and are generally diagnosed on radiographic examination. We report a rare case of complex odontoma of mandible in a young boy. The tumor was treated by surgical excision under general anesthesia.

  15. Basal cell carcinoma of the nipple-areola complex: a case report.

    Science.gov (United States)

    Huang, Ching-Wen; Pan, Ching-Kuen; Shih, Teng-Fu; Tsai, Cheng-Chien; Juan, Chung-Chou; Ker, Chen-Guo

    2005-10-01

    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.

  16. 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.

  17. Ultrasonographic diagnosis of limb-body wall complex: a case report

    Energy Technology Data Exchange (ETDEWEB)

    Goo, Dong Erk; Yoo, Shi Joon; Cho, Kyoung Sik; Choi, Kee Young; Kim, Am [University of Ulsan College of Medicine, Asan Medical Center, Ulsan (Korea, Republic of)

    1993-12-15

    Limb-body wall complex (LBWC) is a rare congenital process believed to result from early rupture of the amnion, possibly as a consequence of vascular disruption. Characteristic fetal deformities include limb defects, scoliosis, thoracoschisis and/or abdominoschisis, and severe craniofacial anomalies. This complex should be distinguished from other body-wall defect including omphalocele and gastroschisis since the prognosis of LBWC is uniformly poor. We report a case of LBWC which was diagnosed by prenatal ultrasonography in 26 weeks of gestation. Prenatal ultrasonograms are correlated with the gross pathologic findings. The present case demonstrates the superb capability of modern ultrasonography in the diagnosis of complex fetal anomalies

  18. Ultrasonographic diagnosis of limb-body wall complex: a case report

    International Nuclear Information System (INIS)

    Goo, Dong Erk; Yoo, Shi Joon; Cho, Kyoung Sik; Choi, Kee Young; Kim, Am

    1993-01-01

    Limb-body wall complex (LBWC) is a rare congenital process believed to result from early rupture of the amnion, possibly as a consequence of vascular disruption. Characteristic fetal deformities include limb defects, scoliosis, thoracoschisis and/or abdominoschisis, and severe craniofacial anomalies. This complex should be distinguished from other body-wall defect including omphalocele and gastroschisis since the prognosis of LBWC is uniformly poor. We report a case of LBWC which was diagnosed by prenatal ultrasonography in 26 weeks of gestation. Prenatal ultrasonograms are correlated with the gross pathologic findings. The present case demonstrates the superb capability of modern ultrasonography in the diagnosis of complex fetal anomalies

  19. Pigmented Epithelioid Melanocytoma (PEM)/Animal Type Melanoma (ATM): Quest for an Origin. Report of One Unusual Case Indicating Follicular Origin and Another Arising in an Intradermal Nevus.

    Science.gov (United States)

    Tarasen, Ashley; Carlson, J Andrew; Leonard, M Kathryn; Merlino, Glenn; Kaetzel, David; Slominski, Andrzej T

    2017-08-15

    Pigmented epithelioid melanocytoma (PEM) is a tumor encompassing epithelioid blue nevus of Carney complex (EBN of CNC) and was previously termed animal-type melanoma. Histologically PEMs are heavily pigmented spindled and epithelioid dermal melanocytic tumors with infiltrative borders, however, their origin remains unclear. Stem cells for the epidermis and hair follicle are located in the bulge area of the hair follicle with the potential to differentiate into multiple lineages. Multiple cutaneous carcinomas, including follicular cutaneous squamous cell carcinoma (FSCC), are thought to arise from stem cells in the follicular bulge. We present two cases of PEM/ATM in a 63 year-old male on the scalp with follicular origin and a 72 year-old female on the upper back arising in an intradermal nevus. Biopsy of both cases revealed a proliferation of heavily pigmented dermal nests of melanocytes with atypia. The Case 1 tumor was in continuation with the outer root sheath of the hair follicle in the bulge region. Case 2 arose in an intradermal melanocytic nevus. Rare mitotic figures, including atypical mitotic figures, were identified in both cases. We present two cases of PEM, with histologic evidence suggesting two origins: one from the follicular bulb and one from an intradermal nevus.

  20. 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…

  1. Presence of voltage-gated potassium channel complex antibody in a case of genetic prion disease.

    Science.gov (United States)

    Jammoul, Adham; Lederman, Richard J; Tavee, Jinny; Li, Yuebing

    2014-06-05

    Voltage-gated potassium channel (VGKC) complex antibody-mediated encephalitis is a recently recognised entity which has been reported to mimic the clinical presentation of Creutzfeldt-Jakob disease (CJD). Testing for the presence of this neuronal surface autoantibody in patients presenting with subacute encephalopathy is therefore crucial as it may both revoke the bleak diagnosis of prion disease and allow institution of potentially life-saving immunotherapy. Tempering this optimistic view is the rare instance when a positive VGKC complex antibody titre occurs in a definite case of prion disease. We present a pathologically and genetically confirmed case of CJD with elevated serum VGKC complex antibody titres. This case highlights the importance of interpreting the result of a positive VGKC complex antibody with caution and in the context of the overall clinical manifestation. 2014 BMJ Publishing Group Ltd.

  2. 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.

  3. 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....

  4. [A reflective case report applied to pain management in a complex care situation].

    Science.gov (United States)

    Kinsperger, Laura; Mayrhofer, Stefanie Maria; Pichler, Birgit; Qin, Hong; Rheinfrank, Iris; Schrems, Berta

    2015-10-01

    This case report deals with the unsatisfying pain management of a 44 year old patient with cardiac arrest and subsequent cardiopulmonary resuscitation. The patient has (1) a reduced consciousness, (2) is isolated due to an infection with multi-resistant germs, (3) has a tracheotomy and (4) contractures of the muscles in fingers and hands. During nursing care he shows facial expressions and body postures that indicate pain which is insufficiently addressed. The case was processed according to the model of reflexive case report by Johns (1995) and interpreted by theoretical expertise and the change of the perspective. Therefore the following questions were answered: Which factors made the nurse who brought the case to the case deliberation feeling dissatisfied with the pain management? Insufficient pain management due to a lack of knowledge, no assessment of the state of consciousness, pain and isolation probably led to unnecessary burden of the patient, next of kin and nurses. Training, systematic pain management and multi-disciplinary case conferences might facilitate dealing with comparable complex situations of caring in the future. The present case report shows that pain can only be treated successfully if pain-triggering factors are recognized, systematically assessed and treated. An adequate external assessment of the pain situation is especially important when dealing with patients who suffer from disorders of consciousness. In complex cases, in which multiple factors influence the pain situation, interdisciplinary case conferences may help to improve the quality of pain management.

  5. 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…

  6. Embodying complexity through movement sonification : case study on empowering the speed-skater

    NARCIS (Netherlands)

    Stienstra, J.T.; Overbeeke, C.J.; Wensveen, S.A.G.

    2011-01-01

    In this paper, we describe the Augmented Speed-skate Experience (ASE), a case of movement sonification in professional speed-skating. We designed and developed a system that provides feedback on technique to a professional speed-skater through an extra sense-modality, i.e. sound. Complexity is

  7. How Well Do Student Nurses Write Case Studies? A Cohesion-Centered Textual Complexity Analysis

    NARCIS (Netherlands)

    Dascalu, Mihai; Dessus, Philippe; Thuez, Laurent; Trausan-Matu, Stefan

    2017-01-01

    Starting from the presumption that writing style is proven to be a reliable predictor of comprehension, this paper investigates the extent to which textual complexity features of nurse students’ essays are related to the scores they were given. Thus, forty essays about case studies on infectious

  8. 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

  9. The Influence of Time Pressure and Case Complexity on Physicians׳ Diagnostic Performance

    Directory of Open Access Journals (Sweden)

    Dalal A. ALQahtani

    2016-12-01

    Conclusions: Time pressure did not impact the diagnostic performance, whereas the complexity of the clinical case negatively influenced the diagnostic accuracy. Further studies with the enhanced experimental manipulation of time pressure are needed to reveal the effect of time pressure, if any, on a physician׳s diagnostic performance.

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

    Directory of Open Access Journals (Sweden)

    Yeliz Guven

    2015-01-01

    Full Text Available 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.

  11. Primary pigmented nodular adrenocortical disease presenting with a unilateral adrenocortical nodule treated with bilateral laparoscopic adrenalectomy: a case report

    Directory of Open Access Journals (Sweden)

    Kaltsas Gregory

    2010-07-01

    Full Text Available Abstract Introduction Primary pigmented nodular adrenocortical disease is a rare cause of adrenocorticotropic hormone-independent Cushing's syndrome. We report an uncommon primary pigmented nodular adrenocortical disease case presenting with a unilateral adrenocortical nodule and provide a brief overview of the existing literature. Case presentation A 27-year-old Caucasian woman was admitted to our Department with adrenocorticotropic hormone-independent Cushing's syndrome. Its cause was initially considered a left adrenocortical adenoma based on computer tomography imaging. The patient underwent left laparoscopic adrenalectomy and histological examination revealed pigmented micronodular adrenal hyperplasia. Evaluation for the presence of Carney complex was negative. Six months later recurrence of hypercortisolism was documented and a right laparoscopic adrenalectomy was performed further establishing the diagnosis of primary pigmented nodular adrenocortical disease. After a nine-year follow-up there is no evidence of residual disease. Conclusions Even though primary pigmented nodular adrenocortical disease is a rare cause of Cushing's syndrome, it should be included in the differential diagnosis of adrenocorticotropic hormone-independent Cushing's syndrome, especially because adrenal imaging can be misleading mimicking other adrenocortical diseases. Bilateral laparoscopic adrenalectomy is the preferred treatment in these subjects.

  12. 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.

  13. Perioprosthetic and Implant-Supported Rehabilitation of Complex Cases: Clinical Management and Timing Strategy.

    Science.gov (United States)

    Landi, Luca; Piccinelli, Stefano; Raia, Roberto; Marinotti, Fabio; Manicone, Paolo Francesco

    2016-01-01

    Treatment of complex perioprosthetic cases is one of the clinical challenges of everyday practice. Only a complete and thorough diagnostic setup may allow the clinician to formulate a realistic prognosis to select the abutments to support prosthetic rehabilitation. Clinical, radiographic, or laboratory parameters used separately are useless to correctly assign a reliable prognosis to single teeth except in the case of a clearly hopeless tooth. Therefore, it is crucial to gather the greatest quantity of data to determine the role that every single element can play in the prosthetic rehabilitation of the case. The following report deals with the management of a multidisciplinary periodontally compromised case in which a treatment strategy and chronology were designed to reach clinical predictability while reducing the duration of the therapy.

  14. Perioprosthetic and Implant-Supported Rehabilitation of Complex Cases: Clinical Management and Timing Strategy

    Directory of Open Access Journals (Sweden)

    Luca Landi

    2016-01-01

    Full Text Available Treatment of complex perioprosthetic cases is one of the clinical challenges of everyday practice. Only a complete and thorough diagnostic setup may allow the clinician to formulate a realistic prognosis to select the abutments to support prosthetic rehabilitation. Clinical, radiographic, or laboratory parameters used separately are useless to correctly assign a reliable prognosis to single teeth except in the case of a clearly hopeless tooth. Therefore, it is crucial to gather the greatest quantity of data to determine the role that every single element can play in the prosthetic rehabilitation of the case. The following report deals with the management of a multidisciplinary periodontally compromised case in which a treatment strategy and chronology were designed to reach clinical predictability while reducing the duration of the therapy.

  15. [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.

  16. 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.

  17. 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.

  18. 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.

  19. APPLICATION OF AUGMENTED AND VIRTUAL REALITY IN RESIDENTIAL COMPLEX PRESENTATION, CASE STUDY: ENERGOPROJEKT SUNNYVILLE

    Directory of Open Access Journals (Sweden)

    PEJIC Petar

    2017-05-01

    Full Text Available The traditional method of residential complex project presentations involves the use of a printed poster or elaborate on which the building is presented by using of two-dimensional drawings and images. The main traditional approach problem is the presentation of three-dimensional space on two-dimensional paper. The main focus of this paper is the development of contemporary, mobile systems for residential complex presentations which will be presented on a case study of “Energoprojekt Sunnyville” using a method of virtual and augmented reality. This approach enables easier and better understanding of all types of architectural objects and urban complex, allowing the user intuitive spatial overview of architectural work.

  20. 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

  1. 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.

  2. [Arterial hypertension and RU-486: a complex case of secondary hypertension].

    Science.gov (United States)

    Leone, Alessandra; Pisaneschi, Silvia; Montereggi, Francesco; Canu, Letizia; Corsini, Elisa; Mannelli, Massimo; Montereggi, Alessio

    2013-06-01

    Secondary hypertension accounts for 10-15% of all cases of hypertension, and early diagnosis with identification of its etiology can be challenging. In this scenario, therapeutic management of affected patients may be difficult. Hypercortisolism is one of the possible causes of secondary hypertension, but its low prevalence and atypical clinical symptoms can lead to a delayed diagnosis. The complex clinical presentation and potential complications need a close collaboration among different clinicians in order to plan optimal or new treatment protocols.

  3. Report of a case of paroxysmal nocturnal hemoglobinuria (PNH) with complex evolution and liver transplant

    OpenAIRE

    Alencar,Railene Célia B.; Guimarães,Andréa M.; Brito Junior,Lacy C.

    2016-01-01

    ABSTRACT The paroxysmal nocturnal hemoglobinuria (PNH) is a rare acquired disease, with thrombotic episodes and frequent pancytopenia. We report the case of a 32 year-old female PNH patient with bone marrow aplasia, which followed a complex course, diagnosed with aplastic anemia associated with PNH, evolving in three years with Budd-Chiari syndrome and liver transplantation. Post-transplant complications, hepatic arterial thrombosis, graft rejection, liver retransplantation and treatment of P...

  4. 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.

  5. 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.

  6. 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.

  7. Toxicological findings in two planned complex suicide cases: ingestion of petroleum distillates and subsequent hanging.

    Science.gov (United States)

    Martínez, María Antonia; Ballesteros, Salomé

    2009-01-01

    This paper describes two fatal cases of planned complex suicide by two male individuals, 86 and 51 years old, involving ingestion of petroleum distillates and hanging. Remarkable internal findings during autopsy of both cases included the intense odor of petroleum distillates that alerted authorities to the suspicion of ingestion. The initial toxicological screening and quantitation of these compounds were performed by gas chromatography with flame-ionization detection, and confirmation was performed using gas chromatography-mass spectrometry in total ion chromatogram mode after liquid-liquid extraction of biological samples following a previously published analytical method. In Case 1, diesel fuel No. 2 concentrations were distillates when there is a suspicion of ingestion of these products due to the odor observed at the scene of death and/or during autopsy. The results of these toxicological investigations can help to determine the manner of death and the medicolegal interpretation.

  8. 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

  9. 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).

  10. Organic complexation of radionuclides in cement pore water: a case study

    International Nuclear Information System (INIS)

    Hummel, W.

    1993-01-01

    The influence of the organic ligands EDTA (ethylenediaminetetraacetate), NTA (nitrilotriacetate), citrate and oxalate on the speciation of Cs, Sr, Ra, Ni, Pd, Tc, Sn, Zr, Th, U, Np, Pu, Am and Cm in cement pore waters is studied by means of chemical equilibria. Emphasis is laid on the development of a complete and consistent thermodynamic data base for the high pH range beyond pH 11. Missing data are estimated using free-energy relationships derived from a large number of experimentally determined stability constants compiled from the literature. In case where a sound estimation of stability constants is not possible due to the scarcity of quantitative information, at least upper limits are assessed for the stability of all possibly important species. Chemical equilibria were computed within the range of pH 11 to 13 and a range of Ca concentrations from 0.001 to 0.1 mol -1 (M). ETDA complexes predominate only in the case of Ni. In all other cases, the competition of Ca-organic or metal-hydroxo complexes successfully prevent any significant influence of EDTA, NTA, citrate or oxalate on the speciation of these radionuclides. (author) 10 figs., 9 refs

  11. 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.

  12. CLINICAL CASE OF TREATMENT WITH RIBOSOMAL COMPLEX IN CHILD WITH COMPROMISED IMMUNITY

    Directory of Open Access Journals (Sweden)

    A.A. Alekseeva

    2011-01-01

    Full Text Available The leading pathology in children is acute respiratory infections (ARI according to the expert data of WHO. The incidence of prolonged and recurrent types of ARI increases during recent years. Patients with these diseases subsequently form the group of children with compromised immunity. Immunogens and immunomodulators are the drugs of nonspecific prophylaxis which are used for the prevention of ARI. The group of bacterial immunomodulators is big but most well-studied systemic drug from this group is Ribomunyl. Ribosomal complex is effective and safe in pediatric practice. The article presents the clinical case of treatment with ribosomal complex in immunocompronised child with allergic pathology.Key words: children with compromised immunity, allergy, acute respiratory infections, treatment.(Voprosy sovremennoi pediatrii — Current Pediatrics. 2011; 10 (2: 211–215

  13. Bacterial flagella and Type III secretion: case studies in the evolution of complexity.

    Science.gov (United States)

    Pallen, M J; Gophna, U

    2007-01-01

    Bacterial flagella at first sight appear uniquely sophisticated in structure, so much so that they have even been considered 'irreducibly complex' by the intelligent design movement. However, a more detailed analysis reveals that these remarkable pieces of molecular machinery are the product of processes that are fully compatible with Darwinian evolution. In this chapter we present evidence for such processes, based on a review of experimental studies, molecular phylogeny and microbial genomics. Several processes have played important roles in flagellar evolution: self-assembly of simple repeating subunits, gene duplication with subsequent divergence, recruitment of elements from other systems ('molecular bricolage'), and recombination. We also discuss additional tentative new assignments of homology (FliG with MgtE, FliO with YscJ). In conclusion, rather than providing evidence of intelligent design, flagellar and non-flagellar Type III secretion systems instead provide excellent case studies in the evolution of complex systems from simpler components.

  14. 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...

  15. Rare association of anophthalmia, complex congenital heart disease and pulmonary hypertension: case report.

    Science.gov (United States)

    Ríos-Méndez, Raúl Enrique; Lozano Chinga, Michell Marola

    2016-10-07

    Clinical congenital anophthalmia is described as the uni- or bilateral absence of the eyeball that might occur in isolation or as part of a syndrome. It has a very low prevalence and its etiology is heterogeneous. Complex congenital cardiac malformations are also rare. The association of congenital anophthalmia and congenital heart disease is rarer still, and the etiology of those associations is not well understood yet. We report the case of a patient who had the very rare association of bilateral anophthalmia, multiple cardiac malformations and severe pulmonary hypertension.

  16. Inflammatory arthritis mimicking Complex Regional Pain Syndrome (CRPS) in a child: A case report.

    Science.gov (United States)

    Egilmez, Zeliha; Turgut, Selin Turan; Icagasioglu, Afitap; Bicakci, Irem

    2016-01-01

    Joint complaints in childhood are seen frequently and differential diagnosis can be difficult. Juvenile idiopathic arthritis (JIA) is the most common rheumatological disease of childhood. It involves peripheral joint arthritis, chronic synovitis, and extra-articular manifestations. Accurate diagnosis can take a long time and sometimes multiple diagnoses are used while following the patient until a final diagnosis can be reached. Arthritis may be triggered by trauma and confused with other diseases like complex regional pain syndrome (CRPS), in which trauma plays a role in the etiology. In the present case, ankle pain in an 8-year-old girl was misdiagnosed as CRPS.

  17. 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.

  18. Therapeutic Assessment of Complex Trauma: A Single-Case Time-Series Study.

    Science.gov (United States)

    Tarocchi, Anna; Aschieri, Filippo; Fantini, Francesca; Smith, Justin D

    2013-06-01

    The cumulative effect of repeated traumatic experiences in early childhood incrementally increases the risk of adjustment problems later in life. Surviving traumatic environments can lead to the development of an interrelated constellation of emotional and interpersonal symptoms termed complex posttraumatic stress disorder (CPTSD). Effective treatment of trauma begins with a multimethod psychological assessment and requires the use of several evidence-based therapeutic processes, including establishing a safe therapeutic environment, reprocessing the trauma, constructing a new narrative, and managing emotional dysregulation. Therapeutic Assessment (TA) is a semistructured, brief intervention that uses psychological testing to promote positive change. The case study of Kelly, a middle-aged woman with a history of repeated interpersonal trauma, illustrates delivery of the TA model for CPTSD. Results of this single-case time-series experiment indicate statistically significant symptom improvement as a result of participating in TA. We discuss the implications of these findings for assessing and treating trauma-related concerns, such as CPTSD.

  19. Complex regional pain syndrome with associated chest wall dystonia: a case report

    Directory of Open Access Journals (Sweden)

    Schwartzman Robert J

    2011-09-01

    Full Text Available Abstract Patients with complex regional pain syndrome (CRPS often suffer from an array of associated movement disorders, including dystonia of an affected limb. We present a case of a patient with long standing CRPS after a brachial plexus injury, who after displaying several features of the movement disorder previously, developed painful dystonia of chest wall musculature. Detailed neurologic examination found palpable sustained contractions of the pectoral and intercostal muscles in addition to surface allodynia. Needle electromyography of the intercostal and paraspinal muscles supported the diagnosis of dystonia. In addition, pulmonary function testing showed both restrictive and obstructive features in the absence of a clear cardiopulmonary etiology. Treatment was initiated with intrathecal baclofen and the patient had symptomatic relief and improvement of dystonia. This case illustrates a novel form of the movement disorder associated with CRPS with response to intrathecal baclofen treatment.

  20. 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.

  1. 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.

  2. 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

  3. AIC and the challenge of complexity: A case study from ecology.

    Science.gov (United States)

    Moll, Remington J; Steel, Daniel; Montgomery, Robert A

    2016-12-01

    Philosophers and scientists alike have suggested Akaike's Information Criterion (AIC), and other similar model selection methods, show predictive accuracy justifies a preference for simplicity in model selection. This epistemic justification of simplicity is limited by an assumption of AIC which requires that the same probability distribution must generate the data used to fit the model and the data about which predictions are made. This limitation has been previously noted but appears to often go unnoticed by philosophers and scientists and has not been analyzed in relation to complexity. If predictions are about future observations, we argue that this assumption is unlikely to hold for models of complex phenomena. That in turn creates a practical limitation for simplicity's AIC-based justification because scientists modeling such phenomena are often interested in predicting the future. We support our argument with an ecological case study concerning the reintroduction of wolves into Yellowstone National Park, U.S.A. We suggest that AIC might still lend epistemic support for simplicity by leading to better explanations of complex phenomena. Copyright © 2016 Elsevier Ltd. All rights reserved.

  4. 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.

  5. 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.

  6. Addressing the Complexities of Big Data Analytics in Healthcare: The Diabetes Screening Case

    Directory of Open Access Journals (Sweden)

    Daswin De Silva

    2015-09-01

    Full Text Available The healthcare industry generates a high throughput of medical, clinical and omics data of varying complexity and features. Clinical decision-support is gaining widespread attention as medical institutions and governing bodies turn towards better management of this data for effective and efficient healthcare delivery and quality assured outcomes. Amass of data across all stages, from disease diagnosis to palliative care, is further indication of the opportunities and challenges to effective data management, analysis, prediction and optimization techniques as parts of knowledge management in clinical environments. Big Data analytics (BDA presents the potential to advance this industry with reforms in clinical decision-support and translational research. However, adoption of big data analytics has been slow due to complexities posed by the nature of healthcare data. The success of these systems is hard to predict, so further research is needed to provide a robust framework to ensure investment in BDA is justified. In this paper we investigate these complexities from the perspective of updated Information Systems (IS participation theory. We present a case study on a large diabetes screening project to integrate, converge and derive expedient insights from such an accumulation of data and make recommendations for a successful BDA implementation grounded in a participatory framework and the specificities of big data in healthcare context.

  7. Three-stage management of complex pancreatic trauma with gastroduodenopancreatectomy: A case report

    Directory of Open Access Journals (Sweden)

    Sergio Henrique Bastos Damous

    Full Text Available Introduction: Severe injuries of the pancreatic head and duodenum in haemodynamically unstable patients are complex management. The purpose of this study is to report a case of complex pancreatic trauma induced by gunshot and managed with surgical approaches at three different times. Presentation of case: Exploratory laparotomy was indicated after initial emergency room care, with findings of cloudy blood-tinged fluid and blood clots on the mesentery near the hepatic angle, on the region of the 2nd portion of the duodenum and at the pancreatic head. Gastroduodenopancreatectomy was performed with right hemicolectomy and the peritoneal cavity was temporarily closed by a vacuum peritoneostomy. Surgical reopening occurred on the fifth postoperative day, and the patient was subjected to single-loop reconstruction of the intestinal transit with telescoping pancreaticojejunal anastomosis, biliodigestive anastomosis with termino-lateral hepaticojejunal anastomosis with a Kehr drain and gastroenteroanastomosis in 2 planes. The terminal ileostomy was maintained. After 2 days, the patient was subjected to abdominal wall closure without complications, which required relaxing Gibson incisions and wound closure with polypropylene mesh placement in a pre-aponeurotic position closed with multiple stitches. Results: The patient was discharged on the 40th post-trauma day without drains, with a functioning ileostomy and with a scheduled reconstruction of intestinal transit. Conclusion: In the presence of multiple associated injuries, hemodynamic instability and the need for an extensive surgical procedure such as duodenopancreatectomy, damage control surgery performed in stages as reported here enables the clinical stabilization of the patient for definitive treatment, achieving better survival results. Keywords: Pancreatic trauma, Complex trauma, Damage control, Trauma, Gastroduodenopancreatectomy

  8. Complexity in the new NHS: longitudinal case studies of CCGs in England.

    Science.gov (United States)

    Checkland, Katherine; McDermott, Imelda; Coleman, Anna; Perkins, Neil

    2016-01-07

    The reform in the English National Health Services (NHS) under the Health and Social Care Act 2012 is unlike previous NHS reorganisations. The establishment of clinical commissioning groups (CCGs) was intended to be 'bottom up' with no central blueprint. This paper sets out to offer evidence about how this process has played out in practice and examines the implications of the complexity and variation which emerged. Detailed case studies in CCGs across England, using interviews, observation and documentary analysis. Using realist framework, we unpacked the complexity of CCG structures. In phase 1 of the study (January 2011 to September 2012), we conducted 96 interviews, 439 h of observation in a wide variety of meetings, 2 online surveys and 38 follow-up telephone interviews. In phase 2 (April 2013 to March 2015), we conducted 42 interviews with general practitioners (GPs) and managers and observation of 48 different types of meetings. Our study has highlighted the complexity inherent in CCGs, arising out of the relatively permissive environment in which they developed. Not only are they very different from one another in size, but also in structure, functions between different bodies and the roles played by GPs. The complexity and lack of uniformity of CCGs is important as it makes it difficult for those who must engage with CCGs to know who to approach at what level. This is of increasing importance as CCGs are moving towards greater integration across health and social care. Our study also suggests that there is little consensus as to what being a 'membership' organisation means and how it should operate. The lack of uniformity in CCG structure and lack of clarity over the meaning of 'membership' raises questions over accountability, which becomes of greater importance as CCG is taking over responsibility for primary care co-commissioning. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go

  9. Creating a Safe Space: A Case Study of Complex Trauma and a Call for Proactive Comprehensive Psychoeducational Assessments and Reviews

    Science.gov (United States)

    Mainwaring, Debra J.

    2015-01-01

    This article advocates for proactive, dynamic and comprehensive psycho-educational assessments for children and young people who have a history of complex trauma, because of its known effects on development and learning. A case study is shared of a young woman with a history of complex trauma because of exposure to parental neglect, multiple…

  10. Case-crossover study of Burkholderia cepacia complex bloodstream infection associated with contaminated intravenous bromopride.

    Science.gov (United States)

    Martins, Ianick Souto; Pellegrino, Flávia Lúcia Piffano Costa; Freitas, Andrea d'Avila; Santos, Marisa da Silva; Ferraiuoli, Giovanna Ianini d'Alemeida; Vasques, Márcia Regina Guimarães; Amorim, Efigenia Lourdes Teixeira; Oliveira, Sandra; Nouér, Simone Aranha; Cardoso, Fernando Luiz Lopes; Mascarenhas, Luiz Affonso; Magalhães, Ana Cristina Gouveia; Cleinman, Isabella Barbosa; Figueiredo, Agnes Marie Sá; Moreira, Beatriz Meurer

    2010-05-01

    To investigate an outbreak of healthcare-associated Burkholderia cepacia complex (BCC) primary bloodstream infections (BCC-BSI). Case-crossover study in a public hospital, a university hospital and a private hospital in Rio de Janeiro, Brazil, from March 2006 to May 2006. Twenty-five patients with BCC-BSI. After determining the date BCC-BSI symptoms started for each patient, 3 time intervals of data collection were defined, each one with a duration of 3 days: the case period, starting just before BCC-BSI symptoms onset; the control period, starting 6 days before BCC-BSI symptoms onset; and the washout period, comprising the 3 days between the case period and the control period. Exposures evaluated were intravascular solutions and invasive devices and procedures. Potential risk factors were identified by using the McNemar chi(2) adjusted test. Cultures of samples of potentially contaminated solutions were performed. BCC strain typing was performed by pulsed-field gel electrophoresis using SpeI. The statistical analysis revealed that the use of bromopride and dipyrone was associated with BCC-BSI. A total of 21 clinical isolates from 17 (68%) of the 25 patients and an isolate obtained from the bromopride vial were available for strain typing. Six pulsotypes were detected. A predominant pulsotype (A) accounted for 11 isolates obtained from 11 patients (65%) in the 3 study hospitals. Our investigation, using a case-crossover design, of an outbreak of BCC-BSI infections concluded it was polyclonal but likely caused by infusion of contaminated bromopride. The epidemiological finding was validated by microbiological analysis. After recall of contaminated bromopride vials by the manufacturer, the outbreak was controlled.

  11. 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.

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

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    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.

  13. 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.

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

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    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.

  15. The case of value-based healthcare for people living with complex long-term conditions.

    Science.gov (United States)

    Elf, Marie; Flink, Maria; Nilsson, Marie; Tistad, Malin; von Koch, Lena; Ytterberg, Charlotte

    2017-01-11

    There is a trend towards value-based health service, striving to cut costs while generating value for the patient. The overall objective comprises higher-quality health services and improved patient safety and cost efficiency. The approach could align with patient-centred care, as it entails a focus on the patient's experience of her or his entire cycle of care, including the use of well-defined outcome measurements. Challenges arise when the approach is applied to health services for people living with long-term complex conditions that require support from various healthcare services. The aim of this work is to critically discuss the value-based approach and its implications for patients with long-term complex conditions. Two cases from clinical practice and research form the foundation for our reasoning, illustrating several challenges regarding value-based health services for people living with long-term complex conditions. Achieving value-based health services that provide the health outcomes that matter to patients and providing greater patient-centredness will place increased demands on the healthcare system. Patients and their informal caregivers must be included in the development and establishment of outcome measures. The outcome measures must be standardized to allow evaluation of specific conditions at an aggregated level, but they must also be sensitive enough to capture each patient's individual needs and goals. Healthcare systems that strive to establish value-based services must collaborate beyond the organizational boundaries to create clear patient trajectories in order to avoid fragmentation. The shift towards value-based health services has the potential to align healthcare-service delivery with patient-centred care if serious efforts to take the patient's perspective into account are made. This is especially challenging in fragmented healthcare systems and for patients with long-term- and multi-setting-care needs.

  16. Operational Complexity of Supplier-Customer Systems Measured by Entropy—Case Studies

    Directory of Open Access Journals (Sweden)

    Ladislav Lukáš

    2016-04-01

    Full Text Available This paper discusses a unified entropy-based approach for the quantitative measurement of operational complexity of company supplier-customer relations. Classical Shannon entropy is utilized. Beside this quantification tool, we also explore the relations between Shannon entropy and (c,d-entropy in more details. An analytic description of so called iso-quant curves is given, too. We present five case studies, albeit in an anonymous setting, describing various details of general procedures for measuring the operational complexity of supplier-customer systems. In general, we assume a problem-oriented database exists, which contains detailed records of all product forecasts, orders and deliveries both in quantity and time, scheduled and realized, too. Data processing detects important flow variations both in volumes and times, e.g., order—forecast, delivery—order, and actual production—scheduled one. The unifying quantity used for entropy computation is the time gap between actual delivery time and order issue time, which is nothing else but a lead time in inventory control models. After data consistency checks, histograms and empirical distribution functions are constructed. Finally, the entropy, information-theoretic measure of supplier-customer operational complexity, is calculated. Basic steps of the algorithm are mentioned briefly, too. Results of supplier-customer system analysis from selected Czech small and medium-sized enterprises (SMEs are presented in various computational and managerial decision making details. An enterprise is ranked as SME one, if it has at most 250 employees and its turnover does not exceed 50 million USD per year, or its balance sheet total does not exceed 43 million USD per year, alternatively.

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

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    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.

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

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    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.

  19. Which is the best oxidant for complexed iron removal from groundwater: The Kogalym case

    Energy Technology Data Exchange (ETDEWEB)

    Munter, R.; Overbeck, P.; Sutt, J. [Tallinn University of Technology, Tallinn (Estonia). Dept. of Chemical Engineering

    2008-07-01

    A short overview of the significance of a preoxidation stage groundwater treatment is presented. As an example the case of complexed iron removal from Kogalym groundwater (Tjumen, Siberia, Russian Federation) using different preoxidants (ozone, oxygen, chlorine, hydrogen peroxide, and potassium permanganate) is discussed. The key problem is stable di- and trivalent iron-organic complexes in groundwater which after aeration tend to pass through the hydroanthracite-sand gravity filters. The total organic carbon (TOC) content in raw groundwater is in the range of 3.2-6.4 mg/L, total iron content 2.7-6.0 mg/L and divalent iron content 2.4-4.0 mg/L. Separation from Kogalym groundwater by XAD-16 adsorbent humic matter fraction was homogeneous, with only 1 peak on the chromatogram with maximum Rt = 10.75 min and corresponding molecular mass 1911 ({lt} 2000). The final developed treatment technology is based on the water oxidation/reduction potential (ORP) optimization according to the iron system pE-pH diagram and consists of intensive aeration of raw water in the Gas-Degas Treatment (GDT) unit with the following sequence: filtration through the hydroanthracite and special anthracite Everzit, with intermediate enrichment of water with pure oxygen between the filtration stages.

  20. Residual Complexity Does Impact Organic Chemistry and Drug Discovery: The Case of Rufomyazine and Rufomycin.

    Science.gov (United States)

    Choules, Mary P; Klein, Larry L; Lankin, David C; McAlpine, James B; Cho, Sang-Hyun; Cheng, Jinhua; Lee, Hanki; Suh, Joo-Won; Jaki, Birgit U; Franzblau, Scott G; Pauli, Guido F

    2018-05-24

    Residual complexity (RC) involves the impact of subtle but critical structural and biological features on drug lead validation, including unexplained effects related to unidentified impurities. RC commonly plagues drug discovery efforts due to the inherent imperfections of chromatographic separation methods. The new diketopiperazine, rufomyazine (6), and the previously known antibiotic, rufomycin (7), represent a prototypical case of RC that (almost) resulted in the misassignment of biological activity. The case exemplifies that impurities well below the natural abundance of 13 C (1.1%) can be highly relevant and calls for advanced analytical characterization of drug leads with extended molar dynamic ranges of >1:1,000 using qNMR and LC-MS. Isolated from an actinomycete strain, 6 was originally found to be active against Mycobacterium tuberculosis with a minimum inhibitory concentration (MIC) of 2 μg/mL and high selectivity. As a part of lead validation, the dipeptide was synthesized and surprisingly found to be inactive. The initially observed activity was eventually attributed to a very minor contamination (0.24% [m/m]) with a highly active cyclic peptide (MIC ∼ 0.02 μM), subsequently identified as an analogue of 7. This study illustrates the serious implications RC can exert on organic chemistry and drug discovery, and what efforts are vital to improve lead validation and efficiency, especially in NP-related drug discovery programs.

  1. 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

  2. Venipuncture-Induced Complex Regional Pain Syndrome: A Case Report and Review of the Literature

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    Foad Elahi

    2014-01-01

    Full Text Available 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.

  3. Three-stage management of complex pancreatic trauma with gastroduodenopancreatectomy: A case report.

    Science.gov (United States)

    Damous, Sergio Henrique Bastos; Darce, George Felipe Bezerra; Leal, Renato Silveira; Costa, Adilson Rodrigues; Ferreira, Pedro Henrique Alves; de Oliveira Bernini, Celso; Utiyama, Edivaldo Massazo

    2018-01-01

    Severe injuries of the pancreatic head and duodenum in haemodynamically unstable patients are complex management. The purpose of this study is to report a case of complex pancreatic trauma induced by gunshot and managed with surgical approaches at three different times. Exploratory laparotomy was indicated after initial emergency room care, with findings of cloudy blood-tinged fluid and blood clots on the mesentery near the hepatic angle, on the region of the 2nd portion of the duodenum and at the pancreatic head. Gastroduodenopancreatectomy was performed with right hemicolectomy and the peritoneal cavity was temporarily closed by a vacuum peritoneostomy. Surgical reopening occurred on the fifth postoperative day, and the patient was subjected to single-loop reconstruction of the intestinal transit with telescoping pancreaticojejunal anastomosis, biliodigestive anastomosis with termino-lateral hepaticojejunal anastomosis with a Kehr drain and gastroenteroanastomosis in 2 planes. The terminal ileostomy was maintained. After 2 days, the patient was subjected to abdominal wall closure without complications, which required relaxing Gibson incisions and wound closure with polypropylene mesh placement in a pre-aponeurotic position closed with multiple stitches. The patient was discharged on the 40th post-trauma day without drains, with a functioning ileostomy and with a scheduled reconstruction of intestinal transit. In the presence of multiple associated injuries, hemodynamic instability and the need for an extensive surgical procedure such as duodenopancreatectomy, damage control surgery performed in stages as reported here enables the clinical stabilization of the patient for definitive treatment, achieving better survival results. Copyright © 2018 The Authors. Published by Elsevier Ltd.. All rights reserved.

  4. Inpatient Complexity in Radiology-a Practical Application of the Case Mix Index Metric.

    Science.gov (United States)

    Mabotuwana, Thusitha; Hall, Christopher S; Flacke, Sebastian; Thomas, Shiby; Wald, Christoph

    2017-06-01

    With ongoing healthcare payment reforms in the USA, radiology is moving from its current state of a revenue generating department to a new reality of a cost-center. Under bundled payment methods, radiology does not get reimbursed for each and every inpatient procedure, but rather, the hospital gets reimbursed for the entire hospital stay under an applicable diagnosis-related group code. The hospital case mix index (CMI) metric, as defined by the Centers for Medicare and Medicaid Services, has a significant impact on how much hospitals get reimbursed for an inpatient stay. Oftentimes, patients with the highest disease acuity are treated in tertiary care radiology departments. Therefore, the average hospital CMI based on the entire inpatient population may not be adequate to determine department-level resource utilization, such as the number of technologists and nurses, as case length and staffing intensity gets quite high for sicker patients. In this study, we determine CMI for the overall radiology department in a tertiary care setting based on inpatients undergoing radiology procedures. Between April and September 2015, CMI for radiology was 1.93. With an average of 2.81, interventional neuroradiology had the highest CMI out of the ten radiology sections. CMI was consistently higher across seven of the radiology sections than the average hospital CMI of 1.81. Our results suggest that inpatients undergoing radiology procedures were on average more complex in this hospital setting during the time period considered. This finding is relevant for accurate calculation of labor analytics and other predictive resource utilization tools.

  5. Presurgical EEG-fMRI in a complex clinical case with seizure recurrence after epilepsy surgery

    Science.gov (United States)

    Zhang, Jing; Liu, Qingzhu; Mei, Shanshan; Zhang, Xiaoming; Wang, Xiaofei; Liu, Weifang; Chen, Hui; Xia, Hong; Zhou, Zhen; Li, Yunlin

    2013-01-01

    Epilepsy surgery has improved over the last decade, but non-seizure-free outcome remains at 10%–40% in temporal lobe epilepsy (TLE) and 40%–60% in extratemporal lobe epilepsy (ETLE). This paper reports a complex multifocal case. With a normal magnetic resonance imaging (MRI) result and nonlocalizing electroencephalography (EEG) findings (bilateral TLE and ETLE, with more interictal epileptiform discharges [IEDs] in the right frontal and temporal regions), a presurgical EEG-functional MRI (fMRI) was performed before the intraoperative intracranial EEG (icEEG) monitoring (icEEG with right hemispheric coverage). Our previous EEG-fMRI analysis results (IEDs in the left hemisphere alone) were contradictory to the EEG and icEEG findings (IEDs in the right frontal and temporal regions). Thus, the EEG-fMRI data were reanalyzed with newly identified IED onsets and different fMRI model options. The reanalyzed EEG-fMRI findings were largely concordant with those of EEG and icEEG, and the failure of our previous EEG-fMRI analysis may lie in the inaccurate identification of IEDs and wrong usage of model options. The right frontal and temporal regions were resected in surgery, and dual pathology (hippocampus sclerosis and focal cortical dysplasia in the extrahippocampal region) was found. The patient became seizure-free for 3 months, but his seizures restarted after antiepileptic drugs (AEDs) were stopped. The seizures were not well controlled after resuming AEDs. Postsurgical EEGs indicated that ictal spikes in the right frontal and temporal regions reduced, while those in the left hemisphere became prominent. This case suggested that (1) EEG-fMRI is valuable in presurgical evaluation, but requires caution; and (2) the intact seizure focus in the remaining brain may cause the non-seizure-free outcome. PMID:23926432

  6. Ureterocystoneostomy in complex oncological cases with an "Uebelhoer" modified Boari bladder flap.

    Science.gov (United States)

    Radtke, Jan P; Korzeniewski, Nina; Huber, Johannes; Alt, Celine D; Pahernik, Sascha; Hadaschik, Boris A; Hohenfellner, Markus; Teber, Dogu

    2017-12-01

    The study aims to describe the technique and analyze the outcome of an arcuated bladder incision with building of a triangular flap, first described by Uebelhoer (UBBF), as a modification of the classical rectangular Boari bladder flap (BBF), that is often viable, but can present difficulties, such as reduced flap vascularization and mobility in pretreated patients. Twelve consecutive patients with distal or mid ureteral leakage or stenosis, that underwent UBBF, were retrospectively analyzed. We assessed postoperative morbidity using Clavien-Dindo classification. Short- and long-term functional outcomes were assessed using glomerular filtration rate (GFR), ultrasound, and renal scintigraphy. Patients underwent UBBF during initial oncological surgery in five cases and due to ureteral defects following oncological surgery or radiotherapy in seven cases. Median patient age was 57 (interquartile range (IQR) 46-72), defect length was 7.5 cm (IQR 5-8 cm), and median follow-up period was 41 (IQR 36-48) months. In short-term follow-up, 11/13 postoperative morbidities were Clavien-Dindo level I-II complications, mostly infections. Two level IIIa complications occurred. One anastomotic leakage was treated sufficiently with temporarily ureteral stenting and one voiding disorder needed intervention. In the long-term follow-up, 84% of patients had improved or constant GFR. In the one-year renal scintigraphy, no urodynamically relevant voiding disorder occurred. The UBBF is a reliable procedure to reconstruct ureteral trauma even in complex oncological, pretreated patients suffering from distal or mid ureteral defects. It can be performed easily by a modified arcuate incision and provides good long-term functional outcomes.

  7. PET/CT in the complex estimation of the patient after breast cancer therapy - case report

    International Nuclear Information System (INIS)

    Ziolkowska, E.; Lozynska-Podhrebelna, D.; Zarzycka, M.; Malkowski, B.

    2007-01-01

    The connection of positron emission tomography (PET) and computer tomography (CT) with the use of FDG is finding wider application to the diagnostics, monitoring and treatment of breast cancer. The use of PET/CT improves the effectiveness of recurrence, metastases to the bones and distant internal organs diagnostics, and in some patients outdistances the presence of lesions which in conventional diagnostic examinations are described considerably later. This work presents the case of a 50-year-old woman with diagnosed breast cancer, after surgery treatment and complementary chemotherapy and radiotherapy. There was a suspicion of local recurrence in postoperative scar (in 18 th month after finished radiotherapy) and the absence of oncocytes in cytological examination in this patient and PET/CT was performed. The recurrence in postoperative scar and signs of dissemination to the bones and the liver was shown in this examination despite the negative tumour marker profile. CT and scintigraphy were performed additionally and they confirmed only the existence of metastatic changes in S1 vertebra and VI rib on the left side. Thanks to PET/CT examination both palliative radiotherapy and chemotherapy were applied immediately. After 5 months the control PET/CT examination was performed which showed a partial response to the applied treatment. The result of the examination and further growth of CA 15-3 marker were reasons for the inclusion of the next two series of chemotherapy. Bone scintigraphy, which was performed after completion of chemotherapy, showed the progression of metastatic changes. The patient was referred for radioisotopic treatment. The introduced case confirms the suitability of PET/CT in the complex assessment of a patient with diagnosed breast cancer. The use of PET/CT is a valuable element of recurrence and dissemination in neoplasmic disease quick diagnostics and directs the ways of the optimum antineoplasmic treatment. (authors)

  8. Distress Propagation in Complex Networks: The Case of Non-Linear DebtRank.

    Directory of Open Access Journals (Sweden)

    Marco Bardoscia

    Full Text Available We consider a dynamical model of distress propagation on complex networks, which we apply to the study of financial contagion in networks of banks connected to each other by direct exposures. The model that we consider is an extension of the DebtRank algorithm, recently introduced in the literature. The mechanics of distress propagation is very simple: When a bank suffers a loss, distress propagates to its creditors, who in turn suffer losses, and so on. The original DebtRank assumes that losses are propagated linearly between connected banks. Here we relax this assumption and introduce a one-parameter family of non-linear propagation functions. As a case study, we apply this algorithm to a data-set of 183 European banks, and we study how the stability of the system depends on the non-linearity parameter under different stress-test scenarios. We find that the system is characterized by a transition between a regime where small shocks can be amplified and a regime where shocks do not propagate, and that the overall stability of the system increases between 2008 and 2013.

  9. Formation, clearance, deposition, pathogenicity, and identification of biopharmaceutical-related immune complexes: review and case studies.

    Science.gov (United States)

    Rojko, Jennifer L; Evans, Mark G; Price, Shari A; Han, Bora; Waine, Gary; DeWitte, Mark; Haynes, Jill; Freimark, Bruce; Martin, Pauline; Raymond, James T; Evering, Winston; Rebelatto, Marlon C; Schenck, Emanuel; Horvath, Christopher

    2014-06-01

    Vascular inflammation, infusion reactions, glomerulopathies, and other potentially adverse effects may be observed in laboratory animals, including monkeys, on toxicity studies of therapeutic monoclonal antibodies and recombinant human protein drugs. Histopathologic and immunohistochemical (IHC) evaluation suggests these effects may be mediated by deposition of immune complexes (ICs) containing the drug, endogenous immunoglobulin, and/or complement components in the affected tissues. ICs may be observed in glomerulus, blood vessels, synovium, lung, liver, skin, eye, choroid plexus, or other tissues or bound to neutrophils, monocytes/macrophages, or platelets. IC deposition may activate complement, kinin, and/or coagulation/fibrinolytic pathways and result in a systemic proinflammatory response. IC clearance is biphasic in humans and monkeys (first from plasma to liver and/or spleen, second from liver or spleen). IC deposition/clearance is affected by IC composition, immunomodulation, and/or complement activation. Case studies are presented from toxicity study monkeys or rats and indicate IHC-IC deposition patterns similar to those predicted by experimental studies of IC-mediated reactions to heterologous protein administration to monkeys and other species. The IHC-staining patterns are consistent with findings associated with generalized and localized IC-associated pathology in humans. However, manifestations of immunogenicity in preclinical species are generally not considered predictive to humans. © 2014 by The Author(s).

  10. A case of complex regional pain syndrome with agnosia for object orientation.

    Science.gov (United States)

    Robinson, Gail; Cohen, Helen; Goebel, Andreas

    2011-07-01

    This systematic investigation of the neurocognitive correlates of complex regional pain syndrome (CRPS) in a single case also reports agnosia for object orientation in the context of persistent CRPS. We report a patient (JW) with severe long-standing CRPS who had no difficulty identifying and naming line drawings of objects presented in 1 of 4 cardinal orientations. In contrast, he was extremely poor at reorienting these objects into the correct upright orientation and in judging whether an object was upright or not. Moreover, JW made orientation errors when copying drawings of objects, and he also showed features of mirror reversal in writing single words and reading single letters. The findings are discussed in relation to accounts of visual processing. Agnosia for object orientation is the term for impaired knowledge of an object's orientation despite good recognition and naming of the same misoriented object. This defect has previously only been reported in patients with major structural brain lesions. The neuroanatomical correlates are discussed. The patient had no structural brain lesion, raising the possibility that nonstructural reorganisation of cortical networks may be responsible for his deficits. Other patients with CRPS may have related neurocognitive defects. Crown Copyright © 2011. Published by Elsevier B.V. All rights reserved.

  11. 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.

  12. Bilateral Giant Renal Angiomyolipoma in a Patient with Tuberous Sclerosis Complex: A Case Report

    Directory of Open Access Journals (Sweden)

    Andika Afriansyah

    2018-04-01

    Full Text Available Tuberous sclerosis complex (TSC has several renal manifestations including angiomyolipomas (AML and renal epithelial neoplasms. A bilateral giant renal AML is extremely rare. We report a case of giant bilateral AML and discuss the diagnosis and treatment of it. The 22-year-old man was admitted due to bilateral flank pain, gross hematuria, and abdominal fullness. He had history of epilepsy, mental retardation, and delayed development during childhood. He had angiofibroma on his face since 10 years ago. Abdominal CT and MRI revealed large lobulated heterogeneous mass with fatty content. Based on those findings, we diagnosed the patient with bilateral giant renal AML. We gave conservative management for the patient and planned to total nephrectomy on the left kidney if the continued bleeding occurred. AML associated with TSC occur more frequently as multiple lesions and grows to larger size than idiopathic AML. Bilateral giant AML, which is very rare, could be treated with conservative management if no significant hemorrhage occurred.

  13. 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.

  14. Spindle cell carcinoma of the breast as complex cystic lesion: a case report

    International Nuclear Information System (INIS)

    Kitada, Masahiro; Hayashi, Satoshi; Matsuda, Yoshinari; Ishibashi, Kei; Oikawa, Keisuke; Miyokawa, Naoyuki

    2014-01-01

    Spindle cell carcinoma of the breast is a rare tumor. This tumor can proliferate rapidly and cause cystic changes because of internal tissue necrosis. We evaluated a 54-year-old woman with right breast lump. Mammography showed a category four mass with a diameter of 2.5 cm. Ultrasonography (US) revealed a complex cystic lesion, and fine-needle aspiration (FNA) cytology demonstrated bloody fluid and malignant cells. Partial breast resection and sentinel lymph node biopsy were performed. Immunohistology revealed spindle cells with positive results for cytokeratin (AE1/AE3) and vimentin, partially positive results for s-100, and negative results for desmin and α-actin. The pathological stage was IIA, and biochemical characterization showed that the tumor was triple negative. Six courses of FEC-100 chemotherapy (5-fluorouracil 500 mg/m 2 , epirubicin 100 mg/m 2 , and cyclophosphamide 500 mg/m 2 ) were administered. Radiotherapy was performed. This case is discussed with reference to the literature

  15. Niche divergence builds the case for ecological speciation in skinks of the Plestiodon skiltonianus species complex

    Science.gov (United States)

    Wogan, Guinevere O.U.; Richmond, Jonathan Q.

    2015-01-01

    Adaptation to different thermal environments has the potential to cause evolutionary changes that are sufficient to drive ecological speciation. Here, we examine whether climate-based niche divergence in lizards of the Plestiodon skiltonianus species complex is consistent with the outcomes of such a process. Previous work on this group shows that a mechanical sexual barrier has evolved between species that differ mainly in body size and that the barrier may be a by-product of selection for increased body size in lineages that have invaded xeric environments; however, baseline information on niche divergence among members of the group is lacking. We quantified the climatic niche using mechanistic physiological and correlative niche models and then estimated niche differences among species using ordination techniques and tests of niche overlap and equivalency. Our results show that the thermal niches of size-divergent, reproductively isolated morphospecies are significantly differentiated and that precipitation may have been as important as temperature in causing increased shifts in body size in xeric habitats. While these findings alone do not demonstrate thermal adaptation or identify the cause of speciation, their integration with earlier genetic and behavioral studies provides a useful test of phenotype–environment associations that further support the case for ecological speciation in these lizards.

  16. A Case Report of Intra-articular Bee Venom Pharmacopuncture for Partial Tear of Triangular Fibrocartilage Complex

    Directory of Open Access Journals (Sweden)

    Lee, Kwangho

    2009-12-01

    Full Text Available Objective: This case was to report a case of Partial Tear of Triangular Fibrocartilage Complex treated by Intra-articular bee venom Pharmacopuncture. Methods: The patient was treated by Intra-articular bee venom Pharmacopuncture. The Effect of Treatment was evaluated by Visual Analog Scale(VAS and Modified Mayo Wrist Score(Wrist Score. Results & Conclusions: After Treatment, Patient's VAS decreased and Wrist Score increased. For this results, Intra-articular Bee Venom Pharmacopuncture may be effective for Partial Tear of Triangular Fibrocartilage Complex.

  17. BCR translocation to derivative chromosome 2, a new case of chronic myeloid leukemia with complex variant translocation and Philadelphia chromosome

    International Nuclear Information System (INIS)

    Al-Achkar, W.; Wafa, A.; Al-Medani, S.

    2011-01-01

    The well-known typical fusion gene BCR/ABL can be observed in connection with a complex translocation event in only 5-8% of cases with chronic myeloid leukemia (CML). Herein we report an exceptional CML case with complex chromosomal aberrations not observed before, translocated BCR to the derivative chromosome 2 [der(2)], additional to involving a four chromosomes translocation implying chromosomal regions such as 1p32 and 2q21 besides 9q34 and 22q11.2. Which were characterized by molecular cytogenetics. (author)

  18. 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.

  19. Presurgical EEG-fMRI in a complex clinical case with seizure recurrence after epilepsy surgery

    Directory of Open Access Journals (Sweden)

    Zhang J

    2013-07-01

    Full Text Available Jing Zhang,1 Qingzhu Liu,2 Shanshan Mei,2 Xiaoming Zhang,2 Xiaofei Wang,2 Weifang Liu,1 Hui Chen,1 Hong Xia,1 Zhen Zhou,1 Yunlin Li2 1School of Biomedical Engineering, Capital Medical University, Beijing, People's Republic of China; 2Department of Functional Neurology and Neurosurgery, Beijing Haidian Hospital, Beijing, People's Republic of China Abstract: Epilepsy surgery has improved over the last decade, but non-seizure-free outcome remains at 10%–40% in temporal lobe epilepsy (TLE and 40%–60% in extratemporal lobe epilepsy (ETLE. This paper reports a complex multifocal case. With a normal magnetic resonance imaging (MRI result and nonlocalizing electroencephalography (EEG findings (bilateral TLE and ETLE, with more interictal epileptiform discharges [IEDs] in the right frontal and temporal regions, a presurgical EEG-functional MRI (fMRI was performed before the intraoperative intracranial EEG (icEEG monitoring (icEEG with right hemispheric coverage. Our previous EEG-fMRI analysis results (IEDs in the left hemisphere alone were contradictory to the EEG and icEEG findings (IEDs in the right frontal and temporal regions. Thus, the EEG-fMRI data were reanalyzed with newly identified IED onsets and different fMRI model options. The reanalyzed EEG-fMRI findings were largely concordant with those of EEG and icEEG, and the failure of our previous EEG-fMRI analysis may lie in the inaccurate identification of IEDs and wrong usage of model options. The right frontal and temporal regions were resected in surgery, and dual pathology (hippocampus sclerosis and focal cortical dysplasia in the extrahippocampal region was found. The patient became seizure-free for 3 months, but his seizures restarted after antiepileptic drugs (AEDs were stopped. The seizures were not well controlled after resuming AEDs. Postsurgical EEGs indicated that ictal spikes in the right frontal and temporal regions reduced, while those in the left hemisphere became prominent

  20. 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.

  1. HEADROOM BEYOND THE QUALITY- ADJUSTED LIFE-YEAR: THE CASE OF COMPLEX PEDIATRIC NEUROLOGY.

    Science.gov (United States)

    van Nimwegen, Kirsten J M; Lilford, Richard J; van der Wilt, Gert J; Grutters, Janneke P C

    2017-01-01

    The headroom method was introduced for the very early evaluation of the potential value of new technologies. It allows for establishing a ceiling price for technologies to still be cost-effective by combining the maximum effect a technology might yield, the maximum willingness-to-pay (WTP) for this effect, and potential downstream expenses and savings. Although the headroom method is QALY-based, not all innovations are expected to result in QALY gain. This study explores the feasibility and usefulness of the headroom method in the evaluation of technologies that are unlikely to result in QALY gain. This will be illustrated with the diagnostic trajectory of complex pediatric neurology (CPN). Our headroom analysis showed a large room for improvement in the current diagnostic trajectory of CPN in terms of diagnostic yield. Combining this with a maximum WTP value for an additional diagnosis and the potential downstream expenses and savings, resulted in a total headroom of €15,028. This indicates that a new technology in this particular diagnostic trajectory, might be cost-effective as long as its costs do not exceed €15,028. The headroom method seems a useful tool in the very early evaluation of medical technologies, also in cases when immediate QALY gain is unlikely. It allows for allocating healthcare resources to those technologies that are most promising. It should be kept in mind, however, that the headroom assumes an optimistic scenario, and for that reason cannot guarantee future cost-effectiveness. It might be most useful for ruling out those technologies that are unlikely to be cost-effective.

  2. Complex Anatomic Abnormalities of the Lower Leg Muscles and Tendons Associated With Phocomelia: A Case Report.

    Science.gov (United States)

    Hodo, Thomas; Hamrick, Mark; Melenevsky, Yulia

    Musculoskeletal anatomy is widely known to have components that stray from the norm in the form of variant muscle and tendon presence, absence, origin, insertion, and bifurcation. Although these variant muscles and tendons might be deemed incidental and insignificant findings by most, they can be important contributors to pathologic physiology or, more importantly, an option for effective treatment. In the present case report, we describe a patient with phocomelia and Müllerian abnormalities secondary to in utero thalidomide exposure. The patient had experienced recurrent bilateral foot pain accompanied by numbness, stiffness, swelling, and longstanding pes planus. These symptoms persisted despite conservative treatment with orthotics, steroids, and nonsteroidal anti-inflammatory drugs. Radiographic imaging showed dysmorphic and degenerative changes of the ankle and foot joints. Further investigation with magnetic resonance imaging revealed complex anatomic abnormalities, including the absence of the posterior tibialis and peroneus brevis, lateralization of the peroneus longus, and the presence of a variant anterior compartment muscle. The variant structure was likely a previously described anterior compartment variant, anterior fibulocalcaneus, and might have been a source of the recurrent pain. Also, the absence of the posterior tibialis might have caused the pes planus in the present patient, considering that posterior tibialis tendon dysfunction is the most common cause of acquired pes planus. Although thalidomide infrequently affects the lower extremities, its effects on growth and development were likely the cause of this rare array of anatomic abnormalities and resulting ankle and foot pathologic features. Copyright © 2017 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  3. 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

  4. On the impedance of galvanic cells XXVI. Application of the complex plane method in the case of mixed currents

    NARCIS (Netherlands)

    Dekker, B.G.; Sluyters-Rehbach, M.; Sluyters, J.H.

    1969-01-01

    The applicability of the complex plane method for the evaluation of the impedance parameters in the case of two simultaneously proceeding electrode reactions is discussed. It is shown that the possibility of the evaluation depends strongly on the values of the irreversibility quotients of both

  5. 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

  6. Postural complexity influences development in infants born preterm with brain injury: relating perception-action theory to 3 cases.

    Science.gov (United States)

    Dusing, Stacey C; Izzo, Theresa; Thacker, Leroy R; Galloway, James Cole

    2014-10-01

    Perception-action theory suggests a cyclical relationship between movement and perceptual information. In this case series, changes in postural complexity were used to quantify an infant's action and perception during the development of early motor behaviors. Three infants born preterm with periventricular white matter injury were included. Longitudinal changes in postural complexity (approximate entropy of the center of pressure), head control, reaching, and global development, measured with the Test of Infant Motor Performance and the Bayley Scales of Infant and Toddler Development, were assessed every 0.5 to 3 months during the first year of life. All 3 infants demonstrated altered postural complexity and developmental delays. However, the timing of the altered postural complexity and the type of delays varied among the infants. For infant 1, reduced postural complexity or limited action while learning to control her head in the midline position may have contributed to her motor delay. However, her ability to adapt her postural complexity eventually may have supported her ability to learn from her environment, as reflected in her relative cognitive strength. For infant 2, limited early postural complexity may have negatively affected his learning through action, resulting in cognitive delay. For infant 3, an increase in postural complexity above typical levels was associated with declining neurological status. Postural complexity is proposed as a measure of perception and action in the postural control system during the development of early behaviors. An optimal, intermediate level of postural complexity supports the use of a variety of postural control strategies and enhances the perception-action cycle. Either excessive or reduced postural complexity may contribute to developmental delays in infants born preterm with white matter injury. © 2014 American Physical Therapy Association.

  7. 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.

  8. Leading and Managing in Complexity: The Case of South African Deans

    Science.gov (United States)

    Seale, Oliver; Cross, Michael

    2016-01-01

    In recent years, deanship in universities has become more complex and challenging. Deans in South African universities take up their positions without appropriate training and prior executive experience, and with no clear understanding of the ambiguity and complexity of their roles. This paper calls for appropriate leadership development…

  9. Case definition for Ebola and Marburg haemorrhagic fevers: a complex challenge for epidemiologists and clinicians.

    Science.gov (United States)

    Pittalis, Silvia; Fusco, Francesco Maria; Lanini, Simone; Nisii, Carla; Puro, Vincenzo; Lauria, Francesco Nicola; Ippolito, Giuseppe

    2009-10-01

    Viral haemorrhagic fevers (VHFs) represent a challenge for public health because of their epidemic potential, and their possible use as bioterrorism agents poses particular concern. In 1999 the World Health Organization (WHO) proposed a case definition for VHFs, subsequently adopted by other international institutions with the aim of early detection of initial cases/outbreaks in western countries. We applied this case definition to reports of Ebola and Marburg virus infections to estimate its sensitivity to detect cases of the disease. We analyzed clinical descriptions of 795 reported cases of Ebola haemorrhagic fever: only 58.5% of patients met the proposed case definition. A similar figure was obtained reviewing 169 cases of Marburg diseases, of which only 64.5% were in accordance with the case definition. In conclusion, the WHO case definition for hemorrhagic fevers is too specific and has poor sensitivity both for case finding during Ebola or Marburg outbreaks, and for early detection of suspected cases in western countries. It can lead to a hazardous number of false negatives and its use should be discouraged for early detection of cases.

  10. An Interdisciplinary Approach to the Diagnosis and Management of a Complex Case of Postencephalitic Behavioral Disorder.

    Science.gov (United States)

    Fialkov, M. Jerome; And Others

    1983-01-01

    The diagnosis and treatment of a 13-year-old female who manifested postencephalitic behavioral syndrome 9 years after an acute measles infection are described, along with the history of the case. The case illustrates that an interdisciplinary approach using a single-case experimental design can be clinically effective. (SEW)

  11. Characterizing complexity in socio-technical systems: a case study of a SAMU Medical Regulation Center.

    Science.gov (United States)

    Righi, Angela Weber; Wachs, Priscila; Saurin, Tarcísio Abreu

    2012-01-01

    Complexity theory has been adopted by a number of studies as a benchmark to investigate the performance of socio-technical systems, especially those that are characterized by relevant cognitive work. However, there is little guidance on how to assess, systematically, the extent to which a system is complex. The main objective of this study is to carry out a systematic analysis of a SAMU (Mobile Emergency Medical Service) Medical Regulation Center in Brazil, based on the core characteristics of complex systems presented by previous studies. The assessment was based on direct observations and nine interviews: three of them with regulator of emergencies medical doctor, three with radio operators and three with telephone attendants. The results indicated that, to a great extent, the core characteristics of complexity are magnified) due to basic shortcomings in the design of the work system. Thus, some recommendations are put forward with a view to reducing unnecessary complexity that hinders the performance of the socio-technical system.

  12. 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

  13. Papillary proliferation of the endometrium: a clinicopathologic study of 59 cases of simple and complex papillae without cytologic atypia.

    Science.gov (United States)

    Ip, Philip P C; Irving, Julie A; McCluggage, W Glenn; Clement, Philip B; Young, Robert H

    2013-02-01

    Papillary proliferation of the endometrium (PPE) without cytologic atypia is uncommon and has only been studied in detail by Lehman and Hart in 2001. On histologic examination, PPE ranges from simple papillae with fibrovascular cores, often involving the surface of endometrial polyps, to complex intracystic proliferations; some consider the latter to be analogous to nonatypical complex hyperplasia. To further characterize PPE, with emphasis on the risk of and features associated with concurrent or subsequent neoplasia, the clinicopathologic features of 59 cases without cytologic atypia were studied. The cases were classified into 2 groups according to the degree of architectural complexity and extent of proliferation. Group 1 consisted of those with localized simple papillae. Simple papillae were defined as those with short, predominantly nonbranching stalks; those with occasional secondary branches and/or detached papillae were also included in this group. Localized proliferations were those with 1 or 2 foci involving the surface or the subjacent glands of polyps or nonpolypoid endometrium. Group 2 consisted of those with complex papillae and/or those with diffuse and crowded intracystic papillae. Complex papillae were those with either short or long stalks, with frequent secondary and complex branches. Diffuse proliferation was defined as presence of 3 or more foci within a specimen or involvement of >50% of the endometrial polyp by simple or complex PPE. Any coexistent or subsequent hyperplasia of conventional type (World Health Organization classification) or adenocarcinoma was recorded. The age of patients ranged from 23 to 82 years (median, 53 y); 36 (61%) were postmenopausal. The majority presented with abnormal vaginal bleeding. Sixteen patients (27%) were receiving hormonal preparations including 5 who were treated with a progestogen for preexisting endometrial hyperplasia or low-grade endometrioid adenocarcinoma. The histologic diagnosis of PPE was made

  14. 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

  15. 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.

  16. AFLP Markers as a tool to reconstruct complex relationships: a case study in Rosa (Rosaceae)

    NARCIS (Netherlands)

    Koopman, W.J.M.; Wissemann, V.; Cock, de K.; Huylenbroeck, van J.; Riek, de J.; Sabatino, G.J.H.; Visser, D.L.; Vosman, B.; Ritz, K.; Maes, B.; Werlemark, G.; Nybom, H.; Debener, T.; Linde, M.; Smulders, M.J.M.

    2008-01-01

    The genus Rosa has a complex evolutionary history caused by several factors, often in conjunction: extensive hybridization, recent radiation, incomplete lineage sorting, and multiple events of polyploidy. We examined the applicability of AFLP markers for reconstructing (species) relationships in

  17. 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.

  18. 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

  19. 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.

  20. 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...

  1. 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.

  2. Basal cell carcinomas of the areola-nipple complex: case reports and review of the literature.

    Science.gov (United States)

    Betti, Roberto; Martino, Patrizia; Moneghini, Laura; Vergani, Raffaelle; Tolomio, Elena; Crosti, Carlo

    2003-11-01

    Two white men 57 and 39 years old, and a 47-year-old white woman were seen with slowly developing papulo-nodular lesions of the areola-nipple complex. None of the patients presented with regional lymphadenopathy, history of trauma, or relevant sun-exposure. After excison of the mass, the histologic diagnosis of basal cell carcinoma was made. At two years of follow-up, no recurrence was evident. The low incidence of basal cell carcinoma in this particular site allows us to consider the areola-nipple complex location as unusual. Moreover, literature reports do not suggest that these BCCs have an increased potential for malignancy. The treatment options depend on the extension of the tumor and on the possible involvement of the areola-nipple complex and mammary tissue.

  3. 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.

  4. 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.

  5. Preictal dynamics of EEG complexity in intracranially recorded epileptic seizure: a case report.

    Science.gov (United States)

    Bob, Petr; Roman, Robert; Svetlak, Miroslav; Kukleta, Miloslav; Chladek, Jan; Brazdil, Milan

    2014-11-01

    Recent findings suggest that neural complexity reflecting a number of independent processes in the brain may characterize typical changes during epileptic seizures and may enable to describe preictal dynamics. With respect to previously reported findings suggesting specific changes in neural complexity during preictal period, we have used measure of pointwise correlation dimension (PD2) as a sensitive indicator of nonstationary changes in complexity of the electroencephalogram (EEG) signal. Although this measure of complexity in epileptic patients was previously reported by Feucht et al (Applications of correlation dimension and pointwise dimension for non-linear topographical analysis of focal onset seizures. Med Biol Comput. 1999;37:208-217), it was not used to study changes in preictal dynamics. With this aim to study preictal changes of EEG complexity, we have examined signals from 11 multicontact depth (intracerebral) EEG electrodes located in 108 cortical and subcortical brain sites, and from 3 scalp EEG electrodes in a patient with intractable epilepsy, who underwent preoperative evaluation before epilepsy surgery. From those 108 EEG contacts, records related to 44 electrode contacts implanted into lesional structures and white matter were not included into the experimental analysis.The results show that in comparison to interictal period (at about 8-6 minutes before seizure onset), there was a statistically significant decrease in PD2 complexity in the preictal period at about 2 minutes before seizure onset in all 64 intracranial channels localized in various brain sites that were included into the analysis and in 3 scalp EEG channels as well. Presented results suggest that using PD2 in EEG analysis may have significant implications for research of preictal dynamics and prediction of epileptic seizures.

  6. The Case for the Use of Nurse Practitioners in the Care of Children with Medical Complexity

    Directory of Open Access Journals (Sweden)

    Cheryl Samuels

    2017-04-01

    Full Text Available Although children with medically complex illness represent less than one percent of the total pediatric population, their health care expenditures and health care system utilization far exceed the numbers of other pediatric patients. Nurse practitioners, with their educational background focused on health care promotion and education, are uniquely qualified to reduce this inequity with cost effective care. Currently, nurse practitioners are used in a variety of health care settings and can provide acute and chronic care. Incorporating nurse practitioners at each step in the care of children with medical complexity can improve the quality of life for these children and their families, increase family satisfaction and decrease costs.

  7. 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.

  8. 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

  9. 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

  10. Prenatal sonographic diagnosis of limb-body wall complex: case series of a rare congenital anomaly

    Directory of Open Access Journals (Sweden)

    Arshad Bhat, MBBS, DMRD

    2016-06-01

    Full Text Available Three case reports of a rare congenital anomaly “limb-body wall complex” also known as “body stalk syndrome” are presented with prenatal ultrasonographic diagnostic features, immediate after delivery evaluation, and histopathologic analysis.

  11. 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.

  12. A Case of Generativity in a Culturally and Linguistically Complex English Language Arts Classroom

    Science.gov (United States)

    Skerrett, Allison

    2011-01-01

    This article examines an ESL English language arts teacher's conceptions of linguistic diversity, literacy learning and her role as teacher in a culturally and linguistically complex classroom. It further examines her processes of learning about, and developing curricular and pedagogical innovations to meet, her students' learning needs. The…

  13. 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…

  14. 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

  15. Design of complex architectures using a three dimension approach : the crosswork case

    NARCIS (Netherlands)

    Seguel Pérez, R.E.; Grefen, P.W.P.J.; Eshuis, H.

    2010-01-01

    In this paper, we present a three dimensional design approach of complex information systems architectures. Key element of this approach is the model transformation cube, which consists of three dimensions along which architecture models can be positioned. Industry architecture frameworks to guide

  16. Holocene glacier variability: three case studies using an intermediate-complexity climate model

    NARCIS (Netherlands)

    Weber, S.L.; Oerlemans, J.

    2003-01-01

    Synthetic glacier length records are generated for the Holocene epoch using a process-based glacier model coupled to the intermediate-complexity climate model ECBilt. The glacier model consists of a massbalance component and an ice-flow component. The climate model is forced by the insolation change

  17. 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.

  18. 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…

  19. Migraine and Complex Regional Pain Syndrome: A Case-Referent Clinical Study

    OpenAIRE

    Woldeamanuel, Yohannes W.; Cooley, Corinne; Foley-Saldena, Katharine; Cowan, Robert P.

    2017-01-01

    We studied clinical phenotype differences between migraineurs with CRPS (Mig + CRPS) and those without (Mig − CRPS). Mig + CRPS cases and Mig − CRPS referents aged ≥18 years were enrolled. Diagnosis was made in accordance with International Classification of Headache Disorders-3 beta (ICHD-3 beta) for migraine and Budapest Criteria for CRPS. Migraines both with and without aura were included. A total of 70 Mig + CRPS cases (13% males, mean age 48 years) and 80 Mig − CRPS referents (17% males,...

  20. 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 risk of exstrophy-epispadias complex in children conceived by in vitro fertilization (OR 14.0, 95% CI 6.5-30.0, p study provides evidence that 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.

  1. Central intake to improve access to physiotherapy for children with complex needs: a mixed methods case report.

    Science.gov (United States)

    Wittmeier, Kristy D M; Restall, Gayle; Mulder, Kathy; Dufault, Brenden; Paterson, Marie; Thiessen, Matthew; Lix, Lisa M

    2016-08-31

    Children with complex needs can face barriers to system access and navigation related to their need for multiple services and healthcare providers. Central intake for pediatric rehabilitation was developed and implemented in 2008 in Winnipeg Manitoba Canada as a means to enhance service coordination and access for children and their families. This study evaluates the process and impact of implementing a central intake system, using pediatric physiotherapy as a case example. A mixed methods instrumental case study design was used. Interviews were completed with 9 individuals. Data was transcribed and analyzed for themes. Quantitative data (wait times, referral volume and caregiver satisfaction) was collected for children referred to physiotherapy with complex needs (n = 1399), and a comparison group of children referred for orthopedic concerns (n = 3901). Wait times were analyzed using the Kruskal-Wallis test, caregiver satisfaction was analyzed using Fisher exact test and change point modeling was applied to examine referral volume over the study period. Interview participants described central intake implementation as creating more streamlined processes. Factors that facilitated successful implementation included 1) agreement among stakeholders, 2) hiring of a central intake coordinator, 3) a financial commitment from the government and 4) leadership at the individual and organization level. Mean (sd) wait times improved for children with complex needs (12.3(13.1) to 8.0(6.9) days from referral to contact with family, p physiotherapy (i.e., decreasing wait times) for families of children with complex needs. Future research is needed to build on this single discipline case study approach to examine changes in wait times, therapy coordination and stakeholder satisfaction within the context of continuing improvements for pediatric therapy services within the province.

  2. 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.

  3. Coordination of a complex welfare system case: rehabilitation entity in Finland.

    Science.gov (United States)

    Miettinen, Sari; Ashorn, Ulla; Lehto, Juhani; Viitanen, Elina

    2011-01-01

    The main purpose of this article is to analyse the institutional and political structures of the Finnish rehabilitation entity and the governmental efforts to improve the governance of the rehabilitation policy. Rehabilitation in Finland is a complex welfare system which has undergone several coordination attempts during the last two decades. The centrality of the coordination of this welfare system is obvious. Based on the content analysis of three Government's rehabilitation reports from 1994 to 2002 and their background papers, this article provides two main findings. First, the rehabilitation entity seems to be based on different funding strategies, different governing and different coordination models between the rehabilitation subsystems. Second, the governance discourse in the reports seems to be unchanging with a predominantly hierarchical mode. The article concludes with a discussion on the challenges to coordinate this kind of a complex welfare system as an entity and also how to overcome those challenges. Copyright © 2010 John Wiley & Sons, Ltd.

  4. 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)

  5. Therapeutic Assessment of Complex Trauma: A Single-Case Time-Series Study

    OpenAIRE

    Tarocchi, Anna; Aschieri, Filippo; Fantini, Francesca; Smith, Justin D.

    2013-01-01

    The cumulative effect of repeated traumatic experiences in early childhood incrementally increases the risk of adjustment problems later in life. Surviving traumatic environments can lead to the development of an interrelated constellation of emotional and interpersonal symptoms termed complex posttraumatic stress disorder (CPTSD). Effective treatment of trauma begins with a multimethod psychological assessment and requires the use of several evidence-based therapeutic processes, including es...

  6. 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...

  7. 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

  8. Entropy and Compression Capture Different Complexity Features: The Case of Fetal Heart Rate

    Directory of Open Access Journals (Sweden)

    João Monteiro-Santos

    2017-12-01

    Full Text Available Entropy and compression have been used to distinguish fetuses at risk of hypoxia from their healthy counterparts through the analysis of Fetal Heart Rate (FHR. Low correlation that was observed between these two approaches suggests that they capture different complexity features. This study aims at characterizing the complexity of FHR features captured by entropy and compression, using as reference international guidelines. Single and multi-scale approaches were considered in the computation of entropy and compression. The following physiologic-based features were considered: FHR baseline; percentage of abnormal long (%abLTV and short (%abSTV term variability; average short term variability; and, number of acceleration and decelerations. All of the features were computed on a set of 68 intrapartum FHR tracings, divided as normal, mildly, and moderately-severely acidemic born fetuses. The correlation between entropy/compression features and the physiologic-based features was assessed. There were correlations between compressions and accelerations and decelerations, but neither accelerations nor decelerations were significantly correlated with entropies. The %abSTV was significantly correlated with entropies (ranging between −0.54 and −0.62, and to a higher extent with compression (ranging between −0.80 and −0.94. Distinction between groups was clearer in the lower scales using entropy and in the higher scales using compression. Entropy and compression are complementary complexity measures.

  9. Dowry-related domestic violence and complex posttraumatic stress disorder: a case report.

    Science.gov (United States)

    O'Connor, Manjula

    2017-08-01

    This paper draws attention to the mental health impact of coercive practice of dowry demands, associated with domestic violence (DV) in an immigrant woman. This study was based on a case report and selective literature review. This case history illustrates the serious mental health impacts of repeated emotional and physical trauma inflicted by a husband who was dissatisfied with his wife's dowry. Bio-psycho-social / cultural aspects of mental health treatments needed to be augmented with attention to safety, advocacy, and access to support networks. Cultural factors are important determinants of mental illness. Psychiatrists need to be aware of DV and dowry when treating immigrant women.

  10. 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...

  11. 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

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

    International Nuclear Information System (INIS)

    Jeewa, Aamir; Culham, J.A.G.; Human, Derek G.

    2010-01-01

    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.)

  13. 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.)

  14. 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…

  15. Developmental Complexity in Student Conduct: An Extended Case Analysis of Student Board Members

    Science.gov (United States)

    Bittinger, Joshua D.; Reif, Gabriel; Kimball, Ezekiel W.

    2018-01-01

    College students frequently serve on boards that hear cases of alleged student misconduct. These students contribute to decisions that can affect their peers' lives and make their colleges vulnerable to litigation and negative media coverage. It is critical that student board members carefully interpret all information presented in disciplinary…

  16. Two cases of Axenfeld-Rieger syndrome, report of the complex pathology and treatment

    NARCIS (Netherlands)

    Bender, C.A.; Koudstaal, M.J.; van Elswijk, J.F.A.; Prahl, C.; Wolvius, E.B.

    2014-01-01

    The purpose of this case report is to report the orthodontic surgical treatment and subsequent dental rehabilitation in two patients with Axenfeld-Rieger syndrome. Axenfeld-Rieger syndrome is a rare autosomal dominant condition characterized by ocular, dental, craniofacial, and periumbilical

  17. 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.

  18. 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.…

  19. 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.

  20. Processing a Complex Architectural Sampling with Meshlab: the Case of Piazza della Signoria

    Science.gov (United States)

    Callieri, M.; Cignoni, P.; Dellepiane, M.; Ranzuglia, G.; Scopigno, R.

    2011-09-01

    The paper presents a recent 3D scanning project performed with long range scanning technology showing how a complex sampled dataset can be processed with the features available in MeshLab, an open source tool. MeshLab is an open source mesh processing system. It is a portable and extensible system aimed to help the processing of the typical not-so-small unstructured models that arise in 3D scanning, providing a set of tools for editing, cleaning, processing, inspecting, rendering and converting meshes. The MeshLab system started in late 2005 as a part of a university course, and considerably evolved since then thanks to the effort of the Visual Computing Lab and of the support of several funded EC projects. MeshLab gained so far an excellent visibility and distribution, with several thousands downloads every month, and a continuous evolution. The aim of this scanning campaign was to sample the façades of the buildings located in Piazza della Signoria (Florence, Italy). This digital 3D model was required, in the framework of a Regional Project, as a basic background model to present a complex set of images using a virtual navigation metaphor (following the PhotoSynth approach). Processing of complex dataset, such as the ones produced by long range scanners, often requires specialized, difficult to use and costly software packages. We show in the paper how it is possible to process this kind of data inside an open source tool, thanks to the many new features recently introduced in MeshLab for the management of large sets of sampled point.

  1. 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

  2. Pulsed Radiofrequency Treatment of Complex Regional Pain Syndrome: A Case Series

    Directory of Open Access Journals (Sweden)

    Vlad Djuric

    2014-01-01

    Full Text Available BACKGROUND: Various forms of sympathetic chain neurolysis (sympathectomy have, at one time or another, held promise as effective treatment options for complex regional pain syndrome (CRPS. Complications, such as worsening pain and the development of new pain syndromes, have prevented sympathectomy from emerging as a standard intervention. In an effort to avoid poor outcomes associated with neurolysis, pulsed radiofrequency (PRF has been proposed as a potential treatment alternative for a number of chronic neuropathic pain states, including some forms of CRPS.

  3. 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

  4. 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.

  5. 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.

  6. 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.

  7. 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.

  8. Neuropsychiatric autoimmune encephalitis without VGKC-complex, NMDAR, and GAD autoantibodies: case report and literature review.

    Science.gov (United States)

    Najjar, Souhel; Pearlman, Daniel; Devinsky, Orrin; Najjar, Amanda; Nadkarni, Siddhartha; Butler, Tracy; Zagzag, David

    2013-03-01

    We report a patient with a seronegative autoimmune panencephalitis, adding a subtype to the emerging spectrum of seronegative autoimmune encephalitis, and we review the sparse literature on isolated psychiatric presentations of autoimmune encephalitis. (A PubMed search for "seronegative autoimmune encephalitis," "nonvasculitic autoimmune inflammatory meningoencephalitis," and related terms revealed VGKC)-complex, N-methyl-D-aspartate receptor (NMDAR), and glutamic acid decarboxylase (GAD) autoantibodies. We excluded genetic, metabolic, paraneoplastic, degenerative, and infectious etiologies. The patient's symptoms remitted fully with immune therapy, but recurred in association with widespread bihemispheric brain lesions. Brain biopsy revealed mild nonvasculitic inflammation and prominent vascular hyalinization. Immune therapy with plasma exchanges cleared the MRI abnormalities but, 10 years after onset, the patient still suffers neuropsychiatric sequelae. We conclude that autoimmune panencephalitis seronegative for VGKC-complex, NMDAR, and GAD autoantibodies is a subtype of autoimmune encephalitis that can present with pure neuropsychiatric features and a normal brain MRI. Immunologic mechanisms may account for psychiatric symptoms in a subset of patients now diagnosed with classical psychotic disorders. Delay in starting immune therapy can lead to permanent neuropsychiatric sequelae. We propose a standardized classification system for the autoimmune encephalitides, integrating earlier pathology-oriented terms with more recently defined serologic and clinical phenotypes.

  9. 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.

  10. Complex pattern of colon cancer recurrence including a kidney metastasis: A case report

    OpenAIRE

    Waleczek, Helfried; Wente, Moritz N; Kozianka, Jürgen

    2005-01-01

    We report a case of a 77-year-old female with a local recurrence of cancer after right hemicolectomy which infiltrated the pancreatic head affording pancrea-toduodenectomy, who developed 3 years later recurrent tumor masses localized in the mesentery of the jejunum and in the lower pole of the left kidney. Partial nephrectomy and a segment resection of the small bowel were performed. Histological examination of both specimens revealed a necrotic metastasis of the primary carcinoma of the colo...

  11. Surgical abdomen in patients with nephrotic syndrome: complexities of differential diagnostics. 2 case reports

    OpenAIRE

    Nogaibayeva, A.; Moldakhmetova, S.; Tuganbekova, S.; Krivoruchko, N.

    2014-01-01

    INTROduCTIONANdAIMS: Differential-diagnostic search is very important at the stage of abdominal nephrotic crisis for determination of therapy tactics; as the probability of development of acute surgical pathology is very high, due to connection of infectious complications on a background of the basic pathology and immunosupression. We report 2 patients with acute onset of abdominal pain on a background of severe nephrotic syndrome (NS). METHOdS: Case 1: 20-years old man with bioptic diagnosis...

  12. 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.

  13. 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)

  14. 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

  15. Matrix elements of the electric multiple transition and relativistic correction operators in the case of complex configurations

    International Nuclear Information System (INIS)

    Kanyauskas, Yu.M.; Rudzikas, Z.B.

    1976-01-01

    Operators and their submatrix elements are studied in the framework of the electric multipole transitions of complex atoms with account of relativistic corrections of the order of the square of the fine structure constant. The analysis is performed by means of irreducible tensor operators and genealogical coefficients. It has been assumed that angular momenta of individual shells are coupled with each other according to ls, lk, jk and jj coupling. Formulas are given for the operator which causes the relativistic corrections for the single-electron multipole transition and for its submatrix element in the case of configurations with two unfilled shells. A possibility is discussed of using the formulas suggested for calculation. As follows from analysis, the relativistic correction operators even with the pure ls coupling allow intercombination transitions with ΔS equals +-1. The expressions obtained may turn out to be useful for performing calculations in the case of the intermediate type of coupling

  16. Employing the Hilbert-Huang Transform to analyze observed natural complex signals: Calm wind meandering cases

    Science.gov (United States)

    Martins, Luis Gustavo Nogueira; Stefanello, Michel Baptistella; Degrazia, Gervásio Annes; Acevedo, Otávio Costa; Puhales, Franciano Scremin; Demarco, Giuliano; Mortarini, Luca; Anfossi, Domenico; Roberti, Débora Regina; Costa, Felipe Denardin; Maldaner, Silvana

    2016-11-01

    In this study we analyze natural complex signals employing the Hilbert-Huang spectral analysis. Specifically, low wind meandering meteorological data are decomposed into turbulent and non turbulent components. These non turbulent movements, responsible for the absence of a preferential direction of the horizontal wind, provoke negative lobes in the meandering autocorrelation functions. The meandering characteristic time scales (meandering periods) are determined from the spectral peak provided by the Hilbert-Huang marginal spectrum. The magnitudes of the temperature and horizontal wind meandering period obtained agree with the results found from the best fit of the heuristic meandering autocorrelation functions. Therefore, the new method represents a new procedure to evaluate meandering periods that does not employ mathematical expressions to represent observed meandering autocorrelation functions.

  17. Development of large scale industrial complex and its pollution. Case study of Kashima area

    Energy Technology Data Exchange (ETDEWEB)

    Nagai, S

    1975-01-01

    The development of Kashima industrial complex which embraces three townships started in 1960 to promote both agricultural and industrial developments using the most advanced techniques available for environmental pollution control. The chronological development progress is described with reference to the capital investment, gross product, employment and labor supply, population, status of the use of agricultural land, annual revenue and expenditure of three townships, and township tax. The environmental pollution control policies and measures taken since 1964 are reviewed. The emphasis was placed on preliminary investigations by various means and emission standards were applied. However, many incidences of pollution damage occurred due to operational errors and accidental causes. The emission quantity of sulfur dioxide is to be reduced from 8212 N cu m/h in 1973 to 4625 N cu m/h in 1976.

  18. Rhinophyma in tuberous sclerosis complex: case report with brief review of literature

    Directory of Open Access Journals (Sweden)

    Friedrich, Reinhard E.

    2014-11-01

    Full Text Available Tuberous sclerosis or tuberous sclerosis complex (TSC is an autosomal dominant inherited disease characterized by the triad epilepsy, hamartomas (angiofibroma and reduced intellectual capacity. Phenotype can vary considerably. Almost all patients with TSC have at least one characteristic dermatologic feature. Facial angiofibroma can cause severe disfigurement. It may involve the cheeks, perioral region and nose, resulting in thick layers of nodular and pustular skin. Aesthetic surgery of the face comprises an individually adapted ablation of the affected skin regions in order to improve physical appearance. Reports on the subject of surgery for nasal angiofibroma confirm the homogenous transformation of the connective tissues by this hamartoma. Hitherto there is only one report in the literature describing the typical epithelial alterations of the nasal skin compatible with a rhinophyma and adjacent angiofibroma. Here we report the successful electrosurgical treatment of a patient with TSC and extensive sebaceous glands giving rise to a rhinophyma in close association with angiofibroma.

  19. Maintenance after a complex orthoperio treatment in a case of generalized aggressive periodontitis: 7-year result.

    Science.gov (United States)

    Zafiropoulos, Gregory-George; di Prisco, Manuela Occipite; Deli, Giorgio; Hoffmann, Oliver; Kasaj, Adrian

    2010-10-01

    Generalized aggressive periodontitis (GAgP) encompasses a distinct type of periodontal disease exhibiting much more rapid periodontal tissue destruction than chronic periodontitis. The best method for management of GAgP may include the use of both regenerative periodontal techniques and the administration of systemic antibiotics. The treatment of a case of GAgP over a period of 6.7 years is presented in this case report. Initial periodontal therapy (week 1- 32) consisted of supragingival plaque control and three appointments of scaling and root planing. Based on the periodontal pathogens isolated (5 species), the patient also received metronidazole plus amoxicillin for one week, followed 10 weeks later by metronidazole plus amoxicillin/clavulanate for one week. The patient was put on regular supportive periodontal therapy (SPT) thereafter. Orthodontic treatment was performed after completion of the initial therapy for 96 weeks. Measurements of clinical attachment level, bleeding on probing and plaque index were obtained at every examination. Antimicrobial and mechanical treatment resulted in eradication of all periopathogens and significantly improved all clinical parameters. During orthodontic treatment and active maintenance, there was no relapse of GAgP. The patient participated in SPT for 194 weeks and thereafter decided to discontinue SPT. Twenty-four months later a relapse of GAgP was diagnosed and all teeth had to be extracted. These results indicate that a combined mechanical and antimicrobial treatment approach can lead to consistent resolution of GAgP. Further studies including a larger number of cases are warranted to validate these findings.

  20. 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.

  1. Improved worst-case and liely accident definition in complex facilities for 40 CFR 68 compliance

    International Nuclear Information System (INIS)

    O'Kula, K.R., Taylor, Robert P., Jr; Hang, P.

    1997-04-01

    Many DOE facilities potentially subject to compliance with offsite consequence criteria under the 40 CFR 68 Risk Management Program house significant inventories of toxic and flammable chemicals. The accident progression event tree methodology is suggested as a useful technical basis to define Worst-Case and Alternative Release Scenarios in facilities performing operations beyond simple storage and/or having several barriers between the chemical hazard and the environment. For multiple chemical release scenarios, a chemical mixture methodology should be applied to conservatively define concentration isopleths. In some instances, the region requiring emergency response planning is larger under this approach than if chemicals are treated individually

  2. 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.)

  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. The use of cinacalcet in pregnancy to treat a complex case of parathyroid carcinoma.

    Science.gov (United States)

    Nadarasa, K; Bailey, M; Chahal, H; Raja, O; Bhat, R; Gayle, C; Grossman, A B; Druce, M R

    2014-01-01

    We present the case of a patient with metastatic parathyroid carcinoma whose hypercalcaemia was medically managed through two pregnancies. The diagnosis was made when the patient presented with chronic knee pain and radiological findings consistent with a brown tumour, at the age of 30. Her corrected calcium and parathyroid hormone (PTH) levels were significantly elevated. Following localisation studies, a right parathyroidectomy was performed with histology revealing parathyroid carcinoma, adherent to thyroid tissue. Aged 33, following biochemical recurrence of disease, the patient underwent a second operation. A subsequent CT and FDG-PET revealed bibasal pulmonary metastases. Aged 35, the patient was referred to our unit for treatment of persistent hypercalcaemia. The focus of treatment at this time was debulking metastatic disease using radiofrequency ablation. Despite advice to the contrary, the patient conceived twice while taking cinacalcet. Even though there are limited available data regarding the use of cinacalcet in pregnancy, both pregnancies continued to term with the delivery of healthy infants, using intensive medical management for persistent hypercalcaemia. Parathyroid carcinoma is a rare cause of primary hyperparathyroidism.Hypercalcaemia during pregnancy can result in significant complications for both the mother and the foetus.The use of high-dose cinacalcet in pregnancy has been shown, in this case, to aid in the management of resistant hypercalcaemia without teratogenicity.

  5. Migraine and Complex Regional Pain Syndrome: A Case-Referent Clinical Study

    Science.gov (United States)

    Cooley, Corinne; Foley-Saldena, Katharine; Cowan, Robert P.

    2017-01-01

    We studied clinical phenotype differences between migraineurs with CRPS (Mig + CRPS) and those without (Mig − CRPS). Mig + CRPS cases and Mig − CRPS referents aged ≥18 years were enrolled. Diagnosis was made in accordance with International Classification of Headache Disorders-3 beta (ICHD-3 beta) for migraine and Budapest Criteria for CRPS. Migraines both with and without aura were included. A total of 70 Mig + CRPS cases (13% males, mean age 48 years) and 80 Mig − CRPS referents (17% males, mean age 51 years) were included. 33% of Mig + CRPS and 38% of Mig − CRPS exhibited episodic migraine (EM) while 66% of Mig + CRPS and 62% of Mig − CRPS had chronic migraine (CM) (OR = 0.98, CI 0.36, 2.67). Median duration of CRPS was 3 years among EM + CRPS and 6 years among CM + CRPS cohort (p CRPS (57%) carried higher psychological and medical comorbidities compared to Mig − CRPS (6%) (OR 16.7, CI 10.2, 23.6). Higher migraine frequency was associated with longer CRPS duration. Migraineurs who developed CRPS had higher prevalence of psychological and medical disorders. Alleviating migraineurs' psychological and medical comorbidities may help lower CRPS occurrence. PMID:29214172

  6. 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.

  7. 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.

  8. Treatment of complex regional pain syndrome type 1 in a pediatric patient using the lidocaine patch 5%: a case report

    Directory of Open Access Journals (Sweden)

    Steven G Frost, MD

    2003-09-01

    Full Text Available Background: Successful treatment of complex regional pain syndrome type 1 (CRPS-1 requires a coordinated, multidisciplinary approach. Physical rehabilitation is an important component of long-term treatment. Unfortunately, patients with significant allodynia or hyperalgesia characteristic of CRPS-1 often have difficulty progressing through a physical therapy (PT regimen. In most adults with CRPS-1, the treatment of choice is PO opioids. Objective: This article presents a case report of the use of the lidocaine patch 5%, a targeted peripheral analgesic, in a pediatric patient and its effects on reducing pain, improving the patient's overall attitude, and facilitating compliance with ongoing PT. Results: A 10-year-old girl developed CRPS-1 after arthroscopic surgery for a sprained ankle. Attempts at PT were unsuccessful due to inadequate pain relief from various treatment modalities. Therapy with the lidocaine patch 5% was initiated and resulted in significant pain relief, improvements in the patient's attitude, and progress with PT. Conclusion: This case report of a child with CRPS-1 showed that therapy with lidocaine patch 5% may be efficacious in treating children with pain resulting from CRPS-1, thereby increasing the success of PT. Keywords: complex regional pain syndrome, lidocaine patch 5%, targeted peripheral analgesic, pediatrics

  9. Electroencephalographic evoked pain response is suppressed by spinal cord stimulation in complex regional pain syndrome: a case report.

    Science.gov (United States)

    Hylands-White, Nicholas; Duarte, Rui V; Beeson, Paul; Mayhew, Stephen D; Raphael, Jon H

    2016-12-01

    Pain is a subjective response that limits assessment. The purpose of this case report was to explore how the objectivity of the electroencephalographic response to thermal stimuli would be affected by concurrent spinal cord stimulation. A patient had been implanted with a spinal cord stimulator for the management of complex regional pain syndrome of both hands for 8 years. Following ethical approval and written informed consent we induced thermal stimuli using the Medoc PATHWAY Pain & Sensory Evaluation System on the right hand of the patient with the spinal cord stimulator switched off and with the spinal cord stimulator switched on. The patient reported a clinically significant reduction in thermal induced pain using the numerical rating scale (71.4 % reduction) with spinal cord stimulator switched on. Analysis of electroencephalogram recordings indicated the occurrence of contact heat evoked potentials (N2-P2) with spinal cord stimulator off, but not with spinal cord stimulator on. This case report suggests that thermal pain can be reduced in complex regional pain syndrome patients with the use of spinal cord stimulation and offers objective validation of the reported outcomes with this treatment.

  10. 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

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

    DEFF Research Database (Denmark)

    Ellegaard, Chris

    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......Companies are increasingly relying on suppliers when developing and manufacturing industrial products. Therefore the supplier relationships of the company need to be managed. This dissertation looks at existing theoretical approaches to supplier relationship management. By studying a number...... 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...

  12. 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.

  13. 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.

  14. 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...

  15. 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.

  16. 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.

  17. 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.

  18. 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)

  19. 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.

  20. 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)

  1. 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.

  2. 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.

  3. Search strategy in a complex and dynamic environment (the Indian Ocean case)

    Science.gov (United States)

    Loire, Sophie; Arbabi, Hassan; Clary, Patrick; Ivic, Stefan; Crnjaric-Zic, Nelida; Macesic, Senka; Crnkovic, Bojan; Mezic, Igor; UCSB Team; Rijeka Team

    2014-11-01

    The disappearance of Malaysia Airlines Flight 370 (MH370) in the early morning hours of 8 March 2014 has exposed the disconcerting lack of efficient methods for identifying where to look and how to look for missing objects in a complex and dynamic environment. The search area for plane debris is a remote part of the Indian Ocean. Searches, of the lawnmower type, have been unsuccessful so far. Lagrangian kinematics of mesoscale features are visible in hypergraph maps of the Indian Ocean surface currents. Without a precise knowledge of the crash site, these maps give an estimate of the time evolution of any initial distribution of plane debris and permits the design of a search strategy. The Dynamic Spectral Multiscale Coverage search algorithm is modified to search a spatial distribution of targets that is evolving with time following the dynamic of ocean surface currents. Trajectories are generated for multiple search agents such that their spatial coverage converges to the target distribution. Central to this DSMC algorithm is a metric for the ergodicity.

  4. 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.

  5. 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.

  6. 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.

  7. POD evaluation using simulation: A phased array UT case on a complex geometry part

    Science.gov (United States)

    Dominguez, Nicolas; Reverdy, Frederic; Jenson, Frederic

    2014-02-01

    The use of Probability of Detection (POD) for NDT performances demonstration is a key link in products lifecycle management. The POD approach is to apply the given NDT procedure on a series of known flaws to estimate the probability to detect with respect to the flaw size. A POD is relevant if and only if NDT operations are carried out within the range of variability authorized by the procedure. Such experimental campaigns require collection of large enough datasets to cover the range of variability with sufficient occurrences to build a reliable POD statistics, leading to expensive costs to get POD curves. In the last decade research activities have been led in the USA with the MAPOD group and later in Europe with the SISTAE and PICASSO projects based on the idea to use models and simulation tools to feed POD estimations. This paper proposes an example of application of POD using simulation on the inspection procedure of a complex -full 3D- geometry part using phased arrays ultrasonic testing. It illustrates the methodology and the associated tools developed in the CIVA software. The paper finally provides elements of further progress in the domain.

  8. Analysis of twenty pediatric cases of tuberous sclerosis complex: Are we doing enough?

    Directory of Open Access Journals (Sweden)

    Jyoti Nath

    2015-01-01

    Full Text Available Background: Tuberous sclerosis complex (TSC is a neuro-cutaneous disease characterized by hamartoma formation in various organs particularly the skin, brain, eye, kidney, heart and lungs. Patients usually have multisystem involvement and thus present to different medical specialties with varied complaints while the true nature of the disease and the hidden manifestations may remain unattended. A im: To assess the frequency and characteristics of various cutaneous and systemic manifestations in TSC and the total impact on different system in a cohort of pediatric patients. Methods: The study included 20 patients fulfilling the diagnostic criteria for TSC from dermatology, pediatrics, and neurology department. Detailed history, examination, and investigations such as chest X-ray, electrocardiography (ECG, ultrasonography (USG abdomen, echocardiography, fundoscopy, computed tomography (CT scan of brain and abdomen were done. Results: Dermatological manifestations included ash leaf macules, angiofibromas, shagreen patch, and fibrous plaque. Systemic findings observed were subependymal calcified nodules, subependymal giant cell astrocytoma, cortical tubers, renal cysts, angiomyolipomas, lung cyst, retinal hamartomas, mental deficits and epilepsy. Limitations: Wechsler′s Intelligence Scale for Children would have been more appropriate for assessing the intelligence. Dental check-up was not done in our group of patients. Conclusion: Our study highlights the wide variety of cutaneous and systemic manifestations of TSC. The study emphasizes the need for comprehensive multidisciplinary treatment and periodic follow-up which are necessary for appropriate management of this multisystem disorder. Counseling regarding education and rehabilitation of the patients and genetic counseling of parents are important.

  9. Connectivity among sinkholes and complex networks: The case of Ring of Cenotes in northwest Yucatan, Mexico

    Science.gov (United States)

    Gomez-Nicolas, Mariana; Rebolledo-Vieyra, Mario; Huerta-Quintanilla, Rodrigo; Canto-Lugo, Efrain

    2014-05-01

    A 180-km-diameter semicircular alignment of abundant karst sinkholes (locally known as cenotes) in northwestern Yucatán, México, coincides approximately with a concentric ring of the buried Chicxulub structure, a circular feature manifested in Cretaceous and older rocks, that has been identified as the product of the impact of a meteorite. The secondary permeability generated by the fracturing and faulting of the sedimentary sequence in the Chicxulub impact, has favored the karstification process and hence the development of genuine underground rivers that carry water from the continent to the sea. The study of the structure and morphology of the crater has allowed researchers to understand the key role of the crater in the Yucatán hydrogeology. It is generally accepted that the Ring of Cenotes, produced by the gravitational deformation of the Tertiary sedimentary sequence within the crater, controls the groundwater in northern Yucatán. However, today there is not solid evidence about the connectivity among cenotes, which is important because if established, public policies could be designed to manage sanitary infrastructure, septic control, regulation of agricultural and industrial activities and the protection of water that has not been compromised by anthropogenic pollution. All these directly affect more than half a million people whose main source of drinking water lies in the aquifer. In this contribution we investigated a set of 16 cenotes located in the vicinity of a gravimetric anomaly of Chicxulub crater ring, using complex networks to model the interconnectivity among them. Data from a geoelectrical tomography survey, collected with SuperSting R1/IP equipment, with multi-electrodes (72 electrodes), in a dipole-dipole configuration was used as input of our model. Since the total number of cenotes on the ring structure amounts to about 2000, the application of graph theoretic algorithms and Monte Carlo simulation to efficiently investigate network

  10. 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

  11. 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.

  12. 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.

  13. 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.

  14. Numerical model for mapping of complex hydrogeological conditions: the Chmielnik area (South Poland) case study

    Science.gov (United States)

    Buszta, Kamila; Szklarczyk, Tadeusz; Malina, Grzegorz

    2017-04-01

    Detailed analysis of hydrogeological conditions at a study area is the basis for characterising adjacent groundwater circulation systems. It is also an essential element during executing hydrogeological documentations. The goal of this work was to reconstruct on a numerical model natural groundwater circulation systems of the studied area located within the municipality of Chmielnik in the region of Kielce (South Poland). The area is characterized by a complex geological structure, which along with the existing hydrographic network, makes the scheme of groundwater circulation complicated and difficult to map on a numerical model. The studied area is situated at the border of three geological units: on the North - the extended portion of the Palaeozoic Swietokrzyskie Mountains (mainly Devonian and Permian), in the center - the S-W part of the Mesozoic Margin of the Swietokrzyskie Mountains, and on the South - a marginal zone of the Carpathian Foredeep. The whole area belongs to the Vistula river basin, and it includes catchments of its left tributaries: the Nida and Czarna Staszowska rivers. Based on the collected field and archival hydrogeological, hydrological and sozological data a conceptual model was built, under which a numerical model of groundwater flow was developed using the specialized software - Visual MODFLOW. The numerical model maps the five-layer groundwater circulation system in conjunction with surface watercourses. Such division reflects appropriately the variability of hydrogeological parameters within the geological structures. Two principal and exploited aquifers comprise: a fractured-porous Neogene and fractured Upper Jurassic formations. The external model borders are based primarily on surface watercourses and locally on watersheds. The modelled area of 130 km2 was divided into square grids of 50 m. The model consists of 275 rows and 277 columns. Each of five layers was simulated with the same number of active blocks. In the construction of

  15. 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.

  16. Recurrent Factitious Subcutaneous Emphysema: Report of a Complex Case in a Young Woman and a Literature Review

    Directory of Open Access Journals (Sweden)

    Yi-Pei Lee

    2010-07-01

    Full Text Available Subcutaneous emphysema (SE can be caused by antecedent trauma, surgery, rupture of visceral organs or serious infection from gas-forming microorganisms. Factitious SE is very rare; only about a dozen cases have been reported. Most patients had an underlying psychiatric condition or relevant history. The diagnosis and management of factitious SE are challenging. We report a new case of factitious SE with a very complex clinical course. A 29-year-old woman was seen at consultation for recurrent attacks of painful soft tissue swelling, affecting her chest wall, abdomen and neck over several months. Factitious disease was suspected because of the negative medical history of identifiable visceral perforations or gas-forming infections and the presence of multiple bizarre linear scars on the arm. This was supported by finding multiple recent puncture marks on the neck, chest and upper extremities on close inspection. The patient's history was remarkable for multiple stressful events in her life, frequent job changes, substance abuse and suicide attempts. Psychiatric evaluation revealed adjustment disorder with depression and anxiety, cluster B personality with bipolar II disorder and substance abuse. During the 1-year period, she had 20 visits to our ER for attacks of SE affecting various parts of her body. This case illustrates that self-infliction should be suspected in a patient presenting with medically unexplained recurrent SE and a hollow history, and one should search for puncture marks to support the diagnosis.

  17. 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] ...

  18. Case Study of High-Dose Ketamine for Treatment of Complex Regional Pain Syndrome in the Pediatric Intensive Care Unit.

    Science.gov (United States)

    Pasek, Tracy Ann; Crowley, Kelli; Campese, Catherine; Lauer, Rachel; Yang, Charles

    2017-06-01

    Complex regional pain syndrome (CRPS) is a life-altering and debilitating chronic pain condition. The authors are presenting a case study of a female who received high-dose ketamine for the management of her CRPS. The innovative treatment lies not only within the pharmacologic management of her pain, but also in the fact that she was the first patient to be admitted to our pediatric intensive care unit solely for pain control. The primary component of the pharmacotherapy treatment strategy plan was escalating-dose ketamine infusion via patient-controlled-analgesia approved by the pharmacy and therapeutics committee guided therapy for this patient. The expertise of advanced practice nurses blended exquisitely to ensure patient and family-centered care and the coordination of care across the illness trajectory. The patient experienced positive outcomes. Copyright © 2017 Elsevier Inc. All rights reserved.

  19. 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.

  20. 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.

  1. 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.

  2. 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.

  3. 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.

  4. 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.

  5. Sickle cell disease and complex congenital cardiac surgery: a case report and review of the pathophysiology and perioperative management.

    Science.gov (United States)

    Sanders, D B; Smith, B P; Sowell, S R; Nguyen, D H; Derby, C; Eshun, F; Nigro, J J

    2014-03-01

    Sickle cell anemia and thalassemia are hemoglobinopathies rarely encountered in the United States. Compounded with congenital heart disease, patients with sickle cell disease (SCD) requiring cardiopulmonary bypass and open-heart surgery represent the proverbial "needle in the haystack". As such, there is some trepidation on the part of clinicians when these patients present for complex cardiac surgery. SCD is an autosomal, recessive condition that results from a single nucleotide polymorphism in the β-globin gene. Hemoglobin SS molecules (HgbSS) with this point mutation can polymerize under the right conditions, stiffening the erythrocyte membrane and distorting the cellular structure to the characteristic sickle shape. This shape change alters cellular transit through the microvasculature. As a result, circumstances such as hypoxia, hypothermia, acidosis or diminished blood flow can lead to aggregation, vascular occlusion and thrombosis. Chronically, SCD can give rise to multiorgan damage secondary to hemolysis and vascular obstruction. This review and case study details an 11-year-old African-American male with known SCD who presented to the cardiothoracic surgical service with congenital heart disease consisting of an anomalous, intramural right coronary artery arising from the left coronary sinus for surgical consultation and subsequent surgical correction. This case report will include a review of the pathophysiology and current literature regarding preoperative, intraoperative and postoperative management of SCD patients.

  6. 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.

  7. 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

  8. 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

  9. Cushing's Syndrome caused by pigmented adrenocortical micro nodular dysplasia - A familial case

    Energy Technology Data Exchange (ETDEWEB)

    Gomez-Segovia, I; Gallowitsch, H J; Kresnik, E; Kumnig, G; Mikosch, P; Lind, P [Dept.of Nuclear Medicine and Endocrinology, LKH Klagenfurt (Austria)

    2002-09-01

    Introduction: We present a Case of Cushing's syndrome (CS) in a 16 year old male adolescent. Adrenocortical micro nodular dysplasia is a rare cause of CS. It mostly develops in the first two decades of life. In pathogenesis a stimulatory effect of circulating Immunoglobulins on adrenal steroidogenesis has been postulated. Familial cases have been reported in relation to Carney's Syndrome. We report the clinical case at first diagnosis and preoperative follow up of 1 year prior to treatment. The leading symptoms were severe bilateral (fibrotic) gynaecomastia, weight gain and growth retardation, without hypertension,but osteoporosis, secondary hypogonadism and glucose intolerance. Laboratory findings and the results of functional tests were diagnostic for CS. In addition LDH (I-131 Isotopes), CK, Lipoproteins, GPT, Androstendion, Prolactin were elevated. MRI abdomen revealed a slight enlargement of the adrenals, and suspected a bilateral micro nodular dysplasia. Iodo-cholesterol-scan under dexamethason suppression showed a diffuse bilateral Iodo-cholesterol uptake confirming the autonomous production of cortisol bilateral in the adrenals.Whole body bone scan showed a diffuse reduced diphosphonate uptake in the skeleton and the growth plates. The bone mineral density was significantly reduced.Radiologically osteoporosis was overt. The rapid increase of free urinary cortisol excretion/24h within one year of observation led to a total bilateral adrenalectomy. Postoperative 5 year follow up examinations. Documentation of the outcome and recovery of clinical signs,symptoms and laboratory findings, discussion about the most appropriate long-term substitution therapy. Familial anamnesis:affected family member was the father (micro nodular bilateral adrenocortical dysplasia), the aunt (pararenal incidentaloma, histologically lipoma) and a cousin (micro nodular adrenocortical dysplasia). Sequential analysis of the menin gene from the patient was negative.The detection of

  10. Cushing's Syndrome caused by pigmented adrenocortical micro nodular dysplasia - A familial case

    International Nuclear Information System (INIS)

    Gomez-Segovia, I.; Gallowitsch, H.J.; Kresnik, E.; Kumnig, G.; Mikosch, P.; Lind, P.

    2002-01-01

    Introduction: We present a Case of Cushing's syndrome (CS) in a 16 year old male adolescent. Adrenocortical micro nodular dysplasia is a rare cause of CS. It mostly develops in the first two decades of life. In pathogenesis a stimulatory effect of circulating Immunoglobulins on adrenal steroidogenesis has been postulated. Familial cases have been reported in relation to Carney's Syndrome. We report the clinical case at first diagnosis and preoperative follow up of 1 year prior to treatment. The leading symptoms were severe bilateral (fibrotic) gynaecomastia, weight gain and growth retardation, without hypertension,but osteoporosis, secondary hypogonadism and glucose intolerance. Laboratory findings and the results of functional tests were diagnostic for CS. In addition LDH (I-131 Isotopes), CK, Lipoproteins, GPT, Androstendion, Prolactin were elevated. MRI abdomen revealed a slight enlargement of the adrenals, and suspected a bilateral micro nodular dysplasia. Iodo-cholesterol-scan under dexamethason suppression showed a diffuse bilateral Iodo-cholesterol uptake confirming the autonomous production of cortisol bilateral in the adrenals.Whole body bone scan showed a diffuse reduced diphosphonate uptake in the skeleton and the growth plates. The bone mineral density was significantly reduced.Radiologically osteoporosis was overt. The rapid increase of free urinary cortisol excretion/24h within one year of observation led to a total bilateral adrenalectomy. Postoperative 5 year follow up examinations. Documentation of the outcome and recovery of clinical signs,symptoms and laboratory findings, discussion about the most appropriate long-term substitution therapy. Familial anamnesis:affected family member was the father (micro nodular bilateral adrenocortical dysplasia), the aunt (pararenal incidentaloma, histologically lipoma) and a cousin (micro nodular adrenocortical dysplasia). Sequential analysis of the menin gene from the patient was negative.The detection of

  11. Complex pelvic ring injuries associated with floating knee in a poly-trauma patient: A case report.

    Science.gov (United States)

    Zhou, Yuebin; Guo, Honggang; Cai, Zhiwei; Zhang, Yuan

    2017-12-01

    Complex pelvic ring fracture associated with floating knee is comparatively rare which usually results from high-energy trauma including vehicle-related accidence, falls from height, and earthquake-related injury. To our knowledge, few literatures have documented such injuries in the individual patient. Management of both injuries present challenges for surgical management and postoperative care. The purpose of this study is to prove the feasibility and benefits of damage control orthopedics (DCO). Our case involved a 45-year-old lady who was hit by a dilapidated building. The patient was anxious, pale and hemodynamically stable at the initial examination. The pelvis was unstable and there were obvious deformities in the left lower extremities. Significant degloved injuries in the left leg were noted. Her radiographs and physical examination verified the above signs. Unstable pelvic fractures, multiple fractures of bilateral lower limbs with floating knee injury, multiple pelvic and rib fractures and multiple degloving injuries and soft tissue contusion formed the characteristics of the multiple-injury. The algorithm of DCO was determined as the treatment. Early simplified procedures such as wound debridement, pelvis fixation, closed reduction and EF of the right shoulder joint, and chest wall fixation were conducted as soon as possible. After a period of time, internal fixations were applied to the fracture sites. The subsequent functional exercise was also conducted in accordance with this algorithm. This patient got recovery after the treatments which were guided by the criterion of DCO. The restoration of limb functional and the quality of life greatly improved. The DCO plays a decisive role in the first aid and follow-up treatment of this patient. The guidelines of management of complex pelvic ring injuries and floating knee should be established by authorities.

  12. When should we test for voltage-gated potassium channel complex antibodies? A retrospective case control study.

    Science.gov (United States)

    O'Sullivan, B J; Steele, T; Ellul, M A; Kirby, E; Duale, A; Kier, G; Crooks, D; Jacob, A; Solomon, T; Michael, B D

    2016-11-01

    Patients with voltage-gated potassium channel (VGKC)-complex antibodies are increasingly recognized as having central, peripheral or combined phenotypes. With increasing awareness, more patients are tested and the clinical spectrum is expanding. Consequently, clinicians may be uncertain as to which patients should or should not be tested. Previous studies have identified common clinical features, but none has looked at the usefulness of these in predicting seropositive disease. We conducted a case-control study of patients tested for VGKC-complex antibodies over 10years at a regional tertiary neurology centre determining which clinical/biochemical features were associated with antibody-positive disease. We found a marked increase in the numbers tested, although the percentage positive remained low. Antibody titre was highest in central disease (pVGKC-disease (p=0.01). Seizures were present in 11 (69%) of those with VGKC-disease versus three (18%) without (odds ratio [OR] 10.3, 95% confidence interval [CI]: 2.0-52.7, p=0.005). There was an inverse correlation between the antibody titre and serum sodium. A multivariate model selected seizures and hyponatraemia as predictive of VGKC disease (sensitivity 75% and specificity 82%); faciobrachial dystonic movements were specific but insensitive. Interestingly serum alkaline phosphatase was higher in those with VGKC-disease (p=0.016) and highest in those with peripheral disease (p=0.015). An ALP>70u/L was strongly associated with antibody positivity (OR 4.11 95% CI: 1.43-11.8, p=0.007) with a sensitivity of 74.2%. The presence of seizures, faciobrachial movements, and hyponatraemia should raise suspicion of VGKC-disease; alkaline phosphatase may represent a novel biomarker, particularly in those with peripheral disease. Copyright © 2016 Elsevier Ltd. All rights reserved.

  13. 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

  14. 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

  15. [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.

  16. 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.

  17. 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 ).

  18. 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

  19. Do All X-ray Structures of Protein-Ligand Complexes Represent Functional States? EPOR, a Case Study.

    Science.gov (United States)

    Corbett, Michael S P; Mark, Alan E; Poger, David

    2017-02-28

    Based on differences between the x-ray crystal structures of ligand-bound and unbound forms, the activation of the erythropoietin receptor (EPOR) was initially proposed to involve a cross-action scissorlike motion. However, the validity of the motions involved in the scissorlike model has been recently challenged. Here, atomistic molecular dynamics simulations are used to examine the structure of the extracellular domain of the EPOR dimer in the presence and absence of erythropoietin and a series of agonistic or antagonistic mimetic peptides free in solution. The simulations suggest that in the absence of crystal packing effects, the EPOR chains in the different dimers adopt very similar conformations with no clear distinction between the agonist and antagonist-bound complexes. This questions whether the available x-ray crystal structures of EPOR truly represent active or inactive conformations. The study demonstrates the difficulty in using such structures to infer a mechanism of action, especially in the case of membrane receptors where just part of the structure has been considered in addition to potential confounding effects that arise from the comparison of structures in a crystal as opposed to a membrane environment. The work highlights the danger of assigning functional significance to small differences between structures of proteins bound to different ligands in a crystal environment without consideration of the effects of the crystal lattice and thermal motion. Copyright © 2017 Biophysical Society. Published by Elsevier Inc. All rights reserved.

  20. 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

  1. 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

  2. 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.

  3. 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.

  4. 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.

  5. 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

  6. Sources and timing of pyroxenite formation in the sub-arc mantle: Case study of the Cabo Ortegal Complex, Spain

    Science.gov (United States)

    Tilhac, Romain; Grégoire, Michel; O'Reilly, Suzanne Y.; Griffin, William L.; Henry, Hadrien; Ceuleneer, Georges

    2017-09-01

    on the sources of the metasomatic agents involved (and potentially the parental melts) and notably indicate the contributions from enriched mantle components (EM I and/or II). This suggests the involvement of an old crustal component, which is consistent with the derivation of the pyroxenites and granulites from an ensialic island arc, potentially built on the northern margin of either Gondwana or a pre-Gondwanan continental block. This case study thus documents the role of melt-rock reactions as major pyroxenite-forming processes in the sub-arc mantle, providing further constraints on their sources and timing in the Cabo Ortegal Complex.

  7. Coral reefs in an urban embayment in Hawaii: a complex case history controlled by natural and anthropogenic stress

    Science.gov (United States)

    Grigg, R. W.

    1995-11-01

    The effects of natural and anthropogenic stress need to be separated before coral reef ecosystems can be effectively managed. In this paper, a 25 year case history of coral reefs in an urban embayment (Mamala Bay) off Honolulu, Hawaii is described and differences between natural and man-induced stress are distinguished. Mamala Bay is a 30 km long shallow coastal bay bordering the southern (leeward) shore of Oahu and the city of Honolulu in the Hawaiian Islands. During the last 25 years, this area has been hit by two magnitude 5 hurricane events (winds > 240 km/h) generating waves in excess of 7.5 m. Also during this period, two large sewer outfalls have discharged up to 90 million gallons per day (mgd) or (360 × 106 L/day) of point source pollution into the bay. Initially the discharge was raw sewage, but since 1977 it has received advanced primary treatment. Non-point source run-off from the Honolulu watershed also enters the bay on a daily basis. The results of the study show that discharge of raw sewage had a serious but highly localized impact on shallow (˜10 m) reef corals in the bay prior to 1977. After 1977, when treatment was upgraded to the advanced primary level and outfalls were extended to deep water (> 65 m), impacts to reef corals were no longer significant. No measurable effects of either point or non-point source pollution on coral calcification, growth, species composition, diversity or community structure related to pollution can now be detected. Conversely the effects of hurricane waves in 1982 and 1992 together caused major physical destruction to the reefs. In 1982, average coral cover of well-developed offshore reefs dropped from 60-75% to 5-15%. Only massive species in high relief areas survived. Today, recovery is occurring, and notwithstanding major future disturbance events, long-term biological processes should eventually return the coral ecosystems to a more mature successional stage. This case history illustrates the complex nature of

  8. Dynamic Parameter Identification of Subject-Specific Body Segment Parameters Using Robotics Formalism: Case Study Head Complex.

    Science.gov (United States)

    Díaz-Rodríguez, Miguel; Valera, Angel; Page, Alvaro; Besa, Antonio; Mata, Vicente

    2016-05-01

    Accurate knowledge of body segment inertia parameters (BSIP) improves the assessment of dynamic analysis based on biomechanical models, which is of paramount importance in fields such as sport activities or impact crash test. Early approaches for BSIP identification rely on the experiments conducted on cadavers or through imaging techniques conducted on living subjects. Recent approaches for BSIP identification rely on inverse dynamic modeling. However, most of the approaches are focused on the entire body, and verification of BSIP for dynamic analysis for distal segment or chain of segments, which has proven to be of significant importance in impact test studies, is rarely established. Previous studies have suggested that BSIP should be obtained by using subject-specific identification techniques. To this end, our paper develops a novel approach for estimating subject-specific BSIP based on static and dynamics identification models (SIM, DIM). We test the validity of SIM and DIM by comparing the results using parameters obtained from a regression model proposed by De Leva (1996, "Adjustments to Zatsiorsky-Seluyanov's Segment Inertia Parameters," J. Biomech., 29(9), pp. 1223-1230). Both SIM and DIM are developed considering robotics formalism. First, the static model allows the mass and center of gravity (COG) to be estimated. Second, the results from the static model are included in the dynamics equation allowing us to estimate the moment of inertia (MOI). As a case study, we applied the approach to evaluate the dynamics modeling of the head complex. Findings provide some insight into the validity not only of the proposed method but also of the application proposed by De Leva (1996, "Adjustments to Zatsiorsky-Seluyanov's Segment Inertia Parameters," J. Biomech., 29(9), pp. 1223-1230) for dynamic modeling of body segments.

  9. Anti tumor necrosis factor - alpha adalimumab for complex regional pain syndrome type 1 (CRPS-I): a case series.

    Science.gov (United States)

    Eisenberg, Elon; Sandler, Ifat; Treister, Roi; Suzan, Erica; Haddad, May

    2013-11-01

    Evidence suggests tumor necrosis factor-alpha (TNF-α) mediates, at least in part, symptoms and signs in complex regional pain syndrome (CRPS). Here, we present a case series of patients with CRPS type 1, in whom the response to the anti-TNF-α adalimumab was assessed. Ten patients with CRPS type 1 were recruited. Assessments were performed before treatment, at 1 week, and 1, 3, and 6 months following 3 biweekly subcutaneous injections (40 mg/0.8 mL) adalimumab (Humira(®) ) and included the followings: Pain intensity using a 0-10 cm visual analog scale; the Short Form of the McGill Pain Questionnaire; the Beck Depression Inventory; the SF-36 questionnaire and mechanical and thermal thresholds (Von frey hair and Thermal Sensory Analyzer, respectively). In addition to the description of individual patient responses, both intention to treat (ITT) and per-protocol (PP) analyses were performed for the entire group. Three subgroups of patients were identified (3 patients in each): "nonresponders", "partial responders", and "robust responders" in whom improvement in almost all parameters was noted. Both the ITT and PP analyses demonstrated only a trend toward improvement in mechanical pain thresholds following treatment (ITT χ² = 13.83, P = 0.008; PP χ² = 10.29, P = 0.036). These results suggest adalimumab, and possibly other anti-TNF-α, can be potentially useful in some (although not in all) patients with CRPS type 1. These preliminary results along with the growing body of evidence which points to the involvement of TNF-α in the pathogenesis of CRPS justify further studies in this area. © 2013 World Institute of Pain.

  10. Complex landslides in the Trans-Mexican Volcanic Belt - a case study in the State of Veracruz

    Science.gov (United States)

    Wilde, M.; Terhorst, B.; Schwindt, D.; Rodriguez Elizarrarás, S. R.; Morales Barrera, W. V.; Bücker, M.; Flores Orozco, A.; García García, E.; Pita de la Paz, C.

    2017-12-01

    The State of Veracruz (Mexico) is a region which is highly affected by landslides, therefore detailed studies on triggering factors and process dynamics of landslides are required. Profound insights are essential for further hazard assessments and compilation of susceptibility maps. Exemplary landslide sites were investigated in order to determine characteristic features of specific regions. In the Chiconquiaco Mountain Range numerous damaging landslide events occurred in the year of 2013 and our case study corresponds to a deep-seated landslide originating from this slide-intensive year. The main scientific aspects are placed on the reconstruction of the landslides geometry and its process dynamics. Therefore, surface and subsurface analysis form the base of a multimethodological approach. In order to perform surface analysis, aerial photographs were collected by an unmanned aerial vehicle (UAV) aiming at the generation of a 3D model with the Structure from Motion (SfM) work routine. Ground control points (GCP) were used to ensure the geometric accuracy of the model. The obtained DEM of the 2013 slide mass as well as an elevation model representing the topographic situation before the event (year 2011) were used to detect surface changes. The data enabled determination of the most affected areas as well as areas characterized by secondary movements. Furthermore, the volume of the slide mass could be calculated. Geophysical methods, as electrical resistivity tomography (ERT) as well as seismic refraction tomography (SRT), were applied for subsurface analysis. Differences in subsurface composition, respectively density, allowed for separation of the slide mass and the underlying unit. Most relevant for our studies is the detection of an earlier landslide leading to the assumption that the 2013 landslide event corresponds to a reactivation process. This multimethodological approach enables a far-reaching visualization of complex landslides and strongly supports the

  11. Universal Plant DNA Barcode Loci May Not Work in Complex Groups: A Case Study with Indian Berberis Species

    Science.gov (United States)

    Roy, Sribash; Tyagi, Antariksh; Shukla, Virendra; Kumar, Anil; Singh, Uma M.; Chaudhary, Lal Babu; Datt, Bhaskar; Bag, Sumit K.; Singh, Pradhyumna K.; Nair, Narayanan K.; Husain, Tariq; Tuli, Rakesh

    2010-01-01

    Background The concept of DNA barcoding for species identification has gained considerable momentum in animals because of fairly successful species identification using cytochrome oxidase I (COI). In plants, matK and rbcL have been proposed as standard barcodes. However, barcoding in complex genera is a challenging task. Methodology and Principal Findings We investigated the species discriminatory power of four reportedly most promising plant DNA barcoding loci (one from nuclear genome- ITS, and three from plastid genome- trnH-psbA, rbcL and matK) in species of Indian Berberis L. (Berberidaceae) and two other genera, Ficus L. (Moraceae) and Gossypium L. (Malvaceae). Berberis species were delineated using morphological characters. These characters resulted in a well resolved species tree. Applying both nucleotide distance and nucleotide character-based approaches, we found that none of the loci, either singly or in combinations, could discriminate the species of Berberis. ITS resolved all the tested species of Ficus and Gossypium and trnH-psbA resolved 82% of the tested species in Ficus. The highly regarded matK and rbcL could not resolve all the species. Finally, we employed amplified fragment length polymorphism test in species of Berberis to determine their relationships. Using ten primer pair combinations in AFLP, the data demonstrated incomplete species resolution. Further, AFLP analysis showed that there was a tendency of the Berberis accessions to cluster according to their geographic origin rather than species affiliation. Conclusions/Significance We reconfirm the earlier reports that the concept of universal barcode in plants may not work in a number of genera. Our results also suggest that the matK and rbcL, recommended as universal barcode loci for plants, may not work in all the genera of land plants. Morphological, geographical and molecular data analyses of Indian species of Berberis suggest probable reticulate evolution and thus barcode markers may

  12. Universal plant DNA barcode loci may not work in complex groups: a case study with Indian berberis species.

    Directory of Open Access Journals (Sweden)

    Sribash Roy

    Full Text Available BACKGROUND: The concept of DNA barcoding for species identification has gained considerable momentum in animals because of fairly successful species identification using cytochrome oxidase I (COI. In plants, matK and rbcL have been proposed as standard barcodes. However, barcoding in complex genera is a challenging task. METHODOLOGY AND PRINCIPAL FINDINGS: We investigated the species discriminatory power of four reportedly most promising plant DNA barcoding loci (one from nuclear genome--ITS, and three from plastid genome--trnH-psbA, rbcL and matK in species of Indian Berberis L. (Berberidaceae and two other genera, Ficus L. (Moraceae and Gossypium L. (Malvaceae. Berberis species were delineated using morphological characters. These characters resulted in a well resolved species tree. Applying both nucleotide distance and nucleotide character-based approaches, we found that none of the loci, either singly or in combinations, could discriminate the species of Berberis. ITS resolved all the tested species of Ficus and Gossypium and trnH-psbA resolved 82% of the tested species in Ficus. The highly regarded matK and rbcL could not resolve all the species. Finally, we employed amplified fragment length polymorphism test in species of Berberis to determine their relationships. Using ten primer pair combinations in AFLP, the data demonstrated incomplete species resolution. Further, AFLP analysis showed that there was a tendency of the Berberis accessions to cluster according to their geographic origin rather than species affiliation. CONCLUSIONS/SIGNIFICANCE: We reconfirm the earlier reports that the concept of universal barcode in plants may not work in a number of genera. Our results also suggest that the matK and rbcL, recommended as universal barcode loci for plants, may not work in all the genera of land plants. Morphological, geographical and molecular data analyses of Indian species of Berberis suggest probable reticulate evolution and thus

  13. 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.

  14. 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…

  15. Exploring representations and experiences of case-management users: towards difficulties and solutions to leading qualitative interviews with older people with complex living conditions.

    Science.gov (United States)

    Balard, Frédéric; Corre, Stéphanie Pin Le; Trouvé, Hélène; Saint-Jean, Olivier; Somme, Dominique

    2013-01-01

    By matching needs to resource services, case management could be a useful tool for improving the care of older people with complex living conditions. Collecting and analysing the users' experiences represents a good way to evaluate the effectiveness and efficiency of a case-management service. However, in the literature, fieldwork is very rarely considered and the users included in qualitative research seem to be the most accessible. This study was undertaken to describe the challenges of conducting qualitative research with older people with complex living conditions in order to understand their experiences with case-management services. Reflective analysis was applied to describe the process of recruiting and interviewing older people with complex living conditions in private homes, describing the protocol with respect to fieldwork chronology. The practical difficulties inherent in this type of study are addressed, particularly in terms of defining a sample, the procedure for contacting the users and conducting the interview. The users are people who suffer from a loss of autonomy because of cognitive impairment, severe disease and/or psychiatric or social problems. Notably, most of them refuse care and assistance. Reflective analysis of our protocol showed that the methodology and difficulties encountered constituted the first phase of data analysis. Understanding the experience of users of case management to analyse the outcomes of case-management services requires a clear methodology for the fieldwork.

  16. 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

  17. Simple and complex hyperplastic papillary proliferations of the endometrium: a clinicopathologic study of nine cases of apparently localized papillary lesions with fibrovascular stromal cores and epithelial metaplasia.

    Science.gov (United States)

    Lehman, M B; Hart, W R

    2001-11-01

    The clinicopathologic features of nine cases of papillary proliferation of the endometrium devoid of malignant nuclear features were studied. The patients ranged in age from 33 to 71 years (median 57 years). All were postmenopausal, except the youngest. The most common symptom was postmenopausal bleeding. Two patients were receiving hormonal replacement therapy and two were taking megestrol acetate. Two lesions were incidental findings in a hysterectomy specimen. Seven were diagnosed in endometrial biopsy or curettage specimens. In six cases (67%) the lesion involved an endometrial polyp. In all cases the papillae had fibrovascular stromal cores and variable degrees of branching. Two architectural patterns were found. A simple papillary pattern with involvement of only a few glands and little epithelial proliferation occurred in five cases, including three that were entirely intracystic. A complex papillary pattern with more extensive involvement of endometrial glands, a greater degree of branching of the papillae, and cellular tufting occurred in four cases. One or more metaplastic epithelial changes occurred in all cases, including endocervical-type mucinous metaplasia in nine cases (90%), eosinophilic cell change in eight (89%), ciliated cell change in seven (70%), focal squamous metaplasia in two cases (22%), and hobnail cell change in two (22%). Mitotic figures were found in three cases. In four lesions (44%), all with a complex papillary pattern, the proliferating cells had mild nuclear atypia. Three of these patients underwent hysterectomy within 5 months. Simple nonpapillary hyperplasia and two endometrial polyps were found in one patient, complex nonpapillary hyperplasia in one, and atrophic endometrium in the other. Two patients had additional endometrial samplings within 4 months that contained small residual simple papillary lesions. One of these had another biopsy at 16 months that showed only atrophy. One patient had no subsequent diagnostic or

  18. 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.

  19. 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.

  20. Complexities within distal sheet turbidite deposits: case study 160,000ka Icod Turbidite, Moroccan Turbidite System

    Science.gov (United States)

    Hunt, James; Wynn, Russell

    2010-05-01

    The Icod landslide from the northern flank of Tenerife not only generated a debris avalanche phase (Watts & Masson, 1995; Masson et al. 2002), but produced a volcaniclastic turbidite that spans three interconnected basins. The Icod turbidite (160,000ka) was reported and correlated during work in the Madeira Abyssal Plain (Pearce & Jarvis, 1992; Rothwell, Pearce & Weaver, 1992). Here it forms a series of vertically stacked sand bodies accumulating into a single event bed. However, the Madeira Abyssal Plain is fed from the Agadir Basin by a series of channels, thus invoking a level of complexity to the deposit with the flow exiting channels at different times. The Icod turbidite can be found deposited more proximally to source in the Agadir Basin as a 0.3-0.6m stacked sand with accompanying 0.2-1.5m mudcap. With this stacked sand facies present here a number of other mechanisms can still be viable: (1) multistage retrogressive landslide failure, (2) flow reflection and (3) internal waves. Geochemical methodologies including ICP-AES, ICP-MS, XRF, ITRAX micro-XRF, SEM EDS and laser-diffraction grain-size analysis have been employed here to investigate the potential of a retrogressive failure at source being the driver of this facies. Evidence suggests that this stacked sand facies in this case is derived from the failure mechanism at source. Five vertical sand packages have been identified and correlated through the Agadir Basin, with the initial basal package representing the thickest. However, this amalgamated sand displays degrees of complexity with correlated internal erosional surfaces marked by sand-sand grain-size breaks. There are also sand-sand grain-size breaks found at the transition between facies associated with flow properties i.e. Bouma Tb parallel laminations and Bouma Tc ripple laminations. Each of the stacked sand intervals also has a sand-mud grain-size break present at the top of the package. This sand-mud break could possibly indicate (1) bypass of

  1. Communication complexity and information complexity

    Science.gov (United States)

    Pankratov, Denis

    Information complexity enables the use of information-theoretic tools in communication complexity theory. Prior to the results presented in this thesis, information complexity was mainly used for proving lower bounds and direct-sum theorems in the setting of communication complexity. We present three results that demonstrate new connections between information complexity and communication complexity. In the first contribution we thoroughly study the information complexity of the smallest nontrivial two-party function: the AND function. While computing the communication complexity of AND is trivial, computing its exact information complexity presents a major technical challenge. In overcoming this challenge, we reveal that information complexity gives rise to rich geometrical structures. Our analysis of information complexity relies on new analytic techniques and new characterizations of communication protocols. We also uncover a connection of information complexity to the theory of elliptic partial differential equations. Once we compute the exact information complexity of AND, we can compute exact communication complexity of several related functions on n-bit inputs with some additional technical work. Previous combinatorial and algebraic techniques could only prove bounds of the form theta( n). Interestingly, this level of precision is typical in the area of information theory, so our result demonstrates that this meta-property of precise bounds carries over to information complexity and in certain cases even to communication complexity. Our result does not only strengthen the lower bound on communication complexity of disjointness by making it more exact, but it also shows that information complexity provides the exact upper bound on communication complexity. In fact, this result is more general and applies to a whole class of communication problems. In the second contribution, we use self-reduction methods to prove strong lower bounds on the information

  2. COMPLEX EVALUATION OF THE NUMBER DYNAMICS OF COLONIAL WATERBIRD COMMUNITIES (THE CASE OF SOME ISLANDS OF SIVASH REGION

    Directory of Open Access Journals (Sweden)

    Matsyura A.V.

    2011-12-01

    Full Text Available The problem of the mathematical analysis of the number dynamics of the nesting waterbirds for the islands of the south of Ukraine is examined. The algorithm of the evaluation of changes in the number of island birds is proposed. Data of the long-term monitoring of the number of birds were analyzed according to this algorithm. The necessity of the implementation of the statistical indices together with the graphic representation of island birds’ turnover is proved. The trends of population dynamics are determined for the key species. The discussed procedure of the complex evaluation is proposed for the management planning of the island bird species and their habitats. The performed analysis of the number dynamics of the key-stone breeding island birds showed that, with the exception of little tern, the population status and the prognosis of number are sufficiently favorable. From the data of long-term monitoring we came up with the conclusion about the existence of island habitats with carrying capacity to maintain the additional number of breeding birds. In the case of unfavorable conditions like strengthening of anthropogenic press, concurrent interrelations, deficiency of feed resources or drastic reduction of breeding biotopes, the birds due to turnover are capable to successfully react even without reducing their number and breeding success. The extinction rate of the breeding bird species from the island sites directly correlates with the number of breeding species. For the species with equal abundance, the extinction probability is higher for birds, whose numbers are unstable and characterized by significant fluctuations. This testifies the urgency of the constant monitoring and analysis of the number dynamics of breeding bird species in region. The suggested procedure of analysis is recommended for drawing up of management plans and performing of prognoses of number of breeding island bird species. More detail analysis with use of

  3. 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

  4. 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.

  5. 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). ...

  6. 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

    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. 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. 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). 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.

  7. 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.

  8. Theorising complex water governance in Africa: the case of the proposed Epupa Dam on the Kunene River

    CSIR Research Space (South Africa)

    Meissner, Richard

    2014-04-01

    Full Text Available Various multi-dimensional governance models have been suggested by scholars and policy makers alike as suitable conceptual lenses through which to view the complexity of water governance, particularly in international river basins. While...

  9. [Case of anti VGKC-complex antibody associated disorder presenting with severe pain and fasciculations predominant in unilateral upper extremity].

    Science.gov (United States)

    Hara, Kenju; Watanabe, Osamu; Shibano, Ken; Ishiguro, Hideaki

    2012-01-01

    A 21-year-old man complained of severe pain and muscle twitching localized in his right arm. Neurological examination showed muscle fasciculations in his right forearm but no myokymia or myotonia. Needle electromyography revealed fibrillation potentials in his biceps brachii muscle and extensor carpi radialis muscle at rest but no myokymic discharges. His serum anti-voltage-gated potassium channel (VGKC)-complex antibody level was significantly high (194.2pM; controls VGKC-complex antibody associated disorder.

  10. An atypical case of postsurgical complex regional pain syndrome in a patient having nonhealing varicose venous ulcer treated by lumbar sympathectomy

    Directory of Open Access Journals (Sweden)

    Kailash Kothari

    2017-01-01

    Full Text Available Complex regional pain syndrome (CRPS of the lower limb is a relatively uncommon entity as compared to CRPS of the upper extremity. Literature search has revealed only 2 retrospective case series and a single case report of lower extremity CRPS type I from 1975 to 2014 on Pubmed, isolated cases of CRPS type I of lower extremity have also been reported following knee surgeries and arthroscopies. This report presents a case of lower limb CRPS type I, following surgery for varicose vein ulcer. Pain was not relieved with medications. Diagnostic lumbar sympathectomy was done and patient had tremendous relief of pain following that, proving sympathetic mediated pain of the involved limb.

  11. A curative treatment option for Complex Regional Pain Syndrome (CRPS) Type I: dorsal root entry zone operation (report of two cases).

    Science.gov (United States)

    Kanpolat, Yucel; Al-Beyati, Eyyub; Ugur, Hasan Caglar; Akpinar, Gokhan; Kahilogullari, Gokmen; Bozkurt, Melih

    2014-01-01

    Complex Regional Pain Syndrome Type I (CRPS-I) is a debated health problem concerning its pathophysiology and treatment strategies. A 12-year-old boy and a 35-year-old woman were diagnosed with CRPS-I at different times. They had previously undergone various types of interventions with no success. After one year of follow-up and observation, DREZ lesioning operation was performed. Afterwards, both cases had transient lower extremity ataxia. The first case was followed for 60 months with no recurrence and total cure. The second case was pain-free until the 6th month, when she required psychological support; she was followed for 33 months with partial satisfactory outcome. Although not a first-line option, DREZ lesioning procedure can be chosen and may be a curative option in selected cases of CRPS-I who are unresponsive to conventional therapies.

  12. [Custom-made implant for complex facial reconstruction: A case of total replacement of temporo-mandibular joint, zygomatic arch and malar bone].

    Science.gov (United States)

    Guillier, D; Moris, V; See, L-A; Girodon, M; Wajszczak, B-L; Zwetyenga, N

    2017-02-01

    Total prosthetic replacement of the temporo-mandibular joint (TMJ) has become a common procedure, but it is usually limited to the TMJ itself. We report about one case of complex prosthetic joint reconstruction extending to the neighbouring bony structures. A 57-year-old patient, operated several times for a cranio-facial fibrous dysplasia, presented with a recurring TMJ ankylosis and a complexe latero-facial bone loss on the right side. We performed a reconstruction procedure including the TMJ, the zygomatic arch and the malar bone by mean of custom made composite prosthesis (chrome-cobalt-molybdenum-titanium and polyethylene). Five years postoperatively, mouth opening, nutrition, pain and oral hygiene were significantly improved. Nowadays technical possibilities allow for complex facial alloplastic reconstructions with good medium term results. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  13. 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

  14. Not a simple case - A first comprehensive phylogenetic hypothesis for the Midas cichlid complex in Nicaragua (Teleostei: Cichlidae: Amphilophus).

    Science.gov (United States)

    Geiger, Matthias F; McCrary, Jeffrey K; Schliewen, Ulrich K

    2010-09-01

    Nicaraguan Midas cichlids from crater lakes have recently attracted attention as potential model systems for speciation research, but no attempt has been made to comprehensively reconstruct phylogenetic relationships of this highly diverse and recently evolved species complex. We present a first AFLP (2793 loci) and mtDNA based phylogenetic hypothesis including all described and several undescribed species from six crater lakes (Apoyeque, Apoyo, Asososca Leon, Masaya, Tiscapa and Xiloá), the two great Lakes Managua and Nicaragua and the San Juan River. Our analyses demonstrate that the relationships between the Midas cichlid members are complex, and that phylogenetic information from different markers and methods do not always yield congruent results. Nevertheless, monophyly support for crater lake assemblages from Lakes Apoyeque, Apoyo, A. Leon is high as compared to those from L. Xiloá indicating occurrence of sympatric speciation. Further, we demonstrate that a 'three species' concept for the Midas cichlid complex is inapplicable and consequently that an individualized and voucher based approach in speciation research of the Midas cichlid complex is necessary at least as long as there is no comprehensive revision of the species complex available. Copyright 2010 Elsevier Inc. All rights reserved.

  15. 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...

  16. The Affordable Care Act: a case study for understanding and applying complexity concepts to health care reform.

    Science.gov (United States)

    Larkin, D Justin; Swanson, R Chad; Fuller, Spencer; Cortese, Denis A

    2016-02-01

    The current health system in the United States is the result of a history of patchwork policy decisions and cultural assumptions that have led to persistent contradictions in practice, gaps in coverage, unsustainable costs, and inconsistent outcomes. In working toward a more efficient health system, understanding and applying complexity science concepts will allow for policy that better promotes desired outcomes and minimizes the effects of unintended consequences. This paper will consider three applied complexity science concepts in the context of the Patient Protection and Affordable Care Act (PPACA): developing a shared vision around reimbursement for value, creating an environment for emergence through simple rules, and embracing transformational leadership at all levels. Transforming the US health system, or any other health system, will be neither easy nor quick. Applying complexity concepts to health reform efforts, however, will facilitate long-term change in all levels, leading to health systems that are more effective, efficient, and equitable. © 2014 John Wiley & Sons, Ltd.

  17. 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.

  18. Energy and environment efficiency analysis based on an improved environment DEA cross-model: Case study of complex chemical processes

    International Nuclear Information System (INIS)

    Geng, ZhiQiang; Dong, JunGen; Han, YongMing; Zhu, QunXiong

    2017-01-01

    Highlights: •An improved environment DEA cross-model method is proposed. •Energy and environment efficiency analysis framework of complex chemical processes is obtained. •This proposed method is efficient in energy-saving and emission reduction of complex chemical processes. -- Abstract: The complex chemical process is a high pollution and high energy consumption industrial process. Therefore, it is very important to analyze and evaluate the energy and environment efficiency of the complex chemical process. Data Envelopment Analysis (DEA) is used to evaluate the relative effectiveness of decision-making units (DMUs). However, the traditional DEA method usually cannot genuinely distinguish the effective and inefficient DMU due to its extreme or unreasonable weight distribution of input and output variables. Therefore, this paper proposes an energy and environment efficiency analysis method based on an improved environment DEA cross-model (DEACM) method. The inputs of the complex chemical process are divided into energy and non-energy inputs. Meanwhile, the outputs are divided into desirable and undesirable outputs. And then the energy and environment performance index (EEPI) based on the cross evaluation is used to represent the overall performance of each DMU. Moreover, the improvement direction of energy-saving and carbon emission reduction of each inefficiency DMU is quantitatively obtained based on the self-evaluation model of the improved environment DEACM. The results show that the improved environment DEACM method has a better effective discrimination than the original DEA method by analyzing the energy and environment efficiency of the ethylene production process in complex chemical processes, and it can obtain the potential of energy-saving and carbon emission reduction of ethylene plants, especially the improvement direction of inefficient DMUs to improve energy efficiency and reduce carbon emission.

  19. 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.

  20. 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".

  1. Randomization-Based Inference about Latent Variables from Complex Samples: The Case of Two-Stage Sampling

    Science.gov (United States)

    Li, Tiandong

    2012-01-01

    In large-scale assessments, such as the National Assessment of Educational Progress (NAEP), plausible values based on Multiple Imputations (MI) have been used to estimate population characteristics for latent constructs under complex sample designs. Mislevy (1991) derived a closed-form analytic solution for a fixed-effect model in creating…

  2. What Governs District Manager Decision Making? A Case Study of Complex Leadership in Dangme West District, Ghana

    NARCIS (Netherlands)

    Kwamie, Aku; Agyepong, Irene Akua; Dijk, Van Han

    2015-01-01

    Management and leadership in complex health systems
    have been little addressed as contributors toward improving maternal
    and newborn health. Widespread perceptions of weak district-level
    management and leadership have encouraged capacity strengthening
    interventions with a predominant

  3. On the effects of sampling, analysis and interpretation strategies for complex forensic DNA research with focus on sexual assault cases

    NARCIS (Netherlands)

    Benschop, C.C.G.

    2012-01-01

    Forensisch DNA-onderzoek kan een grote bijdrage leveren aan het oplossen van diverse soorten misdrijven. Dit DNA-onderzoek kan complex zijn, bijvoorbeeld als de hoeveelheid celmateriaal minimaal is of als het biologische spoor celmateriaal bevat van meerdere (aan elkaar verwante) donoren. Corina

  4. A Case Study : Application of the Systems Engineering Modeling in the early phases of a Complex Space System Project

    NARCIS (Netherlands)

    Bone, M.; Cloutier, R.L.; Gill, E.K.A.; Verma, D.

    2009-01-01

    There is increased recognition of the role of systems engineering in reducing the risk (technical, cost, and schedule) on complex space systems development and integration projects. A number of international systems engineering standards have been published in the last five years (ISO 15288, IEEE

  5. 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

  6. Developing a case mix classification for child and adolescent mental health services: the influence of presenting problems, complexity factors and service providers on number of appointments.

    Science.gov (United States)

    Martin, Peter; Davies, Roger; Macdougall, Amy; Ritchie, Benjamin; Vostanis, Panos; Whale, Andy; Wolpert, Miranda

    2017-09-01

    Case-mix classification is a focus of international attention in considering how best to manage and fund services, by providing a basis for fairer comparison of resource utilization. Yet there is little evidence of the best ways to establish case mix for child and adolescent mental health services (CAMHS). To develop a case mix classification for CAMHS that is clinically meaningful and predictive of number of appointments attended and to investigate the influence of presenting problems, context and complexity factors and provider variation. We analysed 4573 completed episodes of outpatient care from 11 English CAMHS. Cluster analysis, regression trees and a conceptual classification based on clinical best practice guidelines were compared regarding their ability to predict number of appointments, using mixed effects negative binomial regression. The conceptual classification is clinically meaningful and did as well as data-driven classifications in accounting for number of appointments. There was little evidence for effects of complexity or context factors, with the possible exception of school attendance problems. Substantial variation in resource provision between providers was not explained well by case mix. The conceptually-derived classification merits further testing and development in the context of collaborative decision making.

  7. T-cell acute lymphoblastic leukemia associated with complex karyotype and SET-NUP214 rearrangement: a case study and review of the literature.

    Science.gov (United States)

    Lee, Sang-Guk; Park, Tae Sung; Cho, Sun Young; Lim, Gayoung; Park, Gwang Jin; Oh, Seung Hwan; Cho, Eun Hae; Chong, So Young; Huh, Ji Young

    2011-01-01

    SET-NUP214 rearrangements have been rarely reported in T-cell acute lymphoblastic leukemia (T-ALL), acute undifferentiated leukemia, and acute myeloid leukemia, and most documented cases have been associated with normal karyotypes in conventional cytogenetic analyses. Here, we describe a novel case of T-ALL associated with a mediastinal mass and a SET-NUP214 rearrangement, which was masked by a complex karyotype at the time of initial diagnosis. Using multiplex reverse transcriptase-polymerase chain reaction analysis, we detected a cryptic SET-NUP214 rearrangement in our patient. As only 11 cases (including the present study) of T-ALL with SET-NUP214 rearrangement have been reported, the clinical features and treatment outcomes have not been fully determined. Further studies are necessary to evaluate the incidence of SET-NUP214 rearrangement in T-ALL patients and the treatment responses as well as prognosis of these patients.

  8. Emergence of complex networks from diffusion on fractal lattices. A special case of the Sierpinski gasket and tetrahedron

    International Nuclear Information System (INIS)

    Chełminiak, Przemysław

    2012-01-01

    A new approach to the assemblage of complex networks displaying the scale-free architecture is proposed. While the growth and the preferential attachment of incoming nodes assure an emergence of such networks according to the Barabási–Albert model, it is argued here that the preferential linking condition needs not to be a principal rule. To assert this statement a simple computer model based on random walks on fractal lattices is introduced. It is shown that the model successfully reproduces the degree distributions, the ultra-small-worldness and the high clustering arising from the topology of scale-free networks. -- Highlights: ► A new mechanism of evolution for scale-free complex networks is proposed. ► The preferential attachment rule is not necessary to construct such networks. ► It is shown that they reveal some basic properties of classical scale-free nets.

  9. Graph Cellular Automata with Relation-Based Neighbourhoods of Cells for Complex Systems Modelling: A Case of Traffic Simulation

    Directory of Open Access Journals (Sweden)

    Krzysztof Małecki

    2017-12-01

    Full Text Available A complex system is a set of mutually interacting elements for which it is possible to construct a mathematical model. This article focuses on the cellular automata theory and the graph theory in order to compare various types of cellular automata and to analyse applications of graph structures together with cellular automata. It proposes a graph cellular automaton with a variable configuration of cells and relation-based neighbourhoods (r–GCA. The developed mechanism enables modelling of phenomena found in complex systems (e.g., transport networks, urban logistics, social networks taking into account the interaction between the existing objects. As an implementation example, modelling of moving vehicles has been made and r–GCA was compared to the other cellular automata models simulating the road traffic and used in the computer simulation process.

  10. Application of information and complexity theories to public opinion polls. The case of Greece (2004-2007)

    OpenAIRE

    Panos, C. P.; Chatzisavvas, K. Ch.

    2007-01-01

    A general methodology to study public opinion inspired from information and complexity theories is outlined. It is based on probabilistic data extracted from opinion polls. It gives a quantitative information-theoretic explanation of high job approval of Greek Prime Minister Mr. Constantinos Karamanlis (2004-2007), while the same time series of polls conducted by the company Metron Analysis showed that his party New Democracy (abbr. ND) was slightly higher than the opposition party of PASOK -...

  11. 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.

  12. The Communications and Networks Collaborative Technology Alliance Publication Network: A Case Study on Graph and Simplicial Complex Analysis

    Science.gov (United States)

    2015-05-01

    Because of this closure property on subsets, simplicial complexes are amenable to mathe - matical formalism in combinatorics, abstract algebra, and...Introduction. Oxford (United Kingdom): Oxford University Press. 7. Wasserman S, Faust K. 1994. Social Network Analysis: Methods and Applica- tions. New York (NY...Bollen J, Nelson ML, Van de Sompel H. Co-authorship networks in the digital library research community. Information Processing and Management. 2005;41

  13. 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.

  14. The drive for muscle leanness: a complex case with features of muscle dysmorphia and eating disorder not otherwise specified.

    Science.gov (United States)

    Cafri, G; Blevins, N; Thompson, J K

    2006-12-01

    Muscle dysmorphia has been described as a subtype of body dysmorphic disorder in which an individual experiences severe body image disturbance related to muscularity. The current case is of a 20-year-old man who describes a history of muscle dysmorphia in which the nature of the body image concern is related to leanness (i.e., muscularity in the absence of body fat), as opposed to increasing muscle mass, which is how muscle dysmorphia has typically been characterized in the literature. The case illustrates the need to consider this additional facet of body image when diagnosing muscle dysmorphia.

  15. A case of bilateral lower cranial nerve palsies after base of skull trauma with complex management issues: case report and review of the literature.

    Science.gov (United States)

    Lehn, Alexander Christoph; Lettieri, Jennie; Grimley, Rohan

    2012-05-01

    Fractures of the skull base can cause lower cranial nerve palsies because of involvement of the nerves as they traverse the skull. A variety of syndromes have been described, often involving multiple nerves. These are most commonly unilateral, and only a handful of cases of bilateral cranial nerve involvement have been reported. We describe a 64-year-old man with occipital condylar fracture complicated by bilateral palsies of IX and X nerves associated with dramatic physiological derangement causing severe management challenges. Apart from debilitating postural hypotension, he developed dysphagia, severe gastrointestinal dysmotility, issues with airway protection as well as airway obstruction, increased oropharyngeal secretions and variable respiratory control. This is the first report of a patient with traumatic bilateral cranial nerve IX and X nerve palsies. This detailed report and the summary of all 6 previous case reports of traumatic bilateral lower cranial nerve palsies illustrate clinical features, treatment strategies, and outcomes of these rare events.

  16. 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.

  17. 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…

  18. The Complexities of Moral Education in a Liberal, Pluralistic Society: The Cases of Socrates, Mrs. Pettit, and Adolf Eichmann.

    Science.gov (United States)

    Beatty, Joseph

    1985-01-01

    The cases of three individuals charged with corrupting the young are considered in a discussion of the teacher's role in the moral education of youth. Focus is on Socrates, a Los Angeles teacher fired because of membership in a sexually-oriented club, and a Nazi war criminal. (MSE)

  19. 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.

  20. 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.

  1. COMBINATION OF APICALLY POSITIONED AND CORONALLY ADVANCED FLAP IN THE TREATMENT OF A COMPLEX MUCOGINGIVAL AND RESTORATIVE PROBLEM. A 3-YEAR FOLLOW-UP. (Case Report

    Directory of Open Access Journals (Sweden)

    Kamen Kotsilkov

    2015-07-01

    Full Text Available INTRODUCTION: The modern Periodontology has various approaches to achieve a complete functional and aesthetic rehabilitation of the mucogingival complex. These techniques include application of flaps with apical or coronal advancement in order to achieve different treatment objectives. Complex cases with different pathology on adjacent teeth require several surgeries thereby increasing treatment time and patient discomfort. New combined approaches are needed to meet the challenges of such cases. OBJECTIVE: This report presents a case with a simultaneous application of a resective and a mucogingival technique in one dental sextant. METHODS: I.C. (36 with a localized chronic periodontitis, Miller Class I gingival recessions (13,14 and subgingival caries lesions (15,16. A combined approach with simultaneous crown lengthening with apically positioned flap for 16,15 and root coverage with enamel matrix derivate and a coronally advanced flap for 14,13 was applied in order to avoid multiple surgical procedures. RESULTS: On the third month after the surgical procedure a complete root coverage (13,14 was achieved. The crown lengthening procedure enabled the restoration of the caries lesions and the placement of new crowns (15,16. The result at the third year demonstrates a stable gingival margin with no recurrence of the gingival recessions. CONCLUSION: The applied combined procedure led to a complete resolution of the existing problems with a single surgery. The simultaneous application of different procedures seems a promising approach aimed to reduce the treatment time and to diminish patient discomfort.

  2. 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.

  3. 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

  4. 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.

  5. Interpretation of complex electromagnetic data in seismically active regions: Case study of the Chuya Depression, Mountain Altai

    Science.gov (United States)

    Nevedrova, N. N.; Pospeeva, E. V.; Sanchaa, A. M.

    2011-01-01

    A procedure for the simultaneous interpretation of magnetotelluric and near-field transient electromagnetic sounding (MTS and NF TEMS, respectively) data is proposed. The advantages of the complex interpretation are demonstrated by specific examples. In accordance with the interpretation of the field data, geoelectrical sections of the lithosphere in the western part of the Chuya Depression are constructed. A reduction in the depth to the conductive crustal layer in the epicentral zone is found, and the geoelectrical boundary in the upper part of the paleozoic basement is revealed.

  6. 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.

  7. 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

    ABSTRACT 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 the cat) (Bates, Devescovi, & D’Amico, 1999). We used a pointing paradigm to test German-speaking 3-, 4-, and 6-year-old children’s sensitivity to case marking and word order in their interpretation of simple transitives and transitive RCs. In Experiment 1, case marking was ambiguous. The only cue available was word order. In Experiment 2, case was marked on lexical NPs or demonstrative pronouns. In Experiment 3, case was marked on lexical NPs or personal pronouns. Whereas the younger children mainly followed word order, the older children were more likely to base their interpretations on the more reliable case-marking cue. In most cases, children from both age groups were more likely to use these cues in their interpretation of simple transitives than in their interpretation of transitive RCs. Finally, children paid more attention to nominative case when it was marked on first-person personal pronouns than when it was marked on third-person lexical NPs or demonstrative pronouns, such as der Löwe ‘the-NOM lion’ or der ‘he-NOM.’ They were able to successfully integrate this case-marking cue in their sentence processing even when it appeared late in the sentence. We discuss four potential reasons for these differences across development, constructions, and lexical items. (1) Older children are relatively more sensitive to cue reliability. (2) Word order is more reliable in simple transitives than in transitive RCs. (3) The processing of case marking might initially be item-specific. (4) The processing of case marking might depend on its saliency and position in the sentence. PMID:27019652

  8. 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

  9. Information geometric analysis of phase transitions in complex patterns: the case of the Gray-Scott reaction–diffusion model

    International Nuclear Information System (INIS)

    Har-Shemesh, Omri; Quax, Rick; Hoekstra, Alfons G; Sloot, Peter M A

    2016-01-01

    The Fisher–Rao metric from information geometry is related to phase transition phenomena in classical statistical mechanics. Several studies propose to extend the use of information geometry to study more general phase transitions in complex systems. However, it is unclear whether the Fisher–Rao metric does indeed detect these more general transitions, especially in the absence of a statistical model. In this paper we study the transitions between patterns in the Gray-Scott reaction–diffusion model using Fisher information. We describe the system by a probability density function that represents the size distribution of blobs in the patterns and compute its Fisher information with respect to changing the two rate parameters of the underlying model. We estimate the distribution non-parametrically so that we do not assume any statistical model. The resulting Fisher map can be interpreted as a phase-map of the different patterns. Lines with high Fisher information can be considered as boundaries between regions of parameter space where patterns with similar characteristics appear. These lines of high Fisher information can be interpreted as phase transitions between complex patterns. (paper: disordered systems, classical and quantum)

  10. 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.

  11. The place of occupational therapy in rehabilitation strategies of complex regional pain syndrome: Comparative study of 60 cases.

    Science.gov (United States)

    Rome, L

    2016-10-01

    The purpose of the study was to assess the value of combining occupational therapy (OT) with physical therapy (PT) for the rehabilitation of complex regional pain syndrome (CRPS) and to measure its effectiveness on activities of daily life. Sixty patients with CRPS type 1 were recruited and interviewed between September 1, 2014 and February 1, 2015. Thirty patients had undergone PT and thirty had undergone PT+OT. They were administered the short-form of the "Assessment of Life Habits" questionnaire (v.3.0 LIFE-H) created in Canada. This questionnaire consists of 16 items exploring activities of daily living, which were used to compare the effectiveness of the two rehabilitation protocols. The results of each test were submitted to the Wilcoxon test. After confirming the complexity of CRPS in terms of its etiology, clinical signs and progression, rehabilitation was effective, especially for pain. The patients who received PT+OT had on average 10% better dressing and undressing function, 25% better for meal preparation, and 20% better on personal care than those who underwent PT only. In CRPS, OT combined with PT brings a real benefit in restoring the essential activities of daily life. This strategy could be implemented as soon the diagnosis confirmed and continued for a very long time. It helps to avoid the risk of dependence on third parties. Copyright © 2016 SFCM. Published by Elsevier Masson SAS. All rights reserved.

  12. ‘Patient-Centered Care’ for Complex Patients with Type 2 Diabetes Mellitus—Analysis of Two Cases

    OpenAIRE

    Jennifer M. Hackel

    2013-01-01

    Purpose This paper serves to apply and compare aspects of person centered care and recent consensus guidelines to two cases of older adults with poorly controlled diabetes in the context of relatively similar multimorbidity. Methods After review of the literature regarding the shift from guidelines promoting tight control in diabetes management to individualized person centered care, as well as newer treatment approaches emerging in diabetes care, the newer guidelines and potential treatment ...

  13. 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

  14. Complex Regional Pain Syndrome Revived by Epileptic Seizure Then Disappeared Soon during Treatment with Regional Intravenous Nerve Blockade: A Case Report

    Directory of Open Access Journals (Sweden)

    Masahiko Sumitani

    2011-01-01

    Full Text Available We present a case of complex regional pain syndrome (CRPS, in which symptoms, including burning pain and severe allodynia, were alleviated by using a regional intravenous nerve blockade (Bier block combined with physiotherapy, but reappeared following an epileptic seizure. Symptoms disappeared again following control of epileptic discharges, as revealed by single-photon emission computed tomography (SPECT and electroencephalography (EEG results. Although systemic toxicity of a local anesthetic applied by Bier block was suspected as a cause of the first seizure, the patient did not present any other toxic symptoms, and seizures repeatedly occurred after Bier block cessation; the patient was then diagnosed as having temporal symptomatic epilepsy. This case suggests that symptoms of CRPS may be sustained by abnormal brain conditions, and our findings contribute to the understanding of how the central nervous system participates in maintaining pain and allodynia associated with CRPS.

  15. Complex Regional Pain Syndrome (CRPS type-1) in an Adolescent Following Extravasation of Dextrose Containing Fluid-an Underdiagnosed Case.

    Science.gov (United States)

    Subedi, Asish; Bhattarai, Balkrishna; Biswas, Binay K; Khatiwada, Sindhu

    2011-06-01

    Due to its complex pathophysiology and wide spectrum of clinical manifestations, the diagnosis of CRPS is often missed in the early stage by primary care physicians. After being treated by a primary care physician for 5 months for chronic cellulitis, a 16-year-old girl was referred to our hospital with features of type-1 CRPS of the right upper extremity. Inability to diagnose early caused prolonged suffering to the girl with all the consequence of CRPS. The patient responded well with marked functional recovery from multimodal therapy. Ability to distinguish CRPS from other pain conditions, referral for specialty care at the appropriate time and full awareness of this condition and its clinical features among various healthcare professionals are essential in reducing patient suffering and stopping its progression towards difficult-to-treat situations.

  16. 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.

  17. [Pulmonary Mycobacterium Avium-Complex (MAC) Disease Differentially Diagnosed from Metastasis of Testicular Cancer : A Case Report].

    Science.gov (United States)

    Mori, Kohei; Teranishi, Jyn-Ichi; Yoneyama, Shuko; Ishida, Hiroaki; Hattori, Yusuke; Yumura, Yasushi; Miyoshi, Yasuhide; Kondo, Keiichi; Uemura, Hiroji; Noguchi, Kazumi

    2017-01-01

    A 45 year-old-man was admitted to our hospital because of discomfort in his left scrotum. He had a left testicular tumor. We performed high orchiectomy and pathological findings revealed testicular cancer. He was treated with bleomycin, etoposide and cisplatin. Computed tomography showed a new mass in the left lung after 3 cycles of the chemotherapy. Because of its rapid growth, the tumor was thought to be a metastasis lesion of testicular cancer or pulmonary infection. Transbronchial lung biopsy showed an invasion of multinucleated giant cells and granuloma. The culture and polymerase chain reaction of the bronchial sputum were positive for myobacterium avium-complex (MAC). From these findings, the left lung tumor was diagnosed as pulmonary MAC disease. He received partial resection of the left lung and the lesion was diagnosed as granuloma. There was no recurrence of testicular cancer or pulmonary disease after the surgery.

  18. Thermodynamics of complexes formation by ITC in methanol/water = 9/1 (v/v) solution: A case study

    Energy Technology Data Exchange (ETDEWEB)

    Fisicaro, Emilia, E-mail: emilia.fisicaro@unipr.it [University of Parma, Department of Pharmacy, Parco Area delle Scienze, 27/A, 43124 Parma (Italy); Compari, Carlotta; Bacciottini, Franco; Contardi, Laura [University of Parma, Department of Pharmacy, Parco Area delle Scienze, 27/A, 43124 Parma (Italy); Carcelli, Mauro; Rispoli, Gabriele; Rogolino, Dominga [University of Parma, Department of Chemistry, Parco Area delle Scienze, 17/A, 43124 Parma (Italy)

    2014-06-01

    Graphical abstract: Integrase strand transfert inhibitors chelate the metal ions in the active site of HIV integrase. - Highlights: • Development of inhibitors acting against those viral enzymes operating via a cooperative two-metal ion mechanism, such as HIV integrase (IN), requires optimizing the binding affinity to the target. • We have defined an experimental procedure for obtaining reliable thermodynamic data by ITC in methanol/water = 9/1 (v/v) as solvent. • Formation heats in mixed solvent of the complexes formed by a ligand, model of Raltegravir, with Mg(II), Mn(II), Co(II) and Zn(II) are here reported. - Abstract: Most enzymes that participate in the biochemistry of nucleic acids require divalent metal ion cofactors to promote activity. Development of potent inhibitors, acting against those viral enzymes operating via a cooperative two-metal ion mechanism, such as HIV integrase (IN) and RNase H, hepatitis C virus polymerase and influenza endonuclease, requires optimizing the binding affinity to the target, which is dictated by the binding free energy composed of both enthalpic and entropic contributions. They can be obtained by using isothermal titration microcalorimetry. We have defined an experimental procedure for obtaining reliable thermodynamic data in methanol/water = 9/1 0.1 M KCl as solvent, used to overcome solubility problems. In this way we have measured the heats of formation of the complexes formed by N-(4-fluorobenzyl)-5-hydroxy-2-isopropyl-1-methyl-6-oxo-1, 6-dihydroxypyrimidine-4-carboxylate (HL, a model of Raltegravir, the antiretroviral drug produced by Merck and Co.), and a series of divalent metal ions of biological interest (Mg(II), Mn(II), Co(II) and Zn(II)), whose speciation was previously determined by potentiometry.

  19. Probabilistic performance assessment of complex energy process systems - The case of a self-sustained sanitation system.

    Science.gov (United States)

    Kolios, Athanasios; Jiang, Ying; Somorin, Tosin; Sowale, Ayodeji; Anastasopoulou, Aikaterini; Anthony, Edward J; Fidalgo, Beatriz; Parker, Alison; McAdam, Ewan; Williams, Leon; Collins, Matt; Tyrrel, Sean

    2018-05-01

    A probabilistic modelling approach was developed and applied to investigate the energy and environmental performance of an innovative sanitation system, the "Nano-membrane Toilet" (NMT). The system treats human excreta via an advanced energy and water recovery island with the aim of addressing current and future sanitation demands. Due to the complex design and inherent characteristics of the system's input material, there are a number of stochastic variables which may significantly affect the system's performance. The non-intrusive probabilistic approach adopted in this study combines a finite number of deterministic thermodynamic process simulations with an artificial neural network (ANN) approximation model and Monte Carlo simulations (MCS) to assess the effect of system uncertainties on the predicted performance of the NMT system. The joint probability distributions of the process performance indicators suggest a Stirling Engine (SE) power output in the range of 61.5-73 W with a high confidence interval (CI) of 95%. In addition, there is high probability (with 95% CI) that the NMT system can achieve positive net power output between 15.8 and 35 W. A sensitivity study reveals the system power performance is mostly affected by SE heater temperature. Investigation into the environmental performance of the NMT design, including water recovery and CO 2 /NO x emissions, suggests significant environmental benefits compared to conventional systems. Results of the probabilistic analysis can better inform future improvements on the system design and operational strategy and this probabilistic assessment framework can also be applied to similar complex engineering systems.

  20. 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.

  1. Electron transfer across multiple hydrogen bonds: the case of ureapyrimidinedione-substituted vinyl ruthenium and osmium complexes.

    Science.gov (United States)

    Pichlmaier, Markus; Winter, Rainer F; Zabel, Manfred; Zális, Stanislav

    2009-04-08

    Ruthenium and osmium complexes 2a,b and 3a,b featuring the N-4,6-dioxo-5,5-dibutyl- or the N-4,6-dioxo-5,5-di-(2-propenyl)-1,4,5,6-tetrahydropyrimidin-2-yl-N'(4-ethenylphenyl)-urea ligand dimerize by a self-complementary quadruply hydrogen-bonding donor/donor/acceptor/acceptor (DDAA) motif. We provide evidence that the dimeric structures are maintained in nonpolar solvents and in 0.1 M NBu(4)PF(6)/CH(2)Cl(2) supporting electrolyte solution. All complexes are reversibly oxidized in two consecutive two-electron oxidations (DeltaE(1/2) approximately = 500 mV) without any discernible potential splitting for the oxidation of the individual hydrogen-bridged redox active moieties. IR and UV/vis/NIR spectroelectrochemistry show a one-step conversion of the neutral to the dication without any discernible features of an intermediate monooxidized radical cation. Oxidation-induced IR changes of the NH and CO groups that are involved in hydrogen bonding are restricted to the styryl-bonded urea NH function. IR band assignments are aided by quantum chemical calculations. Our experimental findings clearly show that, at least in the present systems, the ureapyrimidinedione (Upy) DDAA hydrogen-bonding motif does not support electron transfer. The apparent reason is that neither of the hydrogen-bonding functionalities contributes to the occupied frontier levels. This results in nearly degenerate pairs of MOs representing the in-phase and out-of-phase combinations of the individual monomeric building blocks.

  2. Hierarchy and Assortativity as New Tools for Binding-Affinity Investigation: The Case of the TBA Aptamer-Ligand Complex.

    Science.gov (United States)

    Cataldo, Rosella; Alfinito, Eleonora; Reggiani, Lino

    2017-12-01

    Aptamers are single stranded DNA, RNA, or peptide sequences having the ability to bind several specific targets (proteins, molecules as well as ions). Therefore, aptamer production and selection for therapeutic and diagnostic applications is very challenging. Usually, they are generated in vitro, although computational approaches have been recently developed for the in silico production. Despite these efforts, the mechanism of aptamer-ligand formation is not completely clear, and producing high-affinity aptamers is still quite difficult. This paper aims to develop a computational model able to describe aptamer-ligand affinity. Topological tools, such as the conventional degree distribution, the rank-degree distribution (hierarchy), and the node assortativity are employed. In doing so, the macromolecules tertiary-structures are mapped into appropriate graphs. These graphs reproduce the main topological features of the macromolecules, by preserving the distances between amino acids (nucleotides). Calculations are applied to the thrombin binding aptamer (TBA), and the TBA-thrombin complex produced in the presence of Na + or K + . The topological analysis is able to detect several differences between complexes obtained in the presence of the two cations, as expected by previous investigations. These results support graph analysis as a novel computational tool for testing affinity. Otherwise, starting from the graphs, an electrical network can be obtained by using the specific electrical properties of amino acids and nucleobases. Therefore, a further analysis concerns with the electrical response, revealing that the resistance is sensitively affected by the presence of sodium or potassium, thus suggesting resistance as a useful physical parameter for testing binding affinity.

  3. The formation of a complex community program for diabetes control: lessons learned from a case study of Project DIRECT.

    Science.gov (United States)

    Goodman, R M; Liburd, L C; Green-Phillips, A

    2001-05-01

    A case study was conducted of the formation of a diabetes initiative in a largely African American urban community. The study focused on how confluent the original project model was with actual formation, what benefits were produced, what areas of needed improvement surfaced, and how different stakeholder groups characterized one another's involvement. The project produced several benefits but also experienced needed improvements in its formation, which suffered from a lack of communication, cooperation, and coordination; unclear goals and personnel roles; and early delays. Lessons include treating project formation as an important developmental stage and reducing bureaucratic management approaches not suited for community partnerships.

  4. At the Intersection of Faith, Culture, and Family Dynamics: A Complex Case of Refusal of Treatment for Childhood Cancer.

    Science.gov (United States)

    Brown, Amy E Caruso

    2017-01-01

    Refusing treatment for potentially curable childhood cancers engenders much discussion and debate. I present a case in which the competent parents of a young Amish child with acute myeloid leukemia deferred authority for decision making to the child's maternal grandfather, who was vocal in his opposition to treatment. I analyze three related concerns that distinguish this case from other accounts of refused treatment. First, I place deference to grandparents as decision makers in the context of surrogate decision making more generally. Second, the maternal grandfather's ardent refusal of treatment and his rationale appeared to be inconsistent with the beliefs expressed by other family members and by members of the same Amish community, leading members of the medical team to question whether refusal of treatment should be treated differently when it appears to be based on the idiosyncratic beliefs of an individual rather than on community-wide values. Third, the medical team perceived tension and dissension between the nonverbal behavior of some family members and the verbal statements made by the maternal grandfather, leading the team to question the parents' true wishes and debate how to weigh nonverbal and indirect forms of communication. Finally, building upon the conclusions of these queries, I explore whether, if the child's prognosis was less favorable or if he were to relapse later, the maternal grandfather should have been permitted to drive a decision to refuse further treatment. Copyright 2017 The Journal of Clinical Ethics. All rights reserved.

  5. The Complex Interaction Between Polycystic Ovary Syndrome and Hereditary Angioedema: Case Reports and Review of the Literature.

    Science.gov (United States)

    Iahn-Aun, Marina; Aun, Marcelo Vivolo; Motta, Antonio Abílio; Kalil, Jorge; Giavina-Bianchi, Pedro; Hayashida, Sylvia Asaka; Baracat, Edmund Chada; Maciel, Gustavo Arantes

    2017-07-01

    Hereditary angioedema (HAE) is a rare but severe disease, with high risk of death, and attacks have been associated to high estrogen levels. Polycystic ovary syndrome (PCOS) is a common hyperandrogenic condition, which is frequently treated with combined oral contraceptives. The aim of this study was to describe 2 clinical cases of young women diagnosed as having PCOS who developed HAE attacks after the introduction of combined estrogen-progestin pills to treat PCOS symptoms. Literature review of sex hormones' role in genesis of HAE attacks and possible mechanisms involved. In the cases reported, after initiation of combined contraceptives, patients presented with facial swelling with airway involvement (laryngeal edema) and abdominal pain. They had a familial history of angioedema and normal C1 inhibitor (C1-INH) levels, leading to the diagnosis of HAE with normal C1-INH (HAEnC1-INH) or HAE type III. After suspension of exogenous estrogen, patients remained asymptomatic from HAE. HAEnC1-INH is an estrogen-dependent form of HAE. It is well established that exogenous estrogen triggers attacks of all types of HAE. However, this is the first description of the association between PCOS and HAE, in which PCOS could be masking HAE symptoms. We propose that PCOS might have a protective role regarding HAE attacks, because of its particular hormonal features, that is, hyperandrogenism and relative stable levels of estradiol. The use of combined estrogen-progestin compounds in women with PCOS and HAE must be avoided, and treatment must be individualized.

  6. 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

  7. 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

  8. Utilization of manual therapy to the lumbar spine in conjunction with traditional conservative care for individuals with bilateral lower extremity complex regional pain syndrome: A case series.

    Science.gov (United States)

    Walston, Zachary; Hernandez, Luis; Yake, Dale

    2018-06-06

    Conservative therapies for complex regional pain syndrome (CRPS) have traditionally focused on exercise and desensitization techniques targeted at the involved extremity. The primary purpose of this case series is to report on the potential benefit of utilizing manual therapy to the lumbar spine in conjunction with traditional conservative care when treating patients with lower extremity CRPS. Two patients with the diagnosis of lower extremity CRPS were treated with manual therapy to the lumbar spine in conjunction with education, exercise, desensitization, and soft tissue techniques for the extremity. Patient 1 received 13 sessions over 6 weeks resulting in a 34-point improvement in oswestry disability index (ODI) and 35-point improvement in lower extremity functional scale (LEFS). Patient 2 received 21 sessions over 12 weeks resulting in a 28-point improvement in ODI and a 41-point improvement in LEFS. Both patients exhibited reductions in pain and clinically meaningful improvements in function. Manual therapies when applied to the lumbar spine in these patients as part of a comprehensive treatment plan resulted in improved spinal mobility, decreased pain, and reduction is distal referred symptoms. Although one cannot infer a cause and effect relationship from a case series, this report identifies meaningful clinical outcomes potentially associated with manual physical therapy to the lumbar spine for two patients with complex regional pain syndrome type 1.

  9. 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.

  10. 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.

  11. 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

    2018-01-25

    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. The aim of our ulcer treatment was a complete and stable wound closure that was hampered by arterial occlusion, exposed tendon, and renal insiffuciency. To improve the prognosis for ulcer surgery, we performed percutaneous transluminal angioplasty, transcutaneous CO 2 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. Complex approaches are necessary, to gain optimum results in leg ulcer therapy in mixed leg ulcers. Therapeutic nihilism should be abandonend.

  12. 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.

  13. 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

  14. Rhabdoid and Undifferentiated Phenotype in Renal Cell Carcinoma: Analysis of 32 Cases Indicating a Distinctive Common Pathway of Dedifferentiation Frequently Associated With SWI/SNF Complex Deficiency.

    Science.gov (United States)

    Agaimy, Abbas; Cheng, Liang; Egevad, Lars; Feyerabend, Bernd; Hes, Ondřej; Keck, Bastian; Pizzolitto, Stefano; Sioletic, Stefano; Wullich, Bernd; Hartmann, Arndt

    2017-02-01

    Undifferentiated (anaplastic) and rhabdoid cell features are increasingly recognized as adverse prognostic findings in renal cell carcinoma (RCC), but their molecular pathogenesis has not been studied sufficiently. Recent studies identified alterations in the Switch Sucrose nonfermentable (SWI/SNF) chromatin remodeling complex as molecular mechanisms underlying dedifferentiation and rhabdoid features in carcinomas of different organs. We herein have analyzed 32 undifferentiated RCCs having in common an undifferentiated (anaplastic) phenotype, prominent rhabdoid features, or both, irrespective of the presence or absence of conventional RCC component. Cases were stained with 6 SWI/SNF pathway members (SMARCB1, SMARCA2, SMARCA4, ARID1A, SMARCC1, and SMARCC2) in addition to conventional RCC markers. Patients were 20 males and 12 females aged 32 to 85 years (mean, 59). A total of 22/27 patients with known stage presented with ≥pT3. A differentiated component varying from microscopic to major component was detected in 20/32 cases (16 clear cell and 2 cases each chromophobe and papillary RCC). The undifferentiated component varied from rhabdoid dyscohesive cells to large epithelioid to small monotonous anaplastic cells. Variable loss of at least 1 SWI/SNF complex subunit was noted in the undifferentiated/rhabdoid component of 21/32 cases (65%) compared with intact or reduced expression in the differentiated component. A total of 15/17 patients (88%) with follow-up died of metastatic disease (mostly within 1 y). Only 2 patients were disease free at last follow-up (1 and 6 y). No difference in survival, age distribution, or sex was observed between the SWI/SNF-deficient and the SWI/SNF-intact group. This is the first study exploring the role of SWI/SNF deficiency as a potential mechanism underlying undifferentiated and rhabdoid phenotype in RCC. Our results highlight the association between the aggressive rhabdoid phenotype and the SWI/SNF complex deficiency, consistent

  15. A Retrospective Study of Causes of Low Vision in Saud Arabia, A Case of Eye World Medical Complex in Riyadh.

    Science.gov (United States)

    Z Alotaibi, Abdullah

    2015-10-20

    Vision is the ability of seeing with a definite understanding of features, color and contrast, and to distinguish between objects visually. In the year 1999, the World Health Organization (WHO) and the International Agency for the Prevention of Blindness formulated a worldwide project for the eradication of preventable loss of sight with the subject of "Vision 2020: the Right to Sight". This global program aims to eradicate preventable loss of sight by the year 2020. This study was conducted to determine the main causes of low vision in Saudi Arabia and also to assess their visual improvement after using low vision aids (LVD).The study is a retrospective study and was conducted in low vision clinic at Eye World Medical Complex in Riyadh, Saudi Arabia. The file medical record of 280 patients attending low vision clinics from February 2008 to June 2010 was included. A data sheet was filled which include: age, gender, cause of low vision, unassisted visual acuity for long distances and short distances, low vision devices needed for long distances and short distances that provides best visual acuity. The result shows that the main cause of low vision was Optic atrophy (28.9%). Retinitis pigmentosa was the second cause of low vision, accounting for 73 patients (26%) followed by Diabetic retinopathy and Macular degeneration with 44 patients (15.7%) and 16 patients (5.7%) respectively. Inter family marriage could be one of the main causes of low vision. Public awareness should be embarked on for enlightenment on ocular diseases result in consanguineous marriage. Also, it is an important issue to start establishing low vision clinics in order to improve the situation.

  16. 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

  17. 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.

  18. 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

  19. 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.

  20. 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)

    2012-01-01

    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. PMID:22436121

  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

    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.

  2. Dynamics of quality as a strategic variable in complex food supply chain network competition: The case of fresh produce

    Science.gov (United States)

    Nagurney, Anna; Besik, Deniz; Yu, Min

    2018-04-01

    In this paper, we construct a competitive food supply chain network model in which the profit-maximizing producers decide not only as to the volume of fresh produce produced and distributed using various supply chain network pathways, but they also decide, with the associated costs, on the initial quality of the fresh produce. Consumers, in turn, respond to the various producers' product outputs through the prices that they are willing to pay, given also the average quality associated with each producer or brand at the retail outlets. The quality of the fresh produce is captured through explicit formulae that incorporate time, temperature, and other link characteristics with links associated with processing, shipment, storage, etc. Capacities on links are also incorporated as well as upper bounds on the initial product quality of the firms at their production/harvesting sites. The governing concept of the competitive supply chain network model is that of Nash Equilibrium, for which alternative variational inequality formulations are derived, along with existence results. An algorithmic procedure, which can be interpreted as a discrete-time tatonnement process, is then described and applied to compute the equilibrium produce flow patterns and accompanying link Lagrange multipliers in a realistic case study, focusing on peaches, which includes disruptions.

  3. The political economy of corporate social responsibility and community development: a case study of Norway's Snoehvit natural gas complex

    Energy Technology Data Exchange (ETDEWEB)

    Klick, Matthew T

    2009-07-01

    This project uses stakeholder evidence from semi-structured interviews to analyze the relative effectiveness of an oil company's stated 'corporate social responsibility' (CSR) initiatives in a new, Arctic host community. Specifically, this project analyzes the outcomes of StatoilHydro initiatives to date in Hammerfest, Norway, where the Snoehvit (Snow White) natural gas project began production in 2007. It gauges the ability of 'socially responsible' approaches to development to internalize negative externalisation and promote positive 'spin-offs'. Arctic countries are increasingly prioritizing petroleum development. The convergence of dramatic climate change, increasing energy demands, and high energy prices has made the Arctic an alluring frontier for the oil industry and Arctic governments. Small Arctic communities are increasingly playing host to large energy projects with the potential for dramatic cultural, social, environmental, and economic upheaval, but also economic growth and increased human capital. In this case study, CSR initiatives resulted in a broader accounting of social costs and benefits, an outcome that better internalized externalities, and pareto-improving trades between stakeholders and industry. (Author). 87 refs., 5 figs., 5 tabs

  4. 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.

  5. Enrolling HIV-positive adolescents in mental health research: A case study reflecting on legal and ethical complexities

    Directory of Open Access Journals (Sweden)

    Nataly Woollett

    2017-08-01

    Full Text Available Background. Adolescents living with HIV are an emerging group in the global HIV/AIDS epidemic. Mental health in this population affects HIV care, treatment, consequential morbidity and secondary transmission. There is a paucity of research regarding these youth in South Africa (SA, partly because section 71 of the National Health Act of 2003 (NHA requires parental or guardian’s consent. Objective. To explore legal and ethical issues related to conducting adolescent mental health research in SA. Methods. After obtaining a High Court order permitting research on minors aged <18 years without prior parental or guardian’s consent, we used qualitative and quantitative methods to interview adolescents in five clinics serving HIV-positive adolescents in Johannesburg. Results. Our study enrolled 343 participants; 74% were orphaned and did not have legal guardians, 27% were symptomatic for depression, anxiety or post-traumatic stress disorder, 24% were suicidal, and almost 90% did not feel that they belonged in the family with which they lived. Without court intervention, most of the participants could not have participated in this research because parental consent was impossible to obtain. This case study argues for exceptions to the parental consent requirement, which excludes orphaned and vulnerable children and youth from research. Conclusions. Recommendations are made to promote ethical integrity in conducting mental health research with adolescents. A balance is needed between protecting adolescents from exploitation and permitting access to benefits of research. Requiring parental consent for all research does not necessarily give effect to policy. For the vast majority of SA HIV-positive adolescents, parental consent is not possible. Section 71 of the NHA ought to be amended to facilitate valuable and necessary research concerning HIV-positive orphan children and adolescents.

  6. 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.

  7. Connections and consequences in complex systems: insights from a case study of the emergence and local impact of crisis resolution and home treatment services.

    Science.gov (United States)

    Hannigan, Ben

    2013-09-01

    In this article the broad contours of a complexity perspective are outlined. Complexity ideas are then drawn on to frame an empirical examination of the connections running between different levels of organisation in health and social care, and to underpin investigation into the intended and unintended local system consequences of service development. Data are used from a study conducted in the UK's mental health field. Here, macro-level policy has led to the supplementing of longstanding community mental health teams by newer, more specialised, services. An example includes teams providing crisis resolution and home treatment (CRHT) care as an alternative to hospital admission. Using an embedded case study design, where 'the case' examined was a new CRHT team set in its surrounding organisational environment, ethnographic data (with interviews predominating) were generated in a single site in Wales over 18 months from the middle of 2007. In a large-scale context favourable to local decision-making, and against a background of a partial and disputed evidence base, the move to establish the new standalone service was contested. Whilst users valued the work of the team, and local practitioners recognised the quality of its contribution, powerful effects were also triggered across the locality's horizontal interfaces. Participants described parts of the interconnected system being closed to release resources, staff gravitating to new crisis services leaving holes elsewhere, and the most needy service users being cared for by the least experienced workers. Some community mental health team staff described unexpected increases in workload, and disputes over eligibility for crisis care with implications for system-wide working relations. Detailed data extracts are used to illustrate these connections and consequences. Concluding lessons are drawn on the use of evidence to inform policy, on the significance of local contexts and system interfaces, and on anticipating the

  8. 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.

  9. 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.

  10. 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.

  11. 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.

  12. Ultrasound-guided stellate ganglion blocks combined with pharmacological and occupational therapy in Complex Regional Pain Syndrome (CRPS): a pilot case series ad interim.

    Science.gov (United States)

    Wei, Karin; Feldmann, Robert E; Brascher, Anne-Kathrin; Benrath, Justus

    2014-12-01

    This preliminary and retrospective pilot case series examines a treatment concept consisting of ultrasound-guided stellate ganglion blocks (SGBs) combined with pharmacological and occupational therapy in patients with complex regional pain syndrome (CRPS) of the hand. Efficacy of combined treatment concepts and safety of ultrasound-guided SGB have not been sufficiently investigated yet. A total number of 156 blocks were evaluated in 16 patients with CRPS in a retrospective analysis. All patients received pharmacotherapy and a standard regimen of occupational therapy offered simultaneously to the SGBs. Changes in both spontaneous and evoked pain levels were assessed by numerical pain rating score before and after the last blockade of a series. Side effects were documented. The overall mean pain reduction was 63.2% regarding spontaneous and 45.3% regarding evoked pain. Mild complications, such as hoarseness or dysphagia, occurred in 13.5% of the blocks (21 SGBs). Serious complications, such as plexus paresis or accidental puncture of vessels or other structures, did not occur. Time between symptom onset and start of treatment did not affect the extent of pain reduction. The combination of ultrasound-guided SGB and simultaneous pharmacological and occupational therapy showed encouraging treatment results under conditions of this pilot case series. Assessment of efficacy of this combined treatment concept and safety of ultrasound-guided SGB require further prospective clinical studies with larger number of participants. Wiley Periodicals, Inc.

  13. 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.

  14. 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.

  15. 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

  16. The Perception of a Three-Dimensional-Printed Heart Model from the Perspective of Different Stakeholders: A Complex Case of Truncus Arteriosus.

    Science.gov (United States)

    Biglino, Giovanni; Moharem-Elgamal, Sarah; Lee, Matthew; Tulloh, Robert; Caputo, Massimo

    2017-01-01

    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 ."

  17. 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.”

  18. 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

  19. Use of the nonsteady monotonic heating method for complex determination of thermophysical properties of chemically reacting mixture in the case of non-equilibrium proceeding of the chemical reaction

    International Nuclear Information System (INIS)

    Serebryanyj, G.Z.

    1984-01-01

    Theoretical analysis is made for the monotonic heating method as applied for complex determination of thermophysical properties of chemically reacting gases. The possibility is shown of simultaneous determination of frozen and equilibrium heat capacity, frozen and equilibrium heat conduction provided non-equilibrium occuring of the reaction in the wide range of temperatures and pressures. The monotonic heating method can be used for complex determination of thermophysical properties of chemically reacting systems in case of non-equilibrium proceeding of the chemical reaction

  20. 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.

  1. 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

    2018-06-01

    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.

  2. Determination of Irreducible Water Saturation from nuclear magnetic resonance based on fractal theory — a case study of sandstone with complex pore structure

    Science.gov (United States)

    Peng, L.; Pan, H.; Ma, H.; Zhao, P.; Qin, R.; Deng, C.

    2017-12-01

    The irreducible water saturation (Swir) is a vital parameter for permeability prediction and original oil and gas estimation. However, the complex pore structure of the rocks makes the parameter difficult to be calculated from both laboratory and conventional well logging methods. In this study, an effective statistical method to predict Swir is derived directly from nuclear magnetic resonance (NMR) data based on fractal theory. The spectrum of transversal relaxation time (T2) is normally considered as an indicator of pore size distribution, and the micro- and meso-pore's fractal dimension in two specific range of T2 spectrum distribution are calculated. Based on the analysis of the fractal characteristics of 22 core samples, which were drilled from four boreholes of tight lithologic oil reservoirs of Ordos Basin in China, the positive correlation between Swir and porosity is derived. Afterwards a predicting model for Swir based on linear regressions of fractal dimensions is proposed. It reveals that the Swir is controlled by the pore size and the roughness of the pore. The reliability of this model is tested and an ideal consistency between predicted results and experimental data is found. This model is a reliable supplementary to predict the irreducible water saturation in the case that T2 cutoff value cannot be accurately determined.

  3. 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.

  4. Real-Time Agent-Based Modeling Simulation with in-situ Visualization of Complex Biological Systems: A Case Study on Vocal Fold Inflammation and Healing.

    Science.gov (United States)

    Seekhao, Nuttiiya; Shung, Caroline; JaJa, Joseph; Mongeau, Luc; Li-Jessen, Nicole Y K

    2016-05-01

    We present an efficient and scalable scheme for implementing agent-based modeling (ABM) simulation with In Situ visualization of large complex systems on heterogeneous computing platforms. The scheme is designed to make optimal use of the resources available on a heterogeneous platform consisting of a multicore CPU and a GPU, resulting in minimal to no resource idle time. Furthermore, the scheme was implemented under a client-server paradigm that enables remote users to visualize and analyze simulation data as it is being generated at each time step of the model. Performance of a simulation case study of vocal fold inflammation and wound healing with 3.8 million agents shows 35× and 7× speedup in execution time over single-core and multi-core CPU respectively. Each iteration of the model took less than 200 ms to simulate, visualize and send the results to the client. This enables users to monitor the simulation in real-time and modify its course as needed.

  5. Complex Regional Pain Syndrome type I of the upper limb - treatment based on Stress Loading Program: a case study

    Directory of Open Access Journals (Sweden)

    Aline Sarturi Ponte

    2015-03-01

    Full Text Available The daily life of an individual suffering from Complex Regional Pain Syndrome type I (CPRS I becomes limited, because this syndrome causes signs and symptoms located in the affected limb, and may occur in other parts. From this premise, this study aims to present the contributions of Occupational Therapy and the Rehabilitation Stress Loading Program for a subject with CRPS I in the upper limb, attended by the Group of Pain from the University Hospital of Santa Maria (HUSM, Rio Grande do Sul state. This research is characterized as a case study, experimental, which deals with pre and post occupational therapy intervention. The instruments used for data collection were the protocols of Disabilities of the Arm, Shoulder and Hand (DASH, the International Classification of Disability, Functioning and Health (ICF, the Canadian Occupational Performance Measure (COPM, the Visual Analogue Scale, and goniometry (EVA. After assessment, the subject was exposed to the treatment of compressive active resistive exercises; after this treatment was completed, the subject was reassessed. It was observed that the treatment applied has contributed to the reduction of the pain and to the improvement in the Range of Motion (ROM of the subject. The use of the stress protocol and active compression contributed significantly to the reduction of pain, ADM gain and occupational performance improvement.

  6. [Control of generalized chronic periodontitis combined with calcium-antagonist-related gingival overgrowth by a complex periodontal-endodontic-prosthodontic treatment. Case report].

    Science.gov (United States)

    Szánto, Erika; Gera, István

    2011-12-01

    To day a relatively high percentage of elderly population of the industrialized world suffers with different cardiovascular diseases and are on permanent antihypertensive therapy. One of the most frequently used drugs is the calcium channel blockers prescribed against high blood pressure. The most common oral side effect of these drugs is the gingival enlargement that might develop even on otherwise healthy gingiva. The incidence of chronic periodontitis in this age group is also high and the Ca antagonist medication in those individuals might substantially modify the clinical course of periodontal inflammation leading to gingival enlargement and hypertrophic pocket wall. The case presented here is a 52 years old hypertonic woman with a long history of Ca-antagonist therapy and generalized chronic periodontitis combined with gingival hyperplasia. After the change of medication the 1,5 years comprehensive periodontal endodontic and prosthodontic therapy restored patient's periodontal health and provided complex dental rehabilitation. Nevertheless, only regular periodontal supportive therapy could ensure predictable outcome and guarantee long lasting periodontal health.

  7. 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

  8. 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

  9. 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

  10. Evaluation and mechanism for outcomes exploration of providing public health care in contract service in rural China: a multiple-case study with complex adaptive systems design.

    Science.gov (United States)

    Zhou, Huixuan; Zhang, Shengfa; Zhang, Weijun; Wang, Fugang; Zhong, You; Gu, Linni; Qu, Zhiyong; Tian, Donghua

    2015-02-27

    The Chinese government has increased the funding for public health in 2009 and experimentally applied a contract service policy (could be seen as a counterpart to family medicine) in 15 counties to promote public health services in the rural areas in 2013. The contract service aimed to convert village doctors, who had privately practiced for decades, into general practitioners under the government management, and better control the rampant chronic diseases. This study made a rare attempt to assess the effectiveness of public health services delivered under the contract service policy, explore the influencing mechanism and draw the implications for the policy extension in the future. Three pilot counties and a non-pilot one with heterogeneity in economic and health development from east to west of China were selected by a purposive sampling method. The case study methods by document collection, non-participant observation and interviews (including key informant interview and focus group interview) with 84 health providers and 20 demanders in multiple level were applied in this study. A thematic approach was used to compare diverse outcomes and analyze mechanism in the complex adaptive systems framework. Without sufficient incentives, the public health services were not conducted effectively, regardless of the implementation of the contract policy. To appropriately increase the funding for public health by local finance and properly allocate subsidy to village doctors was one of the most effective approaches to stimulate health providers and demanders' positivity and promote the policy implementation. County health bureaus acted as the most crucial agents among the complex public health systems. Their mental models influenced by the compound and various environments around them led to the diverse outcomes. If they could provide extra incentives and make the contexts of the systems ripe enough for change, the health providers and demanders would be receptive to the

  11. 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...

  12. Wireless peripheral nerve stimulation for complex regional pain syndrome type I of the upper extremity: a case illustration introducing a novel technology.

    Science.gov (United States)

    Herschkowitz, Daniel; Kubias, Jana

    2018-04-13

    Complex regional pain syndrome (CRPS) is a debilitating painful disorder, cryptic in its pathophysiology and refractory condition with limited therapeutic options. Type I CRPS with its variable relationship to trauma has often no discernible fractures or nerve injuries and remains enigmatic in its response to conservative treatment as well as the other limited interventional therapies. Neuromodulation in the form of spinal cord and dorsal root ganglion stimulation (SCS, DRGS) has shown encouraging results, especially of causalgia or CRPS I of lower extremities. Upper extremity CRPS I is far more difficult. To report a case of upper extremity CRPS I treated by wireless peripheral nerve stimulation (WPNS) for its unique features and minimally invasive technique. The system does not involve implantation of battery or its connections. A 47 year old female patient presented with refractory CRPS I following a blunt trauma to her right forearm. As interventional treatment in the form of local anesthetics (Anesthesia of peripheral branches of radial nerve) and combined infusions of ketamine/lidocaine failed to provide any significant relief she opted for WPNS treatment. Based on the topographic distribution, two electrodes (Stimwave Leads: FR4A-RCV-A0 with tines, Generation 1 and FR4A-RCV-B0 with tines, Generation 1), were placed along the course of radial and median nerves under ultrasonography monitoring and guided by intraoperative stimulation. This procedure did not involve implantation of extension cables or the power source. At a frequency of 60 Hz and 300 μs the stimulation induced paresthesia along the distribution of the nerves. Therapeutic relief was observed with high frequency (HF) stimulation (HF 10 kHz/32 μs, 2.0 mA) reducing her pain from a visual analogue scale (VAS) score of 7-4 postoperatively. Three HF stimulations programs were provided at the time of discharge, as she improved in her sensory impairment to touch, pressure and temperature at her first

  13. 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.

  14. 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.

  15. 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

  16. 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.

  17. 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

  18. Hyperthyroidism and atrial myxoma--an intriguing cardio-endocrine association.

    Science.gov (United States)

    Kumar, Gautam; Chow, John T; Klarich, Kyle W; Dean, Diana S

    2007-12-01

    A 65-year-old woman presented with dyspnea and bilateral leg edema for 1 week, worsening fatigue for 1 month, and a 7-lb weight loss over the last summer. She was clinically and biochemically hyperthyroid. Echocardiography revealed a left atrial myxoma measuring 6.2 x 3.3 cm protruding into the mitral orifice and left ventricle during diastole. She was treated for Graves' disease with Iodine-131. Six weeks later, her left atrial myxoma measuring 10.1 x 6.2 x 2.4 cm was resected. She became euthyroid before surgery and then biochemically hypothyroid 6 weeks after radioiodine treatment, for which she subsequently required thyroxine replacement. Atrial myxomas are the most common primary cardiac neoplasms. At least 5% to 10% can be attributed to Carney's complex. More than two-thirds of patients with Carney's complex develop one or more cardiac myxomas. Although atrial myxomas in Carney's complex are histologically indistinguishable from the sporadic form, their clinical presentation and course is distinct. This is the first case of newly diagnosed Graves' disease that has been reported in association with an atrial myxoma. The features discussed in this article help differentiate between syndromic and sporadic atrial myxomas.

  19. 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.

  20. 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...... 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....

  1. Application of molecular cytogenetic techniques to clarify apparently balanced complex chromosomal rearrangements in two patients with an abnormal phenotype: Case report

    NARCIS (Netherlands)

    P.J.P. de Vree (Paula); M.E.H. Simon (Marleen); M.F. van Dooren (Marieke); G.H.T. Stoevelaar (Gerda); J.T.W. Hilkmann (José); M.A. Rongen (Michel); G.C.M. Huijbregts (Gido); A.J.H.M. Verkerk (Annemieke); P. Poddighe (Pino)

    2009-01-01

    textabstractBackground. 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

  2. The role of hyaluronan as a drug carrier to enhance the bioavailability of extended release ophthalmic formulations. Hyaluronan-timolol ionic complexes as a model case.

    Science.gov (United States)

    Battistini, F D; Tártara, L I; Boiero, C; Guzmán, M L; Luciani-Giaccobbe, L C; Palma, S D; Allemandi, D A; Manzo, R H; Olivera, M E

    2017-07-15

    The aim of this work was to obtain information concerning the properties of ophthalmic formulations based on hyaluronic-drug ionic complexes, to identify the factors that determine the onset, intensity and duration of the pharmacotherapeutic effect. Dispersions of a complex of 0.5% w/v of sodium hyaluronate (HyNa) loaded with 0.5% w/v of timolol maleate (TM) were obtained and presented a counterionic condensation higher than 75%. For comparison a similar complex obtained with hyaluronic acid (HyH) was also prepared. Although the viscosity of HyNa-TM was significantly higher than that of HyH-TM, in vitro release of TM from both complexes showed a similar extended drug release profile (20-31% over 5h) controlled by diffusion and ionic exchange. Ocular pharmacokinetic study performed in normotensive rabbits showed that HyNa-TM complex exhibited attractive bioavailability properties in the aqueous humor (AUC and Cmax significantly higher and later Tmax) compared to commercial TM eye-drops. Moreover, a more prolonged period of lowered intra-ocular pressure (10h) and a more intense hypotensive activity was observed after instillation of a drop of HyNa-TM as compared to the eye-drops. Such behavior was related to the longer pre-corneal residence times (400%) observed with HyNa-TM complex. No significant changes in rabbit transcorneal permeation were detected upon complexation. These results demonstrate that the ability of HyNa to modulate TM release, together with its mucoadhesiveness related to the viscosity, affected both the pharmacokinetic and pharmacodynamic parameters. The HyNa-TM complex is a potentially useful carrier for ocular drug delivery, which could improve the TM efficacy and reduce the frequency of administration to improve patient compliance. Copyright © 2017 Elsevier B.V. All rights reserved.

  3. 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.

  4. (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.

  5. Cuticular Compounds Bring New Insight in the Post-Glacial Recolonization of a Pyrenean Area: Deutonura deficiens Deharveng, 1979 Complex, a Case Study

    Science.gov (United States)

    Porco, David; Bedos, Anne; Deharveng, Louis

    2010-01-01

    Background In most Arthropod groups, the study of systematics and evolution rely mostly on neutral characters, in this context cuticular compounds, as non-neutral characters, represent an underexplored but potentially informative type of characters at the infraspecific level as they have been routinely proven to be involved in sexual attraction. Methods and Findings The collembolan species complex Deutonura deficiens was chosen as a model in order to test the utility of these characters for delineating four infraspecific entities of this group. Specimens were collected for three subspecies (D. d. deficiens, D. d. meridionalis, D. d. sylvatica) and two morphotypes (D. d. sylvatica morphoype A and B) of the complex; an additional species D. monticola was added. Cuticular compounds were extracted and separated by gas chromatography for each individual. Our results demonstrate that cuticular compounds succeeded in separating the different elements of this complex. Those data allowed also the reconstruction of the phylogenetic relationships among them. Conclusions The discriminating power of cuticular compounds is directly related to their involvement in sexual attraction and mate recognition. These findings allowed a discussion on the potential involvement of intrinsic and paleoclimatic factors in the origin and the diversification of this complex in the Pyrenean zone. This character type brings the first advance from pattern to process concerning the origin of this species complex. PMID:21209797

  6. Cuticular compounds bring new insight in the post-glacial recolonization of a Pyrenean area: Deutonura deficiens Deharveng, 1979 complex, a case study.

    Science.gov (United States)

    Porco, David; Bedos, Anne; Deharveng, Louis

    2010-12-21

    In most Arthropod groups, the study of systematics and evolution rely mostly on neutral characters, in this context cuticular compounds, as non-neutral characters, represent an underexplored but potentially informative type of characters at the infraspecific level as they have been routinely proven to be involved in sexual attraction. The collembolan species complex Deutonura deficiens was chosen as a model in order to test the utility of these characters for delineating four infraspecific entities of this group. Specimens were collected for three subspecies (D. d. deficiens, D. d. meridionalis, D. d. sylvatica) and two morphotypes (D. d. sylvatica morphoype A and B) of the complex; an additional species D. monticola was added. Cuticular compounds were extracted and separated by gas chromatography for each individual. Our results demonstrate that cuticular compounds succeeded in separating the different elements of this complex. Those data allowed also the reconstruction of the phylogenetic relationships among them. The discriminating power of cuticular compounds is directly related to their involvement in sexual attraction and mate recognition. These findings allowed a discussion on the potential involvement of intrinsic and paleoclimatic factors in the origin and the diversification of this complex in the Pyrenean zone. This character type brings the first advance from pattern to process concerning the origin of this species complex.

  7. 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.

  8. Critical solvent thermodynamic effect on molecular recognition: The case of the complex formation of carboxylates and ammonium-squaramido based receptors

    International Nuclear Information System (INIS)

    Piña, M. Nieves; López, Kenia A.; Costa, Antoni; Morey, Jeroni

    2013-01-01

    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

  9. The management of complex system innovations. A theoretic approach to network formation and critical success factor identification using the case of fuel cell vehicles

    Energy Technology Data Exchange (ETDEWEB)

    Venghaus, Sandra

    2011-07-01

    Given the economic, ecological and social importance of automotive transportation, the development of alternative fueling and propulsion technologies requires a wise and sustainable political course of action. Not least the public debate on the impact of transport emissions on climate change and the call for limits to automotive CO-2-emissions reflect the relevance of the topic. In the search for innovative alternatives to the conventional gasoline or diesel propulsion technology, electromobility and hydrogen-based fuel cell vehicles constitute the two most widely discussed long-term options. The market introduction of fuel cell vehicles serves as an expedient example of a highly complex system innovation (CSI), which requires the cooperation of a variety of actors from formerly independent economic sectors in order to overcome the significant barriers to market entry. As will be discussed, such CSI can only be successfully implemented in an environment, within which the complexity-induced knowledge gap is reduced by a systematic exchange of information with respect to both the critical success factors identified by each of the involved stakeholders as well as their cooperation needs and expectations. Given this challenge, a framework is developed, which serves as the basis for a structured dialogue among the multiple stakeholders involved in the development process of a complex system innovation. The framework can thus best be classified as a corporate moderation and decision-support tool to achieve transparency in and impose structure on complex contexts. Methodically, the presented thesis addresses the development of a holistic approach to the management of complex system innovations from two perspectives: (1) a theoretical perspective of analyzing underlying structures and processes of CSI management (i.e., the CSI Management Framework), as well as (2) the development of a strategic approach for the practical implementation of CSI management in complex networks

  10. [An autopsy case of amyotrophic lateral sclerosis with prominent muscle cramps, fasciculation, and high titer of anti-voltage gated potassium channel (VGKC) complex antibody].

    Science.gov (United States)

    Sato, Aki; Sakai, Naoko; Shinbo, Junsuke; Hashidate, Hideki; Igarashi, Shuichi; Kakita, Akiyoshi; Yamazaki, Motoyoshi

    2014-01-01

    The patient was a 55-year-old male who had prominent fasciculation and muscle cramps. Muscle weakness and atrophy of the trunk, respiratory system, and extremities gradually progressed. On the basis of these features, we diagnosed this patient as having amyotrophic lateral sclerosis (ALS), however, the upper motor neuron signs were not significant. Following the detection of the anti-voltage gated potassium channel (VGKC) complex antibody at 907.5 pM (normal VGKC complex antibody in the development of cramp-fasciculation syndrome has been speculated. In this ALS patient, the antibodies might be associated with pathomechanisms underlying the characteristic symptoms.

  11. 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.

  12. Integrating stochastic age-structured population dynamics into complex fisheries economic models for management evaluations: the North Sea saithe fishery as a case study

    NARCIS (Netherlands)

    Simons, S.L.; Bartelings, H.; Hamon, K.G.; Kempf, A.J.; Doring, R.; Temming, A.

    2014-01-01

    There is growing interest in bioeconomic models as tools for understanding pathways of fishery behaviour in order to assess the impact of alternative policies on natural resources. A model system is presented that combines stochastic age-structured population dynamics with complex fisheries

  13. 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

  14. In Search for Instructional Techniques to Maximize the Use of Germane Cognitive Resources: A Case of Teaching Complex Tasks in Physics

    Science.gov (United States)

    Sliva, Yekaterina

    2014-01-01

    The purpose of this study was to introduce an instructional technique for teaching complex tasks in physics, test its effectiveness and efficiency, and understand cognitive processes taking place in learners' minds while they are exposed to this technique. The study was based primarily on cognitive load theory (CLT). CLT determines the amount of…

  15. Integrating care for older people with complex needs: key insights and lessons from a seven-country cross-case analysis.

    Science.gov (United States)

    Wodchis, Walter P; Dixon, Anna; Anderson, Geoff M; Goodwin, Nick

    2015-01-01

    To address the challenges of caring for a growing number of older people with a mix of both health problems and functional impairment, programmes in different countries have different approaches to integrating health and social service supports. The goal of this analysis is to identify important lessons for policy makers and service providers to enable better design, implementation and spread of successful integrated care models. This paper provides a structured cross-case synthesis of seven integrated care programmes in Australia, Canada, the Netherlands, New Zealand, Sweden, the UK and the USA. All seven programmes involved bottom-up innovation driven by local needs and included: (1) a single point of entry, (2) holistic care assessments, (3) comprehensive care planning, (4) care co-ordination and (5) a well-connected provider network. The process of achieving successful integration involves collaboration and, although the specific types of collaboration varied considerably across the seven case studies, all involved a care coordinator or case manager. Most programmes were not systematically evaluated but the two with formal external evaluations showed benefit and have been expanded. Case managers or care coordinators who support patient-centred collaborative care are key to successful integration in all our cases as are policies that provide funds and support for local initiatives that allow for bottom-up innovation. However, more robust and systematic evaluation of these initiatives is needed to clarify the 'business case' for integrated health and social care and to ensure successful generalization of local successes.

  16. 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.

  17. Three-dimensional-printed cardiac prototypes aid surgical decision-making and preoperative planning in selected cases of complex congenital heart diseases: Early experience and proof of concept in a resource-limited environment.

    Science.gov (United States)

    Kappanayil, Mahesh; Koneti, Nageshwara Rao; Kannan, Rajesh R; Kottayil, Brijesh P; Kumar, Krishna

    2017-01-01

    Three-dimensional. (3D) printing is an innovative manufacturing process that allows computer-assisted conversion of 3D imaging data into physical "printouts" Healthcare applications are currently in evolution. The objective of this study was to explore the feasibility and impact of using patient-specific 3D-printed cardiac prototypes derived from high-resolution medical imaging data (cardiac magnetic resonance imaging/computed tomography [MRI/CT]) on surgical decision-making and preoperative planning in selected cases of complex congenital heart diseases (CHDs). Five patients with complex CHD with previously unresolved management decisions were chosen. These included two patients with complex double-outlet right ventricle, two patients with criss-cross atrioventricular connections, and one patient with congenitally corrected transposition of great arteries with pulmonary atresia. Cardiac MRI was done for all patients, cardiac CT for one; specific surgical challenges were identified. Volumetric data were used to generate patient-specific 3D models. All cases were reviewed along with their 3D models, and the impact on surgical decision-making and preoperative planning was assessed. Accurate life-sized 3D cardiac prototypes were successfully created for all patients. The models enabled radically improved 3D understanding of anatomy, identification of specific technical challenges, and precise surgical planning. Augmentation of existing clinical and imaging data by 3D prototypes allowed successful execution of complex surgeries for all five patients, in accordance with the preoperative planning. 3D-printed cardiac prototypes can radically assist decision-making, planning, and safe execution of complex congenital heart surgery by improving understanding of 3D anatomy and allowing anticipation of technical challenges.

  18. Estimation of the Pitzer equation parameters for aqueous complexes. A case study for uranium at 298.15 K and 1 atm

    International Nuclear Information System (INIS)

    Plyasunov, A.; Grenthe, I.; Fanghaenel, T.

    1998-01-01

    A procedure to estimate the Pitzer parameters for complexes or complex formation reactions from a small number of equilibrium constants (log K vs. I) obtained in 'constant ionic media' is discussed in some detail. It is then often impossible to determine both log K deg., the equilibrium constant at I=0, and all Pitzer parameters, hence some estimations or other simplifications are necessary. Solution coordination chemists have therefore preferred to use the less parametrized Broensted-Guggenheim-Scatchard (SIT) model. By comparison of analytical statements for the mean activity coefficients and equilibrium constants, for the SIT and Pitzer models we have shown that they are equivalent for ionic strengths less than 4 mol kg -1 , and have also established relationships between the Pitzer parameter β (1) and the charge type of the interacting ions, and between Δβ (1) for a complex formation reaction and ΔZETA 2 for the reaction, where ΔZETA 2 is the sum of the squared charges of the reactants/products with the proper stoichiometric coefficients. The first relationship is based on data in single electrolyte systems and the second on equilibrium-constant data determined in ionic media. For reactions involving species of charges one and two in 1-1 electrolyte ionic media we recommend the use of Δβ (1) /ΔZETA 2 = 0.337±0.014 kg mol -1 for the estimation of the Δβ (1) at 298.15 K and 1 atm. In this way we have used concentration equilibrium constant data to estimate log K deg. and Pitzer parameters β (0) and β (1) for more than 30 uranium complexes with other ions at 298.15 K and 1 atm. The procedure makes it possible to use the information on complex formation, acid/base and redox equilibria obtained in ionic media together with the Pitzer parameters for strong electrolytes for the modeling of complex equilibrium systems oer a broad range of ionic strength/ionic medium compositions, up to at least 4 mol kg -1 . (au)

  19. Methodological approach in determination of small spatial units in a highly complex terrain in atmospheric pollution research: the case of Zasavje region in Slovenia.

    Science.gov (United States)

    Kukec, Andreja; Boznar, Marija Z; Mlakar, Primoz; Grasic, Bostjan; Herakovic, Andrej; Zadnik, Vesna; Zaletel-Kragelj, Lijana; Farkas, Jerneja; Erzen, Ivan

    2014-05-01

    The study of atmospheric air pollution research in complex terrains is challenged by the lack of appropriate methodology supporting the analysis of the spatial relationship between phenomena affected by a multitude of factors. The key is optimal design of a meaningful approach based on small spatial units of observation. The Zasavje region, Slovenia, was chosen as study area with the main objective to investigate in practice the role of such units in a test environment. The process consisted of three steps: modelling of pollution in the atmosphere with dispersion models, transfer of the results to geographical information system software, and then moving on to final determination of the function of small spatial units. A methodology capable of designing useful units for atmospheric air pollution research in highly complex terrains was created, and the results were deemed useful in offering starting points for further research in the field of geospatial health.

  20. Cryptic or pseudocryptic: can morphological methods inform copepod taxonomy? An analysis of publications and a case study of the Eurytemora affinis species complex

    Science.gov (United States)

    Lajus, Dmitry; Sukhikh, Natalia; Alekseev, Victor

    2015-01-01

    Interest in cryptic species has increased significantly with current progress in genetic methods. The large number of cryptic species suggests that the resolution of traditional morphological techniques may be insufficient for taxonomical research. However, some species now considered to be cryptic may, in fact, be designated pseudocryptic after close morphological examination. Thus the “cryptic or pseudocryptic” dilemma speaks to the resolution of morphological analysis and its utility for identifying species. We address this dilemma first by systematically reviewing data published from 1980 to 2013 on cryptic species of Copepoda and then by performing an in-depth morphological study of the former Eurytemora affinis complex of cryptic species. Analyzing the published data showed that, in 5 of 24 revisions eligible for systematic review, cryptic species assignment was based solely on the genetic variation of forms without detailed morphological analysis to confirm the assignment. Therefore, some newly described cryptic species might be designated pseudocryptic under more detailed morphological analysis as happened with Eurytemora affinis complex. Recent genetic analyses of the complex found high levels of heterogeneity without morphological differences; it is argued to be cryptic. However, next detailed morphological analyses allowed to describe a number of valid species. Our study, using deep statistical analyses usually not applied for new species describing, of this species complex confirmed considerable differences between former cryptic species. In particular, fluctuating asymmetry (FA), the random variation of left and right structures, was significantly different between forms and provided independent information about their status. Our work showed that multivariate statistical approaches, such as principal component analysis, can be powerful techniques for the morphological discrimination of cryptic taxons. Despite increasing cryptic species

  1. Case files of the Medical Toxicology Fellowship at the Toxikon Consortium in Chicago: Cocaine-associated wide-complex dysrhythmias and cardiac arrest— treatment nuances and controversies

    OpenAIRE

    Kalimullah, Ejaaz A.; Bryant, Sean M.

    2008-01-01

    Manifestations of cocaine poisoning range widely from mild sympathomimetic overdrive to life-threatening seizures, hyperthermia, and cardiac dysrhythmias. While supportive care, including the judicious use of benzodiazepines and cooling measures, is paramount, the management of cocaine-associated wide-complex dysrhythmias and cardiac arrest regularly includes sodium bicarbonate boluses in order to narrow QRS length. When confronted with refractory dysrhythmias, one must weigh the benefits and...

  2. 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.

  3. 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.

  4. 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.

  5. 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...

  6. Complexity Theory

    Science.gov (United States)

    Lee, William H K.

    2016-01-01

    A complex system consists of many interacting parts, generates new collective behavior through self organization, and adaptively evolves through time. Many theories have been developed to study complex systems, including chaos, fractals, cellular automata, self organization, stochastic processes, turbulence, and genetic algorithms.

  7. Occurrence of faecal pellet-filled simple and composite burrows in cold seep carbonates: A glimpse of a complex benthic ecosystem

    Digital Repository Service at National Institute of Oceanography (India)

    Mazumdar, A.; Joshi, R.K.; Peketi, A.; Kocherla, M.

    of inorganic sulphur in sediments and shales. Chemical Geology 54, 149–155. Cordes, E. E., Carney, S. L., Hourdez, S., Carney, R. S., Brooks, J. M. & Fisher, C. R. 2007. Cold seeps of the deep Gulf of Mexico: Community structure and biogeographic comparisons..., Surficial hydrocarbon seep infauna from the Blake Ridge (Atlantic Ocean, 2150 m) and the Gulf of Mexico (690– 2240 m) PSZN. Marine Ecology 25, 313–336. Sahling, H., Rickert, D., Lee, R.W., Linke, P., Suess, E., 2002, Macrofaunal community structure...

  8. Can the Language of Rights Get Hold of the Complex Realities of Child Domestic Work?: The Case of Young Domestic Workers in Abidjan, Ivory Coast

    Science.gov (United States)

    Jacquemin, Melanie

    2006-01-01

    This review examines refractions of children's rights in development practice from an anthropological point of view and considers the case of young domestic girls working in Abidjan. The author argues that child labour legislation and the children's rights perspective in Abidjan is permeated by patriarchal values that mask the exploitation of work…

  9. Lethal neonatal case and review of primary short-chain enoyl-CoA hydratase (SCEH) deficiency associated with secondary lymphocyte pyruvate dehydrogenase complex (PDC) deficiency

    NARCIS (Netherlands)

    Bedoyan, Jirair K.; Yang, Samuel P.; Ferdinandusse, Sacha; Jack, Rhona M.; Miron, Alexander; Grahame, George; DeBrosse, Suzanne D.; Hoppel, Charles L.; Kerr, Douglas S.; Wanders, Ronald J. A.

    2017-01-01

    Mutations in ECHS1 result in short-chain enoyl-CoA hydratase (SCEH) deficiency which mainly affects the catabolism of various amino acids, particularly valine. We describe a case compound heterozygous for ECHS1 mutations c.836T>C (novel) and c.8C>A identified by whole exome sequencing of proband and

  10. Complexity in Design-Driven Innovation: A Case Study of Knowledge Transfer Flow in Subsea Seismic Sensor Technology and Design Education

    Science.gov (United States)

    Pavel, Nenad; Berg, Arild

    2015-01-01

    To the extent previously claimed, concept exploration is not the key to product innovation. However, companies that are design-focused are twice as innovative as those that are not. To study design-driven innovation and its occurrence in design education, two case studies are conducted. The first is an example of design practice which includes…

  11. Influence of the competition of anions (hydroxides, carbonates) on the complexation of trivalent lanthanides by natural organic matter: case of humic substances

    International Nuclear Information System (INIS)

    Kouhail, Yasmine

    2016-01-01

    The aim of this study is to acquire and refine complexation data for understanding the fate of lanthanides in the environment where the concentrations of organic matter are highly variable. This study is focusing on both the description and understanding of the interactions between the europium(III) and a Suwannee River fulvic acid (SRFA) as a representative of humic substances (HS), and the influence of major anions present in natural waters, i.e. hydroxides and carbonates ions, in these interactions. To understand the ternary systems Eu-OH-SRFA and EU-CO_3-SRFA, Eu-SRFA and EU-CO_3 binary systems are first investigated by time-resolved luminescence spectroscopy (TRLS) for wide ranges of pH, ionic strength, Eu(III), SRFA and CO_3 concentrations. This study shows that the structures of humic substances are influenced by the presence of Eu(III). Interaction constants are determined for the Eu-SRFA binary system and are used for the understanding of the EU-CO_3-SRFA ternary system. EU-CO_3-SRF A ternary complexes are highlighted by SLRT, and an interaction constant has also been proposed in the frame of the NICA-Donnan model. Variations in size of EuSRFA complexes as a function of europium and SRFA concentrations are presented, and the impact of these variations on NICA-Donnan parameters is investigated. The results of this work are challenging modeling concepts of metal-HS interactions at various HS concentrations, in particular for the consideration of electrostatic effects. (author) [fr

  12. Driver’s Cognitive Workload and Driving Performance under Traffic Sign Information Exposure in Complex Environments: A Case Study of the Highways in China

    Directory of Open Access Journals (Sweden)

    Nengchao Lyu

    2017-02-01

    Full Text Available Complex traffic situations and high driving workload are the leading contributing factors to traffic crashes. There is a strong correlation between driving performance and driving workload, such as visual workload from traffic signs on highway off-ramps. This study aimed to evaluate traffic safety by analyzing drivers’ behavior and performance under the cognitive workload in complex environment areas. First, the driving workload of drivers was tested based on traffic signs with different quantities of information. Forty-four drivers were recruited to conduct a traffic sign cognition experiment under static controlled environment conditions. Different complex traffic signs were used for applying the cognitive workload. The static experiment results reveal that workload is highly related to the amount of information on traffic signs and reaction time increases with the information grade, while driving experience and gender effect are not significant. This shows that the cognitive workload of subsequent driving experiments can be controlled by the amount of information on traffic signs. Second, driving characteristics and driving performance were analyzed under different secondary task driving workload levels using a driving simulator. Drivers were required to drive at the required speed on a designed highway off-ramp scene. The cognitive workload was controlled by reading traffic signs with different information, which were divided into four levels. Drivers had to make choices by pushing buttons after reading traffic signs. Meanwhile, the driving performance information was recorded. Questionnaires on objective workload were collected right after each driving task. The results show that speed maintenance and lane deviations are significantly different under different levels of cognitive workload, and the effects of driving experience and gender groups are significant. The research results can be used to analyze traffic safety in highway

  13. Emergency management of major bleeding in a case of maxillofacial trauma and anticoagulation: utility of prothrombin complex concentrates in the shock room

    Directory of Open Access Journals (Sweden)

    Alessandro Morotti

    2015-03-01

    Full Text Available Life-threatening bleeding in anticoagulation with Warfarin is an emergency challenging issue. Several approaches are available to treat bleeding in either over-anticoagulation or propeanticoagulation, including vitamin K, fresh frozen plasma and prothrombin complex concentrates (PCC administration. In coexisting trauma-induced bleeding and anticoagulation, reversal of anticoagulation must be a rapid and highly effective procedure. Furthermore the appropriate treatment must be directly available in each shock rooms to guarantee the rapid management of the emergency. PCC require a simple storage, rapid accessibility, fast administration procedures and high effectiveness. Here we report the utility of PCC in management of a craniofacial trauma in proper-anticoagulation.

  14. Concurrent Peripheral Pathologies and Complex Regional Pain Syndrome Type 1 as Contributors to Acute Post-Stroke Shoulder Pain: A Case Report

    Directory of Open Access Journals (Sweden)

    Seyed Majid Akhavan Hejazi

    2012-04-01

    Full Text Available Post-stroke shoulder pain is associated with either a peripheral or central pathology. However, most of the time, it is challenging to establish a cause-and-effect relationship between the suggested pathology and shoulder pain reported. We report a 66 year-old man who developed a right hemiplegic shoulder pain two months post stroke with initial investigations suggestive of peripheral pathologies. Pharmacological and non-pharmacological treatment did not improve his shoulder pain. Later he developed complex regional pain syndrome (CRPS of the right hand and the initial shoulder pain subsequently relieved following resolution of the CRPS.

  15. Evaluating the Performance of DFT Functionals in Assessing the Interaction Energy and Ground-State Charge Transfer of Donor/Acceptor Complexes: Tetrathiafulvalene−Tetracyanoquinodimethane (TTF−TCNQ) as a Model Case

    KAUST Repository

    Sini, Gjergji; Sears, John S.; Brédas, Jean-Luc

    2011-01-01

    We have evaluated the performance of several density functional theory (DFT) functionals for the description of the ground-state electronic structure and charge transfer in donor/acceptor complexes. The tetrathiafulvalene- tetracyanoquinodimethane (TTF-TCNQ) complex has been considered as a model test case. Hybrid functionals have been chosen together with recently proposed long-range corrected functionals (ωB97X, ωB97X-D, LRC-ωPBEh, and LC-ωPBE) in order to assess the sensitivity of the results to the treatment and magnitude of exact exchange. The results show an approximately linear dependence of the ground-state charge transfer with the HOMO TTF-LUMOTCNQ energy gap, which in turn depends linearly on the percentage of exact exchange in the functional. The reliability of ground-state charge transfer values calculated in the framework of a monodeterminantal DFT approach was also examined. © 2011 American Chemical Society.

  16. Case report 332: A complex anomaly of the craniovertebral junction representing a regressive malformation with agenesis of the neural arch of C-2, hypomorphogenesis at C5-C6 and instability of the upper cervical spine

    International Nuclear Information System (INIS)

    Bernini, F.P.; Muras, I.

    1985-01-01

    In summary, a very complex anomaly, including agenesis of the neural arch of the axis, hypomorphogenesis of the cervical spine at the C5-C6 level with a partial ''blocked'' vertebra and disability of the upper cervical spine, is reported in a 31-year-old man. The anomalies associated with these changes are described in detail in the text and illustrated radiologically. The relationship of the embryological alterations in contrast with the normal is described and emphasized, particularly in the upper cervical area. It is stressed that narrowing of the space from the back of the odontoid (or the posterior lip of the foramen magnum) is a direct result of the complex anomalies described in this case, producing compression of the medulla and/or the upper cervical spinal cord. The literature on this subject is reviewed in depth. (orig.)

  17. Evaluating the Performance of DFT Functionals in Assessing the Interaction Energy and Ground-State Charge Transfer of Donor/Acceptor Complexes: Tetrathiafulvalene−Tetracyanoquinodimethane (TTF−TCNQ) as a Model Case

    KAUST Repository

    Sini, Gjergji

    2011-03-08

    We have evaluated the performance of several density functional theory (DFT) functionals for the description of the ground-state electronic structure and charge transfer in donor/acceptor complexes. The tetrathiafulvalene- tetracyanoquinodimethane (TTF-TCNQ) complex has been considered as a model test case. Hybrid functionals have been chosen together with recently proposed long-range corrected functionals (ωB97X, ωB97X-D, LRC-ωPBEh, and LC-ωPBE) in order to assess the sensitivity of the results to the treatment and magnitude of exact exchange. The results show an approximately linear dependence of the ground-state charge transfer with the HOMO TTF-LUMOTCNQ energy gap, which in turn depends linearly on the percentage of exact exchange in the functional. The reliability of ground-state charge transfer values calculated in the framework of a monodeterminantal DFT approach was also examined. © 2011 American Chemical Society.

  18. Managing Complexity

    DEFF Research Database (Denmark)

    Maylath, Bruce; Vandepitte, Sonia; Minacori, Patricia

    2013-01-01

    and into French. The complexity of the undertaking proved to be a central element in the students' learning, as the collaboration closely resembles the complexity of international documentation workplaces of language service providers. © Association of Teachers of Technical Writing.......This article discusses the largest and most complex international learning-by-doing project to date- a project involving translation from Danish and Dutch into English and editing into American English alongside a project involving writing, usability testing, and translation from English into Dutch...

  19. Complex variables

    CERN Document Server

    Fisher, Stephen D

    1999-01-01

    The most important topics in the theory and application of complex variables receive a thorough, coherent treatment in this introductory text. Intended for undergraduates or graduate students in science, mathematics, and engineering, this volume features hundreds of solved examples, exercises, and applications designed to foster a complete understanding of complex variables as well as an appreciation of their mathematical beauty and elegance. Prerequisites are minimal; a three-semester course in calculus will suffice to prepare students for discussions of these topics: the complex plane, basic

  20. Automatic Complexity Analysis

    DEFF Research Database (Denmark)

    Rosendahl, Mads

    1989-01-01

    One way to analyse programs is to to derive expressions for their computational behaviour. A time bound function (or worst-case complexity) gives an upper bound for the computation time as a function of the size of input. We describe a system to derive such time bounds automatically using abstract...

  1. Supporting complex search tasks

    DEFF Research Database (Denmark)

    Gäde, Maria; Hall, Mark; Huurdeman, Hugo

    2015-01-01

    , is fragmented at best. The workshop addressed the many open research questions: What are the obvious use cases and applications of complex search? What are essential features of work tasks and search tasks to take into account? And how do these evolve over time? With a multitude of information, varying from...

  2. (VI) ML6 Complexes

    African Journals Online (AJOL)

    A geometric analysis revealed that beta-(C-H) and alpha-(C-C) can occupy the seventh and eighth coordination sites in the title Fischer carbene complexes as agostic interactions, which allows classifying the carbene as a η3 ligand in these cases. This theory was supported by the relative energies of the conformers and an ...

  3. Assessment of Ab Initio and Density Functional Theory Methods for the Excitations of Donor-Acceptor Complexes: The Case of the Benzene-Tetracyanoethylene Model

    Directory of Open Access Journals (Sweden)

    Peng Xu

    2018-04-01

    Full Text Available The understanding of the excited-state properties of electron donors, acceptors and their interfaces in organic optoelectronic devices is a fundamental issue for their performance optimization. In order to obtain a balanced description of the different excitation types for electron-donor-acceptor systems, including the singlet charge transfer (CT, local excitations, and triplet excited states, several ab initio and density functional theory (DFT methods for excited-state calculations were evaluated based upon the selected model system of benzene-tetracyanoethylene (B-TCNE complexes. On the basis of benchmark calculations of the equation-of-motion coupled-cluster with single and double excitations method, the arithmetic mean of the absolute errors and standard errors of the electronic excitation energies for the different computational methods suggest that the M11 functional in DFT is superior to the other tested DFT functionals, and time-dependent DFT (TDDFT with the Tamm–Dancoff approximation improves the accuracy of the calculated excitation energies relative to that of the full TDDFT. The performance of the M11 functional underlines the importance of kinetic energy density, spin-density gradient, and range separation in the development of novel DFT functionals. According to the TDDFT results, the performances of the different TDDFT methods on the CT properties of the B-TCNE complexes were also analyzed.

  4. Magnetic interactions and magnetic anisotropy in exchange coupled 4f-3d systems: a case study of a heterodinuclear Ce3+-Fe3+ cyanide-bridged complex.

    Science.gov (United States)

    Sorace, Lorenzo; Sangregorio, Claudio; Figuerola, Albert; Benelli, Cristiano; Gatteschi, Dante

    2009-01-01

    We report here a detailed single-crystal EPR and magnetic study of a homologous series of complexes of the type Ln-M (Ln = La(III), Ce(III); M = Fe(III), Co(III)). We were able to obtain a detailed picture of the low-lying levels of Ce(III) and Fe(III) centres through the combined use of single-crystal EPR and magnetic susceptibility data. We show that classical ligand field theory can be of great help in rationalising the energies of the low-lying levels of both the transition-metal and rare-earth ions. The combined analysis of single-crystal EPR and magnetic data of the coupled system Ce-Fe confirmed the great complexity of the interactions involving rare-earth elements. With little uncertainty, it turned out clearly that the description of the interaction involving the lowest lying spin levels requires the introduction of the isotropic, anisotropic and antisymmetric terms.

  5. Assessment of the potential human health risks from exposure to complex substances in accordance with REACH requirements. "White spirit" as a case study.

    Science.gov (United States)

    McKee, Richard H; Tibaldi, Rosalie; Adenuga, Moyinoluwa D; Carrillo, Juan-Carlos; Margary, Alison

    2018-02-01

    The European chemical control regulation (REACH) requires that data on physical/chemical, toxicological and environmental hazards be compiled. Additionally, REACH requires formal assessments to ensure that substances can be safely used for their intended purposes. For health hazard assessments, reference values (Derived No Effect levels, DNELs) are calculated from toxicology data and compared to estimated exposure levels. If the ratio of the predicted exposure level to the DNEL, i.e. the Risk Characterization Ratio (RCR), is less than 1, the risk is considered controlled; otherwise, additional Risk Management Measures (RMM) must be applied. These requirements pose particular challenges for complex substances. Herein, "white spirit", a complex hydrocarbon solvent, is used as an example to illustrate how these procedures were applied. Hydrocarbon solvents were divided into categories of similar substances. Representative substances were identified for DNEL determinations. Adjustment factors were applied to the no effect levels to calculate the DNELs. Exposure assessments utilized a standardized set of generic exposure scenarios (GES) which incorporated exposure predictions for solvent handling activities. Computer-based tools were developed to automate RCR calculations and identify appropriate RMMs, allowing consistent communications to users via safety data sheets. Copyright © 2017 ExxonMobil Biomedical Sciences Inc. Published by Elsevier Inc. All rights reserved.

  6. 4-Aminobenzoic Acid-Coated Maghemite Nanoparticles as Potential Anticancer Drug Magnetic Carriers: A Case Study on Highly Cytotoxic Cisplatin-Like Complexes Involving 7-Azaindoles

    Directory of Open Access Journals (Sweden)

    Pavel Štarha

    2014-01-01

    Full Text Available This study describes a one-pot synthesis of superparamagnetic maghemite-based 4-aminobenzoic acid-coated spherical core-shell nanoparticles (PABA@FeNPs as suitable nanocomposites potentially usable as magnetic carriers for drug delivery. The PABA@FeNPs system was subsequently functionalized by the activated species (1* and 2* of highly in vitro cytotoxic cis-[PtCl2(3Claza2] (1; 3Claza stands for 3-chloro-7-azaindole or cis-[PtCl2(5Braza2] (2; 5Braza stands for 5-bromo-7-azaindole, which were prepared by a silver(I ion assisted dechlorination of the parent dichlorido complexes. The products 1*@PABA@FeNPs and 2*@PABA@FeNPs, as well as an intermediate PABA@FeNPs, were characterized by a combination of various techniques, such as Mössbauer, FTIR and EDS spectroscopy, thermal analysis, SEM and TEM. The results showed that the products consist of well-dispersed maghemite-based nanoparticles of 13 nm average size that represent an easily obtainable system for delivery of highly cytotoxic cisplatin-like complexes in oncological practice.

  7. Can the Diagnostics of Triangular Fibrocartilage Complex Lesions Be Improved by MRI-Based Soft-Tissue Reconstruction? An Imaging-Based Workup and Case Presentation.

    Science.gov (United States)

    Hammer, Niels; Hirschfeld, Ulrich; Strunz, Hendrik; Werner, Michael; Wolfskämpf, Thomas; Löffler, Sabine

    2017-01-01

    Introduction . The triangular fibrocartilage complex (TFCC) provides both mobility and stability of the radiocarpal joint. TFCC lesions are difficult to diagnose due to the complex anatomy. The standard treatment for TFCC lesions is arthroscopy, posing surgery-related risks onto the patients. This feasibility study aimed at developing a workup for soft-tissue reconstruction using clinical imaging, to verify these results in retrospective patient data. Methods . Microcomputed tomography ( μ -CT), 3 T magnetic resonance imaging (MRI), and plastination were used to visualize the TFCC in cadaveric specimens applying segmentation-based 3D reconstruction. This approach further trialed the MRI dataset of a patient with minor radiological TFCC alterations but persistent pain. Results . TFCC reconstruction was impossible using μ -CT only but feasible using MRI, resulting in an appreciation of its substructures, as seen in the plastinates. Applying this approach allowed for visualizing a Palmer 2C lesion in a patient, confirming ex postum the arthroscopy findings, being markedly different from MRI (Palmer 1B). Discussion . This preliminary study showed that image-based TFCC reconstruction may help to identify pathologies invisible in standard MRI. The combined approach of μ -CT, MRI, and plastination allowed for a three-dimensional appreciation of the TFCC. Image quality and time expenditure limit the approach's usefulness as a diagnostic tool.

  8. Can the Diagnostics of Triangular Fibrocartilage Complex Lesions Be Improved by MRI-Based Soft-Tissue Reconstruction? An Imaging-Based Workup and Case Presentation

    Directory of Open Access Journals (Sweden)

    Niels Hammer

    2017-01-01

    Full Text Available Introduction. The triangular fibrocartilage complex (TFCC provides both mobility and stability of the radiocarpal joint. TFCC lesions are difficult to diagnose due to the complex anatomy. The standard treatment for TFCC lesions is arthroscopy, posing surgery-related risks onto the patients. This feasibility study aimed at developing a workup for soft-tissue reconstruction using clinical imaging, to verify these results in retrospective patient data. Methods. Microcomputed tomography (μ-CT, 3 T magnetic resonance imaging (MRI, and plastination were used to visualize the TFCC in cadaveric specimens applying segmentation-based 3D reconstruction. This approach further trialed the MRI dataset of a patient with minor radiological TFCC alterations but persistent pain. Results. TFCC reconstruction was impossible using μ-CT only but feasible using MRI, resulting in an appreciation of its substructures, as seen in the plastinates. Applying this approach allowed for visualizing a Palmer 2C lesion in a patient, confirming ex postum the arthroscopy findings, being markedly different from MRI (Palmer 1B. Discussion. This preliminary study showed that image-based TFCC reconstruction may help to identify pathologies invisible in standard MRI. The combined approach of μ-CT, MRI, and plastination allowed for a three-dimensional appreciation of the TFCC. Image quality and time expenditure limit the approach’s usefulness as a diagnostic tool.

  9. Prospective outcome of the influence of complexation by natural organic matter on enhanced or retarded transport of radionuclides: case of humic substances retention

    International Nuclear Information System (INIS)

    Reiller, P.

    2010-01-01

    This document takes a prospective stock of the natural organic matter influence on the possible effects on radionuclide migration, as well as a brief critical analysis of the literature data. A comparison with the retention of the 'simple' organic complexing agents is done in order to fix the limit of the 'simplistic' analogies done in the literature very often. It appears that the magnitude of the effects is function of the residence time in the medium, and of the possibilities for the organic complexes to be retained on the mineral surfaces. The contact time between radionuclides and the natural organic matter is also an influent parameter, as it influences part of the reversibility of this interaction vis-a-vis surface retention. Modelling of the metal-organic-surface systems is only satisfying up to now when accounting fractions of organic matter that are less susceptible to form colloidal aggregates, i.e., fulvic acids. These non-aggregated fractions could be considered as simple ligands in a first approximation. Conversely, when it comes to aggregated colloids of organic origin, i.e., humic acids, modelling are limited by the lack of theoretical understanding of their structure and of their evolution in response to geochemical condition variations, as ionic strength (harsh meteoric events), acidity or water composition (non-saturated water table). (author)

  10. Can the integration of multiple biomarkers and sediment geochemistry aid solving the complexity of sediment risk assessment? A case study with a benthic fish

    International Nuclear Information System (INIS)

    Costa, Pedro M.; Caeiro, Sandra; Vale, Carlos; DelValls, T. Àngel; Costa, Maria H.

    2012-01-01

    Surveying toxicity of complex geochemical media as aquatic sediments often yields results that are either difficult to interpret or even contradictory to acknowledged theory. Multi-level biomarkers were investigated in a benthic fish exposed to estuarine sediments through laboratory and in situ bioassays, to evaluate their employment either in ecological risk assessment or in more mechanistic approaches to assess sediment-bound toxicity. Biomarkers reflecting lesions (such as genotoxicity or histopathology), regardless of their low or absent specificity to contaminants, are efficient in segregating exposure to contaminated from uncontaminated sediments even when classical biomarkers like CYP1A and metallothionein induction are inconclusive. Conversely, proteomics and gene transcription analyses provided information on the mechanics of toxicity and aided explaining response variation as a function of metabolic imbalance and impairment of defences against insult. In situ bioassays, although less expedite and more affected by confounding factors, produced data better correlated to overall sediment contamination. Highlights: ► Sediment-bound contaminant mixtures can yield unexpected biomarker responses in fish. ► Biomarkers reflecting lesions are sturdier predictors of pollution by mixed xenobiotics. ► Proteomics and gene transcription analyses disclosed the existence of complex patterns of response to toxicity. ► Laboratory bioassays are less impacted by noise variables but tend to lose ecological relevance. - Evaluation of multi-level biomarker responses in fish for ecological risk assessment

  11. Facilities Management Service Delivery in Public and Private High Rise Residential Buildings in Nigeria: A case study of Eko Court Complex and Niger Towers

    Directory of Open Access Journals (Sweden)

    Olanrele O. O.

    2014-01-01

    Full Text Available This study assessed and compared the delivery of Facilities Management (FM services in public and private high rise residential buildings in Lagos, Nigeria. While some facilities or services may not be available in some public estates, the efficiency of the available ones is inadequate in comparison with the adequacy and efficiency of services provided in private estates. The objectives set for the study include identification of services that are provided in the case studies, service delivery method, and an assessment of the residents’ satisfaction of the services. This study adopted questionnaire survey for collection of data. 127 questionnaires were distributed to the residents of the case studies and 93 were returned. Three of which were discarded for incompleteness, thus 90 were analysed. The study found that most but not all of the facilities services expected in high rise buildings are available in the case studies and the services are outsourced under a standard Service Level Agreement. The service delivery in private high rise residential building is better than the public residential high rise buildings as revealed by the study. The study recommends improved standardization of services, customized services and meeting customer’s expectation for improved service delivery.

  12. Softball Complex

    Science.gov (United States)

    Ellis, Jim

    1977-01-01

    The Parks and Recreation Department of Montgomery, Alabama, has developed a five-field softball complex as part of a growing community park with facilities for camping, golf, aquatics, tennis, and picnicking. (MJB)

  13. Lecithin Complex

    African Journals Online (AJOL)

    1Department of Food Science and Engineering, Xinyang College of Agriculture and ... Results: The UV and IR spectra of the complex showed an additive effect of polydatin-lecithin, in which .... Monochromatic Cu Ka radiation (wavelength =.

  14. Natural and EDTA-complexed lanthanides used as a geochemical probe for aquifers: a case study of Orleans valley's alluvial and karstic aquifers

    International Nuclear Information System (INIS)

    Le Borgne, F.; Treuil, M.; Joron, J.L.; Lepiller, M.

    2005-01-01

    The transit of chemical elements within the different parts of Orleans valley's aquifer is studied by two complementary methods. Those methods rely on the fractionation of lanthanides (Ln) during their migration in natural waters. The first method consists in studying natural lanthanides patterns within the watershed, at its entries and exits. second one lies on multi-tracer experiments with Ln-EDTA complexes. This work is completed through an observation network consisting of 52 piezometers set on a sand and gravel quarry, and the natural entries and exits of the aquifer. Orleans valley's aquifer, which is made of an alluvial watershed lying on a karstic aquifer, is mainly fed by Loire river via a large karstic network. At the entries of the aquifer (Loire river at Jargeau), the Ln concentrations in the dissolved fraction ( heavy Ln. On the other hand, the filtration of alluvial groundwater with high colloids content induces no significant Ln fractionation when the solution contains no strong chelating agent. Hence, the transit of natural and artificial Ln in Orleans valley aquifer can be explained by two complementary processes. (I) Decanting/filtering or, on the opposite, stirring of colloids. Those processes induce no important Ln fractionation. (2) Exchanges of Ln between solute complexes, colloids and sediments due to the presence of strong chelating agents. Those exchanges fractionate the Ln in the order of their stability constants. Considering the natural Ln fractionation that occurs in the Loire river and in the studied aquifer, the carbonates, the stability constants of which follow the order light Ln < heavy Ln, are the best candidates as natural strong chelating agents. From the hydrodynamic point of view, both tracer experiments and natural Ln concentrations show that the transfer of elements within the alluvial watershed is pulsed by the Loire river movements. During an ascent phase, the elements migrate away from and perpendicularly to the karstic

  15. Case report: an unstable wide QRS complexes tachycardia after ablation of a poster-septal accessory pathway: What is the mechanism?

    Science.gov (United States)

    Wang, Huan; Che, Xiaoru

    2018-03-01

    Differentiation of wide QRS complex tachycardia required repeated electrophysiological stimuli and mapping. However, instability of tachycardia would increase the difficulty in differential diagnosis. In this paper, we reported a wide QRS tachycardia following ablation of an atrioventricular reentrant tachycardia participated by a poster-septal accessory pathway. Limited differentiation strategy was performed because the wide QRS tachycardia was self-limited and with unstable hemodynamics. We analyzed the mechanism of the wide QRS tachycardia by only 4 beats ventricular overpacing. On the basis of the last ventricular pacing, an atypical atrioventricular nodal reentrant tachycardia was confirmed. After slow-pathway modification, the wide QRS tachycardia was eliminated. It was an atypical atrial-ventricular node reentrant tachycardia with right bundle branch block. Reasonable analysis based on electrophysiological electrophysiologic knowledge was the basis of successful diagnosis and treatment.

  16. Studies on the power output of a MADE AE-30 operating on complex terrain. Annual Energy Production estimation and Multivariable analysis. A case of multi-stall effect

    Energy Technology Data Exchange (ETDEWEB)

    Cuerva, A.

    1996-12-01

    The main need of the EWTS-II Sub-project IV group is to have a suitable data-base which allows it to reach proper conclusions on the characteristics of power performance of wind turbines in complex terrain. With this aim, this document presents an analysis on the power output of the MADE AE-30 Wind turbine operating at Tarifa (also data from flat terrain are enclosed as a reference). An application of the bin method and AEP estimation for energy production method, in the two last issues a directional analysis and an study for two different turbulence intensity ranges are enclosed. Finally the Stepwise multirregression method is applied on the measurements to identify the stored parameters that have influence on the power output. A brief description of multi stall effect is enclosed. (Author)

  17. Studies on the power output of a MADEAE-30 operating on complex terrain. Annual Energy Production estimation and Multivariable analysis. A case of multi-stall effect

    International Nuclear Information System (INIS)

    Cuerva, A.

    1996-01-01

    The main need of the EWTS-II Sub-project IV group is to have a suitable data-base which allows it to reach proper conclusions on the characteristics of power performance of wind turbines in complex terrain. With this aim, this document presents an analysis on the power output of the MADE AE-30 Wind turbine operating at Tarifa (also data from flat terrain are enclosed as a reference). An application of the bin method and AEP estimation for energy production method. In the two last issues a directional analysis and an study for two different turbulence intensity ranges are enclosed. Finally the STEPWISE multirregression method is applied on the measurements to identify the stored parameters that have influence on the power output. A brief description of multi stall effect is enclosed. (Author) 7 refs

  18. MODIS GPP/NPP for complex land use area: a case study of comparison between MODIS GPP/NPP and ground-based measurements over Korea

    Science.gov (United States)

    Shim, C.

    2013-12-01

    The Moderate Resolution Imaging Radiometer (MODIS) Gross Primary Productivity (GPP)/Net Primary Productivity (NPP) has been widely used for the study on global terrestrial ecosystem and carbon cycle. The current MODIS product with ~ 1 km spatial resolution, however, has limitation on the information on local scale environment (fairly comparable values of the MODIS here however, cannot assure the quality of the MOD17 over the complex vegetation area of Korea since the ground measurements except the eddy covariance tower flux measurements are highly inconsistent. Therefore, the comprehensive experiments to represents GPP/NPP over diverse vegetation types for a comparable scale of MODIS with a consistent measurement technique are necessary in order to evaluate the MODIS vegetation productivity data over Korea, which contains a large portion of highly heterogeneous vegetation area.

  19. Application of systems thinking: 12-month postintervention evaluation of a complex health system intervention in Zambia: the case of the BHOMA.

    Science.gov (United States)

    Mutale, Wilbroad; Ayles, Helen; Bond, Virginia; Chintu, Namwinga; Chilengi, Roma; Mwanamwenge, Margaret Tembo; Taylor, Angela; Spicer, Neil; Balabanova, Dina

    2017-04-01

    Strong health systems are said to be paramount to achieving effective and equitable health care. The World Health Organization has been advocating for using system-wide approaches such as 'systems thinking' to guide intervention design and evaluation. In this paper we report the system-wide effects of a complex health system intervention in Zambia known as Better Health Outcome through Mentorship and Assessment (BHOMA) that aimed to improve service quality. We conducted a qualitative study in three target districts. We used a systems thinking conceptual framework to guide the analysis focusing on intended and unintended consequences of the intervention. NVivo version 10 was used for data analysis. The addressed community responded positively to the BHOMA intervention. The indications were that in the short term there was increased demand for services but the health worker capacity was not severely affected. This means that the prediction that service demand would increase with implementation of BHOMA was correct and the workload also increased, but the help of clinic lay supporters meant that some of the work of clinicians was transferred to these lay workers. However, from a systems perspective, unintended consequences also occurred during the implementation of the BHOMA. We applied an innovative approach to evaluate a complex intervention in low-income settings, exploring empirically how systems thinking can be applied in the context of health system strengthening. Although the intervention had some positive outcomes by employing system-wide approaches, we also noted unintended consequences. © 2015 The Authors. Journal of Evaluation in Clinical Practice published by John Wiley & Sons, Ltd.

  20. Risk Factors for Post-treatment Complex Regional Pain Syndrome (CRPS): An Analysis of 647 Cases of CRPS from the Danish Patient Compensation Association.

    Science.gov (United States)

    Petersen, Pelle B; Mikkelsen, Kim L; Lauritzen, Jes B; Krogsgaard, Michael R

    2018-03-01

    Complex regional pain syndrome is a challenging condition that includes a broad spectrum of sensory, autonomic, and motor features predominantly in extremities recovering from a trauma. Few large-scale studies have addressed occurrence of and factors associated with complex regional pain syndrome (CRPS) following orthopedic treatment. The present study aimed to identify factors associated with post-treatment development of CRPS. Using the Danish Patient Compensation Association's database, we identified 647 patients claiming post-treatment CRPS between 1992 and 2015. Age, gender, initial diagnosis, treatment, and amount of compensation were extracted. Multivariate logistic regressions were performed to identify variables associated with approval of the claim. For carpal tunnel syndrome (CTS) patients, we registered whether symptoms were bilateral or unilateral and if neurophysiology prior to treatment was pathologic. The following ratios were found: women:men was 4:1, primary diagnosis to the upper limb:lower limb was 2.5:1, and surgical:nonsurgical treatment was 3:1. Mean age was 47.5 ± 13.7 years, and no intergender difference was detected. Antebrachial fracture (23%) and CTS (9%) were the most common primary conditions. Surgical treatment was associated with approval of the claim (odds ratio 3.5, 95% confidence interval 2.3 to 5.3; P CRPS patients. In CTS patients developing CRPS, normal neurophysiological examination findings were common, and it could be suspected that these patients were suffering from an pre-clinical stage of CRPS, not CTS. © 2017 World Institute of Pain.